The James Mandell Building is an 116,000 SF, 10-story urban infill project that added 44 inpatient beds and clinical support facilities to Boston Children’s Hospital. The structure’s footprint sits only 55% on grade; the upper eight stories of the building are cantilevered 65 feet over previously existing operating rooms, an ER and ambulance bays that remained open for the duration of construction. In order to create patient rooms that provided the same quality as the existing hospital beds and light-filled floors on a constrained site, a central courtyard referred to as a “hanging garden” was suspended six stories above the street, doubling as a quiet oasis for patients, families, and staff.