The Sound and the Fury

Beep. Beep.




Beep. BLARE! Beep. BLARE! Beep.

*ding* *ding* *ding* *ding*

Beep. BLARE! Beep. BLARE! *ding* *ding* *ding* Beep. *ding* BLARE!

(Door: BAHM, SMACK.)

"Hello, hello, hello! What's going -"



Beep. BLARE.*ding* BLA- off.

Beep. *ding* Beep. *ding* Bee- off.

*ding* *ding* *di- off.

And this is just the auditory feedback.

Signals, sirens, alarms, alerts, and beeps make a cacophonous symphony of continual disruption in the hospital. Scoot too far to one side - Beep. Try to sit up - *ding* *ding* *ding* *ding*. Think too hard - BLARE! BLARE! BLARE!

I have always had sensitive ears. To this day, if my parents are talking below their voices on one end of their house I can hear the sarcasm on the other. While sound can often be my best friend, hospital noises are my worst enemy. Poke me all you need to, check the blood pressure again, make me repeat my name and DOB, ask for the nth time if I'd peed today, sure, but TURN THE F*CKING BEEPING OFF.

Add on top of this the lights that accompany these sounds of distress; angry red for BLARE!, IV drip is completed/out; sanitized blue for *ding*, another PVC on the monitor; plastic emerald green for "Beep," pulse oximeter not reading. Pulse too high, respiratory rate too low, line occluded, other-things-bad...

Quiet, both visual and auditory, is more scarce in a cardiac unit than salt.*

I tried noise cancelling headphones on top of in-ear buds. I tried eye masks. I tried meditation, books on tape, humming; nothing worked. Compound these signals with a heightened alertness (lack of sleep, pain medication, epinephrine, dopamine, prednisone, and your world being slimmed down to a 6ft by 6ft space) and it's basically like a bad acid trip every night that lasts for weeks. Oh, and you can't get up and you can't roll over. So, fun for you.

If you're new to the blog: first, thanks for coming and why has it taken you so long to get here. Second, music is a big deal here. If you're not new, you'll have gleaned by now that music and sound are kind of important to me. They are what I rely on to drown out a busy environment at work, how I focus on note taking, or what motivates me to push myself harder when I feel like giving up at the gym. Music, particularly film scores, transport me to another place, both on screen and beyond. Coincidentally I had a lovely 90 minute massage at work the other day (yes, you can collectively groan now, but I did pay some money for it) and the massage therapist put on a "Relaxing Soundtracks" playlist. Can you guess what I'm going to say next?

Yup. The whole time, My Brain: "What score is this from? I think this is Newman, is this Newman? Jeez this sounds like a dramatic scene. I think this song is resolving- oh, nope, there comes the full orchestration again. Plastic Bag Theme: I love this song!"

Note to self: request non-melodic, new age synth for all future appointments.

In the same way that I can't watch horror movies pervasively because of the soundtrack, I nearly can't live through a horrible situation with the sound on.

Both errant and important hospital noises are known to contribute widely to alarm fatigue: a situation in which nurses and doctors begin to ignore alarms due to the often inane and repetitive recurrence of so many types of sounds. This can cause these caregivers to actually miss alarms which signal possible harm to the patient. Similarly, studies are beginning to show that patients can actually suffer, both by human error (aforementioned lack of appropriate provider response to alarms) and increased levels of patient stress and anxiety: perhaps even lengthening healing time.

Even without the effects of the copious mind-altering medications I was on I still today cannot stomach hearing the telltale pulse of an occluded line or completed IV pump alert. I ask my parents "is that me or them?" (referring to myself and the patient one bed over) when a heart monitor out of sight starts sounding. If and when I can, I reach over and silence the damn thing. Most aren't permanently silence-able (so much fun when you're just trying to have a nice pee and the infusion pump reading "HEPARIN DRIP IS COMPLETED!" decides to sing you the song of its people), but it's an instantly blissful relief when one of them is paused.

If smell is our largest memory-inducing sense, then I think sound might be our next most nostalgic. For me, anyway, sound is what nearly always brings back the location, atmosphere, and context of the last time I heard it.

This phenomenon is a double edged sword. For about thirteen months I couldn't touch Bon Iver. Blood Bank was one of my favorite songs and it helped me get through the most trying nights in ICU. When Blood Bank comes on nowadays I tend to hit skip instead of repeat. Re:Stacks had such a strong connotation for me before surgery that its been a little easier to reconcile, but only just. John Mayer's Wildfire (which has ambient crowd sounds in the background) was on repeat for what felt like hours on 2/15/16 as I tried to drown out the voices, shouting discordantly at me in my head. And TV shows? I'd be very happy to never see another New Girl or Doc Marten again (furthermore, Emma Stone can kindly stay off my screen, thank you very much). But the delusions, the PTSD: that's another post(s) entirely. One I may not write for a long, long time.

What I'll say for now is that even without the squeak of shoes on the tiled floors, the whoosh of the industrial ventilation, and the hums of self-adjusting beds, its hard to escape the sounds in the hospital; even long after you leave.

*shoutout to the floater nurse on D3 (step-down-ICU) who snuck me two packets of salt that one time for my short rib dinner cuz it tasted like airplane food. You dah real MVP.


Currently Listening To: "Them" by Nils Frahm, from Victoria

I am going to try something a little different this time. Sight : unseen. (Source : Unheard?). I have not seen this film. I know nothing of its composer nor his body of work. I frankly have no real idea what the movie is about. But it doesn't matter.

I could not stop listening to this piece.

For about four weeks last summer I incessantly watched Grey's Anatomy. More accurately, I devoured it. I think I watched the entire first season in less than a week.

It was real, it was relatable, it showed me how these "providers," these "professionals," (particularly surgeons whom I have little to no frequent interaction with) left the doors of the hospital as people; just the way they walked in.

Now, I'm not that daft. I've always strived to see the human first and then the specialty, just as I would expect to be viewed (treat the patient not the disease) so I know how to see the person and not just the profession. I also get that this show is #Shondaland and highly dramatized. But something about seeing doctors of all ranks walking home in scrub pants, laughing with friends, and drinking with colleagues; it just humanized so much of medicine for me at that moment in time. I consumed it: I bought into it. And then it broke.

I stopped experiencing the show as an outsider. I stopped seeing the characters as fictional people who had workplace drama, unrealistic love trysts, and a phenomenal lack of HR violations. I saw the agony of their professional losses begin to infiltrate their personal narratives. I saw the sexiness of esteem drip, like saline flush, all over the floors of that seemingly sterile hospital. It stopped being a set. It stopped being fake. It started becoming real.

That is what this song becomes. It is an apotheosis in diejetics. It begins as if played from a record or a slightly out of tune copy of a 1960's film: fuzzy, and poorly mixed for its present-day-and-out-of-time means of amplification. Then, rather unexpectedly, it develops a clear introduction of reality: an unadulterated violin that feels out of place in this other world that the asynchronous white noise has created.

It is minor, it is 3/4, it is hauntingly melodic and repetitious. Not only are some of the piano notes discordant on their own, but the disruption of the recording magnifies the piano to weird and inhuman places. In my mind it conjures nearly the exact setting of the opening scene in The Intouchables (which I will likely write about at a later time, so FYI spoilers ahead.) But imagine (if you can restrain yourself from clicking on the link) a cobblestone street in an ancient part of a major European city. It is night and the stones are wet from a recent fog, lit by Monet swathes of chartreuse, pale yellow, and white from the amalgamation of nearby street lamps, city beacons, and apartments. A figure is walking down the street, likely walking home. They aren't menacing, but they aren't innocent either. They are complex and hidden; raw and unpolished; predictable, but impulsive.

The song embodies this dichotomy. It's piano becomes akin to the plucked strings of a cello in this artificially (though brilliantly authentic) aged soundscape. It's fuzz is a nostalgic wool blanket: somewhat itchy to the ear, but comforting nonetheless. It is comfort and also, simultaneously, discomfort.

Why have I paired this song (for a film I have never seen) with this post? Listen again.

Do you hear it?

It is almost admissible, but entirely crucial.

It is the syncope.

It is that repeated bell tone that appears between the beats and always falls on the same note. It never resolves, it never fully disappears.

It is sustained and repetitious notes in a piece that tell us the nature of the story. It's presence almost always signals an internal conflict between the characters or objectives in the world the score is coloring. Doesn't it sound, oh, just a bit like a benign, but none the less noticeable, alarm? Weeding its way through to remind you that it is there, and that you are there? Not enough to cause a panic, but enough to cautiously linger.

It is the vibrato of the sole violin at just after 4:00 minutes that bursts above the surface tension to craft its own story: at once both tied to and separate from the world the song inhabits. One by one each instrument (now piano; now more strongly the violin; now even hints of cello) start to craft their own tale beyond the world of the song. But as the song ends, the piece begins to break apart without its structure, its key players held together by the fuzzy aurora of remembrance. It stops being a fictionalized, nostalgic story. It starts becoming real.