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  • Valerie Brooke, MD

The Listening Path - Part 2

I used to listen to upbeat music or NPR news on the way to work every day, which is about a 15- minute drive, one of the many blessings of living in a small city. I have learned during this pandemic year in order to decrease the incredible stress I have experienced at work, I needed to decrease any extra stimulation of my sympathetic nervous system so that I could show up at work calm and focused. And, honestly, the news was just full of doom and gloom, every… single… day. So even before I started this Listening Path exercise, I had already been driving to work in silence although on this particular day, I really listened to all the sounds around me in my workplace.


I pulled out of my garage, with the steady hum of the heater attempting to warm up the frigid car. My tires crunched over the frost sprinkling the driveway as it was still winter temperatures here in Reno. While watching the sun’s light spray of yellow over the clouds, I felt the vibration of my tires speeding up… slowing down… speeding up… with the occasional short, abrupt honk of a nearby car, expressing frustration at drivers who were moving too slowly. The friction of the tires on the highway increased the dull droning into a loud rumble that made hearing any music or news on the radio next to impossible. I pulled into the hospital parking lot, found a spot in the back near an aging pine tree, heard the definitive clunk of the gears setting into park, the clinking of my keys as I removed them from the ignition, and the dull thud of the car door as it slammed shut. As I walked away from my car, I pointed the keys back and a sharp shrill bleep of the lock pierced the air. I walked towards the hospital entrance and was accosted by a loud raucous caw…caw…caw…of a dark raven on the roof. He was either welcoming me to work or warning me to go back home.


I walked through two sets of automatic doors hearing the gentle rush of them sliding open, and stepped over to the electronic temperature reader, tried to place my face in the center of the green box, and waited to hear the positive beep of a normal temperature. 97.3. I was in.


I opened the swinging doors to the rehabilitation unit and walked down the hallway toward my office, past open doorways to patient’s rooms and could already hear of the bustling activity of a busy hospital. The beeping dings or call lights of a patient needing assistance were immediately in the background, occasionally punctured by the sharper and more urgent bleeping alarm of a patient who pulled the assistance cord in a bathroom, a reason to get there faster.


I don’t work in a busy emergency room or a life-saving ICU, where I imagine the noises are more urgent and non-stop; but up until this day, I had never really paid close attention to all the sounds I encounter in the rehabilitation hospital: piercing alarms or call lights; reverberating overhead pages; weekly shrieking fire alarm drills; patient’s musical bed and chair alarms – songs in high pitch meant to stand out from all the other noises in the hospital; IVs incessantly beeping that they are done…done…done… infusing fluid or medication into a patient’s vein; patients talking/laughing/crying/and even sometimes screaming. Many patients had their TVs on that day, blaring dark, sensational news, with one hearing-impaired patient engrossed in the drama of a Spanish soap opera, set up to a high volume so that even the love-sick drama was heard in the hallways. As I do not understand Spanish, it was easier to ignore this din. Even the patients who weren’t in their rooms that day, off in the gym doing their therapies, had left on the TVs, polluting the air with commercials.


I could clearly hear the sound of employees talking and laughing, softly and loudly, outside the patients’ rooms, and at the busy nursing station. This was punctuated by the unit phone ringing, picked up by the unit coordination or the charge nurse, getting a report on the status of a new patient being transferred from the acute hospital (“when did they last move their bowels? Mmm…hmm…Do they have a Foley catheter in place? Mmm…hmmm… Are they in any pain?), or a family member calling to find a loved one (“Hold on please while I transfer you to their room. If they don’t pick up then they may be in the gym doing therapy”). That day there were also the calls routed to me, a family member wanting an update on the medical status of his spouse, the radiologist calling me with the results of an urgent head CT scan on a patient who had fallen and whom I had sent out for imaging.


The most abrasive sound in the hospital that day was the alerts from the brilliant new texting application on our phones, the “solution” to improving communication between staff members. The nurses and aides used to communicate by walkie talkie: I would hear the hissing static noise, followed by a nurse calling to another across the hospital, or an aide calling for assistance in a patient’s bathroom. This was a much more pleasant sound than the current, obnoxiously abrasive screech of the text system, one that we all inevitably ignore due to alarm fatigue, that phenomenon of sensory overload that occurs when medical providers are so inundated with excessive alarms that they become desensitized, which has been linked to patient harm. I can just imagine a group of administrators in a room discussing what sound to associate with the texts. “It needs to be so annoying, like fingers on a chalkboard, that the alarm cannot be ignored.”


After rounding on my patients and trying to stay focused despite all the non-stop commotion and noise, I retreated to my office to work on documentation and take a breather from the suffocating N95 mask and face shield. I sat down at my desk and began my computer work, heard the gentle clicking of my fingers on the keys, and the sound of my voice while using the dictation system, which is faster than my typing speed. But it’s not all quiet back in my hibernation den either. There are five other physician offices surrounding mine, and I heard their interactions with nursing and therapy staff who came to their office doors, their shrill phone and mumbling conversations, as well as my colleague giving a lecture on spinal cord injuries to his student (which I actually listened to in order renew my own education!).


I heard the copy machine clicking and spitting out pages, the gush of water out of the dispenser just outside my door, the sharp beep of the microwave buttons followed by the hum of someone’s lunch being warmed up. I closed my door to try to experience a modicum of silence, but still was interrupted by the occasional phone call from a nurse and the more frequent abrasive text from our communication application. I was lucky enough that day not to hear the anxiety-producing sound of an overhead page calling “Rapid Response,” so my afternoon continued on much the same as the morning: constant sounds of technology interspersed with sounds of humanity.


Later that evening I headed toward the front door, the bustling sounds of the rehab hospital dying down. It was after dinner and patients were getting settled in for the night. I heard the gentle murmurs of the nursing aides giving verbal reports to their nighttime replacements, on the status and functional needs of their patients. Shift change had begun. As I headed out to my car, I welcomed the cold dark air, the immense silence, now so much more apparent after a day inside the hospital. I drove home, making my own internal shift change, from worker bee to human being.



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