“Doctor, I have only one complaint.” Only one? I had braced myself for this pre-rounding encounter. The patient--let’s call him “Dean”--was a 45-year-old male admitted to Bellevue for pyoderma grangrenosum. He had endured serial debridements of his legs but continued to suffer from gaping wounds; his hospital course had been complicated, to put it mildly, and I anticipated a difficult conversation. To my surprise, Dean greeted me with a smile despite the early hour and asked courteously how I was doing. When asked about his own situation, moreover, Dean said not a word about his disease or treatment: his distress stemmed exclusively from the noise made by the patient lying one bed over in his four-person room at Bellevue. Separated from Dean by nothing but flimsy curtains, Dean’s roommate persisted in talking very loudly on the phone late into the night, and, when he wasn’t conversing at volume, often groaned in pain. In this cacophonous environment, Dean was finding it difficult to relax, let alone sleep; there was simply no auditory escape.
Just a few moments later, my second patient of the day, “Mary”, was similarly disturbed by elements of her soundscape. Mary, a woman in her 50s admitted for AML and undergoing induction chemotherapy, was housed in the Stepdown Unit. As she conversed with me through an interpreter, our exchange was punctuated by not one but two different alarm sounds: the patient’s own vitals monitor would sound periodically because the oximeter wasn’t making good contact with her finger, and an unspecified alarm kept sounding in the adjacent patient room. Every time an alarm sounded, I could read the distress in Mary’s face; I would hastily reach over and silence it for a minute or so, but it was only a temporizing measure. For the second time in one morning, I was forced to walk away from a patient without offering a solution to the ambient noise.
Interestingly, my third patient of the day, “George,” had devised his own solution to a perceived sound problem. Admitted for decompensated heart failure, George also complained to me about the noise in his room: he was particularly annoyed by the beeping of his telemetry monitor. After conveying his irritation, however, he started to brighten. Reaching out to grasp an item from his bedside table, George concluded triumphantly, “But it was okay because I brought these noise-cancelling earbuds from home!”
These patient encounters could not help but get me thinking about the issue of noise on the wards, at Bellevue and beyond. My previous experience regarding soundscapes in hospital settings had focused solely on the addition of positive elements through music therapy. As an undergraduate student, I had volunteered in a local hospital as part of a student-generated network called “Healing through Harmony.” Every week, volunteers would visit the wards or the common areas of the hospital to play live music or, in my case, sing a range of songs designed to soothe, relax, and comfort patients and their families. I had very much enjoyed this gig and had seen with my own two eyes the relaxed faces and smiles that live music could produce. Indeed, I learned later that these firsthand observations are consistent with multiple studies on the therapeutic benefit of music in hospital settings.
My three patients, however, had drawn my attention to another vital way to alleviate noise pollution in the hospital: by subtracting negative elements. Fortunately, silencing beeping monitors, alarms, the humming of machines, conversation, TV, and the unfortunate sounds of pain—can be remarkably easy: we can simply offer our patients earplugs. Earbuds allow patients to use phones or other devices to add music and other sounds that support their experience in the labor and delivery setting; earplugs allow them to rest and recover after delivery. Some hospitals routinely offer their patients earplugs, and doctors have been known to do the same.
Use of this common-sense strategy to abate unwanted noise is hardly confined to medical settings. Airlines have been known to offer earplugs for overnight flights. Concert venues sell them to patrons as a way of protecting hearing during loud events.
The equation for more therapeutic, more sane soundscapes in the wards at Bellevue, then, has two complementary elements: earplugs to block unwanted noise and earbuds to add therapeutic sound. These tools can be low-cost and are highly transportable; in fact, they can be held in the palm of one hand or tucked into the pocket of a lab coat. Together, they can offer patients what might be called the sound of healing. How I wish I had had these with me when I visited my first patient, Dean, that day on the wards. I could at minimum have allowed him to mute the disturbing sounds emanating from his neighbor in the next bed; ideally, I would have also offered my patient access to a range of healing auditory experiences—the natural sounds of a waterfall or a meadow in summer; music created by a lone singer in a downtown club, a passionate opera diva, or a full symphony orchestra; the joyous laughter and chatter of a country wedding; the soundtrack of a favorite movie; perhaps even the memory-stirring melody of a folk song from his native Iran. The choice could have--should have--been his.