"What treatment in an emergency is administered by ear?"
"Words of comfort."
Cutting For Stone, Abraham Verghese
The Sound of Struggle
I can hear her from the doorway. It's the sound of thick phlegm circling in place, of pooling saliva and mucous that can only be cleared with suctioning. "Cough it up," I say. A stroke, dysphagia, respiratory failure, her cough is weak; so weak that I don't fear she'll expel a loogie onto my face or clothing. Despite the gunk lining her trachea and oozing out of her tracheostomy, her oxygen saturation remains in the high nineties. I once dreaded suctioning patients, but now I dread the sound of an un-suctioned patient. It's harsh on the ears - dirty, rough, static that can't smooth itself out, a raucous kkkksssshhkk.
I grab a suction kit and slide the tubing down the inner cannula placed in the hole of her neck that's acting as her temporary, or possibly permanent, airway. She's anticipating the tube traveling down. Her saturation drops below ninety percent; the machine beeps to tell me so. I ignore it. "Relax," I say. When I hit resistance I place my thumb over the suction cap and coil the tubing into my gloved hand as the mounted wall suction vacuums the thick and frothy content. It sounds like a dental hygienist slurping up your spit during a cleaning and encountering chunks of left over cottage cheese in your mouth. But in reality, it's the sound of modern medicine and treatment - keeping her alive to struggle, to slowly drown in her own secretions.
"Better?" I ask.
The Sound of Regret
The oncologist told "Paul" he had about six to eight weeks to live. The majority of that "living" was laid up in bed. He now had time, well, six to eight weeks, to think about his life and the moments that escaped him.
He tells me that he was a successful lawyer in South Lake Tahoe. He always wanted to get on his bike and ride around the whole city. It was a goal he kept saying he would do, but he put it off, year after year.
"Now I'm lying here wondering why didn't I ever do it? Why didn't I miss one day of work to do it?"
"I don't understand why I didn't do it when I could have. It was something so simple. I guess I thought I'd always be healthy and live beyond 72 years," he continued.
"Do you have kids?" he asks.
"Good for you," he says to my surprise.
"Do everything you ever wanted. Don't put things off, like I've done, only to be on your death bed trying to figure out why you didn't do those things."
Paul did die, within four weeks of this conversation. I silently promised that I would go to South Lake Tahoe and ride my bike around the city in honor of his life. I made that promise three years ago and have yet to do it.
Will I be on my deathbed, too, questioning why I didn't ride around South Lake Tahoe for Paul and why I didn't do the things I planned? I don't want to be "living" my last days with the sound of regret.
The Sound of Loss
Silence was broken with sound coming from the stairwell: rushing steps, screams, and incomprehensible words. I was a fairly new nurse and looked at a seasoned nurse for direction. I knew what it was, but I had yet to learn how to respond.
Death and loss are not silent, especially if the death is that of a child. It manifests itself in a mother's wail that has nuances that are unmistakable. Fear and grief shot through my spine. The seasoned nurse ran to the stairwell. I listened from the other side of the closed door.
I stood paralyzed by the mother's persistent Orca cry.
"I lost my son. I lost my son. Oh God, no!" cried the father.
The nurse returned.
"Their son died in ER. The mom ran when she was told. She's trying to get to the roof to jump off. Security is there now."
"What did you say?"
"Nothing. I just hugged them."
I went to the bathroom and for the first time at work I allowed myself to cry, briefly, silently.
The Sound of Diminishing Sound
I move the stethoscope over my patient's chest to hear his heartbeat. I can't find it, but I know it's there. He's wide awake watching Jimmy Fallon. Slight worry comes over me, not because of his congestive heart failure, but because my audiologist recently confirmed I have genetic hearing loss. I'm losing my mid-range frequency hearing; my high and low-pitched frequencies are still intact. I would think a heartbeat falls between a mid and low range frequency.
How fast will it go? Will hearing aids help? Will I be able to even hear a heartbeat next year? Before I panic, I adjust the earpieces of the stethoscope snuggly into place, right over the opening of my ear canal. I listen again. Ah, there it is. I smile at him, relieved I can hear his heartbeat, for now.
I can hear bed alarms and IV machines beep (high frequency), people in pain groan (low frequency), and nurses, including myself, complain (a disturbing frequent frequency). For eight years, I've learned to distinguish all these "nursing" sounds from the moment I step onto the unit until I get home. I've learned how to break another's silence with a middle of the night phone call or a nudge to tell them their loved one has died. Some emergencies don't involve the patient, like in death. The emergency becomes the family or friend of the patient and how they are coping. A character in the book Cutting for Stone says the treatment is "Words of comfort." It's true and I've learned which "words of comfort" work and those that don't. Like the seasoned nurse, I understand that sometimes what's most consoling is silence and space.
There are so many sounds I'm tired of hearing. It takes a toll. In Cutting for Stone, there's also this line: "Your job is to preserve yourself, not to descend into their hole." This is also called compartmentalization. It's needed to remain sane in nursing. Perhaps my ears, losing that mid-range frequency, are just trying to preserve me.
And it's guaranteed to end, even when each nurse feels like it won't. Night has disappeared, our shift is done. Without a sound, the east welcomed the rising sun. It marks a new day for everyone and the end of ours. I rush home. I climb into bed and listen to my boyfriend's breathing and his heartbeat. Here, I don't have to compartmentalize anything, but I want to. I want to memorize, to preserve, these sounds that regenerate me, before I can no longer hear them. But I descend into sleep and let the rest of the world deal with the sounds of the day.