• Nathan Riley, MD

My Last Sound

Updated: Dec 8, 2019

Photo credit to the NYTimes

As a disclaimer, this story is not a criticism of the quality of obstetrical care that was provided to my patient. Nor is it a criticism of the care provided for the newborn.

I assisted with a cesarean delivery today, and the patient, now a new mom - is doing well from most standards of medicine. Her vital signs are stable, she's conscious, she's not experiencing inordinate pain, and intra-operative blood loss was kept at a minimum. The obstetrical team did their job.

On the other hand, the baby had trouble transitioning, and the pediatric resuscitation team couldn't hear breath sounds after initial intubation efforts. Eventually, though, the newborn was successfully intubated and transferred to the neonatal ICU. The pediatric team did their job.

But again, this isn't a story about the things that the often myopic Western medicine model holds dear. This is a story about the woman behind the curtain.

As soon as the baby was transferred to the warmer, one of the nurses noticed the poor transition and sounded the alarm. A flood of personnel entered the room and an ear-piecing digital alarm filled the air. Meanwhile, our new mom, an ICU nurse who works in the same hospital, is crying and afraid. Her arms are strapped to arm boards. Any information being communicated to her about her new baby is drowned out by the alarm.

Yoko Sen is a sound artist concentrating her talents in hospitals. Sounds can be healing; sounds can make us sick. Her most impassioned work, however, is with the influence of sound at the end of life. In her End Well talk from 2017, she implores her audience to consider that many people "think that hearing is the last sense to go when we die, so what is the last sound I get to hear at the end of my life?"

If it weren't bad enough that 30% of newborns are born by cesarean section or that our patients are strapped down crucifixion-style during the procedure, the environment itself in and around obstetrics may be detrimentally impactful. Surgeons can often be heard catching up on their personal lives, while other staff are frequently too busy typing, carrying out orders, and crossing items off checklists, all the while the experience of the human behind the curtain is overlooked.

The scene I illustrated above is common, and it's scary as hell. Yet, it only lasts for 20 minutes or so for me and other staff in the room. For this patient, however, the fear and the prognosis of her newborn is drowned out by what I can only imagine feels like an eternity of alarms and chatter.

How would this affect you, doctor, if you switched places with this patient?

What if it was your wife or partner on the operating room table?

When our patients and their advocates use the word "trauma", this is what they are talking about. They are not referring exclusively to our insensitive speech or our gaslighting of their feelings. As if giving birth wasn't hard enough, the experience of giving birth in a hospital can be particularly challenging. and I feel for this new mom and the traumatizing experience that she just went through. Hospitals and modern medicine have, of course, saved many lives, but that doesn't satisfy the alarms that are being tripped all over our country and much of the western world regarding the traumatizing experience of being sick in a hospital, or being healthy during birth.

Many people describe the birth process with the same fear, anxiety and tenacity as many of ,my patients describe the dying process. So ask the end of my life, what sounds do I want to accompany my death? What sounds would I want to accompany my birth?

These simple questions, which aren't tasked to "big data" and medical journals, are the answer to healing the hospital-based birthing process, and being sick in a hospital in general.

Before I wrap this up, I want to make myself crystal clear. I'm not suggesting that it's just the sounds in hospitals that are impacting the birth process. But I think that we have drifted away from the patient experience when they're in hospitals, whether they're sick or not. Too often, we as physicians and other health care providers are dismissive of patients' complaints, but in and out illness, the way we talk to people, the way that we treat people, the environment around them can either be a tool for healing or it can be a detriment.

If we can't sit comfortably with the issue of a woman's experience in birth, beyond simply "healthy mom, healthy baby", we will continue to neglect the cries of our patients, like passing ships in the night.

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