Hospital Playlist

Of the sounds, the silences, and the music of a hospital---and of life. TW: death, hospitals

Medical dramas always make it seem like there’s a soundtrack to every hospital scene: An upbeat jingle for the introduction, a dramatic crescendo for the climax, or a soft symphony as the credits roll. In truth though, the hospital can sound pretty boring. The nurses’ station is your regular office ASMR of papers flipping, keyboards clacking, and phones ringing. The clinic is a cacophony of patients and doctors talking, like sopranos, altos, tenors, and basses singing out of harmony. Even in hospital rooms and wards, most of the sound comes from the white noise of daily chatter, plus or minus the TV in the corner.

Of course, there are sounds unique to a hospital. There’s the toot-toot-toot of a ventilator, the ten-ne-nen-ten-nen of the dialysis machine, and the steady beat of a cardiac monitor. The sounds remind me of Nokia ringtones of the early 2000s. My colleagues and I used to make contests identifying one sound from another—the medical edition of Guess-That-Tune. As a medical student, I used to jump at every incessant and unfamiliar sound or alarm. But as with Nokia ringtones, even these become monotonous when you’ve heard enough. With time and repetition, everything becomes background noise.

Medical dramas aren’t completely false, though. There can be dramatic sounds, too, except probably not with the accompanying soundtrack we imagined. A typical scene goes like this: Someone’s heart stops beating. “Code!” someone else screams above the chatter. Doctors and nurses rush to the scene, machine wheels rolling on the vinyl floor. The defibrillator hums to life, charging with each round of resuscitation. Meanwhile, a loved one cries from a distance. They have no idea what’s happening, except that it must be bad. Really bad. The head of the team barks orders. Give three milligrams of this. Give a bolus of that. Resume chest compressions. Order after order, cycle after cycle. The repetitive endeavor of saving a life.

I was five years old when I first heard these sounds. I was in a blue dress and at that time, I wanted to be a queen. “Not a princess, a queen!” I insisted to my father, then lying on a hospital bed. We had Andok’s lechon manok for lunch, and I complained that we should have had Jollibee instead. Mommy scolded. Dad snickered—he was always amused at my feistiness. I talked through my small, greasy fingers until I had to go to the bathroom.

From behind the bathroom door, I heard Mommy scream. My yaya and I rushed out. The scene goes like this: Dad was face-first on his plate. Dad’s heart stopped beating. “Code!” someone else screamed above the chatter. Doctors and nurses rushed to the scene, machine wheels rolling on the vinyl floor. The defibrillator hummed to life. Mommy cried from a distance. She had no idea what was happening. Someone barked orders, but I couldn’t understand a word they said. Order after order, cycle after cycle. The repetitive endeavor of saving my father’s life.

At that moment, I didn’t understand that this moment was supposed to be sad. I was mostly confused. One minute I was dreaming of Chickenjoy and my queendom-to-be, and the next I was staring at my father, motionless in a room of moving parts. A few minutes more, his bed was wheeled out of the room (the bed had wheels? All this time?), to somewhere called the ICU, or intensive care unit, as I would later learn. A few days later, my aunties and uncles visited, talking to Dad. Dad wasn’t talking back. A week later, on the day we got our report cards from kindergarten, they told me Dad was dead.

Twenty years later, I find myself in the middle of scenes like this, this time as the doctor. This time, I was barking the orders, charging the defibrillator, and tinkering with the alarms. The difference is that now, I see more, feel more, hear more. I see the paleness of the skin, the breathlessness, the light gone from a person’s eyes. I can feel the threadiness of a pulse before it comes to a halt. I hear the exact moment the heart stops through my stethoscope. As a child, I found the scene chaotic and confusing, and I thought my medical education would make sense of it all. But even after more than ten years of training, it’s still chaotic and confusing. Sure, now I understand what’s happening. I know how the body deteriorates and what to do when that happens. There’s a system to this, with protocols, algorithms, and guidelines to follow. But the chaotic and confusing part is often not the science of disease, but the loud and reverberating suffering that ensues. No matter the strides we’ve made in science and medicine, it still boggles my mind why a person who can eat, speak, or even laugh one minute, would lose all vitality the next. How can a person larger than life become smaller and smaller with disease?

If there’s something med school doesn’t teach you, it’s that the worst part isn’t the pandemonium of trying to save a life, of pulling someone back from death’s grip. The worst part is after the time of death is called, when death wins the tug-o-war; when instead of a heartbeat, you hear the cruel beep of asystole; when you admit defeat and tell the family that their loved one is gone. Always, silence follows. The soundlessness persists, even when they scream, sob, or fall to the ground. Even when the rest of the world has the gall to move on, all you hear is silence, the worst possible sound in the hospital. You never get used to that sound.

Sometimes, though, music literally can play in the hospital background.

“The hills are alive, with the sound of music…”

On one of our hospital rounds, my senior and I were surprised to hear Julie Andrews’ voice rising above the humdrum of the ventilators and cardiac monitors in the ICU. The sound was coming from one of our patients, Mila. Mila had been in the ICU for three months, barely awake and barely breathing. Her temples and cheeks were hollow, and she barely had any muscle left. I don’t even remember how her whole admission started. She’s been in and out of surgery and has been on every antibiotic imaginable. She drank, fed, and urinated through the tubes inserted in every orifice. I always found it depressing to come and see her, to see this shell of a woman who was hardly alive. In the time she was assigned to my care, I never even had the pleasure of hearing her voice, let alone know her beyond her diagnosis and complications.

As we approached the bedside, we found Mila’s son, Ryan, next to her, staring longingly into the deep sockets of his mother’s eyes. The music was coming from a phone in his hand. We commented on the music. “Sound of Music, her favorite,” Ryan told us. He turned the volume down as we went through the pleasantries of patient rounds. We asked him about his work, and how he and his siblings were keeping on. “How is she?” he asks in return, his voice hesitant, unsure if he wants to hear the answer. What to say in these situations is always tricky. They tell us there’s an art to doing this, which pretty much equates to winging it every time, managing through the hesitation and awkwardness. We told Ryan that his mother was stable. Her blood pressure was holding up with the medications. Her fever’s gone. But she wasn’t improving as much as we’d like. We’re suspecting a new infection. We need another battery of tests. We also told him the more difficult truth: She was likely never going to wake up.

As we ran out of words, Julie Andrew filled the gaps in the air, and I was never more grateful for the music. The irony isn’t lost on me – how a song that so clearly celebrates life and living could coexist in the dreary environment of an ICU. As the lyrics sang of laughing “like a brook as it trips and falls over stones on its way,” I couldn’t help but think of how Mila would never be able to laugh again.

“Thank you,” Ryan said quietly, “Thank you for taking care of her.” He said it sadly, but his eyes still brimmed with appreciation and sincerity. “Why, Ryan?” I want to tell him. We failed. We didn’t save her. We kept her alive enough to suffer, and how can we even call that living? Yet here he was, accepting his mother’s fate and turning the music up again. His eyes were tired, maybe even defeated, but also accepting, even hopeful.

Most people I know hate hospitals, and I can’t blame them. The tone is mostly of exhaustion, drudgery, and despair. But it’s also in the hospital where I’m constantly astounded by humanity’s capacity for gratitude and hope. The look in Ryan’s eyes reminds me of every morning after an overnight shift. When you’re on duty, you get called for everything — hearts stopping, chests hurting, blood sugars spiking, alarms beeping, feet itching, patients not waking, patients not sleeping, et cetera, et cetera. It’s tiring and unforgiving, but the absolute oasis of every shift is seeing the sunrise from a stairwell window, signifying the end of your duty. There’s nothing quite like the sun peeping behind Manila’s skyscrapers, painting the sky orange and purple, waking up a world oblivious to the previous night’s mayhem. Interestingly, there is also no music. No birds chirping. No rivers flowing. No percussion thumping. Nothing but the peace of surviving another day.

The hospital is chock full of ironies. Of trying and persevering despite all our blunders and mishaps. Of medicine failing and succeeding. Of an upbeat melody as you deliver devastating news. Of a sunrise pushing upward through the darkness. And where else would these ironies exist but in a hospital, where life and death are in constant confrontation?

What’s the point of it all, a friend asked me recently. To live, work, and obsess over life, only for all of us to meet a singular grim ending. I do not have the answers. Medicine apparently doesn’t have the answers, either. But maybe this quiet sunrise can be one of them, if only to get us through another day.

After a while, the silence of the dawn gives way as the hospital roars to life. Healthcare workers clock in at the entrance. Wheelchairs and stretchers are pushed to surgery suites and X-ray machines. Medications are prepared. Papers flip. Keyboards clack. Phones ring. In the clinic, the first patient in the queue is called. Mechanical ventilators, dialysis machines, and cardiac monitors join the chorus of a busy day at the hospital. On one of those days, my father died. I remember him with every patient, every death, every question that lacks answers. On another one of those days, a colleague told me that Mila had passed on. We offer a moment of silence in her honor, but even as I do, I also pray that The Sound of Music welcomes her in the afterlife. I hope those left behind eventually find that the music plays on, even in the silence of her death. Ultimately, isn’t that what life is? It’s music that hums, drones, and purrs in the same beat that it whistles, claps, and chimes—an orchestra that plays and plays, until it doesn’t.

Photo by C D-X on Unsplash