Second Place Winner, 2022 Temple Health Essay Contest

May 12, 2022

Ruth Lewis, MD
Emergency Medicine PGY-2

One of the first things anyone notices about the emergency department is the noise. Endless alarms, shouts, phones, overhead announcements, wheels across the linoleum. “How can you stand the chaos? It would drive me mad!” is a question I’ve heard too many times to count.

What few people know is there is no chaos. The noises create order. They act as a GPS in a way, directing everyone to their next task and location. The sirens outside; ambulance or police? This determines the speed at which we need to move. The phones ringing with concerned loved ones on the other end asking for updates. The rush of the oxygen though a portable machine, we should call respiratory therapy. The yells in the halls. Good yelling or bad yelling? Are they in response or do they require a response? Sometimes no yelling is worse. I like my patients with enough lung capacity to yell. And behind a thin curtain that we pretend blocks all these other noises out, my patients’ stories, what has happened to them and why they are here, tells me how to react and help.

Stand in the middle of the department and listen. Instead of a maestro leading the symphony, the symphony conducts the emergency department. The overhead speaker directs the PCT and EKG machine to room 20. A telemetry alarm summons a nurse. That tiger text growl chases the entire team to the trauma bay.

It’s the silence, not the noise, that gets to me. The missing lung sounds, or heartbeat. The empty air after the cardiac monitor is turned off. The lack of words as my patient absorbs their new diagnosis. The harsh decrescendo when you turn off the oxygen. Worst of all, the silence before a mother’s scream. It leaves me feeling aimless, helpless. But despite hating the silences, they are just as important as the noises. Inevitably, the silence is broken. The squeaking of another stretcher rolling in, the metallic brushing of pulling open another curtain, another voice to hear and help.

But like I said, few people understand there is no chaos amongst the noise. Whenever I get asked that question, my response is always a smile, “I love it”.