by Allison Wallis

In Dante’s eighth circle of hell, residents are punished with severe illness, horrific smells, eternal thirst, and constant horrifying screams from other residents. To someone like me, this sounds like an average day in a hospital. I live with severe migraines and other neurological issues that cause hyperacusis. One time I forgot to bring headphones or earplugs for an overnight hospital stay and I was brought to tears multiple times. The hard surfaces of the room and hallways made the sounds echo. Every time I moved my arm, my IV alarm would blare. The machine tracking my vitals beeped nonstop. I felt like I was surrounded by chaos. My migraine was still raging when I finally checked myself out the next day against medical orders (AMA). I just couldn’t take it anymore. 

But what if we were to hear music that provides information about our biorhythms instead of discordant beeps? What if nurses were allowed to decompress in soothing, quiet break spaces filled with nature sounds, and the only alarms that went off were for true emergencies? What if we made hospitals a place to heal and recover comfortably? Over the last two decades, musicians, scientists, and doctors have collaborated to, hopefully, improve how hospitals sound.

Excessive noise in hospitals is a public health issue. Families holding court in shared hospital rooms, cell phones on speaker, machines beeping incessantly and sending out false alarms, the clatter of food carts rolling down the hallway, jarring intercom announcements, and the sirens of ambulances coming and going are just a few of the things that contribute to a soundscape that just doesn’t feel that good for a lot of people who need exactly that — to feel good, no matter the circumstances they’re navigating. Not only does the noise cause stress and impede patient healing, but it can also cause alarm fatigue in medical personnel, which can lead to deadly mistakes.

While a patient can take steps to help mitigate some of the noise, such as bringing a “quiet kit” or headphones and using soothing music like on these playlists suggested by Twitter users, there’s only so much we can do. Even my expensive sound-canceling headphones can’t drown out an IV alarm. 

Part of the problem is that many medical device companies calibrated their alarms to be incredibly sensitive to protect patients from danger (and themselves from legal issues). Over the years, more and more devices were developed, and alarms got louder to compete with one another. What was intended to alert nurses to an issue has instead created an incomprehensible din. While there’s not a lot of data yet, everyone I spoke with said that the pandemic has made the issue worse.

Researcher Dr. Judy Edworthy, professor emerita at the University of Plymouth and an adjunct at Rice University says, “Alarm fatigue is caused by a number of different things, and some patient deaths have been attributed to it. Top of the list of causes is the high number of false alarms which occur in many clinical settings.” A 2013 study discovered that an estimated 72%-99% of alarms are false.

When a patient is hospitalized, they are generally stressed. This causes activation of the sympathetic nervous system, which is responsible for the flight or fight response. Long-term sympathetic nervous system activation can lead to problems like heart disease and mental health issues. On the other hand, the parasympathetic nervous system is responsible for rest and healing. The more you activate the parasympathetic nervous system in a patient, the faster they heal, leading to better outcomes for both patients and stressed-out staff.

I was inundated with replies when I asked for patient stories on Twitter. Writer Denise Reich told me that her mom could have used more soothing sounds when she was in the ICU following heart surgery. “The sounds really frightened her. She was on a ventilator and couldn't move, and every time something beeped or buzzed, her eyes would fly open, and she'd look terrified. Worse, the nurses that were caring for her did not take the time to reassure her about what the noises were and they were annoyed when I tried to explain to her it was just a phone or a routine sound on her IV pump. I think it made her fear and trauma in the hospital far worse.”

Dr. Edworthy has been working on improving hospital noise since 2015. I asked her what she thinks the future holds. “All hospitals in the US have to have an alarms committee which determines what situations alarm (and which do not). This can have a significant effect on noise levels in hospitals. The reduction of bad sounds and the introduction of good ones are likely to happen. In 10 years, I see hospitals being quieter than now, but also the sounds that we hear will be nicer to listen to and intentionally made.”