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Music to the ER

Stravinsky composed the Rite of Spring with innovative asynchronus chords to the appreciation of many fans. Without nearly the same fan base, the emergency department plays a mash-up of Stravinsky records scratched by DJ Qbert. In room one there is constant beeping, every 0.5 to 1 seconds coming from two different sources, the highly resonant sounds cut through the voices of nurses talking, and stands apart from the slower, deeper electronic sound that rises every 3 seconds to a crescendo. Usually, there is a blue and red light show accompanying the sounds, but from my central room for residents I cannot see those photons. Room one is 10 feet away, leaving enough space for room 5--the trauma bay--to intermix its cacaphony of shouts, beeps, screams, and moving bodies. Then there are the questions from nurses, the other residents talking to consultants, the telephone calls, and the computer keyboards being pounded by people who never learned to type.

When I close my eyes, I imagine R2D2 and his robot friends at a blow-out house party for graduation from droid school. Since I don't close my eyes often in the emergency department I do not dwell on those sounds. In fact, I rarely hear the alerts from all the monitors and machines or shouts and questions. Much like those people who live next to the subway or hiway, I don't realize that it is there unless I actively try to listen.

This functionality I owe to my reticular activating system. This part of the brain serves as a high-pass filter, a low-pass filter, and an annoying sound filter. It isn't well understood but helps with attention, focusing on those elements that are important to the exclusion of others. Its loss through stroke is one of the few ways to cause loss of consciousness with one blow to the brain (infarction of other areas does not cause loss of consciousness). Like much of the brain, it might be the last thing we understand once the grand unifying theory comes into our grasp.

Still, I do wonder what the utility is for all these alerts when nobody notices them. I feel comfortable knowing that I can recognize sick patients and keep an eye on their vital signs when I am worried. So, maybe I should start engineering a more intelligent alert system and sell it on the iphone for 0.99 cents.
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About the Author

The Stanford Emergency Room is the center of emergency care at Stanford University.