The Sound of Silence

“You must listen for sixty seconds,” the attending told me on the way in. He didn’t need to ask if it was my first time. I donned gloves before entering because that’s what I’d seen the others do. Now, with the eyes of the room upon me, I hated how they made the whole thing seem cold, clinical, as if I worried I could catch his death like a contagion. I held my stethoscope against his grey, motionless chest. From across the room, the newborn had still held the impression of life, but up close, it seemed drained from him — out of his little body and into the skull, expanded from the volume of blood that had emptied from his congenital vascular malformation and into his ventricles. I moved my hand to the opposite side of his sternum, searching for a heartbeat but knowing the result would be the same. There was no heartbeat.

The family spoke a dialect of a language I’d never heard of before and that no one in the hospital knew how to speak. They’d arrived with a phone number of a friend who could translate into English for them, in case of emergencies. I don’t know when the family first learned of their unborn child’s critical illness, but it hadn’t left them with much time to plan. I think they had travelled from abroad as the dad sought work, but I don’t remember. When I met them a week later, the mom had just had an emergent c-section because the pregnancy had threatened both her life and her unborn child’s. The parents had been counselled about what to expect following delivery – the fetus’ burden of illness was incompatible with life – how those words must have sounded now! They’d wanted “everything” done, and so we did everything. But that was before they arrived, mom wheeled in from another floor, still lying in her hospital bed. Later on, someone explained to me that they just wanted to meet their new son.

It looked like so many other hospital rooms, only the cast assembled was different. The supplies we’d used were scattered across the floor: packaging, empty syringes, and discarded gloves tokens of the tragedy that unfolded there. Where once had been noise and bustling, now was quiet. A room has a way of slowing down when the goals of management change. Someone had held their cell phone in the middle of the space between the family and the medical team. I thought about the person on the other side of that call, and how it must have felt to be yanked from sleep in the dead of night to take it. I imagined them prying themselves from the side of their partner, dressing in a bathrobe before going downstairs to sit by a window, out of earshot, to be the voice of a foreign family prematurely delivering a child with a terminal disease.

How terrifying it must have felt for these parents: traveling in a strange country, finding themselves immersed in a foreign medical system, depending on a room of clinicians whose language they could not even understand! Yet the language barrier felt both enormous and insignificant: once the clinical information was sufficiently understood by everyone, little remained to be said. The family had listened as the attending explained the situation through the phone interpreter, and at some point, dad began to cry. What kind of life could the best machines in the world bring?  After the family had decided not to continue heroic measures, all that had mattered became the brief time that the child and his new family would spend together. Before I later returned to perform his final exam, we had removed the child from the lines and equipment we’d dressed him with and laid him on his mother’s chest.

I don’t know what moment he died, but it feels like the moment after you pull out the endotracheal tube. On the monitor, you might have seen his heart slow to a crawl, had the monitor still been on. I imagined those little lungs flailing for a few hopeless seconds on their own and then the heart slowly fluttering to a final stillness. I liked thinking there was a moment when mom’s and baby’s hearts beat together in synchrony. I had stood against a wall as a specter, watching the moment between them unfold, until a nurse asked me to wait outside.

Now, I stood above the child who had been born into this world not an hour ago, a casualty of an indifferent cosmos. I held a stethoscope above where I imagined his pulmonic valve would be and listening in vain for the flow of life-sustaining blood while a room full of nurses, doctors, respiratory therapists, waited wordlessly for me to finish my assessment. But the only eyes I could feel were those of the family. The third spot on his chest was as quiet as the others. I placed my stethoscope a fourth and final time.

As I moved, the imprecision of my clumsy hand made noise that carried up the black cord of the stethoscope and for a moment, I wondered – had I heard a heartbeat? For a second I patted around for it, searching, as if not looking hard enough had been the problem. I could imagine myself panicking as I announced the child was still alive, and the room jolting back into life-saving mode as someone calmly insisted the family go wait outside. I wished I’d asked the doctor what to do if the child was still alive. Only before I entered the room would that have seemed like a strange question. All that mattered now was the family and how we handled this moment.

I had no idea how long I had been listening. There was no way to know. Every time my hand trembled there was a sound in my ear, and kept I wondering if I had heard another heartbeat. The thought occurred to me how much worse it might be if I had. What would I have done? What would be the compassionate thing, given the circumstances? There was an eternity between each of those seconds. I looked at his small face and thought about the life he would never have. I thought about how I was about to change this family. And then – when it seemed like the right moment – I lifted my hand from his chest and took my instrument out from my ears, the bond between us broken, physically.

Every eye in the room was on me, almost. I could not see his mother’s face. I turned and nodded at the attending. “The time of death is five forty-three,” he said. The boy was now dead.

After slowing almost to a complete stop, at some point the room resumed without warning, stirring uncomfortably toward the hallway. I think the family was crying, but I wasn’t sure anymore. Filing out, I passed mom still in her hospital bed and dad at her side. I dropped to my knee, brought my hand toward my heart, and tried to apologize. He looked away; she was already somewhere else. I wanted to throw my arms around them and cry together, but this moment wasn’t for me. I walked out of the room, finished the shift, and then went home to wonder what else I might have done.

I left the family to their suffering, yet the medical team would suffer, too, but quietly, differently, back at home with a glass of wine or in shudders they divine from the sky as they watched their own children playing outside. Somehow, over following days, the family would take a cab from the hospital to the airport and go back to their home to mourn their son and nurture their pain.