by Iona Heath
Over recent years, the context for the use of the word noise has extended way beyond the audible to signify any disturbance that is intrusive or corrupting. This use originated in electronics but it has now degenerated into what is almost a cliché found extensively in, for example, the literature of photography and information technology. There seems to have been no parallel increase in the use of the precious word quiet.
In his evocation of the work of a rural general practitioner in A Fortunate Man, John Berger points out that ‘with the exception of the one word ‘gale’, a passage from Joseph Conrad’s Typhoon ‘might describe the crisis of an illness, with the voice of Captain MacWhirr transformed into that of a doctor.’
‘And again he heard that voice, forced and ringing feebly, but with a penetrating effect of quietness in the enormous discord of noises, as if sent out from some remote spot of peace beyond the black wastes of the gale; again he heard a man’s voice - the frail and indomitable sound that can be made to carry an infinity of thought, resolution and purpose, that shall be pronouncing confident words on the last day when heavens fall, and justice is done - again he heard it, and it was crying to him, as if from very, very far – ‘All right’.’
This is just what we try to achieve in the consulting room: the penetrating effect of quietness in the enormous discord of noises.
The pervasive fear of the imminence of our own mortality creates just this sort of noisy discord and this is multiplied by the noise, both literal and metaphorical, of contemporary healthcare. MRI scanners, waiting room announcements, telephones, computers, protocols, guidelines and imperatives of every sort all produce a different modality and pitch of noise and, within the resulting cacophony, it is difficult to think at all, let alone to formulate a coherent way forward. The tradition of quiet in libraries – places of study and contemplation – is no coincidence. Quiet, both physical and emotional, is an essential prerequisite for thought.
Interviewed in the Guardian, the pianist Mitsuko Uchida was asked whether there was an art form that she didn’t relate to. She replied: “Anything noisy. Even visual art can be noisy. It’s not just a matter of colour: there are some fantastically colourful artists who are wonderful – Van Gogh, Rembrandt and his use of light. But there are other, noisy artists.” She suggests that noise interferes not only with the capacity for thought but with perception and feeling as well. The persistent noise of fear, alongside the more prosaic interruptions of healthcare systems, emphasises the importance of defending the quiet of the consulting room. This quiet makes it possible for both doctor and patient to hear, to listen, to imagine and to think.
The central human importance of quiet is perhaps underlined by the fact that it is one of the few words that is used in three grammatical forms: as a noun, a verb and an adjective. The role of the doctor is to provide a haven of quiet; by careful listening and active imagining, to locate and, as far as is possible, to quiet the fears and suffering of the patient; and to know and understand the power of a quiet voice and a quiet touch. Too often the practice of medicine becomes synonymous with activity but the soothing of suffering often has much more to do with a quiet accompanying, being prepared to try to be fully present when another human being is facing up to the arbitrary horror that scars lives. I have only to think, among countless examples, of the loaded quiet which precedes the revelation of abuse by a frightened adolescent.
In his poem Night Duty, the Swedish Nobel Laureate Tomas Tranströmer writes:
The language marches in step with the executioners.
Therefore we must get a new language.
Noise belongs to the language of the executioners; quiet belongs to the survivors.