Hearing and the hospital: sound, listening, knowledge and experience by Tom Rice (Canon Pyon: Sean Kingston Publishing, 2013).
Tom Rice’s book offers an anthropology of the soundscapes of the hospital and medical practices of listening, particularly those of the cardiothoractic ward. At its centre is a year’s fieldwork undertaken at St. Thomas’ Hospital in London as part of Rice’s doctoral research. This is supplemented with observations he made during three months of fieldwork as volunteer for hospital radio at the Edinburgh Royal Infirmary while an undergraduate anthropology student. Rice primarily situates his work in two fields – the anthropology of the senses and sound studies – although his work has implications for the medical humanities and more broadly science and technology studies. This rich account of the role of sound and listening in the work of nurses and doctors and the lives of patients draws extensively on interviews as well as Rice’s observations, experience and reflections, including those he made, on occasion, as a patient himself.
The first two chapters of the book draw on Rice’s time at Edinburgh Infirmary, as well as his fieldwork in St Thomas’. Chapter One engages with Foucault’s understandings of surveillance, inflecting these accounts with a focus on listening. Rice considers the way that nurses use monitorial listening as an element of their working practice, and the ways in which patients variously rely upon, extend and resist these ways of using sound to govern the wards. Chapter Two offers a particularly powerful and visceral account of the rupturing of a sense of bodily privacy through the new aural intimacies forced on patients in the hospital. Rice documents the ways in which patients try to manage their emotionally gruelling exposure to others’ “painscapes” (43), for instance, through tuning into media, including hospital radio. His account offers a fresh and gripping discussion of the power of others involuntary bodily noises and cries of pain as aural contagion, threatening the wellbeing of other residents. This chapter also considers the ways in which doctors’ narratives about patients circulate in the private offices and public wards of the hospital, and the role of monitoring technologies, notably electro and echocardiography, in broadcasting bodily states. Rice points out the ways that “as it is sonically broadcast the body is dispersed… sounds – word, whispers, coughs, cries, beeps, whooshes… flow…. constantly shifting and morphing… bodily space” (53-4).
Chapter Three, Four and Five shift focus quite significantly, away from “lay” listening practices in the hospital and towards professional practice of listening, notably auscultation, that is, listening to bodily sounds, usually through a stethoscope. These chapters are more firmly grounded in Rice’s fieldwork in London. Chapter Three offers a history of this kind of medical listening, situating this history as a counterpoint to Foucault’s work on the medical gaze. While the material conveyed here is fascinating, this shift back in time does feel like a side step in the narrative of the book. Both this chapter and Chapter Four reflect on the under-discussed roles of skills and technologies of medical listening as part of the professional identity of doctors as well as those learning to be one. Rice also briefly and intriguingly explores the idea of the stethoscope as an “autobiographical object”. This consideration of the agency of objects is one that is hinted at throughout the book but I felt at times could have been more fully opened up and its implications more fully explored.
One of the standout features of this book is the author’s familiarity of the experiences of medical students learning to listen to patients’ bodies. In reading Hearing and the Hospital, I couldn’t help but compare it to another recent monograph which details with ethnographic richness the sensorial experiences of trainee medics, Rachel Prentice’s book about anatomy and surgery education, Bodies in Formation (Duke 2012). Prentice’s book is a wonderfully rich and nuanced exploration of medical practice and education which draws out the resonances of her observations with debates across teaching and learning, virtual technologies and screen media. However, with a few notable exceptions, like her reflection on disgust and wonder in a dissection class, her ethnography brings us closer to the experiences and worlds of surgeons than to those of their students. Rice’s book is quite the opposite.
At times I felt the full implications of his insights into the sonic environment of the hospital and acoustic exploration of bodies of patients could have been more fully explored in relation to a range of contemporary debates. However, this book gives us a real feel for what it is like to learn to be a medical student, thanks to Rice’s year “on rotation” with a “firm” of third year medical students at St Thomas’s Hospital in London. This experience is particularly palpable in Chapter Five “Auscultation and the transmission of auditory knowledge” in which Rice documents the experiences of learning to use a stethoscope. Rice explores with valuable detail the processes through which teachers move medical students from hearing just “meaningless noise” (101) through a stethoscope to navigating the sonic world of the heart. An unusual and valuable feature of this chapter is its engagement with the route towards competent auscultation of a medical student who describes herself as “hearing impaired” and uses hearing aids and an amplified stethoscope to listen. Although Rice makes only a few brief references early on in the book to the burgeoning theoretical work around space, sociality and identity in Deaf studies, the addition of this student’s experience ensures this book on sound does not leave aside the experiences of those for whom hearing is very hard work.
In Chapters Six and Seven, Rice engages with debates around objectification and visuality. As he notes, work within screen studies has often associated the gaze with reduction of a living being to an object, while sound is often linked to experiences of affect and immersion. In contrast, in Chapter Six, Rice describes patient experiences of being the object of sonic scrutiny because of their “beautiful” or “classic” heart sounds. These experiences contest “the notion that hearing is somehow an intrinsically positive, receptive and benevolent sense” (136). His account in this chapter of the website Heartbeat Babes devoted to “cardioerotica” – sexual pleasure attached to listening to a heartbeat – is a particularly intriguing example of point. Chapter Seven continues this exploration of objectification and subjectification through sound by discussing the patients (and sometimes doctors) listening to their own body sounds. This chapter resonates with poignant narratives of the anxieties felt by those – like the ex-boxer woken in the night by the “strange rasping sound” (148) of his own heart – exposed to the sounds of their own bodies.
Rice’s book offers a fascinating picture of the under-discussed sonic world of the hospital, and a detailed and valuable exploration of the role of aural (and indeed, haptic) routes to learning for medical students. While the implication of his observations remain confined to a fairly narrow disciplinary canvas in this present book, I look forward to reading his future work which will undoubtedly begin to explore the wider interdisciplinary implications of his insights into the role of sound in shaping and defining of bodies and spaces, professional practices and identities.
Reviewed by Dr Nicole Matthews Lecturer in Media and Cultural studies at the Department of Media, Music, Communication and Cultural Studies at Macquarie University in Sydney. Nicole’s work brings together auto/biography, Deaf and disability studies, popular genres of broadcast and electronic media, and education. Her enduring interest is the role of media in processes of social and political change.