The Numbers on the Wall

Every time somebody puts a stethoscope on me, usually during the annual physical, I have roughly the same immediate question: what is this person hearing?

Breathe in. Not like that, like a human. Okay, breathe out. Again. The cold piece of metal moves somewhere else. More inhuman-to-human breathing.

And then usually: okay, all good.

There's an enormous amount of information apparently contained in a set of biological sounds that, if I handled the same instrument, would register as heart noises, maybe-thats-a-lung noises, and some stomach noises if I got lost. The stethoscope makes something easier to hear, but it does almost none of the interesting work. Somebody else has to know what hearing all the biology stuff means.

In my work life, I spent years wanting numbers to know more than they possibly could. One number would move and I wanted that movement to contain its own explanation, to have a deeper meaning exposed via my airtight analysis. Why did it happen? Was that happening any good? What was at fault or behind that movement? What should we do next?

But the number, annoyingly, had only moved. That's it.

The placement of the stethoscope matters, but much more important than that is the fact that the doctor has done this before, presumably thousands of times, whereas I've done it a few times as a kid and then after that I've heard exactly one heart from inside my own body, and even that mostly when I'm lying awake and would rather not be doing that.

I've a very basic idea of what normal sounds like through a stethoscope, mostly from TV. Put the scope somewhere else and maybe that's lungs. Shoulder: probably nothing useful at all, but maybe there is useful shoulder stuff. I wouldn't know.

It's familiarity and practice that generate “normal” out of strangeness.^[1] Take an instrument we all know, like numbers, which acquire meaning in exactly this way. Seventy-two by itself tells me almost nothing. Seventy-two for the hundredth time, in the same place, under what looks like roughly the same conditions, has a familiar, normal shape.

And then of course there is the possibility that you've become exquisitely good at listening to the shoulder.