Horror in the emergency department: Pirates, Presidents, and ‘non-linear’ sounds

Inevitably, the Halloween ‘season’ is upon us, as any reader with a nervous pet will know. I use the word ‘season’, because as many emergency department (ED) soldiers will attest, some patients will show up to the ED over Halloween weekend fresh from a party and still wearing a costume.

Then there are those whose Halloween costume includes a fake sword, even the plastic variety. Add in copious amounts of alcohol and that’s a recipe for a visit to the ED. Halloween make-up has also become more intricate as the years have passed and there are anecdotes about people whose fake injuries looked so realistic that they sent some nurses into a panic.

Dr Michael Lynch, Toxicologist and Emergency Medicine Specialist at the University of Pittsburgh Medical Centre, US, once reported to CBS that he has basically seen “every President you can think of” in the ED, including both Bushes, Clinton, Obama, and, of course, Donald Trump. The staff at the hospital where he worked at the time quietly had a competition going to establish whose patients had the best costume. So, a doctor or a nurse could conceivably jump from cubicle-to-cubicle treating Wonder Woman’s broken toe in one, to giving Batman some stitches in the next.

He has also seen an example of the aforementioned fake sword causing problems for a 22-year-old man who attended a costume party. An incident took place, during which he was beaten with a plastic sword. “He was, ironically, dressed up as a pirate,” Lynch said. “He lost his sword fight.”

One Halloween, Dr Lynch’s ED also reported how an intoxicated patient dressed in a nurse costume had to be physically restrained in order to prevent her from leaving her cubicle and ‘treating’ other patients.

On a separate note, with the increased use of cannabis ‘edibles’ in the shape of gummy bears or brownies, it’s a good idea for parents to closely supervise what their children pick up while trick-or-treating. Then there’s the pumpkin-carving accidents, peanut allergies, fireworks-related injuries… the list goes on and makes Halloween a serious candidate for the most dangerous time of the year.

Of course, a lot of horror films will be re-run around now. Even from the early days of the genre, these films have been associated with the blood-curdling screams of a man being devoured by a zombie, or a woman who is about to become a midnight snack for Dracula. But why do we have such a visceral reaction to the sound of someone screaming in horror? What ‘button’ does that press within us?

Dr Jodi Sasaki-Miraglia, Diagnostic Audiologist, has researched the topic and drilled into the science of it. Screams, she explains, fall into the category of ‘non-linear’ sounds that evoke some ancient fight-or-flight responses. Basically, these are sound waves with unusually high amplitude and much greater volume compared to other types of sounds. They are usually chaotic, discordant and make us feel uneasy on some level. Think of the soundtrack for the movie Psycho, or the famous ‘Here’s Johnny!’ scene from The Shining.

The influence of these types of sounds was taken seriously in times gone by, with medieval-era religious leaders warning against the use of the ‘tritone’, a chord that was believed to have the power to summon evil forces and was known as ‘The Devil’s Interval’.

Screams fall into this family of these non-linear sounds: In audiology, it’s known as the ‘acoustic startle reflex’. Our brains have evolved to recognise these sounds as a warning, or sign of some kind of impending danger. The ancient machinery working away in our brains responds by increasing breathing rate and releasing adrenaline and cortisol.

Of course, this opens up a new can of worms with regard to how listening to patients scream in pain or psychological distress affects healthcare workers. A quick look at the literature confirms what you might expect: “Noisy emergency departments pose health risks to physicians, but noise-related stress did not significantly affect attention, beneficial for patient care.” This is according to the authors of a 2023 study in the American Journal of Emergency Medicine.

But perhaps it’s a topic to explore further another day.