“The Texture of Air”: performing the sense of place in NHS hospitals

Laura Khan Mitchison

On the Record

To Cite this Article

Khan Mitchison, L. (2022). “The Texture of Air”: performing the sense of place in NHS hospitals. p-e-r-f-o-r-m-a-n-c-e, 6.

The Texture of Air was an artist-led “inventory” of two lost London hospitals and the extraordinary perceptual worlds of those within. It was a response to an artist commission from University College London Hospitals Arts and Heritage department. The stimulus for the commission was the closure, in early 2020, of the Eastman Dental Hospital and the Royal National Throat Nose and Ear Hospital, after 233 years of independent history on the Grays Inn Road, London. The NHS is usually intensely private and guarded, but, in their last days, the two sites opened up to our gentle enquiry. I, along with my collaborators Olivia Bellas and Nicole Robson, had almost unrestricted access between 2017 and late 2019 when we were artists in residence.

The Eastman Dental Hospital and the Royal National Throat Nose and Ear Hospital were deeply inhabited places within a historic area of London (Grays Inn Road) that was once nicknamed “shadyville”. Many hospital staff had worked together for 25 years or more, fallen in love with one another, volunteered for one another’s experiments, fed one another’s pet terrapins with fresh shrimp. The prospect of leaving the Grays Inn Road was met with hope and trepidation.

Our “inventory” deployed many different documentary media – LiDAR (3D scanning), 16mm film, oral history and original musical pieces that captured the resonant frequencies of the space. Hospital staff showed us the treasured objects of the old buildings – a museum of ear trumpets, a cherub fountain, a pair of antique rocking horses. Hospital patients let us into clandestine consultations and operating theatres. After dark, our musician friends captured the acoustic profile of courtyards and corridors.

The purpose of The Texture of Air was to ensure that the sounds, memories and heritage objects of the old buildings would be preserved after the old sites closed. The project culminated in an audio-visual artwork & digital archive, which will be available for at least 5 more years here: www.thetextureofair.uk. We also created three sculptures revealing an X-ray like view through the two old hospitals. These, along with the audio visual artwork, are installed permanently at 47-49 Huntley street – where the two old hospital services, and many of their staff and patients, were transferred.

2 sculptures at 47-49 Huntley Street.

We could have sought the identity and impetus for our project in the stories of the Hospitals’ Founding Fathers and Mothers. (It’s tempting, as the feminist geographer Doreen Masseyi observes to respond to change and insecurity by looking inward and backwards.) However, this would miss the way the modern NHS is shaped by connections to places and people beyond. The Texture of Air traced a constellation of routes through the buildings, rather than roots into the past. We brought people from 100s of miles away back to walk through the sites with us, such as a British sign language campaigner and musician Danny Lane, who had not been to the Hospitals since he was a small boy playing on the rocking horses.

Our creative research attempted to solve this puzzle: How to listen to public hospital buildings democratically? To break the question down:

How to put patients, cleaning staff, and nurses on an equal footing with the medical pioneers?
How to listen to inanimate architecture along with the animate lives within?

How to bring in the perspectives of outside groups, even dissenting voices, such as British Sign Language users who protested that the cochlear implant programme established in the 1980s was tantamount to linguistic genocide.

Everything else flowed from this.

Naturally, we interviewed the senior dramatis personae: David Kemp – the scientist who discovered tiny sounds coming out of the ears (otoacoustic emissions, Royal National Throat Nose and Ear Hospital). Joanna Zakrzewska – the oral physician who has developed a visual arts based technique for enabling patients to more accurately describe the painful sensations in their faces (the Eastman Dental Hospital). David Howard – the throat surgeon who treated Stephen Hawking (the Royal National Throat Nose and Ear Hospital. It is easy for these figures to integrate their life history into the course of an institutional history over which they exerted some influence. But this linear trajectory and chronology is less accessible to those without power or long-service behind them.

It occurred to me that the way to bring many different voices together, democratically, was through people’s senses of place. I listened for the perceptual juice that mixes body, building and memory – three notes striking a chord. As Karl Marxii observed: “the forming of the five senses is a labour of the entire history of the world down to the present”. Each of my interviewees occupied a position of sensory expertise, built on aeons of barely conscious personal and collective memory. Some of the extraordinary perceptual vignettes that our project uncovered include:

a cochlear implant being switched on for the first time
a patient awakening to a phantasmagorical monkey playing a tiny pipe-organ (sudden hearing loss)
the trills and purrs of voice therapy
the numinous feeling of a perfectly pitched anaesthetic

the “raw-onion” sensation on the tongue caused by a combination of mouth ulcers and speaking German consonants. (This last comes from a bi-lingual patient, Chris Cook, whose symptoms come from a rare syndrome called Riley Day: “Prof Porter can often tell if I’ve been teaching a lot of German by my tongue, which gets quite a battering anyway, doesn’t it Prof?”iii

So, how did we unlock these senses of place? Clinicians are reticent at work, patients feel strange about returning to a place of sickness. To enable people to speak freely, The Texture of Air began incorporating creative research methods from performance and music. We broke form with the standard mise en scène of the oral history interview, which is usually seated, and often follows a thematic or chronological path into a narrator’s lived experience. The idea, for The Texture of Air was to create a shared moment of exploration in each recording. I stuck a little message to my audio recorder – “DO SOMETHING TOGETHER”. This is reflected in the archive page of www.thetextureofair, where visitors can filter the items by the various movements or gestures of our creative research – walk and talk, show and tell, music, field recording, audio moment, seated oral history etc.

I’ll unpack what I discovered about each gesture, both practically and theoretically:

“Walk and talk”: When two people walk side by side, body rhythm and heartrate starts to fall into sync. The interviewee lays down a path by walking that gives structure to the narrative – they are in charge. It may also feel more natural for hospital staff – they are used to snatching conversation while marching through corridors to their next appointment. Attention moves fluidly between external stimuli and inner reflection. Moving with staff and patients through the old hospitals taught me to embrace “noise” and disturbances, noticed while pausing in a space. For example, when Colin Hopper, a maxillofacial surgeon at the Eastman, was moving through an abandoned operating theatre, a sudden whoosh from the air-conditioning sparked his memory of volatile anaesthetic gases exploding back in the 1970s. There was always a sound beyond the original frame of listening, overstepping, interrupting, offering an extra perspective. Because it emanates from a source and then dissipates into the soundscape, sound often seems to lead people’s imagination metonymically, to a larger whole.

“Show and tell”: Staff and patients created scenes with the interviewer. A dental implant patient showed us how to play the piano, a dentist demonstrated how she hypnotised anxious children, a physician cradled our heads and fixed us with her gaze to test for vertigo, a trainee nurse taught us to mix dental impressions paste “like baking a cake”. Paul Connerton demonstrated how much of social memory is “sedimented” in habits and gestures of the body. iv He believed this was inchoate, even undermined by verbal recollection, but we found people naturally move from doing to describing. By exploring their work routines or staging procedures together, we drew out the eloquence of repeated practice.

“Music”: As part of the exhibition, Nicole Robson created a suite of compositions for the Eastman Dental Hospital and the Royal National Throat Nose and Ear Hospital.v Some pieces riff on the resonant frequencies of corridors or mathematical measurements of iconic objects. In one algorithmic piece, two rhythms are taken from “gallop” heartbeats, which trigger notes on a piano. The rhythms move out of phase at a rate dictated by the relative sizes of two rocking horses. In another, oboe and clarinet move towards one another from opposite ends of the Eastman Dental Hospital, calling back and forth to one another until they meet in an Art Deco entrance hall. Melodies rebounding off marble floors and vaulted ceilings are heightened by spaces between notes – the silences that invite you to hear the environment in the absence of intentional composition. It was very important to us to express architectural substance within the sounds and music we recorded. Nick Coleman, patient, had earlier explained to us: “I used to hear buildings whenever I listened to music…I did not hear see in the classic synesthetic way, so much as sense them. These forms had “floors” “walls” “roofs” “windows” “cellars”vi. They expressed volume”. There was something full bodied and cross-modal in Nick’s sense of music.

“Audio moments”: Many creative sessions – group or one-to-one – exploring listening in an expanded sense. Sometimes, we shared silence with people, eyes closed, breathing relaxed, tuning into new layers of a waiting room: “the clicking of the catch and the banging. And then lots of chattering, chattering. It makes me think of the mah-jong game, when they shuffle the pieces, they call it the chattering of a thousand sparrows” (Annette Fry, voice patient)vii. As composer Hildegard Westerkamp discovered – sound and listening exist in a symbiotic dance – the environment is enlivened by listening.

“Oral histories”: In sedentary interviews, the comfort and long-format allowed us to probe deeper symbolism and subjective interpretations: Imagine the hospital building as a piece of music, what sounds would it have? Mike Nesbit, dental technical at the Eastman, pondered awhile: “This building makes me think of my favourite time in music – the change over from the late romantic period to the jazz infused modern. All those composers that I like have this ‘betwixt and between’, this schizoid thing. They can’t quite make their mind up between having beautiful melodies and someone scratching their fingers down a blackboard.”viii The Texture of Air was also about listening to what is deep within the imagination, to what is impossible to hear in a narrow audiological sense.

“LiDAR scans”: The architecture was a character – a resonating body that structured the listening of the bodies within. I decided to turn an emerging medical technology called 3D scanning – used to fabricate dentures and hearing aids – onto the fabric of the ailing buildings themselves. We walked through the entirety of two hospitals one Christmas with a LiDAR scanner, operated by Bernadette Devilat from the Bartlett School of Architecture to our brief. The scanner fired millions of pulses of laser light per second into each room, gathering measurements with micrometre precision. Around 600 scans were stitched together into a 3D model called a “point cloud”, sectioned across multiple planes to reveal the innards – rocking horses, pink bunkers for testing ears, surgeons in theatre, boiler houses, Christmas decorations, a cleaner’s mop, “phantom heads”, doctors typing letters of an evening. Although the point cloud was edited rigorously, the 3D scanner’s machinic memory does not discriminate, unlike the subjective human memory. An exuberant excess of detail generated by this technology creates the atmosphere of the real, it’s a code that tells us – “this is how things are”ix. In the artwork, “the reality effect” is subcutaneous, a strange hybrid of nostalgic doll’s house and a futuristic MRI scan. There appears to be a flat equality in the visual field, rather than focusing the eye on a telling detail or two. The 3Dimensional work is mute but one can sense noise – the ghostly traces of figures moving across the scanner’s gaze, hinting at the sound and memory worlds within.

Details from a 4 metre x 1 m x 0.50m LiDAR sculpture made of glass, light, timbre,aluminium and many digital images was inserted through a sleight-of-hand manoeuvre into the fabric of the new building. A slice of the old hospitals is now perfectly flush with the walls of the new building. Author Bernadette Devilat & Laura Mitchison.

Details from an operating theatre. Author Bernadette Devilat & Laura Mitchison.

Conclusion

An experimental combination of creative research techniques enabled patients and inanimate architecture to speak with as much eloquence about their senses of hospital treatment as the expert clinicians who had a much deeper connection to these two institutions.

When we talked to people who had sensory losses or differences, their anomalies furnished us with a better understanding of normality. Ordinarily, one’s own body is in the world “just as the heart is in the organism.”x In other words, are engaged bodily and holistically with meaningful projects out there; self and world are indivisible. We can choose to intellectually translate objects in a sort of Cartesian co-ordinate system, splitting them up into sounds, sights, tastes etc (a mosaic of magentas, muttering, miasmas for example). But this is categorically not how they appear to us in normal life. When something goes wrong with the ear, or the voice, or the nose, our fundamental contract with the whole world is broken – qualia separate from their objects. When the aforementioned Nick Coleman woke up, one morning, with sudden sensory neural hearing in one ear, the world did not fall silent, as one might expect. Real sounds were displaced by an intercranial mariachi band of clanks, zizzes and hisses, punctuated by a hallucination of a tiny monkey playing a tiny pipe-organ.xi In a similar vein, labyrinthitis patient Emma told me: “It was like a juggling saucepan of water that would move and bring your head with it. Also a snowdome with all the bits whizzing around your head, and marbles whizzing around your head. Also a visual, so I would visibly see the ground visibly moving and it would feel like I’m on a bouncy castle.” xii

When the body no longer opens us to the shared world of things, there’s a suspension of the pre-reflective natural attitude. The people we recorded became detectives inside their own bodies, approaching their sense of place with a sort of philosophical curiosity, which we encouraged through questions and prompts. The act of perceiving itself was amplified, just as clasping a seashell to the ear amplifies the blood flow feeding the action of ear and auditory nerve. A patient, James, struggled to express the loss of his olfaction, which had been a Cinderella-like presence in his earlier life, but was now deeply missed. He came up with a beautiful phrase, which became the title for the exhibition: “I know when the grass has been cut, it’s the texture of the air”.xiii

Coining metaphors and similes, like James, in order to deal with sensory disintegration was the rule rather than the exception. Children with tinnitus would hear “bees” and “bouncy balls” and “ghosts,”xiv adults would even characterise and befriend their phantom orchestras. One 40-something patient, Kinnari, still hears a tinnitus sound that she imagines to belong to a fat opera singer, dressed in a full tuxedo. Even after a cochlear implant had partially restored her hearing, she says, “He is my lifelong friend, my dearest”. xv)

It is surely no coincidence that the area of the brain which is at the crossroads of touch, hearing and sound -the angular gyrus – is experimentally linked to metaphor. Patients studied by a German scientist called Von Bubnoff, who all had legions in their angular gyrus, systematically failed to grasp the meaning of common metaphors. They couldn’t come up with anything other than the most literal translation. For example, when asked to parse the phrase “all that glitters is not gold”, test participants would say things like “the deep meaning is that we have to be very careful when buying jewellery”xvi. Taking it a step further, people’s ability to link unrelated things might be heightened precisely at the moments when cross-modal synthesis is most urgent, when the body schema is being re-mapped by illness. After all, the force of a good metaphor is not simple substitution of one term for another, but the attempt to change reality by performing a fresh story about it. It fashions a new world from which the original appears unreal. The Texture of Air preserved these sensory insights from voyagers to otherwise unimaginable lands, before they evaporated. The digital archive we created, I hope, imbues an isolating experience with solidity and cultural value.

My tentative conclusion is emboldened by The Texture of Air‘s dialogue with people who had been born Deaf or those who strongly associated with sign language culture. For these individuals, the issue of loss or disability had no meaningful validity.xvii Much like the hearing folks, the Deaf participants were fully attuned to their world. When invited to make music in our creative programme, they responded to buildings and settings, words and imaginings, players, and movements. The cerebral crosstalk which links rhythmic repeated patterns in the visual field with beats in the ears for instance, was present in their compositions, but didn’t need to be articulated explicitly.

Biography of Laura Khan Mitchison

I’m an oral history artist, working for www.on-the-record.org.uk. My creative research begins by seeking out people who are not usually ‘interviewed’ and recording their stories, usually as audio. Next, I juxtapose their words, with sounds, music, and image. I accumulate meaning through montage or by arranging voices in a musical structure. I can simmer the voices to a flavoursome reduction, I can add a little zest to their natural timbre, but I cannot alter their meaning. I have a contract with my interviewees to keep the intention behind their words intact.

I’m reflecting, here, on a public art project called The Texture of Air because it shook up the way I practice, and turned oral history interviews into performances.