Life After Deaf

by Noel Holston

  Courtesy of Cochlear Americas © 2020

  Oddly, it was easier to get a glimpse of what would be inside my head than it was to get a clear idea of what the device was going to look like to other people. No doubt Cochlear Americas has research to prove that many potential implantees are anxious about becoming sideshow freaks or objects of derision. It’s well known that thousands, perhaps millions, of people who would benefit greatly from hearing aids don’t take advantage of the technology because, to some degree, they don’t want to call attention to their disability. As I noted earlier, however, we, the hearing impaired, really can’t afford such pride, such vanity. And it’s disappointing that implant companies tend to cater to those worries rather than explode them.

  The elaborate Cochlear promotional kit that Dr. Hoffmann gave me was as glossy and as short on hard information as a brochure for time-share condos on Maui. Photograph after photograph of satisfied implantees seemed carefully staged to demonstrate how easy it is to hide the device from view. The angle the person was shot from gave only a hint of the processor and coil, or the device was carefully covered by long hair.

  What does one of these gizmos look like upside the head of a guy with a buzz cut or a shaved head? My hair was in fact medium long at the time, but I wanted to know what it was going to look like if I decided to try the Marine look.

  I had to do Internet research to find a photo of an implant attached to someone with close-cropped hair. When I did, it was . . . interesting. The first one I saw looked like a charcoal-gray insect had attached itself to the guy’s noggin. It looked to me like something that grew up to costar in Aliens, giving Sigourney Weaver’s Ripley the fight of her life, or that would feed on my brain. It was kind of cool, actually, a potential conversation starter, assuming it indeed allowed me to converse.

  I told myself the potential positives far outweighed the negatives. I repeated what was becoming my mantra:

  Deaf be not proud. Deaf be not proud. Deaf be not proud.

  Chapter 11

  Goldberg Variations

  We live in an age when surgeons can rebuild hearts; replace corneas, knees, and lungs; rewire brains; and equip amputees with race-track prosthetics, yet the inner ear remains challenging territory, a minuscule Marianas Trench inside your skull. It’s complicated, delicate, and surrounded by hard, bony material that makes it difficult to reach without doing serious damage. As a cochlear audiologist once told me, the only way truly to have your ear examined and a problem diagnosed is for you to die so that a specialist could cut open your head and section the temporal bone. I did not want to know what was causing my hearing loss quite that badly.

  Instead, I spent hours contemplating diagrams of the ear in the pages of books and on the screen of my computer.

  In another essay published on www.likethedew.com, I noted that:

  Going deaf tends to encourage that sort of thing. You want to know all you can about this sensory organ you until only recently had taken for granted.

  Among other things, studying these drawings gave me new ideas about the nature of God. I came to believe that God is Rube Goldberg—or, at least, as the casting agents out the West Coast might say, a Rube Goldberg type.

  For those possibly unfamiliar with his name and genius, Goldberg (1883–1970) was an author, an engineer, a sculptor and inventor. Most famously, he was a cartoonist who envisioned and drew comically complex devices that perform simple tasks in indirect, convoluted ways.

  Keep Mr. Goldberg’s work in mind as I briefly refresh your memory as to the construction and working of the intricate, delicate, sensitive, goofy apparatus we call the ear.

  We gather and focus sound waves by way of the outer ear, outcroppings of cartilage and skin that grow on each side of our heads rather like mushrooms. I have the portabellas myself, but the model varies from person to person.

  The outer ear, scientifically known as the pinna, directs the sound waves down a short tunnel, or canal, to the tympanic membrane, better known as the eardrum, which begins to vibrate from the pressure.

  The vibration causes a chain reaction among the ossicles, three very tiny, closely connected bones on the other side of the eardrum, in the middle ear. The first bone, the malleus (hammer), moves from side to side like a lever, causing motion in the adjacent incus (anvil), which in turn jiggles the stapes (stirrup), which sends rippling waves through the fluid contained in the snail shell-shaped cochlea in the inner ear.

  Tiny, hair-like cells inside the cochlea translate the wave motion into electrical impulses that travel along the auditory nerve to the brain. The brain decodes the impulses and makes it possible for us to discern whether what created the original vibration was a cat meowing or a politician barking or Eric Clapton playing slide guitar.

  Courtesy of lyrichearing.com

  Take a close look at the ear diagram included here. Now, take a close look at the classic Goldberg cartoon panel on the next page.

  Isn’t a contraption/process that involves a kitty’s yowl, a drum, a hammer, an anvil, a stirrup and something that looks like it would make a nice home for a garden slug every bit as Goldberg-ian as a napkin-dabbing system that requires a clock, a scythe and a toucan?

  Isn’t it just as absurd? Isn’t it, if anything, more miraculous?

  * * *

  There’s more to it than this, of course. Rube took his time. Eons. The ears of mammals, ours included, are profound examples of evolutionary design, cumulative constructions that came together over a stretch of more than 250 million years.5 Ears were the last paired organs to develop during evolution, and what we visualize when we say “ear,” the visible outer ear, the pinna, developed last of all.

  Primitive fish and, later, primitive amphibians “heard” by picking up vibrations through ground and water, much as salamanders do today. They detected vibration through their entire bodies, but mostly through the denser components, the bones. The complex, interactive parts of the ear—the ossicles, the tympanic membrane, and the coiled cochlea—developed slowly over time, as conditions and needs changed. Air doesn’t conduct vibration as well as soil and rock or water, so animals that spent most of their time on land and in the open had to adapt, to develop keener, more subtle means of detecting vibrations in order to survive.

  Our ears aren’t the best in the animal world, but they’re not the worst, either. Ours can differentiate up to four hundred thousand different sounds. They can process more impressions than our eyes, about fifty per second.6 On first impulse, you might think that if surgeons can transplant hearts, lending a deaf person an ear would be a relative snap. But no, not by a long shot. Surgical techniques for replacing the stapes (stirrup) have been around for more than four decades, with a near-imperishable polymer prosthesis now replacing the earlier silver replacement part. But the inner ear, in which most causes of deafness originate, is a surgical challenge far more daunting than connecting an artificial heart or reattaching a severed limb.

  “First of all, the inner ear is a tiny, pea-sized organ located within the temporal bone, one of the hardest bones in the body,” my brother, Dr. J. Timothy Holston, told me. He’s a longtime professor at the University of South Alabama, now retired, and past president of the Alabama Academy of Audiology.

  “Accessibility is not easy,” he further explained. “Second, the inner ear is very complex—they don’t call it the ‘labyrinth’ for nothing. You have two different fluids in the inner ear, both of which have different electrical polarities that have to remain balanced. Also, the interconnections between the sensory hair cells (two kinds, inner and outer, both of which have different functions) and the nerve endings at their base are quite complex.”

  Dr. William Slattery, a surgeon and researcher at the House Institute in Los Angeles, told me that while it would be wonderful to transplant cochleas, it’s beyond our surgical capabilities now. Large organs like the heart and liver, while complex, provide much simpler functions. Not only is the cochlea smaller than a jelly bean, but its fu
nctions are dramatically more diverse and complicated than those of the larger organs.

  “There are fifteen thousand hair cells that each respond to different frequencies [and they’re] packed within the area the size of a pea,” Slattery said. “And this is only one type of cell. In addition to this, there are supporting cells, there are fluid regulation cells. It is truly a quite complex organization that requires all of these mechanisms to be working together and in sync.

  “Transplanting a cochlea would then require the nerves to all function properly. It is kind of like taking a piano of fifteen thousand keys and trying to transplant that with input of all these different frequencies.”

  Cochlear implants continue to be refined. New models developed by Cochlear Limited and MED-EL are hybrids—part implant, part hearing aid. They’re primarily for people who have better hearing in the low frequencies but drop to a severe/profound deficit in the mid-to-high frequencies. “The hearing aid part of the device works for the lows, while the implant part stimulates the mid-highs, where the aid is not effective,” Tim said.

  Scientists also have developed a prototype for a “bionic cochlea” that mimics the function of the inner ear. “The problem would be getting something like that to a size that would approximate the tiny inner ear and getting it in via the temporal bone,” Tim said. “If this ever came to fruition, I think it would have to be something external that would perform the function of the cochlea.”

  Researchers are continuing to experiment with chemical and drug therapies, including treatments that would regenerate hair cells. “This has been much more difficult than initially proposed,” Slattery said. “Much of this work started in 1995. As you can see, it is now twenty years later and we still do not have treatments for this type of hair cell loss.”

  We have known since the late 1980s that the ears of young chickens are able to regrow dead hair cells and regain lost hearing.7 A mammal with similar capability has yet to be discovered, but scientists remain intrigued by the possibility that a way to induce hair-cell regrowth in humans may be found. A research project at Massachusetts Eye and Ear is perhaps a preview: scientists have had some success restoring the damaged hearing of test mice with a drug that was developed to treat Alzheimer’s.8

  “Research on regenerating hair cells is promising and perhaps closer to coming to fruition that we might think,” Dr. Holston said. “The primary avenues of study are in genetic modification of supporting cells that exist around the hair cells into actual hair cells. The other is using embryonic stem cells that may have a propensity to develop into hair cells and placing them with supporting cells with the hope that they will develop into hair cells. Again, the problem is that, once you’ve developed the hair cells, will they make the complex re-connections with the underlying nerve fibers and would there be any relearning process, as you go through with a cochlear implant.”

  Slatttery said the major focus of treating hearing loss has become “trying to prevent further loss of hearing. The goal is to try and stabilize patients when they are first experiencing some kind of hearing loss.”

  A Paul McCartney song comes to mind, the bittersweet “Tug of War.” Macca ruefully acknowledges that revelations and discoveries about science and life, inevitable though they may be in the future, won’t happen while he’s still drawing breath and dreaming up melodies.

  5 Geoffrey A. Manley, “Aural History,” The Scientist, Sept. 1, 2015, https://www.the-scientist.com/features/aural-history-34918.

  6 “How the Hearing Works,” Hear the World Foundation, accessed May 21, 2019, https://www.hear-the-world.com/en/knowledge/hearing/how-hearing-works.

  7 “Do You Hear What I Hear: All About Chicken Hearing,” Fresh Eggs Daily, September, 2016, https://www.fresheggsdaily.com/2016/09/do-you-hear-what-i-hear-all-about.html.

  8 Jon Hamilton, “Alzheimer’s Drug Dials Back Deafness in Mice,” National Public Radio, January 9, 2013, https://www.npr.org/sections/health-shots/2013/01/09/168960377/mice-dial-back-deafness-with-alzheimers-drug.

  Chapter 12

  Drill, Baby, Drill

  My implantation surgery was set for September 27 at Atlanta’s Piedmont Hospital. Every professional with whom Marty and I consulted, including Dr. Hoffmann and my brother, Tim, said that given my age, excellent overall health, high educational level, work ethic, and the recency of my hearing loss, the odds of a favorable outcome were very good. Education, I was told, indicated that I would have a larger vocabulary from which to identify words I’d be hearing in a new, digitized form. My work history predicted diligence, while the newness of my hearing loss meant that I, unlike a lifelong or longtime deaf person getting an implant, would not be starting from ground zero.

  Life, meanwhile, had thrown us another curve. In August, Marty had found a lump in her right breast. A biopsy determined that it was cancerous. Her surgery, a lumpectomy, was scheduled for less than a week after mine. She had been the proverbial saint during the early months of my hearing loss, diligently making and taking phone calls I could not, scheduling me for medical appointments and haircuts, painstakingly writing down her thoughts on a steno pad so we could “converse,” nagging me about practicing sign language, and endlessly repeating words and phrases I didn’t understand.

  I had heard it said, as a bitter joke, that nothing undermines a good marriage worse than the death of a child or a kitchen remodeling. To that short list I would add sudden deafness.

  Marty’s patience withered after her cancer diagnosis. She was frightened and frantic, suddenly resentful of the time and effort I required. For as long as I had known her, she had had an acute sense of life slipping away. One of her songs, “Sand,” begins, “There is only so much sand/In the hourglass/In the hourglass.” Another, “Big Brass Ring,” has a bridge that includes the lines “You never know when this life/Is going to end/Stop putting your todays off until tomorrow.”

  Now she was on a tear, a binge, getting out of bed in the middle of the night, rearranging the furniture almost daily, dragging old photos and half-finished lyrics out of boxes in closets and leaving a trail of clutter like Pigpen in the Peanuts comic strip.

  I was already on edge. Now I was alarmed and discombobulated. I worried that she might be losing her mind. I expressed my fears to my stepdaughter, Downie, who shared the conversation with her mom. Marty sent me a stinging email—at that point the surest way to communicate with me—and laid out her frustration and anger.

  “I realize that you’ve had something very traumatic happen to you in the past seven months,” she said. “So have I.

  “I need to write,” she continued. “I need time to myself. I need not to have anyone else insist that their needs are greater. Part of why my illness came to light (belatedly) is because I didn’t have time to find the lump. We’ve been super-focused on you. We need to focus on me. Or I need to focus on me. I can’t tell you how angry I am. I feel taken advantage of and taken for granted, the whole nine yards.”

  It was a kick in the head. Through six increasingly frustrating months, I had continued to go to work at the Peabodys and bring home a paycheck. I did most of the cooking, most of the yard-work, and more than my fair share of housework (Marty was raised in a Nebraska house that looks like a thrift store tossed by Drug Enforcement Agency operatives and has no problem with clutter). Friends and colleagues had praised me for the grace and humor with which they believed I was dealing with my deafness, and I was only too happy to agree with them. But none of them, I finally realized, had to be around me twelve or fourteen waking hours a day. None of them comprehended what it was like for Marty to have to repeat the simplest comments and requests again and again. None of them knew what it was like to have a partner who couldn’t listen, not deeply and fully anyway, or who was too consumed with anxiety and the difficulty of everyday activities to be truly empathetic. But that was me. Unintentionally or not, that was me.

  As my surgery date approached, we aired out our differences. We had some marriage counseling sessi
ons with a therapist we found insightful, compassionate, and frank. We went bird-watching, one of Marty’s favorite pastimes, at lakes and swamps where not talking was essential. We went dancing—I could feel deep bass notes even if I couldn’t hear them, and I could watch Marty’s movements for cues. We got to what seemed like a better place.

  Marty made a barber shop appointment for me. I got my hair buzzed. Then, at home, I shaved my head completely, figuring most of my hair would go at the pre-op anyway. I hadn’t had short-short hair since I was a little kid. I wanted to be proactive, make a game of it, and see what I looked like in Howie Mandel mode. I fantasized about trying out for the Yul Brynner role in a community theater production of The King and I once my hearing was restored. Etcetera, etcetera, etcetera.

  We decided that we should get a motel room in Atlanta for the Sunday night before my Monday morning surgery. Under perfect circumstances, it would be an hour-and-a-half drive from Athens to the hospital. We didn’t want to risk a delay caused by workday traffic, let alone drive in it. We planned to head for Atlanta Sunday afternoon, check in to the motel, take a dip in the pool, and have a leisurely dinner someplace cool. And I, at least, was thinking we would have time for some motel romance, a last tryst in case I didn’t wake up from the anesthesia.

  The best laid plans of laboratory mice and men . . .

  We were late getting on the road to Atlanta. Like, two hours late. When we were on I-85, well inside the sprawling city’s boundaries, we realized we had left the motel reservation, including its address, at home. When Marty attempted to call the motel on her cell phone, hoping for guidance, she discovered she could only get a national switchboard. The operator on duty could find no trace of our reservation at any of the chain’s outlets in greater Atlanta. Marty had to make a new reservation and, because we were largely ignorant of Atlanta’s layout, had to guess which one was closest to the hospital. The operator, who was in Ohio or maybe India, was no help.