Eyes closed, head bent forward, mildly sonorous, he sat on the lanai as the sun faded into the western skies. No beach, here, he and his wife of over 50 years live in a modest, but very nice retirement condo in West Central Florida. Because of his fair skin and a few basal cell skin cancers, he avoids direct sunlight, but the screened-in lanai affords him some opportunity for fresh air, sun warmth, and quiet contemplation. Well, not quite quiet. His ears are constantly noisy, seashell noises from time to time, a mix of discordant tones at others, buzzing static, insect noises, and at times very intense non-descript noise.

Ever since that ill fated trip to Detroit over 20 years ago, he has had tinnitus. He contracted a viral heart infection that interrupted an academic conference with an admission to the local teaching hospital. At first, fever and severe malaise dominated. Alternating between excessive drowsiness, brief wakefulness, and extreme fatigue, he remembers feeling a bit dizzy and for the first time in his life, hearing tinnitus. He didn’t remember quite enough to describe the specifics; nevertheless, that was the beginning of ear problems.

Beyond eyelids too heavy to open, he heard a rumbling, speech-like noise that became quite intrusive, bringing back other memories. As the noise chattered incomprehensibly in the background, he remembered the old compressor in the pathology lab. Its cacophonous tones often intruded into his preparations for the board certification examinations in pathology, and doing his daily work as a pathologist-in-training. The drone of the compressor, though, drowned out intrusions from laboratory staff and the din of other nearby equipment.

During his daily stealth-like sorties out of the pathology department for lunch, a perky young nurse always seemed to find him. Though he paid her little mind, initially, she introduced herself to him and he obliged by offering his own name. As he moseyed through the lunch line, she sashayed with effervescent prattle. Her eyes flashed and her face grinned as she vivaciously described her encounters with patients, other nurses, and even her volunteer work. Just out of training herself, she was so excited to be working at the big teaching hospital. She always seemed to stroll with him to a table where the one-sided conversations continued until he excused himself and returned to his disharmonic compressor motor and pathologist’s microscope.

When she proposed marriage, he realized how much he enjoyed her company. Relieved that she always seemed to carry the conversation, he agreed that he would love to spend his life with her. So many years ago, he mused with a certain pleasure and gratitude. She was there through it all, nursing him through the heart ailment and its sequelae. And, when the Meniere’s disease later wracked his body with paroxysms of vertigo, nausea, and vomiting, accompanied by the most intense tinnitus, she had wetted his brow with washcloths, administered the nausea suppositories, and eased his discomfort.

After a few months of the unpredictable and unwelcome vertiginous episodes, he learned that intense humming seashell noise in the left ear portended another moira of Meniere’s. Heralded by ear pressure and depressed hearing, vertigo erupted in short order followed by hour upon hour of whirling, only overwhelmed by eructations of nausea and emesis. And, that gawd-awful tinnitus, variably humming, ringing, katydids, shrill, as if his head would burst. When the attacks became frequent, surgery to cut the left balance nerve resolved the vertigo. Initially, usable hearing was preserved in the operated ear, but in time it became severely impaired. Years later, when the other ear hearing began to fluctuate ominously, he feared the Meniere’s would send him once again into dervish fits of vertigo and disable his only hearing ear. With medication, he avoided the vertigo, but the hearing declined so that listening required utmost concentration, exhausting effort.

Even with hearing aids in both ears, the hearing became so bad that almost all high frequency hearing was unusable. Hearing aids seemed to assist only low to mid frequencies and unless he could see lips, he understood almost nothing complex. Speech sounded like mumble, warbling low frequencies not unlike that old lab compressor. Comprehending speech required close attention to lip reading, watching the speaker’s face, and asking the speaker to slow down. Repeatedly, he had to find the speaker’s face and, then, ask the speaker to start over, speaking more slowly. Any background noise made communication impossible.

In his graying malaise, he was grateful that he had heard his love chatter so endlessly that he knew her every inflection, intonation, and idiom, able in most contexts to finish every sentence and complete every thought. In their early years, he didn’t need to watch her to know what she was saying. Face buried in his journals, study always his passion, just a few syllables from her conjured the full picture. He still knows all of her phrases, but her first few syllables are now discordant stammer to his duplicitous ears. Rather, with what little hearing remains, her rumbling mumble is only interpretable if he scrutinizes her face intently. But, that is not his habit, not his practiced effort, and, now, new predilections are hard to develop.

She complains that he is isolated and depressed. He denies depression, but admits, “it’s so hard to hear, it’s too much effort to bother.” And, thus, he reads in the mornings and drifts into sonorous naps in the late afternoons, with the sun in his face, and tinnitus as his unwelcome companion, until that rumbling becomes a familiar figure shading the sun in front of him.

He lifts his head, wrinkling forehead and bushy eyebrows tugging the heavy eyelids upwards. A distant look forewarns her that he has understood nothing of what she has been saying. Saddened by his isolation, she wants so much to know that he is hearing, hearing her, the adult children, and the grandchildren. “Honey, isn’t it time to get that bionic inner ear implant?”

“God told me you would give me my hearing back so that I could hear my grandchildren.”

I had just offered my hand in introduction and asked, “What brought you to see the ear specialist?”

With nicely brushed soft white hair and pale-pink skin, she was obviously a touch over 70. Dressed in clean modest clothing, grandmotherly looking, she was apparently in her right mind. Her odd introductory statement, almost blurted out, seemed sincere and innocent. Her calm direct manner told me that she believed every word and, “God told me…” reverberated in my mind.

Fascinated, quizzical, I wondered, “God?…did He?…really?”

Even though I carefully avoided any effort to discourage or to encourage her inspiration, her avowal set the backdrop for the medical interview, face to face, me on a stool, and she in an examination chair. She was deaf, but a good lip reader for common context. As the conversation became technical, she rapidly became unable to comprehend even when I articulated phrases slowly and distinctly. To avoid risking the exasperation of shouted repetition and distracting rephrasing, I powered up a laptop computer. Her story tumbled out bit by bit. I constructed questions letter by letter, word by word, category by category and tediously assembled a complete medical history, response by response. Her steady personality and strong faith patiently tolerated my queries as she waited for us to decide if we could help her, something she clearly already “knew” we could do.

Hearing loss had started in childhood. In spite of visits with numerous doctors and several rounds of antibiotics and steroids, her hearing had continued to deteriorate. She had worn large hearing aids, amplifier in a pocket, long cords and ear pieces. When ear-level hearing aids finally developed sufficient power, she upgraded. Even the most powerful hearing aids provided no more than garbled noise, now. She had not completely abandoned her hearing aids, but felt that they provided little benefit. Like many deaf persons, she had gradually learned to accept isolation as her hearing slipped away, leaving behind ringing, insect noises and perceptions so severely distorted as to be incomprehensible. Her interactions were reduced to simply worded basic necessities for which word choices were predictable and lip reading was easy.

But then, her rapidly growing circle of grandchildren rekindled a persistent murmuring desire to hear. From her world whose only noise was bewildering worthless prattle, I imagined her watching grandbabies growing rapidly, transitioning from babbling infants to mumbling toddlers. Their chattering mouths were gibberish through almost useless hearing aids, creating a maddening sense of deprivation. Her eagerness to hear them erupted into a passion to perceive language as her toddlers’ expressive ability flowed in spurts and showers of words, surging squeals and gushing giggles. She rebelled and tossed away her tolerance for lonely silence. Praying earnestly, she embarked on a determined quest to hear again. Something had to be possible “in this day and age.”

During a visit with an ear-nose-throat specialist in her rural central Florida community, she learned about cochlear implants, devices that bypass deaf inner ears to stimulate residual hearing nerve fibers directly. He told her that an “ear doctor over in Tampa” would likely be able to restore some hearing. The thought that anything could open her ears to those dear childish voices energized her. With only vague notions about cochlear implants, she felt the news was a “wonderful answer” to her prayers. She pursued the idea eagerly, sure it was for her, bubbling with enthusiasm.

As her eyebrows traced in animation with the mention of grandchildren, my mind’s eye danced along, mirroring images of small children showing her coloring and small crafts from pre-school, grasping her adult hand with a diminutive one, gleaming into her face, and doing their best to tell Grandma. Vibrant faces with sweet little lips excitedly chattering, hands and arms gesturing, to a grandma who could only grope for understanding! She almost moaned, pleading, actually, “They just don’t understand that I cannot hear.” The vision faded reluctantly to renewed clinical inquiry. Never before had I seen a person so determined to hear her grandchildren, enjoy their jabber, praise their handiwork, and hug their words. Who wouldn’t want to hear the children in her dream?

Puzzled about her hearing loss story, its progressive nature, and curious that shots had been given repeatedly, I ordered CAT scans, blood analysis, and a battery of hearing tests. As I compiled the data, quite clear was that the hearing loss was secondary to congenital infection which her pregnant mother had contracted. The CAT scan showed that the normally rock hard bony walls of the inner ears had turned into spongy soft bone, an implication that inflammatory reaction in the inner ear was life-long, inexorably progressive, and irreversible. The interior of the inner ear and the hearing nerve appeared intact implying that a cochlear implant could be inserted. The data showed that she met accepted criteria for cochlear implant surgery.

During a return visit, I purposely disclosed the diagnosis without emotion and indicated that medicines could not bring the hearing back. It seemed of no concern to her, nothing more than raising old nettlesome issues. Compared to the goal of hearing, and, perhaps, compared to the inspired promise of hearing, the clinical etiology seemed immaterial. I wondered, but didn’t ask, “Is the clinical etiology of no relevance because of the faith you have in the promise that you understood to come from God?” The press of time pushed away for a while a temptation to explore her faith.

She just wanted hear, the sooner the better. In apparent good health otherwise, she elected to have the surgery as is usual, as an outpatient. No patient ever arrived on the pre-op day with such confident smiles, more keen to hear again, not a grain of fear or anxiety. She “knew” that she was going to hear her grandkids, soon. She was ready. Surgery the next day was routine, not even a twinge of a problem.

While she was under general anesthesia, I made a small incision behind the ear, and inserted an internal antenna-computer system under her scalp and threaded an attached electrode through a surgical opening of the mastoid bone into her inner ear. After the one hour operation, her recovery was uneventful. About five weeks later, she received an external microphone-computer-antenna system. Housed in an instrument just a bit larger than a hearing aid, this computerized cochlear implant system was programmed in another hour-long session. While we tuned the systems, her eyes lighted up with delight and tears of joy trickled down her cheeks as she heard for the first time in years. “Oh, I can’t wait to see my grand kids!” was her parting statement.

Her weekly cochlear implant computer programming sessions became infrequent visits over the next several months as her new found hearing stabilized. During those visits, she beamed with pleasure as she related tales of new hearing. Eyes sparkling, eyebrows dancing, and smiles from ear to ear, she was every bit as vivacious as any child could be. Her enthusiasm again generated a vision of excited children’s voices, and I thrilled along with the animated elderly woman as she bubbled with the joy of hearing again, of hearing children, her own grandchildren. And, finally, she was able to participate in their childhoods, understand their “look at this, Nana,” laugh with them, sit them on her lap, read to them, watch their tiny fingers point to pictures and hear them tell her the stories, and snuggle their precious words. Memories welled up, memories of the unique enthusiasm of child-grandmother relationships, and how exciting and heart warming such can be for both. Are parents ever happier than when watching and experiencing along with the precious ones they love so much? Recollections of the warmth of intimate family times lingered in the atmosphere as the lady left the office to go back to her rural home.

The lady was so pleased that she wrote us a very nice letter of thanks which she allowed us to put in our waiting room scrapbook. Many other patients were encouraged by her words. Indeed, the most effective way to inspire a patient seems to be the story of another with similar challenges.

As is the case with other cochlear implant patients, the lady eventually needed less computer adjustment and we saw her only occasionally. So, receiving a letter from her about 18 months later was a surprise. It started, “I just wanted you to know…” Apparently, she had developed a terminal illness and had just a short time to live. She again expressed her gratitude for all we had done for her. And, then, she closed her letter, “I want you to know, I’m not mad at God because He kept his promise to me and I got to hear my grandchildren…”

Tears welled up, streaming images of a lovely white-haired grandmother ecstatic to hear her grandchildren. Echoing visions of her surged through my mind like ocean swells: “…God told me…!” alternated with “God kept His promise…!” For a woman who wanted more than anything to enjoy and embrace her grandchildren’s voices, a woman who lived so much in the faith that she would hear that surgery was only a stepping stone, not a thing to fear. A grateful woman whose faith was indestructible as her life was ebbing into joyous sounds of eternity, … faith now eternal.