After hearty handshakes and friendly hugs with a lovely young couple and their daughter, we walked away thinking back about seven years earlier. When I first met them, they sat quietly, eyes staring forward, unanimated, and I presumed, sadly. I had heard that they were coming in. The six-month old baby girl with them seemed unusually quiet as well.

The story stared with a pretty typical ear infection but something changed. She had become obtunded, lethargic, but also irritable. An urgent trip to the pediatrician resulted in emergency hospitalization and a spinal tap.

Meningitis had only been a vague term, not a familiar entity, not a personal reality. Its dreaded complications were even more unknown. On two intravenous antibiotics, initial hope that their third child, a girl after two boys, would rapidly improve faded as her lethargy persisted.

Five days into treatment, the reason became apparent: the bacteria were resistant to the usual antibiotics. With a medication change, she turned the corner and her personality showed glimmers of her prior vivaciousness. Soon thereafter, auditory brainstem response testing confirmed a major complication: the baby was now deaf, no signs of any ability to hear, not electrical and not even to loud sound. And that’s what brought them to see me, and ear specialist.

My wife and I marveled at this now sever-year old blonde delight with untamable rolls of curly hair, and an energetic personality to match. My eyes misted as I envisioned her performance that evening. In the Christmas play in the midst of several similarly aged children, she had been Angel Gabriel, reciting her lines perfectly:

“Do not be afraid, for behold, I bring you good tidings of great joy…”

Our Christmas tradition for over 30 years has been turkey and dressing and family with a reading of the Advent passages. Our celebration used to have more family over, but we are a smaller crowd, now. Only my wife’s mother was to join us. Even with a smaller turkey and less stuffing, the house was festively decorated, fitting for a quiet distinctly Christmas day.

Up early together to stuff the turkey, my wife heated some water, melted the butter, and folded in just a half bag of Pepperidge Farm Onion and Sage cornbread dressing as I chopped scallions, onions, celery, and parsley to complement the stuffing. From a small turkey, giblets were diced and placed in a pot with water to simmer with bay leaves, oregano, poultry seasoning, garlic powder, salt and pepper. The aromatic herbs forecast a fragrant broth which, when blended with a flour and oil roux, makes the most wonderful gravy. After stuffing the turkey, we placed it in the oven and my wife set the leftover stuffing aside.

She planned to go for a quiet morning coffee and pastry with her 90 year old mother. “Gamma,” to our Down’s syndrome son, would take her usual mid-morning nap. My wife, too, would have a restful morning, luxuriating a bit in that lovely assisted living facility efficiency, leaving the rest of the cooking to others. “Gamma,” spreading Christmas joy in her uniquely New York Italian way, and my wife would join the Christmas table in a few hours.

While I cleaned the kitchen, my college-age daughter was working on the yams with a top secret idea. No way was I to learn what she was up to until the creation was finished. The dishwasher was filled with prep dishes and my son’s early cereal remnants. The drips had all been cleaned up and the herbs were back in their places. The onion skins with celery and scallion trimmings were ground down the garbage disposal. The larger prep pans were washed and put away. Even with the exhaust fan running, the simmering giblets were broadcasting aromas and whetting appetites.

“What should I do with the left over dressing?” Discarding it down the disposal was unthinkable. Too little to bake, it could not be saved, and it wouldn’t go into our traditional turkey soup. “What should I do with it?” The residual onions sat in another dish, but they could be added to the turkey soup, later. Same with the celery and scallions. “But what about that dressing?”
A rumbling midriff whimpered, “I’m hungry, HUNGRY!” My mind drifted the potato pancakes I had made for the office staff a few days before: shredded potatoes, eggs, a bit of flour, onion, and for holiday color, finely sliced green and red peppers, and shredded carrots. The pancakes had been dressed with a mix of two parts apple sauce and one part cranberry sauce. Fondly remembering that time with my staff, my hunger grew. “What should I have for breakfast?”… “An omelet!” …“A Pepperidge Farm Onion and Sage dressing omelet,” I told my daughter. Her eyebrows curled upwards wrinkling her forehead and her lips formed a wryly quizzical way, but her focus remained on her yams-inspiration. Into a skillet with melted butter, less than a cup of residual dressing with celery, onions, scallions, and parsley blended with two eggs, and a dash of salt and pepper. After browning the first side with medium heat, lowered heat for the second side promised a well cooked center.

“Almost like bread pudding custard,” I thought as I set a fork and a glass of orange juice with a coaster on the decorated table in front of a bay of windows. It was covered with a lovely flowered Christmas cloth, under laid with a medium green skirt. A thick red candle adorned the center along with a tiny manger scene, my wife’s lovely blend of holiday colors.

Christmas morning was a Florida-style overcast winter day, drizzly and cool, evidence of a cold front ushering in a relatively bright morning. From light intermittent rain all night, the pool enclosure was shedding rivulets of water, making the lanai look like a tropical garden with potted palms, philodendrons, and schefflera, even a few orchids, and geraniums with blooms. Beyond the lanai, the golf course looked like an endless manicured lawn. Distant scrub oak and pine trees mixed with a few scraggly palms bordered the ill defined, low lying skyline above which well lighted clouds were still dripping with moisture. Ligustrum trees, a large gardenia bush, two bottle brush trees, and a bare crepe myrtle filled the foreground. A bird bath full of rain water silently invited feathered friends of all sorts. “A lovely place on a quiet Christmas day,” I mused.

Musical bubbling from the coffee maker turned my attention back prompting a check of the slowly curing omelet, not yet brown on the second side. The giblets were checked, their low boil spreading aroma images of fragrant gravy, a wonderful blend of oregano and garlic. “Freshly sautéed mushrooms will complement the gravy perfectly,” I thought, remembering the recipe of butter, olive oil, garlic, salt, and pepper in which to sauté them. I could almost taste them. The cooktop spoon rest needed washing. Done. Stains dried on a cooktop burner were vanquished with Softscrub. A repetitive tone signaled that the oven had just reached cooking temperature, turkey baking suitably underway. My daughter finished a special topping for the yams, crumbled brown sugar on top of yam juices blended with pumpkin style spices. The creation was in a Corning Ware dish, ready to be baked in the second oven, later. “So, that was her secret!” I noted while bringing a small plate to the cooktop.

I dished out the fully cooked omelet just as my wife appeared at the kitchen door, finally reaching the source of the Christmas fragrances. Her warm colorful sweater and purse said that she was about to leave. “Just a little bite before you go, honey?” I cut a fork full and fed it to her. “Oh, that’s sooooo gooood! What is it?” “Another?” “Yes, …..mmmmm, thank you, Honey.” Touching my shoulder gently, she kissed me and with that, she was off to her mother’s place, promising to be back in time. My daughter came in with her Yorkie, Kuuipo. “A bite for you.” “Ok, but I’m not so hungry…hmmmmm, good. I knew it would be.” I peaked past the kitchen desk into my son’s bedroom. He had gone back to sleep and seemed quietly comfortable.

Christmas music gently filled the room and the Christmas tree with its lights and gifts sparkled in the morning light, engendering a quiet joy, presaging “Gamma’s” arrival for the extra chair around the table. As I sat overlooking the pool, the golf course, and gray winter skies, cool air convecting down the tall windows, the aroma of a cup of freshly brewed decaf turned my head back to a small glass of orange juice and the fragrant celery-onion-sage-stuffing omelet in front of me. Leftovers.

A soft, gentle hand grasping my own
Squeezed back memories from long-ago.
The eager first time was delicious.
From a thrill to the “will you?” precious.
Warmth wonderful any minute.
Hands held before a minister.
Gold in unending circles of circles
Slipped easily past beautiful nails.
Hands held in the mountains
Hand tugged to fountains
Hands gently grasped in prayer,
Hands, joined at dinner,

Hands that prepared for parties,
Hands that co-signed legal entities.
Hands that pushed vacuum cleaners,
Hands that learned stick shifters,
Hands that packed and moved,
Hands that did laundry,
Hands that worked jobs sundry,
Hands that rocked babies to trance,
But never hands of malevolence.
Hands that caressed an ill father’s face
And finally his cooling hand with grace.
Hands that assisted her mother.
Hands that found her mother’s gnarled fingers.

Imagining a prospective bride when old,
The best guide is her mother we’re told.
Her mother’s hands were gnarled while
Her mother’s hands gestured Italian style.
Her mother’s busy hands happily prepared meals.
Watching only her hands, one knew the deals,
Gestures of sarcasm, welcoming, comment bland
Emotion in path, fold, and flick of the hand
Gnarled hands expressive with chuckles
But the worn, gnarled knuckles
No longer slipped past the original rings
But with hearty husky voice, she still sings.

Gnarled hands that prepared meals remain soft.
The gnarles still smile, laugh aloft.
Mirroring the intent of a gracious lady.
Gnarles still welcome and hold a grand baby.
The gnarles may distract from rest,
May disrupt sleep, so terribly distressed.
Gnarles alter grabbing knobs for doors,
Slowing and adapting chores;
But though gnarly, they are warm still,
Still soft, still laugh and smile, never shrill:
As soothing as oats and barley,
They are lovably, sweetly, wonderfully gnarly.

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.