“I Hear You”

The alarm chirruped. Half-asleep, I realized I couldn’t hear the beeping in my left ear. In fact, I could hear nothing except a rushing noise like a river. I snapped my fingers, clapped my hands—nothing.

As I walked into work, traffic and voices sounded like steam trains. I couldn’t hear my colleagues talking to me. I kept tilting my head to the right, but the trains turned speech into cacophonous nonsense. I kept apologizing; “I’m sorry, what? Sorry, I can’t hear.” I telephoned my boss, but the handset was dead; except that it was not, it was held to my left ear.

Within hours, audiology confirmed severe unilateral sensorineural hearing loss. The ENT surgeon was efficient and to the point (though I had to turn my head to hear him, directing his voice to my good ear). “We can inject steroids today and see what happens. If we wait, I can’t guarantee it will improve.” My literature search that morning had said the same thing; it was reassuring to hear him echoing the evidence. He warned me the local anesthetic would burn: “I’ve had this myself and it will really hurt, but only for 30 seconds.” The tiny sponge of phenol touched my tympanum with a sting that built into a long, slow, deep burn that crescendoed until I could barely breathe for pain. He had not lied. This made me trust him about the 30 seconds, and on cue, the pain faded away.

I spent the weekend in near-silence in the garden, noticing sounds differently. Loud noises, echoes in rooms, even my own voice hurt and made the roaring river in my head louder. Birdsong and insect buzz were heavenly: quiet enough not to hurt and profoundly welcome in that they could be heard at all. Over a few days, high-frequency sounds returned, but low frequencies remained missing. I could no longer hear heartbeats or my cat’s purr with my left ear, and I grieved for the loss. Music was distorted by tinnitus and thus not welcome. The bass line of hip-hop was missing, the baritones of polyphony were silent.

I am a psychiatrist. One of the most crucial parts of my job is actively listening to my patients, the content of their words, their emotions as they talk, and how they organize their thoughts. Losing half my hearing was profoundly intrusive. In clinic, I struggled to hear softly murmured stories, or discriminate syllables between sobs. I kept turning my head and frowning as I concentrated to identify words above the rushing waters of tinnitus. It was draining. Loud voices and screaming children made me wince in pain. Never, in all the ENT lectures of medical school, had anyone explained just how much good hearing depends on two good ears and that losing one suddenly makes conversations, seminars, and lectures difficult. As someone whose profession requires both listening and speaking, partial hearing loss was a dreadful handicap.

For the first time, I recognized when a patient or colleague did that subtle head turn I had adopted, and I was careful to speak more precisely to them. With shame, I realized my habit of talking loudly at the hearing-impaired could exacerbate voice distortion. Where I had always assumed unilateral deafness was merely an annoying sensory loss, I found a life-changing barrier between the self and others. The oft-quoted paraphrase of Helen Keller (1), “Blindness separates us from things, but deafness separates us from people” was truly apt.

Losing hearing made me physically struggle to hear, but it also forced me to observe the process of listening. The verb “to hear,” from the Old English heran, captures the physical perception of sound, whereas “to listen,” from Old English hlysnan, “pay attention,” suggests the added task of concentrating on what is heard. In modern vernacular, “hear” is often used synonymously with “listen”: “I hear you” translating as “I understand, I get it.” Yet how often do we sit with a patient and hear the words they are saying while the mind meanders, not listening? Hearing the ENT surgeon tell me that a procedure was painful, then discovering he was truthful and accurate, turned a passive hearing into an active listening at his words, paying attention to them, testing them. It altered the nature of our communication, exerting me as a participant.

The roaring steam train has left the station, and the occasional soft buzz of tinnitus is the only medical reminder of my deafness. It was an unpleasant but valuable experience that made me a more deliberate clinician. I speak more slowly, and less frequently. I am in less haste to reply, to keep the table tennis of conversation going and the pace of clinic moving. I learned several things: first, to practice patience and kindness for the hearing-impaired (no matter how busy the day) since the patient’s frustration and disorientation is the greater. Second, speaking loudly may be (counterintuitively) less helpful, distorting words or even causing pain. As Beethoven expressed, “Often I can scarcely hear someone speaking softly…. However, as soon as anyone shouts it becomes intolerable” (2). Third, if your hearing is intact, enjoy and protect it. Hearing loss can be overcome with patience, persistence, and the kindness of self and others, but I was astonished how much I missed music, and birdsong, even street noise. Finally, the concentration needed to truly hear and listen may tax some of my patients struggling with severe mental illness. Compassionate communication, repeated as often as needed, is part of my duty of care.

Language is arguably our defining human trait, and we forget the ease with which we communicate until hearing loss imposes a dramatic barrier. Concentrating on what people say changes the experience of hearing them, adding a curious intimacy. Learning to listen helps us understand ourselves and one another, and it ultimately lies at the heart of what we do as humans caring for our fellow beings.