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The irony is not lost on me that a pediatric cochlear implant surgeon is writing a book on the power of parent talk. Surgeons are known for many things; talk is not among them. Rather than words, we are defined by our hands, our dexterity in the operating room, and our ability to identify problems and find solutions. To a surgeon, there is nothing more gratifying than when the puzzle pieces fit just so.
Cochlear implantation, allowing a child born deaf to hear, is an extraordinary example of all those components. Coiled two and a half times around the snail-shaped cochlea, the organ where the nerve part of hearing begins, a cochlear implant successfully skips over the defective cells, the point along the hearing pathway where sound had come to a screeching halt, going directly to the acoustic, or hearing, nerve, the superhighway that connects the ear to the brain. The amazing result is that a child born into silence now has the ability to hear, to talk, and to meld into the world both educationally and socially. The cochlear implant is a puzzle piece that fits, just so, a miraculous solution to total deafness.
At least, that's what I thought.
In medical school, it was the brain, not the ear, that captured my imagination. The brain seemed a profound mystery holding the key to all the unanswered questions about life. My dream was to be a neurosurgeon, fixing with my hands some of the most important and vexing issues facing humanity.
My first neurosurgical case in medical school did not, however, go smoothly. The chief of neurosurgery, Dr. R., had invited me to “scrub in” on a meningioma resection, the removal of a benign brain tumor. We'd been writing a textbook chapter on meningioma resection and he thought it might be helpful if I actually saw one. When I came into the operating room, Dr. R. gestured me toward the operating room table, where a shaved head, stained with the yellow and red of Betadine and blood, confronted me. Inside a large gap of missing skull, a grayish gelatinous mass pulsated rhythmically, as if trying to escape its bony confines. The patient's torso had disappeared completely, like a magician's assistant's, under long blue drapes.
As I walked toward the patient, I suddenly became aware of my own pulsations. Could this blob of overly congealed gelatin really be the epicenter of who we are? Dazzling lights crisscrossed my vision and I could barely register what Dr. R. was saying. The next thing I knew, I was being lowered onto a chair by one of the surgical nurses. Humiliating? You bet!
But that was not the reason I did not go into brain surgery. Ultimately, that was more a fantasy-meets-reality decision.
“When the air hits the brain, you're never quite the same” was a common saying in neurosurgery back in the 1980s. At that time, surgery on the brain often left patients severely debilitated, though alive. In the intervening years, of course, things have changed for the better, but my own experience prompted me to think of other ways of working with the brain. And, in a circuitous way, I did: the ear. Under the guidance of my extraordinary mentor, Dr. Rod Lusk, during my fellowship at Washington University in St. Louis, I learned the skills necessary to help ensure the success of cochlear implantation.
Cochlear implantation is, to me, one of the most elegant of surgeries. Performed under a high-powered microscope that magnifies the inner ear from the size of a tiny pea to the size of a quarter, it relies on small, precise instruments that match its small, precise movements. I operate with the room lights off, the single light beam from the microscope a spotlight on the star of the show, the ear. The microscope's penetrating beam has been said to cast an almost romantic halo around the patient and surgeon. And while many surgeons operate with music, I prefer my operating room to be quiet and calm, with only the hum of my drill as backdrop to my concentration on the surgical procedure.
My decision to become a pediatric head and neck surgeon specializing in cochlear implantation was serendipitous. Because the confluence of two historic medical events was about to usher in a golden age for children born deaf.
In 1993, the National Institutes of Health recommended that all newborns undergo a hearing evaluation, the universal newborn screening, before leaving the hospital. This astute public health initiative plummeted the age of the diagnosis of deafness from three years to three months. No longer could parents and pediatricians rest comfortably with “He's just a slow talker” or “Her older brother does all her talking,” when, in fact, the child was deaf. But its significance was increased exponentially because it coincided with the development of a neurologic miracle, the cochlear implant. The possibility of changing the life course for millions of deaf children had arrived.