Monday, June 14, 2010

The Sounds of Silence

It's been four days since surgery and I can't believe how good I'm feeling. I'm on my feet, no longer feeling as dizzy when I walk, and back to chewing most foods. Reading no longer gives me a headache, and the pressure wrap is off my head. I finally showered yesterday - the high point of my weekend, believe me! The CI is now a sore spot on the left side of my head, nothing more. Though I'm still on antibiotics and pain meds, and though I get tired more easily than normal, I'm so pleased at how quickly I've progressed. It's been a Godsend. Most blessedly, the ringing in my ears has stopped. For the most part. Someone told me that now I know the gist of the Simon and Garfunkel song, "The Sounds of Silence." Indeed I do. And I hope that pulsing, echoing, buzzing silence never returns - good riddance!

Now that I'm rested and my head is clear, I think it's time to try to make sense of what's happened to me since last Thursday.

The true miracle is that I was as calm as I was the morning of the surgery itself. A bit of Benadryl did the trick for sleep the night before (my anxiety-ridden self already hadn't been sleeping well for several nights), and I woke up in the hotel feeling remarkably relaxed. It's funny, though: regardless of how occupied I kept myself, with books and email and conversation, as the time drew closer my chest started to tremble. It's as if my body couldn't forget what was about to happen to it, even if my mind traitoriously did. (I'm sure the fact that I hadn't eaten since some ice cream late the previous night had something to do with this. I wasn't allowed to drink, either. Watching my parents eat breakfast only increased this physical tremulousness, and my lovely father was so nice as to tease me with the full water bottle he was drinking. Bad move, buddy.)

After taking a short walk in what ended up being a gorgeous California morning, we headed to the hospital.

(The BEFORE: my last moments with my left hearing aid. Notice the brilliant weather outside. What a sad day to be detained for surgery!)

I'll say it again, the Stanford hospital is a very open, airy, welcoming place. Once inside, I was still floating in a self-imposed cloud of calm. But even so, my nerves were rattling. Evidence: lipreading while I checked in at the ambulatory surgery front desk (and afterwards, while chatting with the nurses) was much harder than usual. I felt myself stammering, my eyes losing focus, trying to keep my anxiety in that nice little box where it could not escape. Once checked in, we waited and made pleasantries together in the waiting room until I was finally called back into pre-op.

My pre-op nurse was very kind and chatty, just what I needed despite needing to answer her list of obligatory questions. No, I don't have heart or liver problems. No, I've never been pregnant. No, I don't do recreational drugs. The only issue I confessed to was a fear of needles. We made small talk about Stanford and the area, about books and English. Several times she asked me, in response to my physical stature and cardiovascular signs, whether I was an athlete (a question that many other doctors and nurses asked over the course of the day, apparently). I smiled and said, yes, an equestrian. I don't know whether she knew what to make of that!

(After verifying for at least the fifth time, my surgeon marks my left ear as the one to be operated on. Yes, those are his initials. They refuse to wash off completely, even several days later.)

Another source of reassurance: hearing about my surgeon. He's a kind, well-respected guy - something which I could have guessed from my personal encounters with him, but something that was only confirmed several times in pre-op. My nurse, a operating room nurse for 30 years before moving to pre-op, told me that he's the only surgeon she'll work with for OR shifts these days. "He's the best," she said. "He treats us all so well. He's such a gentleman!" And, after he slipped in with a smile, talked to me for a moment, and gripped my hand, I tended to agree. The feeling that I was in good hands made such a difference.

(Trying to look confident even if the whites of my eyes are showing. I wouldn't be smiling if they'd put the IV in yet!)

By far the most stressful part of the entire day was getting my IV in. But we'll skip over that. (A summary: I managed not to faint.) A little more nervous small talk with my parents in pre-op, while trying to ignore the tubes and appendages connected to my body, before it was time. The nurses rolled me out, down the hallway, and through a series of automated doors. I felt almost as if I were being kidnapped.

I don't remember much of the operating room itself (thankfully) except that when I got in, the fear was starting to flow. I stared up at the lights overhead, which looked like huge suspended disks, and thought only of just how many shiny metal surfaces (read: knives and needles) were in the room. The doctors and nurses were all wearing masks, probably speaking to each other, and there was no way for me to hear or lipread them - I remember telling myself to remain calm, even as my subconscious screamed that I might as well have been transported to an alien planet -

Finally, the guy nearest me pulled out a pad of paper and wrote, "What's your major at Stanford?" I answered that it was English. He took a second and wrote, "Literature or composition?" We chatted a little bit, like that, and I felt a huge surge of gratitude for his perception and thoughtfulness. It was possibly the most human moment of my entire day. Then someone pulled out an anesthesiologist's mask, I breathed three breaths, and that was it.

I woke up feeling the typical post-anesthesia dreaminess, like I had been away for a hundred years and had only just been transported back into my old life. Only, of course, this wasn't any semblance of life that I recognized. If I felt any kind of emotion, it was annoyance. More specifically, annoyance that the blood-pressure monitor on my arm kept going off. If there's one thing that makes me shudder, it's a blood pressure cuff. The tightening and releasing pressure was my primary link with reality for almost an hour, until I asked the nurse to please make it stop. (Of course, she didn't.)

After a while, they had me roll over on my back from my right side. At one point a nurse came in to take a X-ray of my skull, to verify that the implant was in the right place. Apparently, it was. Overall, besides some nasty business with nausea during the later stages of recovery, the entire thing went excellently. The nurses had me change back into my clothes and wheeled me out of the hospital around 7:00pm. My parents and I returned to our hotel room, where I staggered into bed and made them promise not to poke or otherwise bother me. Then I was out.

One other thing I should mention: according to my dad, when my surgeon came out to the waiting room he was smiling broadly. While I was still under, likely still in the OR, he had fired the implant itself to see if the nerve connection was functional. And my nerve fired in response. It fired! So, looks like whenever I turn this darned thing on, it'll be working.

(The AFTER: my lovely Princess Leia cap and bandage.)

As I've already written about, I felt remarkably good the day after surgery, but unfortunately by the second day my energy level had dropped. The ringing in my left ear, which started on Friday afternoon, was unbearable by Saturday morning. I wasn't in pain, but felt too weak and dizzy to really stand up. I spent 80 percent of the time sleeping. Whatever I did, while waking, was consumed by that aggravating, bewildered, cerebrally-confused silence. My parents and I decided to travel home from California that day, regardless - though my head wasn't too pleased at the jolts and bumps of the truck ride, I was pleased that it learned to deal.

(So happy not to have a bandage on my right ear - and to wear my hearing aid besides!)

It still does feel strange to hear out of only one ear, and admittedly I've caught myself fiddling with my left side, as if expecting my left hearing aid to be there, turned off or otherwise asleep on the job. It's as if I'm searching for a ghost limb. Since the programming on my hearing aids doesn't give exactly equal sound and frequency input to each ear, I've been feeling off-balance at hearing only half of what I normally do. It's easy to feel detached from the events around me, too, or to inadvertently not pay attention to what's happening on my left side. Especially since the muscles in my neck are still sore and I can only look right.

(When the bandage finally comes off: a tefla pad covers the stitches on my skull.)

After three days, yesterday afternoon I could not wait for the bandage to come off. Besides the fact that it was getting uncomfortable, itchy, and my hair was starting to smell, I couldn't wait to see what my head actually looked like underneath it. We'd taken a few glimpses, of course, while readjusting the bandage and plastic cap, but the skin was still too tender to touch. What I found was slightly strange.

First of all, my left ear is still numb. There are no medications inducing this; it's just that the nerve sensation near the tip of the pinna is almost completely gone. My dad thinks that might be an unavoidable consequence of surgery, cutting a few sensory nerves on the way to drilling to the cochlea. Maybe I'll get the feeling back on that ear, but maybe I won't. When I touch it, it feels like a plastic ear. My fingers feel it, as normally as ever, but to the rest of my head it's as if the ear itself - my ear - is not there.

Second, the incision the surgeon made for my CI is so small. It's just a line of stitches behind my ear, and they barely had to shave off any hair. Remarkable. It should heal quickly, and the stitches should dissolve and come out within 10 days of the surgery. I marvel at the skill of the surgeon, to do so much work within a space of less than an inch and a half.

Third, and perhaps most creepily, is that I can feel the CI internal processor and magnet on the side of my skull. It's just a small lump, under my hair, and smooth - still a bit tender, but doesn't hurt. I can't stop my fingers from running over it. This, in a few weeks, this will be the interface between what happens in the outside world and what I experience inside my body. There's no incision on top: the surgeon must have slipped it into the single cut he made, then worked it up between my skin and the surface of my skull. It's all so elegant, so deftly done, that I almost can't stand it.

But this is a new definition of reality, and many marvels yet remain. Onward and upward!


  1. Rachel,
    I have enjoyed your reflections on your journey. My prayers are with you.
    Love, Aunt Louise

  2. Glad you're safe and almost sound! =D Have you had surgery before? Sounds tense (I haven't). You're a pretty good bandage model! It does look a little Princess Leia, also a little bit like a modern art turtle is chilling on your head.

    And, while you can eat, I should STOP eating because I gained like 12 pounds in Chile. Ew, that's like more than a pound a week. And mostly in the waist/butt. Time to do some exercise and go on my parent's salad sad since I wanted to eat so many yummy foods...

    Also, if you don't gain feeling back in your left ear, that means you can get some cool piercings! That was my theory about trying to get tattooed while having my wisdom teeth pulled, which my mom highly disapproved of! But really, I hope that fixes itself...cmon axonal plasticity...

    Anyways, you survived surgery! Yay congratulations! Does it feel suddenly life-altering in the way that birthdays don't?

  3. I've always thought the IV is the worst part of any surgery - needle phobics unite!

    I'm glad everything went well and that tormenting ringing has subsided. It sounds like you were lucky enough to have a surgeon that was both technically and socially competent, a rare combo, given my experiences.

    This is very exciting, and I'm looking forward to the next edition of Perceptions Unearthed.


  4. Linda & I are so glad everything went well. I agree with everything you said about the operating room!! We are so excited and anxious to learn about your journey as you also find what lies ahead..

    In Christ's Name

    Chris Pfeiffer