The Other Side

There was a time when going to medical school with the dream of matching into otolaryngology felt crazy. It still is crazy, but what feels even crazier yet is that I am writing to you, on this side of match day, to share that I have successfully matched into otolaryngology. Otolaryngology, in case you are wondering, is the field of head and neck surgery and is colloquially referred to as ENT (Ear, Nose, and Throat). Everything from the shoulders up (save for the eyes and the brain) fall within the scope of this specialty. As you may have pieced together by now, because the ears reside above the shoulders, I get to do ear surgery as part of my training!  

Most days in medical school felt like an inch forward towards this goal, and some days even felt like a backward slide. Yet, in the blink of an eye, it feels like I have catapulted further towards my dream of being able to help others hear better. Even if I never do become a neurotologist (read: ear doctor) specifically, I am always going to be privileged with knowledge and training in these specific procedures, a skill set I once thought would always be out of reach. 

As I have touched on a few times in this blog, I learned very early on that the operating room is not an easy place to be deaf (unless you’re the patient). While otolaryngology is known to be a very competitive specialty, requiring above average board scores and research productivity, I had to tack on the question of my ability to hear and communicate in the OR. In hindsight, having sat through a slew of residency interviews, I realize the person who doubted in my hearing abilities in the OR the most was . . . me. While studying and preparing for cases every day on my various surgical and ENT rotations, I was simultaneously performing a rigorous internal assessment of my own abilities and shortcomings. On an invisible chalkboard, I kept the score: +1 for visual acuity and observational skills, -1 for fatigue affecting my active hearing abilities (it is hard work to constantly strain your ears over the hums, beeps, and chatter in the OR), +1 for my manual agility, -1 for not being able to push in my sweaty ear mold as it was slipping out of my ear under the hot surgical lights without breaking sterile field. 

It would take another few weeks, if not months, to realize that this decision wasn’t a matter of simple addition or subtraction. There were weights to each entry: the skill sets I did have, the assets I did bring to the table, held more weight than the things I perceived to be negatives. It is with deep gratitude to my mentors and friends who pointed this out to me, that I began to see things this way. I realized the things I considered to be “negatives” were not roadblocks, but opportunities to be more creative and find workaround solutions. The brain is a muscle and it gets used to long hours in residency – this is not a muscle I, exclusively, will have to train, because all residents need to make this adjustment. All newly minted residents awkwardly fumble through communication with OR staff until it becomes secondhand nature. Everyone finds their style and stride. I watched many an OR circulating nurse answer pages, texts and calls on behalf of residents, turn their headlamps on/off, or bring them an extra set of gloves if the sterile field was violated. I’ve come to understand that simple things, like disclosing my hearing impairment to staff, makes it a lot less awkward to ask them, mid-case, to push in my slipping ear mold.

Eventually, I tossed the chalkboard aside altogether. Here’s why: surgery is a team sport. If I have the grit, the academic ability, the manual agility and the passion for my work – and most importantly, if I show up for work every day, I will always have a team working alongside me to help me deliver the best care to my patients. My shortcoming was thinking I would have to come up with solutions alone, to make the adjustments alone. We’re all there for each other so we can be there for the patient. Maybe this is a product of being privileged to train at an amazing institution with a culture of support, but I genuinely believe this to be true. It isn’t always a given, but if I can communicate effectively, then I can deliver care effectively. I look forward to the next five years of exercising, revising, and honing all my skills. Before I know it, I hope I will be writing another blog post in the future, on the other side of this exciting, and nerve-wracking, journey.

Can you hear me now?

Every so often I seem to dust off the ol’ blog with some witty opener — chalk it up to COVID-19, but this opener will have to do. Yikes, already one mention of coronavirus right off the bat . . . but that is precisely what I am here to write about. The world looks, and sounds, different from the last time I posted. Face masks and face shields are so ubiquitous, I am beginning to find myself thinking that they look . . . cool? But, if you’re a fellow lip reader like me, or even someone who craves the emotional connection of a smile or a frown, you are keenly aware of how masks have changed the way we interact. I cannot count how many people have asked me, “How does a deaf person navigate a world where everyone wears a mask?”

The first person to ask me this question was myself. Back in March, somewhere between my 14th and 140th walk of the day, the question entered my head like a thunderclap — how the f#@! was I going to navigate my clinical rotations? I had been concerned about the auditory challenges that lay ahead of me ever since my medical school interview trail, when an older surgeon from Harvard asked me: “why should I admit you when the last hearing impaired person I accepted, who was only partially deaf, quit general surgery residency because he couldn’t hear in the operating room?” Despite the fact that he was comparing apples to oranges with that question, an unease surrounding my abilities in the operating room, and a noisy hospital in general, as a deaf provider began to settle in.

So there I am on my 57th walk of the day in March, without a clue about how clinical rotations work in general, wondering what lay in store for me. A few proactive classmates and I initiated a conversation with our medical school administration about the implementation of masks with a clear plastic panel, to allow visualization of the speaker’s mouth, at our institution. Making this a reality felt like one insurmountable obstacle after the other, starting with the fact that the only FDA approved masks with clear panels were hopelessly backordered already, and ending with the fact that all masks had to go through a separate approval at our hospital before it could be bought in bulk and disseminated to the healthcare workforce.

When it quickly became apparent that the effort to implement clear masks wasn’t going to be fruitful in time for my rotations, I had no choice but to pray to the cochlear implant gods that my hearing technology would be enough to get me through rotations. I cautiously began my clinical rotations with family medicine, almost immediately navigating the glitchy waters of telehealth visits. A few visits in, I began to notice something:

“Are you on mute?”

“I can’t hear you, can you turn your volume up?”

“Can you please angle the camera so I can see your face?”

Wait a minute — these were MY lines. Now, the nurses, the medical assistants, and the attending physicians were saying them. My occasional requests for repetition or louder volume were no longer unique, they were the norm.

As I moved through my next few clerkships, obstetrics and gynecology, then pediatrics, the evidence continued to mount. I observed nurses and residents leaning across counters to hear each other, attending physicians asking their teams to speak up, and quick apologies being muttered about how “face shields deflect sound waves” and “N-95s muffle speech.” I was amazed — OTHER people were asking people, on more than one occasion, to speak up.

It was glorious. My comfort with asking these questions, on the occasions that I do, was an asset that benefitted not only me, but also my team. At the beginning of every rotation, when I would introduce myself to the team I was assigned to, I would always say, “I am deaf, I wear a hearing aid and a cochlear implant, so if I ever can’t hear you or seem like I’m ignoring you, please don’t be shy about nudging me or speaking louder. I won’t be offended!” Suddenly, people began responding with, “I am having the same problem these days. It’s the damn masks.” Or something of that sort. Just like that, the pressure was lifted. People have generally always been kind and sympathetic, but now they were empathetic — they understood exactly what I meant.

As the pandemic has stretched into the final months of the year (remember the two week lockdown plan? Me neither), this empathy has grown. People began wearing larger pictures of themselves on their badges so patients can see what they look like, several more companies have developed clear masks, and the number of posts (and support) on the American Professionals with Hearing Loss Facebook page has exploded. My institution has provided clear window masks for all providers in the ENT department, which feels like a major win. As I look back on my first six months as a clerkship student, my hearing loss feels like such a small part of it. I had been worried my hearing loss would cause me to underperform, or create awkward/frustrating scenarios where I could not hear, but that hasn’t been the case. The irony is, I can’t tell if this is in spite of, or because of, the ubiquity of facial masks.

To be completely honest, I have never experienced the wards without COVID, so I don’t know what it was like “before” but I do know that while the challenges are still present (there are some days I miss more than others), there has also been a quieter understanding, a subtle shift underneath the chaos that is healthcare in the time of a pandemic, towards being a little more patient when it comes to verbal communications. While I sorely miss being able to tell what people actually look like and being able to smile (and be smiled at), I am grateful for the increased awareness and understanding of difficulties communicating. The past six months have been a dumpster fire for many reasons, but for me, the dumpster fire has a silver lining.

Before I sign off, I just want to extend a sincere thank you to those working the frontline in health care settings. From the janitors to the attending physicians, this strange new world would have been far stranger and uglier without the daily efforts of those who show up every day to bring this chapter of our existence to a close. I am constantly in awe of the bravery and drive of the staff that I am privileged to call my colleagues. Stay home, wear a mask, and when you get the chance, get vaccinated!