“Dead Ear” by James Steck
BLAST, TMR’s online-only prose anthology, features fiction and nonfiction too lively to be confined between the covers of a journal. In “Dead Ear,” an excerpt from his memoir-in-progress, James Steck writes about ER medicine, a sudden hearing loss, and the discovery of his Buddhist faith.
When I was thirty-five, I went deaf in one ear.
Nothing had really gone wrong before. I’d had the usual romantic reversals, but I was successful in school and at work; I was an active outdoorsman, and I was reasonably happy.
I woke up one morning with my ear feeling stuffed, as with a bad cold. I didn’t usually prescribe medicines for colds or take them myself, but on this occasion, my ear was so plugged, I took a Sudafed and went to work. As it happened, an ENT surgeon walked through the ER on his way to his office. I told him—and I thought I was merely engaging in small talk—that I had the worst case of Eustachian-tube dysfunction.
“Can you hear the phone with that ear?” he asked. He said it with that flat tone some policemen use.
Since it was the ear I usually used, I recalled that I’d had to switch sides with the phone that morning when I’d talked to a teller at my bank (an activity that used to be possible). The ENT guy arranged a hearing test for when I got off shift that day.
For the hearing test, I sat in something like a telephone booth (another anachronism, like phoning a bank teller) and the audiologist sent a series of squeaks into each of my ears. When she was testing my bad ear with squeaks, I had a difficult time distinguishing the squeaks from the sounds of silence. I imagined that those latter sounds were from cosmic rays or from my own brain electronics. I regarded the hearing test as a school quiz. I strategized and tried very hard to raise my hand at the right moments.
I’d gotten only one sound correct, the loudest one, at 100 decibels. In the audiologist’s office was a pamphlet explaining the decibel system. It said that 100 decibels was a level equivalent to the sound of an explosion.
The cause of my deafness was a rare condition called “sudden sensorineural deafness.” I read about in my favorite textbook, a British textbook. British texts were more concerned with the clinical story than the technical aspects. The language was cool, like David Attenborough talking about mangrove swamps. In the case of sudden sensorineural deafness, the book said when it struck, many patients heard the sound as of a great door closing.
The ENT doctor prescribed prednisone for two weeks and said it might work. “Take care of your other ear,” he said. “No rock concerts or scuba diving. Carry earplugs.”
This wasn’t good that he emphasized preventive medicine.
In the days after my hearing loss, before my brain compensated, I walked around with a noiseless right hemisphere. I could see palm fronds shaking and birds with their mouths open and bicycles gliding, but there was no sound whatsoever. I went to a dinner party where the people on my left were engaged in their usual repartee but the people on my right were opening and closing their mouths like freshly caught fish. Moreover, I worried that they were talking about me. The audiologist had warned me that newly deaf people could be a little paranoid.
The prednisone didn’t work at all. I was frustrated because it seemed that in the ER I could always do something. The treatments I administered there always worked—at least partially, or for a while.
Around this time, I visited my parents back in Wisconsin. Even though it was fall, my little town looked as if it were hunkered down for winter. The dull redbrick houses had all their windows and doors closed. I took a walk to the local Catholic church, St. Jude’s, the center of my social life during my teens. There was almost no one on the streets, and when cars passed, the drivers looked straight ahead without acknowledging me.
St. Jude’s was unlocked. It was the first time I’d been inside a church since college. The modernistic stained-glass windows looked pretty good. I could make out the scene of Veronica offering Jesus her handkerchief and Gabriel announcing the pregnancy to Mary. There was just a trace of incense, as if it were being used as air freshener.
I spotted the votive candles, of two sizes, one-dollar and three-dollar. I genuflected, made the sign of the cross, and did what I saw Guatemalans do: I tapped my coins on the candle stand to wake up the saint whom I was petitioning. I paid for and lit one of the bigger candles. I prayed that my hearing would come back.
I went back outside. I did not actually imagine that votive candles would improve my hearing, but I did put my finger in my left ear to test whether I was still deaf in my right.
Some years later, a friend of mine contended that there was scientific evidence that prayer did some good, but you had to be praying for another person. That would explain why I was still partly deaf. I prayed only twice more in my life (for seriously ill family members), and both times it worked.
I did some reading about deafness. The fullness I’d felt in my ear was the usual way patients recognized that something was wrong. It was less common to perceive the loss of hearing directly. Like most people with sensorineural deafness, I also got tinnitus, ringing in the ear. Tinnitus is a phantom sound generated by the brain in the absence of input from the ear. The brain needs constant acoustic stimulation, as if it’s a toddler singing “La, la, la.” The frequency of the tinnitus resembles the lost hearing. Low frequencies sound like the ocean and high frequencies sound like the neighbor’s phone. My tinnitus sounded like that place between radio stations when you’re driving in the West.
I got in the habit, when I was at a table with a group of people, of sitting at a certain corner facing the rest of the group and, whenever I was walking, gravitating to my companion’s right side. Once, I met someone who was also deaf in her right ear, and we ended up circling each other like mating geese.
No one knew the cause of sudden sensorineural deafness, but the most popular theory was that it was caused by a virus, based on some positive evidence: traces of the herpes virus in the diseased ear.
Needless to say, I always got a worried when I caught a cold or when my good ear started ringing. There was a period when I supposed that dehydration was the cause of my plight and I walked around with a bottle of water always in hand.
At some point, when the topic came up, I told people that a virus had caused my deafness and that “viruses have to live too.” I meant that. Not that I was a partisan of viruses, but I appreciated the interconnectedness of life. My observation about viruses was the result of a satori—a sudden enlightenment. The enlightenment was largely ineffable, but it had to do with the comparative triviality of my suffering. I felt as if dwelling on it somehow took away from other people’s distress, as if world suffering were zero-sum.
I told my friend, Ginny, the Buddhist, the one who said I wasn’t breathing right, about my satori, and I mentioned in passing that I’d had perhaps a dozen such satoris in my life. This was even before I hit my head in Tikal. For example, I told her, during my surgical rotation in medical school—the rotation in which I didn’t see the sun at all—I was walking home one evening, and I noticed the light from a streetlamp broken up by an oak tree. I suddenly understood, “Let there be light.” Light precedes and is necessary for life. My insight was undoubtedly prompted by the compression of all my free time in those days into my walk home. At my report, Ginny seemed almost envious—insofar as a Buddhist can get envious.
* * *
Although I hadn’t been to church since college, I considered myself a cultural Catholic. The Jesuits had a saying that they didn’t seek to have influence over a boy for his entire life—between the ages of thirteen and seventeen was sufficient. I think they were onto something. I liked church rituals and Renaissance art. I liked cathedrals and Gregorian chant. I regarded romanticism as Catholics’ gift to the world. I embraced the idea that we should behave as if someone were watching and as if we might die (probably in a bus accident) later that day. I did not discern that Protestants held any principles that differed from those of good banking.
I did think too much about dying. I had a fear of dying myself, and in the ER, I had a fear of other people dying. Months went by without my witnessing any patient die. If a patient was critically ill, I got them to the elevators. If they weren’t breathing, I intubated them and got them on a respirator. If their heart wasn’t beating, I put them on an external pacemaker. If they were brain dead, I let the people upstairs decide what to do. I did not want to watch anyone die.
One day in 2010, I had a patient with a perforated stomach. The stomach’s hydrochloric acid was pouring out over his insides. He was a middle-aged Thai fellow, gray and under-nourished from chronic suffering. He looked like the victim of some nineteenth-century historical tragedy. The reason for the perforation was stomach cancer. I gave him several doses of morphine, but his mouth remained stretched in a grimace.
I thought that something could always be done. I called the surgeon on call, who leafed through the fellow’s chart and examined him briefly. He wasn’t a mean surgeon; he had the thick dark eyebrows and humorous eyes of the black Irish. He was said to have “the best hands” in the department.
He came out of the workroom shaking his head. “You can’t sew up the stomach when there’s cancer there,” he said.
“Just cut the cancer out and sew up the remaining tissue,” I said. The patient kept crying out, and I couldn’t think straight.
“I’m sorry. It can’t be done.”
“I’ll call someone else.”
As a courtesy, the patient’s oncologist came down from clinic. He walked in and out of the patient’s room as if there were a revolving door at the entrance. He said to me, “Why is the patient suffering like this?” He said it in a soft, perplexed way. It sounded like a philosophical question.
“I was trying to get a hold of surgery,” I answered.
“He’s dying,” the oncologist said. He ordered five times the usual dose of morphine, and after the patient got the drug, he stopped breathing, forever.
A few weeks later, a banker in his seventies came in with a headache that he knew from the beginning was not good. He was especially tall and a little awkward, and he had a fringe of gray hair. He looked like the sort of person who’d played basketball in high school because of his height but had gone no further in his sports career. That the headache was serious wasn’t evident to me at first.
After ordering a CT scan of his head, I stayed at his bedside a minute with him and his wife. I mentioned that I liked my bank because the tellers were nice. He was keenly interested in what bank it was and what it was about the tellers I liked. Because he had come to the ER during a financial panic, I commented, “People don’t like bankers so much these days.”
“People have never liked bankers,” he said with a smile.
It was the last thing he ever said. His face suddenly took on a dazed expression, and his eyes unfocused, just when the tech arrived to transport him to the CT suite.
“He may be having a stroke,” I said to his wife. “We’ll see what the scan shows and what we can do about it.”
“No, he’s dying,” she said like a teacher gently correcting a middle schooler.
She was right. There’s not much room for the brain in the cranium; otherwise the bone couldn’t serve its evolutionary purpose of protecting it. On this fellow’s scan, I could see a white torrent of blood, and I could see the blood pushing his brain downward against the unyielding tentorial membrane, squeezing his brainstem. The brainstem functions—breathing, temperature control, heartbeat—went out one by one, like the lights of a great city at night.
That evening I turned on the television and by happenstance landed on a PBS program featuring a favorite poet of mine, W. S. Merwin. It was a documentary about Siddhartha Gautama. I was rapt. Gautama had been born in Nepal; a week after he was born, his mother died. In midlife he became concerned with the problem of suffering. No matter what your circumstance, he said, you will end up losing everything you love, but there is joy in the transitoriness of things. Twenty-five hundred years before John Lennon, Siddhartha Gautama imagined there was no heaven and no hell. Twenty-five hundred years before Joni Mitchell sang, “We are stardust, we are carbon,” Gautama imagined that we are all recycled and therefore that the next person you meet could be the Buddha. Ginny was right. And on account of a TV program, I became a Buddhist.
James Steck practiced and taught emergency medicine for forty years. He is married with two adult children and lives in suburban San Francisco. This essay is one chapter of a memoir of his working life, entitled People Who Are Trying to Die.