Understanding people’s suffering: A doctor’s perspective

I will always try to remember that no matter how minor I think the patient’s condition is, to the person who is suffering it is frightening, depressing and very, very real.

June 23, 2013 21:49
A Syria girl and her mothWolfson Medical Centerer at

Syrian girl after surgery hospital 370. (photo credit: Courtesy Save a Child's Heart)

The literature is full of moving, inspirational accounts of doctors’ experience as patients living through and sometimes dying from life-threatening illnesses. What about doctors who experience somewhat less serious conditions? I am an Ear-Nose-and-Throat specialist.

Unfortunately, I recently lost some hearing in my right ear.

Kind of funny, no? I spend most of my time trying to help people regain hearing, whether by removing earwax in the clinic or by performing cochlear implant surgery to give hearing to a deaf child. I realize that my hearing loss is unilateral and mild. I realize that most of my patients have it much worse than me. My colleagues have reminded me of that as well. Surprisingly, none of that is particularly comforting.

Two weeks ago, I traveled to Jerusalem for a rehearsal in a TV pilot I was recently cast for the lead role in. Acting has always been my passion, but I haven’t given up medicine, yet. After making a quick stop at the famous Mahane Yehuda market and picking up some super-gooey and delicious rugalach, I started my trip back home to Ra’anana. While descending from Jerusalem toward the coastal plain, my right ear plugged and I was unable to pop it open. I was getting over a pretty bad cold at the time which is why my Eustachian tube didn’t function properly, and I couldn’t equalize the pressure in my ear. Okay, it happens. It usually takes a few minutes, a couple of swallows and maybe a good nose blow and everything goes back to normal.

Except this time it didn’t work.

Over the next few hours my ear became progressively plugged and I developed severe pain. Over the weekend, the pain gradually resolved but my hearing didn’t return. I wasn’t too concerned because I’ve seen this hundreds of times. I dutifully followed the recommendations I have given every patient in the same situation. I started taking nasal steroids, antihistamines and decongestants. The negative pressure in my ear caused fluid to accumulate, interfering with the natural motion of the tympanic membrane and the three tiny ossicles or bones of the middle ear.

There are two types of hearing loss. Conductive hearing loss, which can be caused by common problems like earwax or fluid in the middle ear, is not a big deal. A little bit of cleaning or very minor surgery (tubes or grommets) generally cures it. Often no treatment is needed at all and the problem resolves spontaneously.

The other type of hearing loss, sensorineural hearing loss, is the bad kind. That is the type of hearing loss that comes with age, after excessive noise exposure, or when you take drugs that kill the cells in your cochlea. It is usually irreversible.

I knew that I had a conductive hearing loss. No biggie. Within a few days, at most a couple of weeks, the congestion resolves, the fluid drains, and my ear goes back to normal. I found it annoying having only one good ear but I really couldn’t complain. That same day, while I was at rehearsal, my brother-in-law sustained an injury during a basketball game and was rushed to the hospital where he underwent emergency surgery to try to save his eye. I wasn’t going to get too worked up about my temporary, minor problem.

The problem was, it didn’t seem to be getting better. If anything, my hearing was getting worse. On the second day I developed deafening ringing in my right ear, known as tinnitus. By the time I got back to work after the weekend I was beginning to get nervous. I had my ear checked by my colleagues.

(Actually, I checked it myself as well by attaching an endoscope to a screen and snaking it into my own ear. I won’t be doing that again for awhile!) My eardrum was significantly inflamed and my middle ear, normally an air-filled cavity, was halfway filled with blood.

Although it might come as a surprise to some, that was actually reassuring because it was consistent with conductive hearing loss.

By the next day, things weren’t improving, so I finally arranged for a formal hearing test. I couldn’t believe the results! I was in shock. I had actually sustained some sensorineural hearing loss in my right ear.

That’s when everything changed.

I realized that my ear might never get better. I had already been through denial, and now I started going through the other stages of Kubler-Ross grieving. I was angry that I had driven to Jerusalem for that ill-fated rehearsal. Bargaining came in the form of megadoses of steroids to somehow try to stem the damage to my cochlea or auditory nerve, and possibly even reverse it.

By no means was I clinically depressed but I often felt sad about what I might miss should my hearing fail to return; The sound of my children laughing, the baby crying, localizing noise, understanding speech in a crowded room to name a few. Dammit, I know too much about hearing loss! Since then I have been inching closer to acceptance.

Through all this, however, the most eye-opening experience was hearing the remarks of my colleagues, including audiologists, nurses and physicians. They all made well-intentioned comments of a type I myself have made countless times to patients in similar situations: “Oh, that’s not so bad!” “You probably had it before and didn’t notice.”

No, I’m pretty sure I only stopped hearing the same day my ear popped! “I don’t believe the hearing test.”

Except for the fact that I have screaming tinnitus.

“Why are you upset? It’s so minor you are not even going to notice it.”

Newsflash: it’s driving me CRAZY! “It’s so mild it doesn’t even fulfill the criteria for treatment.”

I refer you to my earlier comment on bargaining and megadose steroids.

It’s a little bit ironic. I pride myself on communication skills and empathy. I’m a graduate of McMaster University Medical School, probably the world leader at training doctors in communicating with patients. My father is a psychiatrist and my mother is a social worker. I was pretty much born communicating. And here I am, on the other end of the otoscope, being schooled on what it means to have a “minor” condition.

One of the doctors was able to make me feel bit better by pointing out that I hadn’t even suffered this barotrauma due to one of the sexy causes, such as sky diving or scuba diving. I got it driving down a hill with a stuffy nose. Sometimes laughter is the best medicine.

A few days later, when I was feeling the full effects of the steroids in my mood swings, extreme fatigue, disturbed sleep patterns and ravenous appetite, I was bemoaning my condition over lunch to a friend of mine who is a pediatric lung specialist at Schneider Children’s Medical Center in Petah Tikva. He asked me very specific questions, demonstrating a rare and keen knowledge of hearing loss. He then proceeded to tell me about his own severe unilateral conductive hearing loss.

He has no idea what caused it, despite various attempts at diagnostic surgery and imaging. Hearing that his situation was much worse than mine didn’t make me feel any better. But instead of just rattling off how he really only needs one ear, how a hearing aid might be helpful and how we can try new diagnostic modalities, I was able to really feel his frustration and despair. I still plan on doing everything I can to help, but I think a little bit of empathy probably helps as well.

If nothing else, I will always try to remember that no matter how minor I think the patient’s condition is, to the person who is suffering it is frightening, depressing and very, very real.

Since then I’ve been monitoring my hearing by asking my kids to whisper things in my right ear.

They almost always whisper “I love you, Daddy.”

(I have gotten “Can I play with your iPhone, Daddy” a few times as well.) My most recent audiogram shows my hearing has started to improve. The tinnitus is also almost gone. Turns out my prognosis may not be so bad in the end! Thankfully, my brother-in-law’s surgery was a success and his vision has been steadily improving.

We are taking it one day at a time.

The TV pilot was a flop. I guess I’ll have to keep my day job.

Becoming a Hollywood star is temporarily on hold.

The author, formerly from Toronto, Canada, is a pediatric ear nose and throat surgeon practicing at Scheinder Children’s Hospital in Petah Tikva.

He lives with his wife and four boys in Ra’anana.

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