Today is the first day in many, many weeks that I won’t put any medicine in my left ear, and the first time in the last couple of years that I’m not doing so because all is presumably as it should be in the ear. The hearing is not what it was prior to the surgeries, there’s probably a little further correction that needs to be done in the TMJ on that side, and I still need to keep the ear dry for now (that no longer being necessary will be an enormous milestone), but I’m getting a little more comfortable thinking of myself as healed. All through this, I’ve been meaning to go back and describe some of what I’ve learned about how the process of hearing actually works. I figured it would be a nice change from the fretting and complaining that has so far been the bulk of what I’ve had to say about this experience, but I’ve been hesitant to do so, mostly out of a sense of superstition. Telling the story of my ear surgeries and the subsequent healing process before that healing was done felt a bit like writing an autobiography while still in my twenties–it seemed the sort of hubris that invites catastrophe. But now I’m willing to take a chance.
When I came home from the first surgery, the ear packed with antibiotic jelly and my head wrapped in gauze, I had no external hearing in my left ear (though I could hear a wet squishing in the ear itself whenever anything on that side of my head moved). At first, my brain, receiving external aural stimulus only from the right ear, located the sources of all sounds directly to my right. In its experience to that point, the only time that it would receive aural stimulus associated with a specific sound that much stronger from the right ear than the left ear would be when the source of that sound would be straight to off to my right, in much the same way that most people’s brains would interpret the sound from a stereo with the balance turned all the way to the right. That evening, I was sitting in front of my computer, and my wife passed behind me from my right to my left, touching me on the way past. She was standing ten or fifteen feet to my left, and I could just see her out of the corner of my left eye. She called out to me, and despite all of the information I had telling me she was to my left, I heard the sound as coming from my right and I reflexively turned my head that way.
Thankfully, that only lasted a couple of days. Somehow, whatever apparatus in my brain interprets sounds realized that it was receiving input from only one side and adjusted accordingly. This meant that I was now hearing sounds as though they were coming from a single monaural speaker rather than from a right-sided stereo speaker. Though this was a less distorted interpretation of my experience, I was no longer able to locate the sources of sounds based solely on my sense of hearing. If, while walking in the street, I heard a horn blown or a person yell, I would turn around and around trying to figure out where the sound came from. I would do the same in the elevator lobby of my office when the bell announcing the arrival of one of the elevators rang, spinning around until I could find the light signaling up or down for the elevator that had just arrived. This had further unexpected implications, especially in the office.
What we understand to be a collection of separate sounds are together contributing to a complex pattern of vibration of our eardrums. Our brain uses several mechanisms to reverse the process of aggregation that happens as these diverse vibrations in the air enter our ear canal, and to allow us to experience simultaneous sounds as distinct. I imagine that the calculation behind this process is staggering, but it seems to happen instantaneously and seamlessly. It feels effortless to sit in the middle of a room with our eyes closed and independently identify and locate the sounds of the air conditioner to our right, the television in front of us, and the person speaking to our left. However, with one ear, all of those sounds seem to be coming from the same place. We can separate them to the extent that the sounds are qualitatively different, but if they’re of similar frequency and timbre, they’re virtually impossible to separate. With our eyes open, it gets easier because we can connect visual cues to parts of the noise surrounding us and make intelligible sounds of those parts (by, say, reading lips). So for weeks after the first surgery, if I was in a meeting and more than one person was speaking, it was almost impossible to understand any of what was being said. And ambient noises outside or in crowded places had the same effect.
The effects on my ability to properly interpret my experience were mitigated as the hearing in my left ear gradually returned. After the second surgery, I returned directly to the monaural state, without going through the interim broken stereo state. Whatever had made the adjustment after the first surgery remembered it and made it again immediately after the second surgery. I’d be curious to see brain scans showing if and how the physical structure of my brain and the patterns of my neurological activity changed as these adjustments were made and then gradually became unnecessary. And the fact that it all happened outside of my conscious awareness makes it seem less like a subjective process in which I participated and more like an objective process to which I was subjected. The change from hearing everything to my right to hearing without direction wasn’t a change about which I had any choice, but it also wasn’t genetic. It was an adaptive and, in some abstract sense at least, reasoned response by a mechanism that would have to be considered part of me, but over which I have no conscious control. This disruption of the normally invisible process of interpretation that mediates all of our experience made that process, or at least its effects, temporarily apparent, and highlighted how far from bare awareness and how thoroughly conceptual conventional conscious experience actually is.
…and just like that, the graft in my left ear has healed, at least for now. Like so many said yesterday, I thought this day would never come. But of course, though it has come, it hasn’t come simply. Yes, the surgery in my left ear is now fully healed. A thin layer of translucent dry skin now covers the last of the granulation tissue, and there’s no evidence of eczema in the left ear. This is still delicate and must be protected. There’s no eczema in the right ear, either, yet the condition of the ear canal is no better than it was ten days ago. And I suppose if I were to look at this rationally, I would be fairly concerned about that, as it could be construed as a threat to the one ear that really works at this point.
We’re going to protect the gains we’ve made in the left ear. I’ll use the drops for the rest of this week and continue to keep the ear dry. In the right ear, we’ll try something different, at least different for that ear, and that means resorting to the power of the powder once again. And I’ll have to continue to keep that ear dry as well. Keeping both ears dry is actually more than twice as difficult as keeping one ear dry, so I haven’t worked out in ten days and I feel it in my back. At some point I’ll get everything working properly all at the same time, but I’m not quite there yet. I probably haven’t been this close in eighteen months, though.
The good news is that the ear canal of my left ear, the ear on which the surgery was performed, now looks largely indistinguishable from the ear canal of my right ear. The bad news is that this is because the condition of my right ear canal is deteriorating as a result of the eczema that’s plaguing both ears. I hadn’t actually entertained that as a possibility, and I’m still trying to figure out just how hysterical I should get about this. About ten to fifteen percent of each ear canal is now covered with granulation tissue. In the left ear, that’s the tissue that hasn’t quite finished growing back from the surgery, a process that has been stopped but not reversed by the eczema, and in the right ear, it’s the result of deterioration due to the eczema. For most of last week, the eczema seemed to have gotten much better, but it returned with a vengeance on Saturday, so I wasn’t completely surprised by this news.
Where does this leave me? The problem now has been reduced to addressing the eczema. Doing so should cause both ears to heal correctly. The left ear has gone as far as the powder will take it. Before the cholesteatoma had been diagnosed, I had intermittent problems with eczema in each ear, and various drops always seemed to address it effectively. We’re going to stop the powder, and instead try drops that include an antibiotic, an antifungal agent, and a steroid. Though the powder and other drops we’ve used have generally been some combination of these three components, this is a new one (actually, it’s a very old one that’s rarely used anymore), and drops are generally more effective in treating eczema (where the powder is apparently better as a protective agent). We may have to try alternating between the drops and the powder. I’ll go back next Wednesday and see where things stand, but after the first usage of the drops, my ears do feel a bit calmer.
Perhaps the worst news is that I now have to keep both ears dry until I see the doctor again. That means blocking both of my ears with cotton and vaseline for every shower, and that will effectively mean no significant workouts for the next week or so. But I can take some comfort in the face of this in the fact that mine are now clearly the most difficult ears the doctor has ever had to deal with. So I’ve got that going for me.
I think I’ll be better off once I’m back at work on Monday. I’ve been off since the day before Christmas, as we’ve been on an extended holiday, and I don’t do well with long periods of free, unstructured time. I become obsessed with small matters and fall prey to my imagination. After several days of dire premonitions and dread, I saw my ear doctor again today. My ears, both of them, are still suffering an extended bout of eczema and nothing more. There is no infection in my left ear, and despite the eczema, the healing of the graft continues to progress.
The doctor would like me to see a dermatologist to get some insight and advice on the eczema, but it’s tricky to find one with this particular sort of expertise. Skin inside the ear isn’t like other skin, at least not once something goes wrong with it. There was a dermatologist he used to trust with these sorts of issues, but he retired. His office manager suggested one I could try, but there’s no indication that he has this particular sort of expertise. I also asked the doctor about the ENT’s suggestion of an oral steroid, but he said he didn’t know enough about it to feel comfortable trying it. The good news is that even if we just have to wait out this eczema, it looks like the tissue will continue healing while we wait. And Monday I’ll be back at work and will have something to do with my mind.
As I mentioned, I’ve been reading the Bodhicharyavatara and various commentaries on it for the last few weeks. Though the root text, in verse, is quite pithy and aphoristic (and deceptively ironic–I wish I could read Sanskrit or Tibetan so I could appreciate it more fully as a poem), in conjunction with the commentaries, it provides comprehensive guidance for practitioners of Mahayana Buddhism. There are so many themes that wind in and out of the text, passed first from one perspective and then later from another. One such theme is our relationship with our bodies:
This body–running sore in human form–
Merely touched, it cannot stand the pain!
I’m the one who grasped it in blind attachment,
Whom should I resent when pain occurs?
Because the mind is bodiless
It cannot be destroyed by anyone.
Because of mind’s attachment to the body,
This body is oppressed by pain.
Dust and ashes are the body’s final state–
This body which, inert, is moved by other forces.
This form so frightening and foul–
Why do I so regard it as my “self”?
Through lavishing attention on this body,
Such sorrow have I brought myself so senselessly.
What use is all my wanting, all my hating,
For what indeed is like a log of wood?
Therefore, free from all attachment,
I will give this body for the benefit of beings.
And though it is afflicted by so many faults,
I shall adopt it as my necessary tool.
Pulling these stanzas out of their context probably heightens the appearance of mortification with the body, but I’m too lazy to quote enough context to rectify that appearance. Please trust me when I claim that this appearance is simply a reflection of our own ambivalence toward our bodies. On the one hand, we are attached to our bodies as our selves (or at least as the temples housing our selves), and on the other hand, we tend to find most of what the body contains and is composed of disgusting. Simultaneously holding these two extreme and incompatible views can only lead to suffering, and neither view is accurate. In truth, our body is neither our self nor its home, and notions like disgust and repulsion are merely concepts with no genuine reality.
These contemplations have seemed relevant as my supposedly healing ear has continued to leak more and more persistently. It had stopped for a little over a week, but then started again on Sunday night, a little at first, but accompanied by an itch. The last couple of mornings, I’ve had to get out of bed and run to the bathroom with my head tilted so that whatever my ear’s full of didn’t run down my face. It’s not an uplifting way to start the day. Because of the itching, I tried to contact my ear doctor on Monday morning, but he’s unavailable until Friday (when I already have an appointment with him). And the other ear doctor I saw when he broke his hip is also unavailable until Friday. I did find that I could control the itching with Benadryl, though it left me dehydrated.
But yesterday it was still bothering me, so I tried the ENT who had originally referred me to my current ear doctor, and she was available, so I zipped through the park to see her. She confirmed that my ear isn’t infected and that I’m having an eczema flare up in both ears. She said that the ear actually looked better than she expected given my description of the symptoms, and wondered if my doctor had considered using an oral steroid like prednisone to suppress the eczema until the graft in my ear healed. Then she coated my ear (and most of that side of my head) with boric acid and said I’d be okay until my Friday visit with my regular ear doctor.
It could simply be that my ear is actually healing, and that the liquid (thin and clear) is an attempt to flush my ear of the foreign substances in it, much like a lingering runny nose after a cold. But I’m very hesitant to leave my ear so moist and susceptible to infection without that magic powder. I’m on the verge of losing all sense of perspective. The ENT’s surprise at the actual state of my ear given my description of the symptoms suggests that I may be overreacting, but I have very little ability to convince myself of that anymore. Yes, I’m not in any pain; yes, I can actually hear fairly well from that ear; yes, the ear isn’t infected or about to become so; and yet I have this overwhelming desire to give up. All that seems to be preventing me from doing so is the fact that I can’t figure out what giving up would actually entail. And so I eventually get distracted, and maybe even do something useful. Monday, I created a prototype of a Web site for the Buddhist study program I’m in. Yesterday, I fixed the configuration of our wireless network so that I can now move large files around at up to 4 MB/s and control all non-cable audio and video from my phone. And today, so far, I’ve reflected on the Bodhicharyavatara and written this.
I am clearly suffering, and no one seems surprised by that (in fact, someone compared me to Job today), but I can’t really put my finger on why I’m suffering so much. The physical basis of that suffering is slight, and I have nearly all of the freedom and leisure that a human could reasonably expect. Yet it is the First Noble Truth of Buddhism that we suffer, and I offer this testament to that truth’s veracity. But, Shantideva reminds us, there are three more Noble Truths:
Suffering also has its worth.
Through sorrow, pride is driven out
And pity felt for those who wander in samsara;
Evil is avoided; goodness seems delightful.
And so it is that if I want contentment,
I should never seek to please myself.
And likewise, if I wish to guard myself,
Of others I should always be the guard.
I’d be lying if I said I led my life that way, or that my aspiration to do so is any more than theoretical at this point, but the past eighteen months’ intensive seminar on impermanence has made the truth of those two stanzas seem more plausible.
I’ve been reading Shantideva‘s Bodhicharyavatara, and various commentaries on it. I even made it through part of a weekend program on it. I came across this little fable in Kunzang Pelden’s commentary on it, called The Nectar of Manjushri’s Speech:
Once upon a time, when the son of Vallabha… was setting off on a sea voyage, his mother wept and caught hold of the hem of his clothes. “Your tears,” he cried, “will bring me bad luck on the journey.” And with that, he kicked his mother in the head. In the course of his voyage, [he] was shipwrecked, but holding fast to a spar, he was washed ashore on an island. …he had to undergo the unbearable pain produced by an iron wheel spinning on his head. But then he thought to himself, “May the pain of other beings who are suffering for having kicked their mothers in the head ripen upon me. May they not experience it.” At that very moment, his torture ceased…
This morning, after waking up around 5:00 with an ear mysteriously filled with liquid, doing my best to dry it out and pack it with cotton, and then lying back down to try to sleep, it came to mind. Something had obviously gone quite wrong with my ear, and I had no idea what it was. The ear didn’t hurt, and the liquid was clear and of the approximate density and viscosity of water, so it didn’t seem like the symptoms of an infection, but I couldn’t figure out what else it could be. And so I lay there considering what suffering I could aspire to have ripen upon me. Finally, I decided that I would seek to take on the suffering of all of those who were as frightened as I was for reasons they couldn’t entirely explain. I don’t know how much it helped, but I was able to keep myself functionally calm until I got to the doctor’s office.
He looked in my left ear, and saw just a little spot of blood on the tissue that hadn’t quite healed yet. But everything looked basically okay. There was no infection, and the tissue was still covering all of the bone. Then he looked in my right ear, and it was a mess. It was full of sloughing skin, irritated, and on the verge of an infection. It seems that I’m having an episode of eczema in both ears, and that it wasn’t as bad in the left ear because I’ve been putting the powder in it every other day. Now I’ll be putting the powder in both ears every day for the rest of this week, and hoping that this bout of eczema passes. Walking through the lobby of the doctor’s building on the way back to work, I almost collapsed in tears, and I’m not entirely sure why, except that I was tired and I’m just about completely wrung out by this process. And still I must go on, I can’t go on, I’ll go on.
I don’t what was going on in my left ear between October 1st and October 22nd, but whatever it was, it doesn’t seem to be happening anymore. In that three week stretch, the skin graft that had been put there back in May went from three-quarters healed to ninety percent healed. In the six weeks since then, granulation tissue (or mucosa) has grown over the remaining exposed bone, but hasn’t yet become the dry skin it’s supposed to. Upon hearing the word mucosa, I panicked a little as I remembered that being a bad thing. But the doctor assured me that this was the expected progress. After my pressing him a bit for a prediction, he guessed that, given my history, my ear would be healed in another month. I was really hoping that with the momentum that I’d managed to build up through October, he would tell that it was healed today. Though it’s not, he assured that all was going well, and he seemed quite pleased (which seems to be the best measure of progress available to me).
I’ll see him again before Christmas, but until then, it’s more of the powder and more of the cotton and vaseline in the ear for workouts and showers. I’d be lying if I said I wasn’t tired of this, but things continue to go well. Yet despite my best efforts to maintain a positive or simply realistic perspective, I find myself wondering if the trajectory of my ear’s healing will become asymptotic with the ear being fully healed, forever approaching but never quite reaching that state. Will I be sixty years old and still putting powder, cotton, and vaseline in my ear in hopes that the last percent of the graft will somehow transform from mucosa to simple dry skin? I know logically that it will heal, but I can’t quite believe it. When it does happen, I fully expect to weep tears of joy in the doctor’s office. I wonder how he’ll take that.
Do not doubt the power of Crazy Sam’s Good Time Magic Powder® (though there may be reason to doubt Sam’s messianic tendencies–more on that below). After using the powder every day for a little over a week, and despite a catastrophic breaching on Monday morning of the cotton and petroleum jelly levee I use to protect my ear from moisture in the shower, my ear looked much better today than it did last Monday. The tissue hasn’t really made much progress in eclipsing the exposed bone since last week, but it looks “much calmer” in the doctor’s words. I don’t know what this means in practical terms anymore, but where he was a bit discouraged last week, he was very upbeat this week. I asked why, given little or no progress in the tissue growth, I should be encouraged by this, and he said that there likely wouldn’t be much tissue growth in a week, but that the area looks far more conducive to tissue growth with the powder. So I’ll keep using the powder every other day, and we’ll check back in three weeks.
I asked the doctor if I’d told him the story of Sam the Pharmacist and his profound faith in this powder and his wild-eyed (I’m assuming–I only spoke to him on the phone) messianism. He said I hadn’t, and that he was surprised to hear that, since Sam’s not the first pharmacist to make this powder, though there aren’t many who do. Apparently it’s a fairly old treatment, and it’s expensive and difficult for patients to properly administer (making me special, I suppose). In fact, he had convinced a pharmacist in New York to make the powder, but the pharmacist stopped after a while due to a lack of interest. I’m a true believer in what is apparently a small church or, perhaps more accurately, cult.
The best health-related news of the week is that it finally dawned on me that this odd levee system for my ear could also protect it from moisture while I exercise, as long as the exercise isn’t too strenuous (which, after a layoff of months, it won’t be). I started working out in the morning before work yesterday, and I already feel much better, just like Rich said I would. I feel calmer, I sleep better, and my back, which was already somewhat better, feels both stronger and looser. I might just get through this saga, which may yet challenge the longevity of The Archers, without losing my mind.