I Can Hear You Whisper Read online

  Early in 1967, Simmons presented everything that was known about cochlear implants at a Chicago conference on microsurgery of the ear. “I am glad this meeting is a workshop,” he began, “because most of what I have to suggest means exactly that: work.” The auditory stimulation done to that point had been crude, said Simmons. “We must be able to produce an orderly and predictable array of pitches, loudnesses, rhythms, etc. These must be close enough to normal neural patterns so that a deaf person’s task in learning will be no more difficult than learning a foreign language.” Should they ever succeed, Simmons guessed it would take new users at least as long to acclimate as it takes babies to decipher the auditory world around them: a year, give or take a few months.

  Success would require a cooperative effort, Simmons said. Part of the problem was just how little was known about how the brain understood pitch. Frequency information was transmitted in two ways: via the rhythm of the sound, technically the repetition rate of the stimulus; and via the place on the basilar membrane that is tuned to respond best to a particular frequency. Like real estate investors, scientists were essentially asking which mattered more: timing or location. Simmons was blunt about their ignorance. When he displayed Mr. Vierra’s responses to variations in the rate of the pulse, the lines of the graph lay on top of a photograph of a crater of the moon. “The exact information we have about the major portion of the conventional speech frequencies (500–2,000 Hz) is best represented by the rather large hole I have placed in the background,” he said. The question of pitch needed an answer because it would guide the placement of electrodes and decisions about what information to send over them. Even if no one ever succeeded in building a workable artificial ear, Simmons concluded, the knowledge they would gain about how the ear and the brain process sound would be valuable and important. Besides, he finished a little impishly, a cochlear implant “just might be possible.”

  Bill House had “unabashed admiration” for Simmons. It encouraged him that someone of the Stanford researcher’s stature was tackling cochlear implants. “You have no idea how many people have told me that this problem is completely unsolvable,” House told Simmons that day in Chicago. But he disagreed about the need for animal studies and working out answers in the laboratory—standard operating procedure for most research scientists. “We must be willing to take some risks in applying what we have already found out,” said House. He insisted there was benefit to patients even “if they can only hear sounds such as footsteps and auto horns.”

  • • •

  Anything House could offer appealed to Charles “Chuck” Graser. The California man had been writing to House every six months since news of the 1961 surgeries broke. A high school teacher, Graser drove a tanker truck in the summers to make extra money and had been badly burned in a truck fire. Doctors had given him streptomycin to fight infection, and it had caused him to lose his hearing. In the ten years that he was deaf before getting an implant, Graser depended completely on lipreading and he experienced “strictly silence.” He had begun to think, he joked, that in order to communicate he would have to carry around a pair of scissors to cut off all the newly fashionable mustaches. After the accident, he had to give up his teaching job and was only able to take on part-time work as a school librarian. Like many people who had lost their hearing as adults, Graser experienced deafness purely as a loss of the life he had once had.

  Nearly ten years after they began corresponding, Bill House finally told Chuck Graser he was ready to try again. Biocompatible silicone had been developed by the inventors of the pacemaker, and in aerospace engineer Jack Urban he had found a collaborator who was more of a soul mate than Jim Doyle had ever been. Most of Urban’s other work was defense-related, and he told House he was “no longer anxious to help blow people up” and wanted to do some good. That suited House, who never applied for a patent for his implant because “I felt it would restrict others who might want to pursue this promising lead.” Since both men had day jobs, they hammered out ideas over dinner in their regular booth at a favorite Italian restaurant.

  Like the earlier prototype, the prosthesis that House and Urban built for Graser and two others could only be used in the laboratory. An early computer served as both microphone and sound processor and sent its instructions along wires that connected to the implanted electrodes via the metal plug behind the patients’ ears. Of the volunteers, Graser proved to be the most determined and interested. He came to Urban’s laboratory several days a week and kept extensive field notes of his own. “We knew exactly what electricity was going into the head because he was hardwired,” says House. “It allowed us to try all different kinds of electrical stimuli. Then we’d think of something else. Everything we built was battery-operated. We weren’t going to hook him up to the wall circuit because we didn’t know what was going to happen.” As an additional precaution against the delivery of too great a shock, they had Graser sit on a wooden chair placed on a rubber mat. Two years into the work, in 1972, Urban miniaturized the electronics and packaged them in a gunmetal-gray box the size of two stacked decks of cards, which Graser could wear on his belt or in a pocket. House worried about the untested effects of constant stimulation of the nerve, but they were all excited by the prospect of allowing Graser to hear at home.

  Suddenly, Graser could hear a dog bark and was able to recognize the squawk of blue jays from time to time. He wrote of his experience: “You would probably describe my current progress as changing from profoundly deaf to just hard of hearing, but difficulty hearing and comprehending is in a completely different league from silence. For instance, tonight I can finally hear the bell that indicates that I am at the right hand margin, as I type this letter… . I used to be a [ham] radio operator, and sometimes I would get a distant signal that I couldn’t really hear. It sounded dim and garbled. That’s the way this sounds. It’s definitely an electronic sound.”

  Graser and his wife, Barbara, took to playing games to practice his listening skills. House’s daughter, Karen, a filmmaker, captured one for posterity.

  “Say some of the simple words to get me started,” says Graser, a square-jawed, black-haired man, who was forty-four at the time. For the game, he removes the electronics case, with its microphone and processor, from his pocket and holds it up close to his wife’s mouth. Then he looks away so he can’t see her lips.

  Barbara leans in close with her arm resting on his shoulder and says, “Baby.”

  “Say it again.”

  “Baby.”

  “Baby,” he repeats. Then he turns to look at her. “Am I right?”

  She nods and he turns away again. Concentrating hard, Graser gets “sailboat” and “earthquake” but stumbles on “cowboy.” Then they try some sentences. He misses “It’s time for supper.” But the next one is easy: “Baby, it’s cold outside,” he repeats after her with a big grin. “I remember that one.”

  Listening to the world now, especially to music, is a bit like the game he plays with Barbara, he says: “You put enough clues together, and you hope you’re pretty close to knowing what’s going on.”

  On the same film, a nineteen-year-old woman named Karen, the first congenitally deaf person House implanted, is shown hearing sound for the first time. She is sitting in the laboratory with machines all around her. Unlike Graser’s, her electrodes had been completely implanted. The behind-the-ear plug was gone, and signals were to be sent via radio transmission through the skin from a coil held to the outside of her head. Until the external and internal coils lined up, there would be no sound. (In later versions, a magnet solved this problem.) In the clip, House stands behind Karen, holding back her long dark hair and circling the external coil slowly behind her ear. “Can you hear my voice?” Jack Urban says periodically. Karen’s sister, Andy, stands nearby, echoing Urban: “Can you hear my voice?”

  Suddenly, Karen’s eyes widen and her face brightens. She raises her closed fist and shakes it forward and back, signing: YES! YES! Her sister signs that
she should begin counting …

  “One … two … three …” Karen’s voice has the flat, nasal tone common to the deaf. She shakes her fist again, then hesitates as the sound disappears.

  “One … two … three … four …” Her eyes widen again, and she begins to cry. She holds her hand to her chest for a second, then covers her face momentarily. It is the first time she has ever heard her own voice.

  A few minutes later, Karen is showing off. The external transmitter has been fixed in place with a headband. Urban is playing “Six Variations on the Turkish March” by Beethoven, and she is grandly rolling her hand away from her mouth to indicate someone singing, to show that she recognizes music.

  “It was a moment I will never forget,” House tells me as we sit watching the film together.

  “Did you get emotional yourself sometimes?” I ask.

  “Yes,” he says quietly.

  Parts of the movie of Karen were shown on 60 Minutes, Nova, That’s Incredible!, and a 1975 National Geographic special called “The Incredible Machine.” The dreams of science fiction seemed to have been made real.

  • • •

  As Chuck Graser proved, some people did very well with the House implant. But the device had serious limitations. Based on Graser’s responses, House and Urban had decided to use only one electrode—a single channel of information—that would stimulate the entire cochlea at once rather than separate electrodes capable of stimulating discrete sections of nerve fibers. While there was a lot researchers didn’t know about hearing, House’s device violated one principle they did know: the tonotopic theory, the idea established by Békésy that frequencies were laid out along the basilar membrane like keys on a piano. The Frenchmen—Djourno and Eyriès—had already concluded that multiple channels would be necessary to understand speech. Dr. Nelson Kiang, one of the most prominent auditory neurophysiologists in the nation, maintained that, Graser’s experience notwithstanding, a single-channel implant could only produce a kind of buzzing. “Enthusiastic testimonials from patients cannot take the place of objective measures of performance capabilities,” said Kiang. Scientifically speaking, he was right. “There were some basic fallacies in House’s understanding of auditory physiology,” Marc Eisen told me. Yet it was undeniable that something was working for patients like Graser.

  “I remember once having an argument with [House] about the sort of simpleminded engineering approach he had adopted,” Michael Merzenich told me. “And he said, ‘Mike, if I have a man that has no leg and I can give him a stick to prop his leg up on, I’m going to give it to him.’ The first thing I thought was, That’s ridiculous. Then when I thought about it a little bit, I thought, Well, you know, so would I.” Merzenich laughed heartily at the memory. “You have to give him a lot of credit for being courageous. He was a man filled to the brim with gumption.”

  In 1975, all thirteen existing cochlear implant patients—each with a single-channel device—traveled to Pittsburgh for a week of evaluation. The National Institutes of Health had waded into the debate and funded an independent review headed by Dr. Robert Bilger, an audiologist and neurophysiologist at the University of Pittsburgh. Eleven of the patients, including Graser, were House’s and two had been implanted by a San Francisco doctor named Robin Michelson, who had gotten into the game a little later than House and Simmons and created a device of his own. (It was Michelson who brought Merzenich into the work.) Bilger began the study as a skeptic but emerged modestly optimistic. His report was released in 1977, and the findings were announced by the chairman of Pittsburgh’s ear, nose, and throat department, Eugene Myers. There was no longer any question that cochlear implants worked, said Myers. They did. Users found them helpful with lipreading and had improved awareness of environmental sounds. Myers likened their stage of development to the Wright brothers’ flight at Kitty Hawk. Bill House had indeed reinvented the airplane.

  It should have been vindication, yet the moment was bittersweet. Yes, cochlear implants worked, said the report, but House’s single-channel device was not the way forward for understanding speech. Overall, the average closed-set word recognition score in the Bilger study was 16 percent (closed-set word lists are related and somewhat predictable)—better than without an implant but a long way from conversational understanding. The study concluded: “[A single-channel device] will not provide a speech input that either sounds speech-like, or is understandable… . Until such multichannel prostheses become a reality, one must consider the question of whether or not it is reasonable to continue implanting single-channel prostheses.”

  House was frustrated and angry. Perhaps this is the saddest part of his story, the part that explains how House could be viewed as both a hero and a kook. For decades after the Bilger report, House defended his single-channel device, insisting that it did allow some people to hear speech. That was true, but only for a very few. “The single channel provides an electrical field without any pitch discrimination,” explains Dr. Simon Parisier, one of the first otolaryngologists to embrace cochlear implants. “Most people get good information [combining it] with lipreading; a few star people could understand without lipreading.” But for the majority, a single-channel implant provided only access to environmental sounds—the footsteps and car horns House mentioned in 1967. “In medicine,” says Parisier, “the person who develops something never gives it up. House never really accepted the multichannel device.” That meant House and his considerable achievements were left behind when cochlear implants advanced to the next stage. “He was stubborn,” says his nephew, John House. “It’s unfortunate.”

  Fifty years later, sitting in his living room, Bill House tries to be philosophical. “It’s the pioneer that gets the arrows,” he says. His tone suggests that some of those arrows hurt.

  9

  PRIDE

  In 1967, the same year that Blair Simmons stood in front of a crowd of doctors and scientists to discuss the possibility of creating an artificial ear that worked, another man took to a different stage one thousand miles to the east for a presentation that would help to transform the world of the deaf in a completely different way.

  “The lone actor strutted proudly to the center of the stage, chest out, and head held high,” wrote Jack Gannon in his history of the deaf in America. “He bowed slightly, then straightened and moved his head slowly sideways as his eyes scanned the audience. He raised his right, white-gloved hand and fingerspelled with machine-gun rapidity: ‘G-i-a-n-n-i-S-c-h-i-c-c-h-i.’ He clapped his hands and suddenly the stage was overflowing with colorfully-costumed actors and movement … movement everywhere. Hands, fingers, faces, bodies, and voices began to communicate. No one had ever seen anything like it before.”

  This unusual version of Puccini’s comic one-act opera was one of four short plays that made up the first performance of the National Theatre of the Deaf, and though only six people bought tickets, the curtain had been raised on a new era.

  The idea for a theater company showcasing deaf actors was first proposed in the 1950s by Edna Levine, a psychologist who worked with the deaf, and Anne Bancroft and Arthur Penn, the star and director respectively of the Broadway production of The Miracle Worker. They couldn’t get funding and the project died. In the 1960s, the idea was revived by Broadway set designer David Hays, who had been captivated by a signed performance he saw at Gallaudet. Hays joined forces with Bernard Bragg, a deaf actor whose popular one-man mime performances earned him a four-year run on television in a show called The Quiet Man. They found a fitting home for the experimental troupe in the newly established Eugene O’Neill Theater Center in Waterford, Connecticut.

  After oralism took over in deaf schools at the end of the nineteenth century, sign language was relegated to “a villain-like role,” wrote Gannon. Teachers and parents blamed sign language when deaf students struggled with English. “As a result, sign language became unpopular and a stigma was attached to it which made many [people] uncomfortable and unwilling to use it in public.”


  Ted Supalla, a linguist who studies ASL at Georgetown University Medical Center, and who also happens to be married to neuroscientist Elissa Newport, grew up in such an environment. In the Deaf world, Supalla is “deaf of deaf,” meaning his parents were deaf and he was raised signing. Even if he wasn’t an expert on ASL, that makes him royalty of a sort, at the top of the Deaf social hierarchy. It was his younger brother, Sam, who had to be told the little girl next door was HEARING.

  Although the Supallas used sign language at home and at the Deaf clubs where they socialized, Ted, who is profoundly deaf and got no help from hearing aids, began school in the 1950s and had to communicate with the teachers at the Oregon School for the Deaf in English. When we met at Georgetown, I could see that his ASL was beautiful, though I had to rely on an interpreter because mine was rudimentary. He described a day at school when he was clearly frustrated and a teacher took him out to the hall to talk to him alone. To his amazement, she began to use sign language. His relief was so enormous, he remembers, “I started to cry.” But then he had to go back into the classroom and use his voice, which was not something he did well. “I just read books in class all day long,” he says. “I knew I was missing out.” His solution was eventually to transfer to a hearing school, which he attended without the benefit of an interpreter as there were none to be had in those days. If he was going to be hamstrung by lack of communication either way, he figured he was better off in the hearing school.

  Then one day, as a young man, he attended a performance of the fledgling National Theatre of the Deaf, who “put sign language onstage literally,” he says. For Supalla, that moment led to a career, first in the theater and then studying sign language as an academic. All around him, other deaf people were having a similar experience and found themselves thinking about deafness and sign language in new ways.