Copyright 2014, Mark Judelson
The words “ice cream” may have been the first sounds 92 year old Evelyn Wood heard in four years. Ms. Wood (not her actual name) was seated in the testing booth at Dr. Angela Loavenbruck’s office. Dr. Loavenbruck, a practicing audiologist for 50 years, was on one side of the booth, separated from Ms. Wood by a clear glass window. (As a caregiver to Ms. Wood, I sat next to her in the booth.) With head phones over Ms. Wood’s ears, Dr. Loavenbruck manipulated a sound board that sent beeping sounds to the head phones. Ms. Wood made no response. Then Dr. Loavenbruck spoke into a microphone connected to the head phones. She said, “Ice cream.” Ms. Wood’s eyes opened wide and she clearly repeated “ice cream.” I felt I was in the presence of a miracle.
I work at the Fellowship Community in Chestnut Ridge, New York where Ms. Wood lives. The Fellowship, a community centered around the care of the elderly and the earth, is an inter-generational home to approximately 60 senior citizens (who are called “members”), ten dairy cows, more than 100 chickens, ten sheep, acres of gardens, orchards and woods. The Fellowship has been Ms. Wood’s home for four years. Soon after she arrived, Ms. Wood lost her hearing aids. Despite a significant search, they were never found and not replaced because of her limited financial resources.
One of my jobs at the Fellowship was to help Sandy, a member who could not feed herself. Sandy was a bright soul, interested in the outside world and able to access it through animated conversations with those of us able to venture beyond the confines of the main care building. Every Thursday morning, I sat with Sandy in the large dining room. We talked and laughed while I fed Sandy her breakfast. Every morning, Ms. Wood was brought to the dining room and seated at the same table as Sandy. People nodded to Ms. Wood but as she couldn’t hear, no one spoke with her. She ate her pureed meals quickly, then folded and unfolded her hands, for extended periods of time. Sometimes, she tapped a plastic cup on the table.
When I arrived one Thursday morning, a fellow caregiver told me that Sandy had passed away. Living in her body with the limitations caused by her illnesses had become more and more of a burden for Sandy. She was ready to go and I wished her well. Sandy’s passing did not change that others continued living … and eating breakfast.
The Thursday morning after Sandy’s passing, Ms. Wood was brought to her usual seat in the dining room. No one else sat at her table so I went over. We looked at each other and despite no words being exchanged, I felt we had a real meeting. I took out a pen and wrote her a note that read, “I’d like to have a conversation with you. Would you like that?” and handed her the note and pen. Ms. Wood regarded the note intently. I didn’t know if she needed reading glasses to see it and, even if she could read it, what her level of comprehension was. After a moment, she took the pen in her right hand, wrote on the paper and handed me the note with clearly written letters, “Yes. Let’s begin!” This was the start of a deep friendship with Ms. Wood who I call “Evelyn.” Through our notes, I learned that she loved cats and colorful flowers and leaves. I learned, too, that she did not like being touched by someone with cold hands. I made sure that my sometimes cold hands were warmed before touching her.
Despite her inability to hear that had closed off a significant source of connection with others, Evelyn demonstrated a brightness that came from keenly observing what was going on around her. She frequently winked to me and others conspiratorially. Because of degeneration of her jaw, she had no teeth and could not tolerate dentures. Her toothless smiles were among the warmest I’ve ever experienced. Sometimes, she drew my face to her and gave me a warm toothless kiss on the cheek punctuated by a loud popping sound.
For several years, I have worn hearing aids that help me tremendously. I wondered if Evelyn wanted to re-enter the hearing world and – if she did – how to obtain proper hearing aids. Dr. Loavenbruck is my audiologist and has been consistently competent, thorough, generous, warm and kind. A remarkable combination of qualities to find in a busy health care provider. I wrote her an email, describing Evelyn, her condition and limited financial resources and asked if she would evaluate Evelyn to find out if she could hear at all and, if she could, if hearing aids would help. This was a place to start. If we found that hearing aids could help, and that Evelyn wanted to hear again, I’d explore how to make that happen. Dr. Loavenbruck quickly responded saying that she’d be happy to see Evelyn and that the evaluation was a gift.
I wrote Evelyn a note asking if she’d like to pursue this. She wrote back – in large print – “YES!” So, I made an appointment. On the appointed day, I was excited and hopeful. Evelyn was more subdued. We arrived at Dr. Loavenbruck’s office, navigating Evelyn and her wheelchair into the waiting room. Evelyn rarely leaves the Fellowship and I was concerned that this trip and the new surroundings might be overload for her. She sat impassively, visually taking in the waiting room, the folks waiting with her and the office staff. I didn’t know if she understood what was going on, what this place was and its implications to her and took relief that she appeared calm.
Dr. Loavenbruck appeared in the doorway. Evelyn looked at her. Dr. Loavenbruck smiled her genuine, warm smile and met Evelyn’s gaze. Dr. Loavenbruck continued to smile and said in a slow, loud and clear voice, “Hello Evelyn. Please come into my office.” Sometimes you see simpatico in real time. This was one of those precious moments. Evelyn’s eyes twinkled, she smiled her unique smile. I pushed her wheelchair into Dr. Loavenbruck’s private office. Dr. Loavenbruck and Evelyn continued to meet each other’s gaze as Dr. Loavenbruck asked, “How can I help you, Evelyn?” Evelyn’s face furrowed and she said nothing. Dr. Loavenbruck repeated her question, even more slowly and louder. The furrows deepened more. After a pause, Evelyn said, “I can’t hear you.” Dr. Loavenbruck, still speaking directly to Evelyn, said, “We’re going to take you into the testing booth.” After some difficulty negotiating a small door and a step, Evelyn sat inside the soundproof booth with me at her side. Dr. Loavenbruck fitted headphones over Evelyn ears, left the booth and closed the door which made a whooshing noise. It was quiet. Dr. Loavenbruck quickly reappeared on the other side of the glass window separating her control booth from the soundproof booth. Even with my diminished hearing, I could clearly hear Dr. Loavenbruck’s voice coming through the head phones. She said, “Evelyn, you’re going to hear a series of beeping sounds. When you do, raise your right hand.” She proceeded to gaze down at a control panel and press buttons. Evelyn made no gesture to indicate that heard anything. Then Dr. Loavenbruck said, “Evelyn, I’m going to say some words. Please repeat them.” Evelyn gave no indication of understanding. I heard Dr. Loavenbruck’s voice through the headphones on Evelyn’s head. She said, “Ice cream.” After a brief pause, Evelyn said, “Ice cream.” She proceeded to repeat several of the words Dr. Loavenbruck spoke. Evelyn could hear! Evelyn could process what she hears and repeat it!
When Dr. Loavenbruck completed the test, she invited us back to her private office. She said, “I’ll be right back,” and left the room. After a few minutes, Dr. Loavenbruck re-appeared. In her hand, she held two hearing aids. The “brains” of the hearing aid are about the size and shape of a small piece of garlic. A thin wire is connected from the brains to the ear piece which slides into the ear canal. The whole thing might weigh less than an ounce. Despite their small size, these are expensive. Each of my hearing aids cost $1,500. Mine are several years old. I do not know how much the two brand new, top of the line aids that Dr. Loavenbruck expertly inserted into Evelyn’s ear cost but I suspect more than mine. Dr. Loavenbruck adjusted the volume levels, asking for Evelyn’s feedback which she gave freely and clearly. When they were satisfied, Dr. Loavenbruck said to Evelyn, “Evelyn, these are yours. Please come back in two weeks for a checkup.” She bent over and gave Evelyn a hug.
After the follow-up appointment, Dr. Loavenbruck reported, “I really wanted to know how she was doing. She was clearly more responsive the second time. There were still times when you ask her a question and you don’t an answer back. There’s a time lag there. I think it takes her longer to process. I asked her what she likes to do and she didn’t respond. You said that she likes cats and we talked about cats and Evelyn just lit up.”
The third appointment was three weeks later. “She was more engaged,” Dr. Loavenbruck recalled. “My hope for her is that she wears her hearing aids all the time she’s awake and she’s put in situations where she has to interact and she is stimulated, stimulated, stimulated. With long period of silence, neurons die. The connectors die. When someone doesn’t hear, the lights go off. The longer they don’t hear, the more lights go off. And then, suddenly, they start to hear. And the lights go on. After someone has been living in silence for too long and they get hearing aids, my fear is that they’ll be rejected. It can be overwhelming. It’s too loud. It’s too hard. It’s too different. They’ve come to be comfortable in the silence. And now you’re messing with it. When I saw Evelyn for the follow up appointments, I was afraid she would reject the sound. I was happy to know she had not done that.”
At the end of the third visit, Dr. Loavenbruck said, “Evelyn, you’re welcome to come back and visit whenever you’d like but we don’t need to make any more appointments. Is there anything you want to ask or say?” Evelyn smiled and shook her no. A few days before this visit, Evelyn said to me, “I don’t have any hearing aids.” I told she did, that Dr. Loavenbruck had given her a gift. The hearing aids were hers and literally sitting inside her ear canals as we spoke. Evelyn shook her head no. So, before we left Dr. Loavenbruck’s office, I wanted to be sure that Evelyn heard from Dr. Loavenbruck about the hearing aids. I said to Evelyn, “A few days ago, you said you don’t have hearing aids and I told you they are yours. “ Evelyn’s face furrowed. Dr. Loavenbruck looked her in the eye and said, “Evelyn, these are your hearing aids.” The furrows grew deeper in Evelyn’s face. After a moment, she said, “I don’t have money. I’m on Medicaid.” Dr. Loavenbruck took Evelyn’s hands in hers and repeated, “Evelyn, these are your hearing aids,” and gave her warm hug which Evelyn returned.
During a later interview, Dr. Loavenbruck spoke about why she made this significant gift to a stranger. She responded, “I’ll tell you about Evelyn. I’ve seen thousands of people. Literally, thousands over 50 years in that office. You don’t love every person you see. But many patients I come to love. I know them. Part of the way I operate is that I’m very personal with my patients. I want to know about their lives and what’s important to them because it helps me to understand what their communication needs are. There are some people I love instantly – and I loved Evelyn instantly. There was something that just touched me about her. And it was instant. From minute one, there was no question that I was going to do whatever I needed to do to make sure she got whatever help I could give her. There’s something kind of open about her. She is a person who’s like, ‘Here I am. Here I am.’ Her face is open. There’s something warm about her which I saw immediately. I felt she was kind. And also kind of helpless. It was awful to me that she was sitting in a state where – with that state of hearing loss – she was lost in the world she was in. She could not participate in it. So, it hurt me.”
“Part of my response to Evelyn has to do with my mom and the extraordinary sorrow that me and my siblings had about how she died from Parkinson’s disease. My mother was this independent, fierce, loving woman. Watching her go from living in her house that was her domain was painful. She had fallen and we had to wrest her from that house that she had lived in for all her adult life and placed her in an independent living center that had actually been my Catholic school grammar school that was converted into the assisted living center. The apartment my mother got had been the principal’s office. We kept her in that place for as long as we possibly could until the Parkinson’s was much worse. After she fell again, we had to put her in a nursing home. It was like watching this woman be diminished from this larger than life, five foot one inch tall woman who made ravioli for all of us until she was well into her seventies, be diminished.” Dr. Loavenbruck began to cry and continued, “I remember visiting my mother in her nursing home and when it was time to leave I had to force myself to turn away from her and I’d have to walk to get the hell out of there because I couldn’t stand leaving her there. Sometimes when I meet an older woman or man, when I met Evelyn, something about her recalls that. It hurts. That’s a part of what I responded to.”
Dr. Loavenbruck remarkable care for her patients is inspired, in part, by one of her high school teachers. “One of the most important sentences of my life came from Mrs. Stromberg. She was very prim and proper. Every day she walked into class and wrote this sentence of the black board – ‘The biggest enemy of the best is the good enough.’ I have cursed that woman so many times because every time I‘m doing something – cooking a meal, writing a paper, making cookies – I start to think, ‘This is good enough.’ It stops me in my tracks and I go for the best.”
I asked Dr. Loavenbruck how she reconciled being a business person with making this substantial gift. She responded, “I’m in business to make more money than I spend. And I do. I paid for those hearing aids. They are expensive hearing aids. And I gladly gave of my time. I’m always trying to find ways to help people without going out of business because then we wouldn’t be there to help.”
In the waiting room at her office, there is a drawing of an old man, hunched over on a park bench with a blanket over his shoulder. The words that accompany the drawing are lyrics of the song “Hello in There” by John Prine.
Ya’ know that old trees just grow stronger
And old rivers grow wilder every day
Old people just grow lonesome
Waiting for someone to say, “Hello in there, hello.”
So if you’re walking down the street sometime
And spot some hollow ancient eyes
Please don’t just pass ’em by and stare
As if you didn’t care, say, “Hello in there, hello.”
Dr. Loavenbruck spoke about the drawing and words. “I genuinely enjoy old people. (She laughed.) Now, I’m an older person. As a young person, I always liked older people.
For many people in our culture, I see as I get older, they don’t see me. They don’t make eye contact with older people. To many folks in our culture, older people aren’t really there. I’ve always known that old people are there.”
Now able to hear much more, Evelyn’s world has changed. She speaks frequently. Aided by her walker, she walks taller and takes longer strides. Her gaze, which had been on the floor, now rises to the horizon.