Chapter 6: Learning to Listen, Part I

Learning to Listen One of the most persistent misunderstandings people have had about Grace’s activation is that although she was instantly able to hear, she couldn't understand what any of the sounds she was hearing meant. I don’t think people expected her to understand speech. But it didn’t occur to them that no sound Grace heard in the beginning would be meaningful. She didn’t know a voice from a vacuum cleaner. It was all just a lot of meaningless noise, coming at her from unidentifiable sources; I can only imagine what a strange cacophony it must have been.

For many people, the initial reaction to this sudden bombardment is, essentially, to tune everything out. None of the sounds mean anything, or contribute to the value of people’s perceptions, so none of it is useful. It’s not that newly implanted people aren’t hearing sound. It’s just that their brains aren’t yet capable of doing anything with the information. This is why we were discouraged from expecting Grace to react to noises for several weeks. She needed time to start making sense of everything, before she could noticeably respond to anything. And yet, that very same day, when we got home from Hopkins, Jason remarked that Grace turned and reacted to some loud and sudden noise.

It took some time to get used to the equipment. Grace wore a little black “backpack” with a harness to hold the processor. It took me a few months to realize that the cross straps should go in back, and the straight ones, like suspenders, down the front; up till then, I had the harness backward. Sometimes, Grace wore her processor on top of her clothes, sometimes underneath. Over the years, people thought all kinds of things – that it was a leash to keep her from running away. That she was wearing a heart monitor. That she was a hip little kid listening to her very own toddler IPod.

Her CI equipment used rechargeable batteries that lasted about one waking day. All day long we tuned ourselves in to sound with Grace, becoming suddenly far more aware of sound than we ever had been before. After a few weeks, maybe a month, I remember a day when Grace seemed terrified to “put her sound on.” In the morning, I tried, and she fought me. I was deeply uncomfortable with the idea of forcing it. I wanted her to want to listen. Otherwise, I was imposing something on her. After several attempts with my hands trembling, my internal conflict waging itself as I half-heartedly tried to Make Grace Listen, I gave up, turned off the processor, and took her to The River School for her parent-infant session. When we got there, I told Sarah, the Parent-Infant teacher, what had happened. She tried putting the CI equipment on herself. Grace cried. She put her hand up to keep the sound out, to keep the coil off. Sarah said, “Are you making a cultural choice already here, kid?” After many long, drawn out minutes of trying, we stopped, not wanting to turn it into an awful, ongoing battle for control.

When Jason got home from work, I told him what had happened. He said “Okay. Did you try switching it to a different program?” No. He switched it from “P1” to “P2”, which was a duplicate of PI, like a back-up file. He held Grace’s arms down at her sides, one of his strong arms wrapped around her, while he used the other to set the magnet in place. She squirmed and fought him. He held it on, hugging her tight to his chest. Spoke to her softly. Told her it was fine. But held her firm. Until she stopped struggling and relented.

That was the worst fight. It was extremely difficult for me to make her wear her hearing equipment. After all, this was about options, right? On the other hand, we knew how important it was for Grace to be constantly exposed to sounds.

Narrate your life

Hearing babies learn to speak via passive osmosis. It is unlike learning many other skills – tying shoes, writing the alphabet, washing your hands. Learning language just happens. I’m guessing that it might have been almost that straightforward a process with Grace, despite a lost year of auditory linguistic input to form building blocks, and despite a still significant hearing loss once her implant was activated. But at the time, we knew it was critical for us to Teach Grace English. The first strategy we were encouraged to use was to Narrate Our Lives. What this meant, basically, was to Never Shut Up in her presence. To provide her with a running commentary like a play-by-play sportscaster, on everything, as it was, as it went. Comical, exhausting, and tedious. So, pushing Grace in her stroller, I’d say: “Okay, now we are going up Up UP the hill. Listen Grace, hear the bird? Tweet tweet tweet. I feel the wind Grace. Whooo. Bump. Over the root. Ready to turn, now Grace? Ttuurrnn… Look over there Grace – a big black dog. He is barking at Pilot. Woof! Woof! Dooowwwnnnn another hill…”

I imagine our neighbors raising quizzical indulgent eyebrows at the way-over-enthusiastic new mom up the street. I didn’t care. I was going to be the best damn speech model anyone had ever heard.

They also gave us strategies for teaching Grace words and associated sounds: Boat was “puh puh puh”. Airplane was “aaAAHHHH”. A vacuum cleaner was “Eeeeeeee”. Whenever we worked with her on these words, we would say the word, while showing her a card with a picture on it, and then voice the associated sound. We were also supposed to accentuate and differentiate. So, instead of saying ‘up’ and ‘down’, which are both short, one-syllable, punch type words, we should instead make them as different-sounding as possible, by saying “up up Up UP!” and “Dooowwwwnnnnn”. Every time we climbed or descended the stairs. Every time we scaled a neighborhood hill. Every time we saw an airplane take off or land.

Another early technique we were encouraged to use was called “Sandwiching”. This required us to use two languages – the one we’d been relying on previously – sign language, and the new one – spoken English. In the beginning, the sandwich was made from two pieces of “sign” bread, with English filling in the middle. If we were saying the word more for example, we would sign more, then say it, then sign it again.  Within a short time, Grace seemed to begin to grasp the idea of spoken language as a communication tool. We were able to now say more, then sign it, then say it again. Before we really realized it was happening, we found ourselves eliminating sign language during most parts of most conversations. We might still sign key words (like “go” or “now” or “look”).

For Grace, making sense of the auditory world did not take long. Not at all. Within perhaps a month, no more than two, I got a call from Ana Maria while I was at work. When Grace had first been activated, Ana had said, “Do you want me to speak English or Spanish with her? I will do whatever you prefer. But if I speak English, it will be not so good. If I speak Spanish, it will be perfect.”

“Perfect Spanish,” we said.

That day on the phone, Ana could barely contain her excitement. She told me that she was downstairs playing with Grace, and that they were sitting on the rug, surrounded by small mountains of stuffed animals and toys. Ana said, “Oink Oink, Grace.”

Grace stood and walked straight to the stuffed Piglet, picked it up, and handed it to Ana.

She had begun, already, to attach meaning to sounds. Words meant something. Grace had learned to interpret a specific sound in a specific, meaningful way.

Soon after that, we observed Grace take another auditory step. It was spring or early summer, on a warm weekend evening, and we were sitting on the porch. Jason had just finished a beer. Absentmindedly, he puckered his lower lip along the rim of the bottle, and blew. A mellow, foghorn type noise echoed around us. Grace was watching him. He did it again. She walked to him, and leaned down over the bottle. She put her mouth to the glass, and, while blowing, voiced, “Hhheewww….” It was a perfect imitation.

When Grace was eighteen months old, we went up to the Listening Center for her six-month post-activation appointment. She had another audiogram, this time with her CI equipment on. And we were able to do a few language measures. The findings of these tests showed that she had caught up to, and in many measures was actually outperforming, her hearing peers in both receptive and expressive language. She was, by now, actually talkative. I was relying on sign language to support her comprehension less and less, and used it mostly now in the bath, and in the morning when we were first getting her out of bed and ready to start her day.

I was completely committed to providing every opportunity for Grace’s spoken language to develop. It became evident that once I started, it was hard to shut it off. In trying to provide Grace with input before she was implanted, we had spent hour after hour naming and identifying things; making eye contact while I signed to her, her eyes shifting from me, to the object or person I was referring to, to me again. We had learned to communicate with each other, and it required a great deal of physical closeness and constant mutual attention. Although she was a highly active baby, and although she walked very early, we were still very oriented toward the tactile when it came to our interactions.

So, once Grace’s CI had been activated and it was time to start teaching her a new language – the language of sound – we sort of picked up where we had left off. If she sat and played by herself, while I watched from even a short distance away, I felt as if I were missing a potential language-building opportunity. So we interacted. Constantly. I would have been exhausted but to tell the truth, I was having a lot of fun. Plus, Grace paid me back so quickly with progress that it helped keep me going. We played with noisy toys. I read her books. We went for walks. I named colors. Look Grace, a Red Car. Sign, say, sign. Then, not long after, Say, sign, say. Then, sooner than I’d imagined the day would come, just Say.

I paid the price a little bit – Grace didn’t really learn to play by herself until she was at least 4 years old. Although part of that probably is just her nature, her inclination toward social interaction when the opportunity presents itself, I am sure that part of her constant demanding of my attention was simply my conditioning her in that direction during the first two years of her life – first, as a signing deaf baby, and then, as a newly implanted deaf toddler.

The lasting impact of this ongoing attention echoed for a long time. In the car, on walks, at dinner-time, during random periods of silence. The refrain, now coming often in stereo as her little sister has learned to echo it and sometimes ask on her own: Tell me a story, mama.

Tell me a story, mama, on the way home from school.

Tell me a story, mama, on the evening walk through Mount Pleasant with the dog.

Fill the air with words, mama. Give my brain some sound to puzzle over, marvel at, employ for entertainment. Satisfy my curiosity. Feed my insatiable need for input and interaction. For language.

There were three kinds of stories: Movie stories (that is, I would tell the story of a movie they knew, like Princess Bride or Finding Nemo or Return of the Jedi). The movie stories were good because I didn’t have to think so hard when I told them, and because often I could just pick up where I left off the last time. Then there were stories About Things That Really Happened (like how I taught my youngest brother how to ride a bike, or how my grandparents’ pet bird pooped in my dad’s eggs the first time he went to their house, or about the night Kali was born). And finally, there were the ultimate stories: the Made Up Stories. These were the girls’ favorites. These were exhausting.

Jason, thank goodness, came up with a way to minimize story time in the car on the way to and from school. One morning, when Grace asked him to Tell A Story he said, “I will, when we get to Fiona’s castle.” Fiona’s castle is the National Cathedral, and is a visible, favorite landmark located almost exactly half way between school and home. By the time Grace was three or four, she knew to preface her request by saying “Mama. When we get to Fiona’s castle, can you tell me a story?”

And Kali, not long after, would say, when we got there, “Mama, look! Fo-eena’s Castle! Can you tell me a story now?”

I guess it kept me limber. Grace wouldn’t often let me off the hook when I’d say, “My brain is too tired for stories.” Or, “Not today Grace.” Or, “Can we listen to music instead? How about Hallelujah or Padme’s Favorite Song?” Or “What’s a story?”

There were other interactive time-fillers I learned I could sometimes get her to agree to instead; slightly less brain-draining ones. “Can you kid me?” she’d sometimes ask, when I’d tell her no more stories. This meant I might start a little game of “Hey, it’s too bad it’s raining outside.” And she’d say, “Nahh!! It’s sunny!” Or, I’d say, “Bo Bou Bant Be Bo Balk Bike Bis?”

Another game was “What movie is it from?” We’d take turns; one of us coming up with a line from a movie and then the other guessing the movie, and the character who said it. Grace was way too good at this. Because, and believe me the irony is not lost on me, ever, when I say this: Grace has an audiological memory. It is not perfect. But it is close.

She learned new negotiating skills to keep me talking. Like, she’d say, “Okay mom, if you choose the hand that’s making a 2, you have to tell me a story. If you choose the hand that’s making a 5, you have to play What Movie Is it From? Those are your two choices. Which hand do you choose?” “I choose Quiet Time,” I say softly. I choose not to play.

“Nope, mom. Not a choice.”

I got caught on a videotape of one of our bi-annual sessions, as part of a longitudinal research study at Hopkins on kids’ progress after implantation, saying to Jill, as a sort of aside, who is holding the camera, while Grace’s running-monologue is continuing beyond the set five-minute session time, “She. Never. Stops. Talking. It’s like this all day. Even at night, in her bed, with her equipment off, we can hear her in bed. Talk talk talk. Chat chat chat…”

In this session, she is just two years old.