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The Sounds of Silence
John G. Spangler, MD, MPH
(Reprinted) JAMA, June 6, 2007—Vol 297, No. 21
From beneath the kitchen table, I see its four stout posts squaring off jaunty chair legs like a picket fence enclosing me in a snug fort. There are several pairs of feet. I see my mother’s red shoes. Ah, there is her voice. The underside of the table is gray-black, just a shade past a dusky sky, and chrome hugs the under-edge, like a perfect bead of caulk around the rim. Shadows gather in the kitchen. It must be late afternoon, after naps. I feel hidden and secure.
This is my earliest childhood memory, cozy, familiar, and coupled with sounds I can still hear if I concentrate. This is a memory of light contrasting with darkness, and household sounds were accepted without thought. The television. Street noises. Squabbling siblings.
My childhood memories are dim, but I can always recreate the sounds: Rice Krispies in a bowl of ice-cold milk. Skipping stones at the lake. Marsh mud slurping around my feet. Chattering and singing birds in our woods. The distinct sounds of both my mother’s and my father’s cars as they pulled into the garage. The scraping of the garage door being manually opened. The grating of a snow shovel on the sidewalk. The voice of each brother and sister and parent: In my mind I can hear how each of their voices would sound if they read this sentence aloud.
Childhood vacations were full of sounds. Each summer we rented a house at Myrtle Beach, back before central air conditioning was installed in every cottage. All of the screened windows were opened wide, letting in a salty damp breeze that clung to my skin like sticky cotton candy, with a hint of sulfur from the marsh and dried fish and crabs. During the day, seagulls screeched and cackled. At night I could hear the rhythmic surf, and although the first night it usually kept me awake, it was a comforting sound. The following nights, as I listened to the waves, I would recall the day spent in the water, floating up and down with each swell, and remarkably, with each wave crash at night, I felt my body float as if I were still bobbing up in the water. Somehow the waves hushed other sounds, reminding me of the “Shush” of my mother as she comforted me, helping me drift off to sleep.
Memories of sound became more consolidated as I grew older. My next oldest brother, Tom—with whom I shared a bedroom and a love-hate relationship—and I alternately played and fought. I can still see his angry face (we teased him about the bulging vein running diagonally down the middle of his forehead) and hear him say, “I’m going to bust you one!” That meant he was about to hit me. We also called it frogging, which was a fist punch with the middle finger hyperflexed so that it bent outward like a church steeple, causing more concentrated pain to the receiving target. I also remember when, in my own anger, I threw sand in Tom’s mouth and can still hear him gagging as he tried to spit it out. This memory makes me very sad.
My favorite sounds? Birds. Chickadees behind our house with their song “Chick-a-dee-dee-dee.” Or the towhee, whose song sounds exactly like its name: “Tow-HEE.” The mourning dove had a lonesome song, “Coah-cooo-cooo-cooo.” From around a crowded bird feeder on snowy days, the sounds ricocheted in joyous cacophony.
As a kid I listened to the radio and can still hear the jingle that woke me each morning: “Thirteen twenty, WCOG, All American!” My memories of the Beatles span from “I Want to Hold Your Hand” through “Hey, Jude.” I had memorized the words to all the songs on “the White Album” and remember hearing the disk jockeys play one song backward, which everyone swore sounded like “Paul is dead, Paul is dead.” It did not really sound like that to me. The radio was always on in the car and in my bedroom. I could sing all the lyrics to the Top Twenty. On the way to afternoon swim practice (I swam year round), I remember all of us belting out, “Knock three times on the ceiling if you want me” and “Dead skunk in the middle of the road, dead skunk in the middle of the road.” How about “I’m hooked on a feeling”? Or “Tie a yellow ribbon ’round the old oak tree”? Or “ . . . and she’s buying a stairway to heaven . . . ”? I know most of the Rolling Stones tunes if not lyrics. What was the name of their yellow album, the one with a tongue sticking out on its cover? If one is of a certain age, the album jackets, lyrics, and melodies still stick. I can hear them right now.
I also loved classical music, a world far from the music my teenaged friends listened to. My mother introduced me to this mesmerizing world thick with German. The very first symphony I heard was Beethoven’s Symphony No. 9. It was a rainy afternoon and I was about 10. The album was scratched because it was so old, but that did not lessen the pleasure it gave. Mymom had been in a thousand-voice chorale that performed this symphony in college, and she sang the German lyrics as the symphony climaxed, tears in her eyes. She also introduced me to Mozart, Bach, and Vivaldi. The Four Seasons remains a favorite.
One cannot forget childhood friends either. I can hear the voices in my mind of Ned, Jeff, Brian, Dan, and Brad. Dan had the habit of making up nicknames. Ned was “Nudson.” Jeff, somehow, became “Hershey Taug,” later shortened to “Taug.” Brian was “Brutey,” a joke because he was so small at the time (a brute, get it?). Dan called himself “Dang- EEEE,” emphasis on “eeeee.” My nickname was Sponge, I think because one night at church youth group I ate everyone’s leftover sponge cake. At first it was “Moldy Sponge Cake,” shorthanded to simply “Sponge.” I can hear each of these names said by each friend, as if we were standing in a circle greeting each other all over again.
Nighttime noises were a constant of spring, summer, and fall. My childhood home still is surrounded by woods, and there is a lake across the street so cicadas’, crickets’ and bullfrogs’ songs were omnipresent if not deafening.
Today, there are the exquisite sounds of my wife’s and children’s voices and household sounds like the water rushing through the pipes when someone is taking a shower. The front door needs extra force to close: SLAM! The garage door has an automatic opener: VMMMMMMM. The central vacuum system has a very loud WEEEEEEEEEEENNNNN. The chickadees still visit the bird feeder, and towhees nested last year in a bush behind our house.
But the sounds are growing slowly, inexorably more faint. I have hereditary hearing loss, almost certainly autosomal dominant: my maternal grandmother, my mother, my sister, one brother, and a maternal first cousin all have hearing loss bad enough to require hearing aids. Unfortunately, our hearing loss is, as my audiologist describes it, a cookie bite: worst in the central frequencies, which happen to include the frequencies of speech.
This year I bought, and mostly wear, hearing aids, especially in situations like meetings and when watching movies and television. This year was also a benchmark: I can no longer hear one of my favorite sounds of growing up: rain hitting the roof while I lay in bed going to sleep. I have to bend down to hear my 7-year-old daughter speak and cannot understand her at all when she whispers to me.
Fortunately, in the silence of the examination room, I can still hear my patients. I sit very close to them and wear my aids. With an amplified stethoscope, I can still hear regular rate and rhythm without murmurs, rubs, or gallops. Lungs are still clear to auscultation and percussion. And normal bowel sounds are present in all four quadrants. I frequently hear carotid bruits missed by my colleagues. In short, I am not limited in my job.
Not yet.
Over the years I watched as my grandmother withdrew socially as her hearing loss worsened. She sat patiently at the Thanksgiving table, missing all conversation, a passive smile on her face. My mother, even with aids, misses much. My sister refuses to wear her aids and telephone conversations with her are frustrating. My audiologist has been very patient and reassures me that if things get very bad, cochlear implants are now available. Right now, though, she is very happy with my aided hearing. So am I.
What does the future hold? Avoiding the telephone? Social withdrawal?
I don’t really know, but today, at least, I feel blessed and content. The tinnitus that I hear in place of background noise combines pure high notes sung by seamless angelic voices. I can single out each flawless tone. Like praise and adoration, they lead me in prayer as I lie quietly at night falling asleep. Is this what Simon and Garfunkel sang about so plaintively in my youth? Is this my way of listening to “the sound of silence”? |