A sense of purpose

From: Fresno Bee, CA - Oct 12, 2003

Cochlear implant: a tiny device with huge implications for the deaf. For one Fresno father, it may be the bridge to his hearing kids' world.

By Don Mayhew
(Published Sunday, October 12, 2003, 5:45 AM)

First thing in the morning, Jimmy Bronson wakes up and heads to the fridge for a canned cappuccino and a glass of water.

During the school year, when he teaches at Fresno's Hoover High School, he often follows that with fruit and cereal. His family still asleep, he uses the quiet of daybreak to read the Bible as he eats.

His 2-year-old son, A.J., usually is next to awaken. Jimmy gets him milk. Then A.J. and his infant sister, Courtney, spend the next hour or so cuddling in bed with their mother, Michelle.

Jimmy brushes his teeth, showers, dresses and leaves the house.

It's a life so ordinary it would be easy to miss what happens next. Jimmy takes a brown electronic device attached to what looks like a tiny steering wheel and wraps it around his right ear. He presses the inch-wide wheel against his brown hair, just behind and above the ear.

There it sticks, held in place by a magnet inside Jimmy's head.

Jimmy, who is deaf, had cochlear implant surgery more than a year ago. Inside his skull is not only the magnet but a microprocessor that simulates the sounds captured by the exterior device.

Deciding whether to have surgery was difficult, because implants don't cure deafness.

But in combination with lip reading, the implant goes a long way to help Jimmy decipher others' speech. Although Michelle also is deaf, the children hear. Like any toddler, A.J. has begun to talk. A lot.

Jimmy hopes the implant will open doors otherwise closed to him. He might like to write books someday. He wants to talk on the phone -- and understand what's being said on the other end of the line.

More importantly, he wants to hear every new word his children utter.

Given the kinds of sacrifices we all make for our loved ones, implant surgery may not sound like much. The procedure itself is relatively safe and rarely has lasting side effects.

So becoming an implant user isn't taking a bullet or giving up a kidney. But for a proud deaf man like Jimmy, it challenged assumptions about his identity in ways he had never before contemplated.

First thing in the morning, Jimmy doesn't hear anything softer than a kitchen cupboard thumping shut. He says it's like standing in a dark room at night, with only the outlines of objects visible.

Wearing his implant is like flipping a light switch. Sometimes the results are illuminating. Other times, they're a little harsh and take some getting used to.

When they were children, Jimmy and Michelle Bronson were voracious readers. Both grew up educated orally, with an emphasis on speech and lip reading, often in mainstream classrooms with the help of interpreters.

But Jimmy, 31, lived in San Jose with parents and a sister who were deaf. Michelle, 30, grew up in a hearing Clovis family. After A.J. was born, Jimmy had to learn to be quiet so he wouldn't waken the child. He'd never permanently lived with a hearing person.

Jimmy understood some speech even without hearing aids until age 4. In stages, his hearing went quiet, until it leveled off at age 7.

Jimmy's mother, Ellen, is profoundly deaf, so she signed to him. His father, Jim, has more hearing and often spoke to Jimmy instead of signing.

The combination helped Jimmy adjust to school. He attended preschool alongside hearing and deaf students. In elementary school, he split time between deaf and regular classrooms. By fifth grade, he spent all day in ordinary classes.

"My father doesn't subscribe to the deaf-community theory that deafness is cause for celebration," Jimmy says. "He wanted to make sure I was doing all right. When he saw how much I was reading and understanding things, he didn't worry quite so much."

Jimmy attended San Jose's Leigh High School, which had a program much like the one at Hoover, where he teaches deaf students today. Jimmy spent the last two years of high school in regular classrooms, using interpreters.

The first day of his junior year, "I came home with very tired eyes," Jimmy says. "I wasn't used to watching an interpreter all day. It took some getting used to."

Michelle's childhood also was one of accommodation and adjustment. By the time she was 2, her parents suspected she was deaf. Her mother, Karen Balske, says her daughter "was doing wonderful on everything not verbal."

Michelle's father, Ron Balske, was a Marine. Stationed in Japan, Ron decided to learn sign language. The instructor was from Texas. When Ron returned to the United States and his family, they discovered he and Michelle couldn't understand one another because of regional variations in sign language.

Shortly after moving to Clovis, the family began attending sign classes together at Norseman Elementary School in Fresno to communicate better with one another. By second grade, Michelle was attending her neighborhood school, Miramonte, and using an interpreter.

Karen Balske says, "They asked us if we wanted to educate her orally or sign. We said, 'No, both.' "

Michelle also worked privately with a speech therapist from third through eighth grades. Mother and daughter remember many long days filled with hard work. Michelle didn't relish them, but she's grateful now that her parents pushed her.

Middle school was difficult. As social circles intensified and adolescence beckoned, Michelle found herself embarrassed by her deafness. Kids made fun of her.

"My friends started to listen to music," Michelle says. "I couldn't."

At Clovis High School, Michelle found only a couple of other deaf students -- and they were two years older, busy running around with their own friends.

Like many deaf teens, Michelle felt isolated, part of neither the hearing nor the deaf worlds. She didn't fully accept her deafness until she was 21 and attending California State University, Fresno, surrounded by bright, industrious deaf people.

The first time Jimmy laid eyes on Michelle, he sat in the grandstands during Clovis High's 1991 graduation ceremony as she awaited her diploma. Jimmy was there because his cousin also was graduating.

Amid a sea of robes, Michelle was easy to spot. She was the one turned away from the speakers on the stage, gazing at her interpreter.

It was hardly love at first sight.

Jimmy, then studying at California State University, Northridge, didn't understand why a deaf girl would choose Clovis High over a perfectly good program for deaf students at Roosevelt in Fresno.

"I thought she was very hearing-minded," Jimmy says.

He didn't see her again until five years later, in Oregon at a National Association for the Deaf conference. In the meantime, Michelle had accepted her deafness, and Jimmy had started to loosen his definition of what it meant to be deaf.

His first words to Michelle in Portland were, "Did you graduate from Clovis High School in 1991?"

Michelle was taken aback. Who was this man? A stalker?

The deaf community is so close-knit that it's normal, when one deaf person meets another, for a social connection to already exist. An aunt of one, say, will have taught the cousin of another.

Michelle grew up outside all that. Suspicious, she asked, "How did you know?"

Jimmy explained about his cousin. Sparks flew.

"We started talking naturally, and I'd never had that happen," Jimmy says, "even with my parents."

They sat together at the convention banquet. Jimmy hadn't planned to go. He secretly ran out and bought a ticket. Afterward, during an Independence Day fireworks display, Jimmy cracked a joke.

"She laughed a long time and put her hand on my shoulder," Jimmy says. He knew then she was interested.

After marrying at the end of 1997, Jimmy and Michelle were regulars at local deaf social events. Now they're homebodies. Weekend trips out of town, once common, are rare.

Clearly, A.J.'s arrival changed the Bronsons' lives.

After A.J. was born, Michelle asked Jimmy whether he would support her decision to get a cochlear implant. He said yes, but that he wouldn't want one himself.

By the time A.J. was 6 months old, Jimmy had changed his mind.

Infants and toddlers are notoriously difficult to lip-read. They mumble. They mispronounce. Their voices are tiny and high-pitched, making them difficult for people with even slight hearing loss to understand.

Jimmy says, "The way my mind works, if I hear something that doesn't fit in with what I know, it doesn't even stay in my head.

"After A.J. was born, Michelle said she wanted an implant."

For the first time, "that made sense to me."

It was not a revelation that struck lightly. Cochlear implants are controversial among some deaf people, who perceive the devices as a threat that may one day eradicate deaf cultural touchstones, such as sign language.

Any cranial surgery is not without risk. Because implant surgeons are working near nerves that control facial movements, there's a small chance of numbness or paralysis in the face and neck.

So the Bronsons' decision was emotional as well as practical. They knew they risked being ostracized. When they decided two years ago to have implant surgery together, they kept it quiet. They told only family members and friends who had implants themselves.

The Bronsons didn't want to be bothered with people trying to change their minds.

Jimmy understands their objections. Before A.J., an implant would have been unthinkable. For some deaf people, it's an identity issue, akin to a black person wishing he or she were white.

"I used to look at implants as a bad thing," Jimmy says. "My question was always, 'Why aren't you happy being deaf?' "

But Michelle has always felt differently, and that rubbed off on her husband.

"Deafness is like having brown hair," Michelle says. "It's a physical characteristic. It's not who you are."

Besides, Jimmy says, "I'm still going to be deaf. You don't stop signing just because you have this."

You also don't stop being yourself. In Jimmy's case, a passion for precision makes him a good candidate for an implant.

Erick Posner of Visalia, a deaf college roommate from Northridge days, remembers buying a 32-cent stamp from Jimmy and handing him 35 cents. Jimmy insisted on giving back three cents, even after Posner said he didn't want it. Someone like that is likely to find an implant valuable.

Michelle says her husband doesn't like gossip or hearsay.

"Jimmy does not like partial information," she says. "He doesn't like to speculate or hypothesize."

In many situations, an implant will get him information more directly.

"With interpreters, it's almost like hearing it from a third party," Michelle says. "Some interpreters are excellent. But there are others who are not so skilled. When that happens, he's very worried. What's he missing?"

Like most kids in deaf households, A.J. quickly learned to wave or tap on his parents' legs to get attention. He's not shy about tugging on an arm, if that's what it takes.

But at 15 months old, A.J. had picked up only two signs, for "what?" and "fan."

When he was a baby, Michelle says, "he watched us signing and was fascinated by it. You could tell. But he would not do it. So I'm following his preference. He's naturally auditory."

One sunny spring day, he wandered through the Bronsons' living room, playing with toys and investigating the contents of a cardboard box sitting on the floor. A red steer was imprinted on one side.

He walked up, sat down and said, "Moo."

Told of this, Michelle put one hand over her heart and said, "That's why I want to hear. I want to catch the little things like that."

Moments later, Jimmy took A.J. outside to the backyard patio, where a wind chime tinkled in the wind. He picked up his child and lifted him to the chimes. A.J. reached out.

"What do you hear?" his father asked.

The Bronsons carefully weighed their options, agonized a little and made a momentous choice to have implant surgery together.

Then life threw a curve their way. Michelle discovered she was pregnant and would have to postpone the procedure. Jimmy considered putting it off, too, until after the baby was born.

But with two kids in diapers, the days and nights topsy-turvy, the last thing the Bronsons needed was to be recovering from surgery at the same time.

Jimmy decided to go ahead as planned. Michelle figured she would still benefit by following her husband through surgery and auditory programming.

At the same time, the Bronsons struggled with another decision: to find a new church. They'd attended the deaf church at Evangelical Free Fellowship for many years. Its pastor was the man who married them.

But A.J.'s arrival gave them pause. When he was a baby, Michelle often stayed home while Jimmy went on a religious reconnaissance mission, returning to report on the day's sermon. It would take but a minute or two.

The Bronsons realized the services didn't cover much ground. Deaf children often fall behind their hearing counterparts in school and never catch up. Many never move beyond doing schoolwork at the fourth-grade level. The learning deficit follows many deaf people into adulthood. So to be understood by everyone in his congregation, the deaf pastor carefully explains everything.

"If he uses the word 'widow,' " Jimmy says, "he must stop to explain that that is a woman whose husband has died."

The Bronsons had misgivings about moving to another church. But they also wanted what was best for their son.

Michelle says, "With children, it's important to make an emotional connection first to religion. If it's not fun, he's not going to be interested. We want him eager to go."

After batting around a couple of ideas, the Bronsons settled on Clovis Hills Community Church. Signing interpreters and age-specific child care already were in place.

They also searched for a way to bow out of the deaf congregation gracefully. They made a plan. First, they'd tell the deaf congregation one Sunday that Michelle was expecting. Then they'd mention they were leaving the church. Then they'd tell everyone about the cochlear implant.

When they did, several people came up after services to congratulate them on the new baby. A couple asked about the new church. Nobody mentioned the surgery.

Jimmy is not prone to outbursts. Posner describes him as a mensch, Hebrew for an honorable, dependable man.

Still, there's something about someone -- even a highly trained, experienced surgeon -- drilling a hole through your skull that will make even the calmest of people a little jittery.

On a gurney inside the Stanford University Medical Center, June 6, 2002, Jimmy is wrapped in a white gown. A hairnet, so thin it's almost transparent, is pulled down over his dark hair.

Surgery is scheduled for 7:30 a.m. Jimmy has been up since before dawn.

Anesthesiologist Michael Champeau walks in and introduces himself. He asks if there are any questions.

Jimmy doesn't bat an eye: "What are my chances of dying?"

Champeau has an answer ready: "Less than the chances of you dying while driving here."

The exchange is so matter-of-fact that it's only later, when Champeau relates the conversation in the operating room with Jimmy unconscious, that it becomes clear the doctor was taken aback.

"At least you know what's on his mind," Champeau says.

As the anesthetic takes hold, an operating room nurse named Jill Fisher loosens Jimmy's gown.

"You're not going to do the wrong ear, are you?" Jimmy asks.

She laughs: "No, no, we have it marked."

Reassured, Jimmy removes the hearing aid from his left ear and plops it into a turquoise plastic container.

By the time surgery officially has begun, Jimmy is unrecognizable, strapped on his left side to the operating table, eyes taped shut. He's sheathed in layers of blue cloth and sheets of plastic. Tubes, wires, cuffs and suction cups monitor his breathing, blood pressure and oxygen intake.

The surgery site behind his ear is shaved. Tiny drops of blood slowly ooze from a nick. The area is sterilized.

Nurse Fisher reminds everyone they're operating on the right ear. Surgeon Joseph Roberson removes the tag from behind it.

Bronson's head is wrapped in blue cloth, leaving a trapezoid less than a square foot exposed. A transparent yellow film is applied to the area.

A microscope attached to a long, overhead metal arm and wrapped in clear plastic is stretched across the room and over Jimmy's head. Roberson will use it nearly the entire procedure.

The incision is made, and a clamp holds it open. Lower layers of Jimmy's scalp are exposed and scraped away with a thin, flat tool. Roberson works to open the incision over Jimmy's ear as well as behind it. Though not perfectly round, it's about the size of a golf ball.

Once Jimmy's skull is exposed, Roberson begins drilling. Imagine a dentist's drill, except higher-pitched. Some of the powdery skull debris is sucked away with the blood. The rest softly floats, barely visible, from the back of Jimmy's head to the floor.

Roberson carefully burrows into the skull. The canal is sort of cone-shaped, wide as a pinky finger and narrowing to a hole as narrow as the tip of a pen. That's where the cochlea will be seen through the microscope.

While the implant is about a half-inch long and shaped like an 8, only two wires that tail away from it will be inserted inside the skull. The figure 8 contains a magnet that will keep the exterior component attached to Jimmy's head.

That part contains a microphone and a miniature computer that converts sound waves into radio signals. The implant takes those radio signals and converts them into electrical impulses that stimulate the cochlea, imitating sound.

This process mimics the way the cochlea operates in people who hear normally. An ordinary cochlea converts sounds from mechanical vibrations into electrical signals, which are carried to the brain by the auditory nerve.

A video monitor in the operating room shows everyone what Roberson is seeing through the microscope. Once he's done drilling through the skull, he uses the drill to create a pocket nearby in which the device itself will sit. Roberson measures the pocket with a metal key to make sure it's the right size.

The implant will be sutured to the bone, which eventually will grow back, around the device.

It's placed into the skull pocket, sutured, then the wires are inserted through the hole inside Jimmy's skull and along the cochlea, which is snail-shaped. Once inside, a thin sheath is pulled from wires, so they will follow the cochlea's curl.

Putting the wires in place often temporarily affects the patient's equilibrium, so the more delicately this is carried out, the better. Jimmy later will experience vertigo, on and off, for several weeks. The tip of his right ear will remain numb for a couple of months.

With everything in place, he's sewn up and bandages are applied to his head.

The incisions are smaller than they used to be. Technology, too, has improved. Early devices had one electrode, or channel, on the wire that runs along the cochlea. Today's have 22. To make a crude analogy, think of the transistor radios teens carried around in the 1960s and compare them to today's boomboxes.

Programming also has improved, adding nuance to the electronic dance the implants perform along the cochlea.

The surgery itself has gotten faster. Roberson says the first one he did took nearly six hours.

Champeau says, "When I first began doing these surgeries nine years ago, it was a semi-all-day ordeal."

Jimmy's procedure took less than 75 minutes.

But perhaps most amazing is the sight of Jimmy, a couple hours later, not only up and moving but leaving the hospital for his parents' house, back in time for lunch.

A.J. is a little freaked out by the bandage arund his father's head, but he gets over it soon enough.

Jimmy is groggy but coherent, happy to report that he doesn't have any facial paralysis: "I can wiggle my ears."

The reporter can be reached at dmayhew@fresnobee.com or 441-6322.

© 2003, The Fresno Bee