TONY Parker, dressed in a disposable apron over navy blue scrubs, makes a precise incision behind Jennifer's right ear. This marks one of the first steps in a modern miracle the former Wallaby estimates he's performed 600 times in the past two decades.
Jennifer Borowsky is under general anaesthetic for the first time in her life on a Brisbane operating table because, at 29, she's decided to do something about her diminishing hearing she once tried to hide.
After 'a couple of years' considering this decision and a startling 25 decibel drop in the mid-frequency sounds she is able to hear, Jennifer is out cold under drapes in the Mater Private Hospital with the mastoid section of her skull exposed. Within two hours she will be stitched up and will have a cochlear implant embedded in her head.
The procedure is expensive and there is, according to her surgeon, a 20 per cent risk that she will completely lose all hearing in her right ear.
Although she can now only really hear low-frequency sounds, like traffic, it's not something she wants to lose completely, hence her decision to not have implants in both ears at once.
If she keeps her residual hearing, Jennifer says she will consider also getting her left ear done.
"I had weighed up the pros and cons including whether I was going to lose my residual hearing. I decided to go ahead with it," Jennifer says.
"There were risks involved with the operation, but, they were reasonably low for the operation that it is."
When it comes to understanding the risks, Jennifer is miles ahead of the layperson. This affable, board-game-loving woman has been a doctor since the age of 22 and is now part of the Anatomical Pathology training program and well on her way towards becoming a pathologist.
Jennifer knows her well-decorated surgeon is working on some very sensitive areas of her anatomy and small mistakes can cost her more than just her residual hearing.
"During the surgery we need to keep an eye on the facial nerve as that is one of the major structures that runs through the mastoid cavity and can be damaged," says Tony, who has inserted devices in patients as old as 92 and as young as four months.
"In saying that, I hope to go to my grave without having damaged one."
Under a blazing surgical light, he creates a recess in Jennifer's skull for the body of the implant to sit, and threads the array of electrodes into the inner ear. As the anaesthetic slowly wears off, Jennifer awakens, slightly groggy, to find a pressure bandage wrapped around her head. The device will not be switched on until the tissue swelling subsides in a few weeks.
Dealing with the impairment
Jennifer was 17, and living in New Zealand, when she was first diagnosed with a hearing impairment.
"We went to an audiologist because I was working at a toy store and I couldn't hear the alarm that was in the manager's office which he used to indicate to the staff on the floor that he needed something done," she explains.
"We did the audiogram and it showed profound hearing loss in the high frequencies. I also had some mild to moderate hearing loss in the mid frequencies and my low frequencies were normal. So we called that a ski slope hearing loss."
Initially, she was reluctant to wear hearing aids and she did not share news of her hearing impairment with others.
It was during this "non-disclosing" period she met her husband-to-be, Dylan Flaws.
"She was still quite afraid to talk about it," he says. "It took a while for her to really talk openly about it."
Dylan, also a doctor, says Jennifer's hearing impairment changed his behaviour.
"I became more aware of background noise than I normally am because I need to modify the way that I speak. Like, if a truck goes by I will pause for a second, let it go and then continue talking. I think about if she's turning away from me or if I'm covering my mouth with my hand."
They learned the radio alphabet together so they could spell out names and ambiguous words that can't be guessed from the context.
Gradually, Jennifer became comfortable disclosing her impairment with others.
Former workmate and anatomical registrar Sarah Sim says Jennifer was always upfront with her.
"At the very beginning when she introduced herself she said, 'look I have a hearing impairment, if I don't reply to any of your questions it's not that I'm ignoring you, it's just that I can't hear you so you might have to repeat yourself'. And I think ever since then, it's not really been a problem because when you interact with her, I just make sure that I'm standing right in front of her so that she can see what I'm saying," Sarah says. "And she lip reads a lot so I just make sure I articulate my words a bit more than I usually would."
But, Jennifer could no longer ignore her fading hearing and she made an appointment at the Mater cochlear Implant Clinic.
"Basically, even with hearing aids, the testing determined that I understood about 18 per cent of words in my right ear … but I think it's 86 per cent of sentences. So my brain's over time - because I've probably had a hearing impairment for a long time, most likely since birth - my brain's learned to fill in the gaps," Jennifer says.
"I think that made me realise how bad my hearing impairment was."
The Australian-developed cochlear implant was first successfully inserted into a man named Rod Saunders' head in 1978 after being funded by a Channel Ten telethon.
The implanted part of the device contains a receiver and a stimulator with 22 electrodes.
This pairs with a speech processor that magnetically snaps to the back of the user's head and sends electrical signals back to the implant.
The device's electrodes then stimulate the hearing nerve to create the sensation of hearing.
Lisa Goode, an audiologist working at the Mater, says this sensation is much different to how most people hear.
"In a normal hearing system sound comes in, it hits the ear drum, it starts a vibration, that gets carried on to the inner ear," the audiologist says, seated at her cable-covered desk.
"With this, what happens is the sound comes in, this device takes that sound and changes it from acoustic energy to electrical pulses or current which then stimulates the cochlear and the hearing nerve.
"So it's not a natural way of hearing and, probably, that's why people say it sounds chipmunky or robotic."
Making the switch
Jennifer has watched her fair share of inspirational cochlear implant videos on YouTube, but she is under no illusions ahead of having the device switched on.
"It's going to sound like robots or chipmunks on helium or whatever people have said," Jennifer says. "I think it will sound like that initially. I'm hoping I'll immediately hear some sounds that I haven't heard before.
"I don't remember ever hearing sparrows or other birds... That's definitely something I'm looking forward to and I hope they don't sound too horrible."
Dylan knows there may be some teething issues after switch-on.
"We've been warned about a few little things that can happen - a few little sounds that might start to really irritate you like the sound of shuffling paper," he says. "I've tried to go in as an empty slate."
After several weeks of waiting, she was anxious to finally have the device switched on and get the upper hand on her hearing.
"Switch-on" is Lisa's favourite part of her job as an audiologist.
"(It's) so satisfying to be involved in something that really changes people's lives for the better," she explains.
"She'll actually hear sound through the implant for the first time today.
"We do that by taking a few measurements of levels of current needed for her to get a sound sensation and then when we have a basic program we'll turn it on. And she'll hear whatever sound is in the room."
This is the moment Jennifer has been waiting for. A door to a new world immediately opens.
"It's just amazing how much of your speech has something that my (left) ear can't hear," she tells the audiologist excitedly.
"The speech is not sharper, I think that's going to take time.
"Like, every single syllable has something. I was expecting it to be just certain parts of a word."
Jennifer and Dylan head outside to the busy main road to ensure the newly created program is not going to irritate her once she leaves the audiologist's quiet office. A look of wonderment appears on her face as she explores the urban landscape.
"When I first got the cochlear implant it sounded very, very strange and it took quite some time to get used to it and I have to say it sounds perfectly fine to me now," Jennifer says some months after switch-on.
Dylan says his wife now hears the calls of birds and she can hold a conversation in the car.
"And there were a couple of other times when she heard a sound and would say 'what is that?' and it would be something that I hear and tune out, something like the sound of the refrigerator or an alarm or something like that," he says.
"I noticed that she answered the phone more often even if she was downstairs. Or she would reply to me when I was in a situation where normally she wouldn't have heard me."
Jennifer's word recognition for her right ear just before the three month mark was the same as it was for her using hearing aids before the operation, but she is hopeful this will improve over time.
"I have to admit that, of course because I'm expecting the miracle, it was a bit of a disappointment. It would have been nice to go from 30 per cent to 70 per cent word recognition, but I think I have to take a step back and go easy on myself," she says.
"I have another assessment in October and, to be honest, I'm enjoying the cochlear implant.
"I would enjoy to have a statistical improvement as well, but even if there isn't a statistical improvement I'll live with that."
But, Jennifer will not be rushing out to get an implant in her left ear.
She was, unfortunately, one of the 20 per cent that lose their residual hearing as a result of the surgery.
"I would probably think about it differently if I hadn't lost my residual hearing in my right ear," she explains.
"But the way I see it, I've lost it on my right so there is something to lose."
She now mentors young deaf people through the Hear For You organisation where she encourages them to view their deafness as a difference rather than a disadvantage.
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