As I sat across the table from one of my favorite patients - a blue-collar worker in his early 40's with noise-induced hearing loss after his 4-year stint in the military, deployed to Iraq - a hard worker, strong and handsome, I noticed something different about him. His speech was different - like his tongue was thick. Drew, I'll call him, wasn't slurring per se, just a slight difference in voice quality. "Have you had some work done on your teeth recently? " I asked. "No," he said, "My voice has just been a little weird the last couple weeks. I think I just caught a cold." I kicked into a scientist-investigator mode. "Have you had any pain in your ears? Any pressure feelings? Tinnitus or balance disturbance?" His answers were all negative - except to the last question. "I'm not spinning or anything, but my feet feel heavy lately like my muscles don't respond as quickly. I've been tripping a lot." Alarm bells started going off in my head. "Any change in how you're understanding speech?" I asked. "Yeah," he said, "that's why I'm here. All of a sudden, I feel like nothing's clear; like everything is getting jumbled together. I can hear okay with my hearing aids, I just can't understand." I knew at that point that I'd be referring him on but into the hearing test booth we went.
The first tests gave me an idea of what we were dealing with - tympanometry: normal, ipsilateral and contralateral acoustic reflexes: completely absent. Reflexes had been completely present except in the extreme high frequencies the year before. This told me we were likely looking at something neurological. Pure-tone thresholds were stable. Word recognition in quiet was only slightly poorer but speech-in-noise was absolutely horrendous. In a 1 year span of time, Drew's ability to understand speech in noise went from a mild deficit to completely obliterated. What the heck happened??
I counseled Drew on managing his surroundings and discussed the possibility of assistive listening devices. But first, I wanted him to see a neurologist. He thought that was overkill. I insisted and made him promise he would strongly consider it. I told him I'd check in on him in a few weeks.
I didn't have to check in on Drew. In 2 weeks, he was back in my office. His speech was noticeably more slurred and his eyelids were droopy. When he walked he looked as if he was carrying an extra 200 pounds. The sleek stallion had become a loping gorilla. "What's going on?" I asked, more than a little alarmed at the change in such a short time. "Doc, I can't understand a thing. I need some help!" he pleaded. I set him up with a pair of newer technology demo hearing aids with a companion mic to borrow. These were more hands-free, something he didn't require 3 years ago when he first got his hearing aids. "Have you seen your doctor?" I asked. "Yeah," he said, "MRI tomorrow." There was sadness in his eyes. He and I both knew something was terribly wrong. "Will you call me and let me know the results?" I asked. "Sure," he said. "Thanks for caring. Your'e the bestest."
Two weeks had passed and I hadn't heard from Drew. I hadn't called because I knew he was scheduled to check back with me that day. When he arrived at his appointment, I was there to greet him. He walked in with his wife, Sherry, who I'd never met before. He was using a cane and she held on to his left arm. He looked as if he'd aged 20 years. "Come in, sit down. Tell me what's going on." I directed.
Sherry was the one to speak first. "Drew has been to a slew of doctors in the past 2 weeks." She stopped talking as her voice got choked in her throat. Tears filled her eyes. I was trying to hold it together. "I have ALS and its progressing fast." Drew stated matter-of-factly. I was in shock. How could this be? But the proof was in front of me. This virile man had been reduced to weakness in the span of 1 month and the sadness behind his eyes cut me to the core. "What's the prognosis?" I asked, knowing full well that he had been handed a death sentence. "6 months to a year." he said. "I can't buy these hearing aids so I'm here to give them back to you. But I wanted to thank you because they were helpful during my appointments." As I looked him in the eye, there was no question, I was going to help him. "You're going to borrow these hearing aids until you don't need them. And I'm going to teach Sherry how to care for them. Is that okay with you?" I stated more than asked. His eyes misted over. "You're the bestest, Doc."
We spent the next hour going over the ins and outs of care and maintenance of hearing aids. Drew didn't say much and it felt so surreal in that moment. At the end of the appointment, I said, "see you in 6 months, Drew." He nodded and smiled. I hoped it was true. 6 months came and went and I had thought of Drew often. When he arrived to his checkup, Drew was in a wheelchair, head stabilized and unable to talk. I talked to him as if nothing had changed and hoped the sadness didn't show in my eyes. I cleaned and checked his loaner hearing aids and then grabbed his hand. "See you in 6 months, Drew." A tear ran down his cheek. He made a sign with his hand that he wanted to write. Sherry got out the pad of paper that was his only means of communication. "Thank You. You Are Bestest." he wrote. I started to cry. He and I knew we wouldn't see each other again. I stood and kissed him on the top of his head. "Goodbye, Drew. You're the bestest, too."
Drew passed away 6 weeks later at the age of 43. I still have his note on a board that I keep in my office that reminds me every day why I do what I do. We make a difference. And our patients change our lives as much as we change theirs.