![\"\"](\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/02\/isabelle_williams.jpg\")
\u201cPardon?\u201d<\/span><\/i> I say, again. It has got to that awkward stage where on the third asking, I still haven\u2019t heard what was said. The patient I am speaking with has slurred speech and a facial droop. They\u2019ve had a “textbook” stroke, but for a medical student with a hearing impairment, these cases are anything but straightforward. The fact that this patient also has age related hearing loss turns our simplest interactions into a struggle.\u00a0<\/span><\/p>\nI have lived with a bilateral sensorineural hearing loss since birth. Few of my friends and colleagues know about my hearing impairment, and even those who do may still mistake my inability to hear for being “ditsy” or “inattentive.”\u00a0<\/span><\/p>\n Hearing impairments affect different people in different ways. I have lost my high frequencies but <\/span>have <\/span>preserved my low to mid tones. My overall hearing is not affected, but my clarity and understanding of speech is. I can hear people talking but I cannot always decipher what they are saying. Consonants are harder to hear than vowels; I might mistake \u201cplane\u201d for \u201cplate,\u201d for example. Luckily for me, heart and lung sounds fall in the low frequencies.\u00a0<\/span><\/p>\n Being hearing impaired is a challenge, as was my transition from library based learning to clinical practice. Deafness is not a visible disability, although the aids to hearing are conspicuous. When I started rotations on the wards, I felt caught between this contradiction: I wanted people to understand the obstacles I have to hearing, while simultaneously wanting to appear “normal.”\u00a0<\/span><\/p>\n Imagine learning clinical medicine in a foreign country and it may give you some idea of my experience of life on the wards. If I miss words, I can often work it out from context or lip reading, yet this takes time and concentration and can be exhausting. It is not selective hearing\u2014I didn\u2019t hear you ask me for a pen but made sense of your request a beat too late, when you\u2019d already found another one. I can\u2019t formulate speech as quickly as others. Without my aids, listening and speaking is like trying to ride a bike with flat tyres. It takes a lot of extra work and can be an uphill struggle.\u00a0<\/span><\/p>\n Medical professionals with hearing impairments can find working difficult when any one of a number of factors that aid hearing are compromised. For example, when we\u2019re in environments where there is a lot of background noise, such as the ICU, or in situations where lip reading is made difficult or impossible, such as MDT meetings or in theatre. Very loud noises can also be unpleasant and distorted. Similarly, raising your voice when I have not heard you may not help and, if anything, can feel a little patronising. It is much better to face me and repeat what you\u2019ve said at the same volume.\u00a0<\/span><\/p>\n The impact of hearing loss on communication is partial, subtle, and (as you can recognise by now) requires greater explanation. This can be exhausting, especially when it has to be done with each new encounter. Maybe this is why, in the past, it has seemed so much easier for me to muddle through.\u00a0<\/span><\/p>\n On one particular occasion, not being completely open about my hearing impairment led to a misunderstanding and a complaint<\/span>. \u201cDear Isabelle, I am sorry to have to contact you about this\u2026\u201d<\/span><\/i> the email began. Having been present at, but unable to hear, a child psychiatry assessment behind a one way mirror, I left early and without explanation. In my anxiety, I had overlooked the most important step to take, which was to fully communicate my situation to my colleagues. They misinterpreted my actions as disinterest and rudeness. I recognise now that this was an easily avoidable outcome, but it can still at times be difficult to admit to a vulnerability.\u00a0<\/span><\/p>\n I do not want to be labelled as a disabled person. I grew up believing that I was “normal.” I wore hearing aids as a young child, before rejecting them as a teenager, believing I could overcome my “problem.” Like every other young person, I wanted to fit in. I am learning that acceptance of myself is key to being accepted by others.\u00a0<\/span><\/p>\n