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Even if the implant works perfectly, Franklin explained, Ashley wouldn't "hear" in the way that hearing people do. The implant's 22 electrodes can't reproduce all the subtleties conveyed to a hearing person by thousands of hair cells and nerves. Adults who've lost their hearing, then received an implant, say that voices sound as though they've been computerized. Most likely, the implant would bring Ashley's hearing to the mid-range of normal speech; she'd probably miss light, high-pitched sounds like s's, f's and th's, but would be able to hear almost everything else.
The computerized "brain" would need to be adjusted periodically, as Ashley learned to hear. And that, Franklin explained, would mean regular visits to Rose Chmiel-Hardcastle's office. In fact, it wouldn't be until after the first visit to Rose -- more than a month after the surgery -- that the implant would be turned on.
"If we move," Greg asked, "can we still find people who tune it?"
Yes, Franklin said, but moving wouldn't be a good idea. The surgery wouldn't be the hard part for Ashley; the hard part would be teaching her to use the implant. It takes about a year for a child to develop the neural networks needed to make sense of sound -- learning that most people do in their infancy. And even after that year, Ashley would likely need the Center's specialized help.
Gayle chimed in. "It would be better, if you move, to move to a big city rather than a little town. There aren't that many oral schools. Also, if you could not move for about two years, that would be nice."
Greg absorbed the information gravely. Staying in Houston meant a significant sacrifice.
Joe Yanazco, the funny, joking grandfather who spoils Ashley most, asked his question: "After this, no sign language?"
"Yes," Franklin replied without hesitation. "No sign language."
Julie asked which ear the implant would go in. Franklin suggested the right ear -- even though that's the ear that has slightly more residual hearing, which the implant would destroy. The right has better wiring to the auditory cortex, he explained. And Gayle noted, gently, that even in Ashley's better ear, there was basically no hearing to lose. "If you decide to not to get the cochlear implant, I'd have to recommend that you put her in a signing program."
"You have to realize that that's a real option," said Franklin. But no one in the room argued in its favor.
"I don't do these implants because it's great surgery," the doctor continued. "I do it because it's a way to get children into the hearing world."
The family was convinced: If there were a chance Ashley could join the hearing world, they wanted to take it. Julie scheduled surgery for the next Friday.
The surgery was canceled three times, always because Ashley had an ear infection. As fall turned to winter, Julie grew impatient, anxious for Ashley to hear in time for Christmas.
Finally, around dawn on November 20, Ashley was pronounced free of infection, and ready for pre-op. Her relatives and well-wishers filled nearly a third of the waiting room at St. Luke's. Nan Thompson, the therapist, brought bagels; Joe and Earlene brought a family friend; Denise Yount, Greg's stepmother, carried a mystery novel; Ann Goodpaster, Julie's own mom, had traveled all the way from Missouri. In honor of the occasion, Julie wore a gauzy, off-white dress, rather than her usual shorts or jeans. Greg lugged their video camera.
At 8:15, the operating team took Ashley into surgery. In the waiting room, the group chatted, determined not to look nervous. They talked about the venison in Joe and Earlene's freezer, about Bryce's first haircut, about Cricket and Danny on The Young and the Restless.
Every half hour, a nurse from the operating room phoned the waiting room and delivered a bulletin to Julie. At 11:15 a.m., the nurse reported that they'd finished drilling into Ashley's skull, and were safely past the craniofacial nerve. (A false move could have paralyzed Ashley's face.) They'd just begun inserting the implant into Ashley's cochlea.
At 11:50, the nurses called to report that they were closing and bandaging Ashley, and that everything was fine.
An hour later, Dr. Franklin finally appeared, dressed in blue scrubs. Ashley's group gathered around him, hungry for news. The report, Franklin said, was good: Ashley's insertion had been almost the best possible. He'd managed to get in not only all 22 electrode bands, but also five backups.
Nan was jubilant: "I've never heard it so good!" she said; most implant users get by on fewer working electrodes. "She's gonna be hearing so much!"
Julie hugged the surgeon. Everyone hugged Julie. Ann cried, and Julie daubed her eyes.
Almost a month later, Ashley's team gathered once again, this time, in the office of audiologist Rose Chmiel-Hardcastle. Ashley's long blond hair covered the patch of scalp that had been shaved for the implant; she looked her usual stubborn self, perfectly happy to be surrounded by her parents, grandparents and adults from the Center.
In the waiting room, Julie pulled out Ashley's stuffed lion, equipped with a toy cochlear implant. She signed to Ashley: "Ashley, where's your hearing aid? This will be yours." And with that, she handed the lion's implant to Ashley.