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Cochlear Implant on TV Show “House”

April 27th, 2009 by | Tags: , , , , , , | 18 Comments »

Tonight’s episode of the Fox network’s television show “House” featured a story about a deaf (probably considers him self Deaf?) high school wrestler who develops some mysterious symptoms.  Sounds like a case for Dr. House and his team!

 

While watching, I jotted down a few of my notes/observations about the episode:

  • When the doctors are discussing why the young man, deafened by meningitis at age four, doesn’t have a CI, one doctor says something along the lines of, “He doesn’t have a CI because he’s comfortable with who he is.  That’s admirable.”  I dislike that statement because it implies that people who have cochlear implants are not accepting of themselves or their deafness.  Having a cochlear implant does not deny that you have a hearing loss or magically make a deaf person “hearing” or “healed” or any nonsense like that.  Many people with cochlear implants are proud of their CIs and who they are.
  • On the other hand, another doctor says, “Anything I can simulate with $3 earplugs isn’t a culture!” when discussing deafness as a disability vs. a culture with his colleagues.  Though I understand his point, and his reaction is one that is very common among hearing people who have little/no experience with d/Deafness, I still felt that was insulting.  Deaf Culture is not just about the inability to hear.  I do think this was telling, though, because most people who are unfamiliar with the d/Deaf debates (aka the majority of the world!) have a similar reaction — “What!?!  Of course it’s a disability not being able to hear!  Of course you’d want to hear if you could!”  That’s just the general public’s perception.
  • The hospital did not provide an ASL interpreter… or at least not in any of the scenes that were shown.  His mom was with him, serving as interpreter, for the entire hospital stay.  Speaks for itself.  Now I’m not saying that any mother wouldn’t want to be by her son’s side throughout such a scary time in his life BUT that she’s his link to the world is, well… a limitation.  There.  I said it.  Also, if he does communicate only through sign, he deserves a certified ASL interpreter so Mom can be “mom” and not working during his hospital stay.
  • In one scene, Dr. House brings in a boom box and places it on the patient’s stomach, asking if he can feel the vibrations.  When the boy says he can feel the music but not hear it, House mutters, “Apparently your Mom doesn’t care what you’re missing.”  Perhaps true, but that is really hurtful (and in keeping with his character).  Even though I am a strong proponent of CIs/AVT, I don’t think for a minute that parents who choose otherwise don’t “care” for their children.  I believe that, given all the choices, the listening and spoken language approach literally “speaks” for itself and holds up quite well under scrutiny, but I know that parents agonize over this very important decision, and if they do not choose listening and spoken language, it’s not usually because they don’t care for their child.  In fact, it’s quite the opposite.  Most parents choose what they feel will be best for their child and their family, and that is their right!
  • Spoiler alert: House orders one of this subordinate physicians to implant a CI in the patient while he is under anesthesia for another procedure (a brain biopsy).  Whoa!  Totally unethical, illegal, and all kinds of wrong!  That’s just ridiculous.  Also, hospitals don’t just keep CIs lying around.  They have to be ordered from a specific manufacturer (one selected by a consenting patient or their parent/guardian, I might add!) for each specific patient at their specific surgery time.  It’s not just, “Go to the supply closet and pull out one of those CI kits — I feel like doing a surgery today!”  Also, if the patient was deafened by meningitis over a decade earlier, there’s not telling what the state of his cochlea would be — most likely it would have suffered significant ossification (bony growth) and implanting the electrode array might be close to impossible.  (Side note:  If you are deafened due to meningitis and considering a cochlear implant — seek medical advice quickly before cochlear ossification may make the choice for you!)
  • Then in the next scene, TA-DA!  Not only has his incision site miraculously healed, but his external processor has already been activated and he is hearing.  By gum, it’s MAGIC!  No MAPing or audiologist necessary.  Wow.  Whatever surgical technique Dr. House and his team are using, I sure wish they’d share it with the rest of us and spare us all the weeks of waiting between surgery and initial stimulation!
  • As a result of the brain biopsy (the original reason for putting the patient under anesthesia… that then turned into the spur-of-the-moment CI surgery) he emerged from the procedure with two circular scar-like marks on his forehead.  Those were from the brain biopsy, NOT the cochlear implant surgery.  This was never explained, so now people are going to think that’s what CI surgery involves/looks like.  Great.  Because we needed another myth!  
  • The CI surgery was referred to as “brain surgery” several times.  COCHLEAR IMPLANT SURGERY IS NOT BRAIN SURGERY.  How many times do I have to say it?  It’s not.
  • Another spoiler:  After his instantaneous surgery, recovery, and hook-up, the young man decides he does not want the CI and… brace yourself… RIPS IT OUT OF HIS HEAD.  Yeah, right!  First of all, the internal part of the CI is usually sutured into the “well” that is created in the temporal bone to house the internal receiver.  Ripping it out, or even having it move from the original insertion site on its own, is highly unlikely.  But that he would even be able to get to the internal part is laughable, because he’d have to get through layers of hair, skin, and cartilage PLUS the staples, sutures, and/or steri-strips (surgical glue, alternative to stitches) used to close the incision site.  So yup, if you get sick of your CI, just reach up there behind your ear, scratch a little, and that sucker’ll pop right out.  Magic!

 

So, all in all, a not-so-offensive but also not-so-factual portrayal of deafness and cochlear implants in the media.  Interestingly enough, the CI brand that was featured (though never named) in this episode was the same one used in the made-for-TV movie “Sweet Nothing in My Ear”.  That means nothing to me either way — good or bad — but I just think it’s fascinating what must go on behind the scenes for these “product placement” negotiations and how much say the companies have as to how their products are portrayed.

 

Did you see this episode?  What did you think?

18 Comments

Cami

April 27, 2009 at 9:11 pm

I didn’t see the episode, but you are right on SO many levels!! My friend Luke, who is on The Amazing Race, has been facing a lot of criticism in online forums about his decision not to wear his cochlear implant (because he didn’t benefit from it, so why wear it?) and said that if his mother “really cared” about her son’s well-being, she would have taught him to read lips and speak for himself. I hit the roof with fury!! However, I think it’s important to remember that hearing people unexposed to any form of deafness (i.e. culture, etc) would think it impossible to survive in today’s world without spoken language. It is sad that popular culture, like this episode of House, only reinforces this concept. Plus, I’m pretty sure that legally the hospital HAS to provide an interpreter because if his mother interprets and something goes wrong, her translations can’t be used in a court of law, or something like that, I don’t remember exactly. All in all, there are many “levels” of deafness – it is not black and white, and there are most definitely NO right or wrong answers.

V

April 27, 2009 at 9:14 pm

I was most stunned by the “implant him” scene. I know the fictional character does stuff like this all the time on the show, but that was taking things a bit far. Of course I also laughed at the CI rip out… um, I would have expected half his inner ear to come out. The show did what it does best. Stirs up controversy through outrageous fictional medical scenarios.

ER did the best coverage of CI in my opinion.

I will say, the kids reaction to sound is very much what I would expect myself to go through. I’d need to get myself a pair of those $3 ear plugs just to be able to sleep (silently) at night.

Cami

April 27, 2009 at 9:27 pm

I just re-read the entry and would like to return to my soapbox, pardon me… I found the line about earplugs and Deaf culture ESPECIALLY hurtful. As you know, Elizabeth, I grew up very mainstreamed and didn’t have many deaf friends. Admittedly, I didn’t want to go to RIT originally because of the high number of deaf students. However, during my four years there, I got to experience the culture inside and out, at all points on the spectrum. Because I was lucky enough to grow up signing and speaking, I could interact with the completely oral kids as well as the ASL school for the deaf kids. After being re-immersed in hearing culture for nearly a year, I returned to Rochester last weekend to visit old friends, and I really noticed the differences between the hearing and deaf worlds. It is truly an entirely different way of living. Deaf people, even those like me with good speech, usually have to adapt and find a way to survive in a world that was designed by hearing people for hearing people. As a result, you get an entirely different way of life, which is by definition a culture.

I agree with you also on the difficult decision parents must make when choosing a primary communication mode for their child who is deaf. Personally, I advocate hearing aids / cochlear implants, speech therapy, AND sign language, but that is not going to be applicable to every child out there. Children who derive absolutely no benefit from listening devices will face a much greater challenge in learning to speak or lip-read than those with residual hearing. While some parents decide that raising their child to best fit in our hearing world is the appropriate route, others may choose to immerse their child in a world where he/she would belong more readily. Either way, I totally agree with you that parents make this decision with their child’s best interests at heart. What fits one child his/her family may not fit another’s. C’est la vie, that’s life, live and let live!

Cami

April 27, 2009 at 9:35 pm

LAST THING, I promise… I actually had my staples taken out 7 days after surgery and right after that went in for my initial stimulation. They crammed me up early because I was home for only 3 weeks for Christmas, so it CAN be done in a week’s time – but maybe also because I was older (18y.o.)? Not entirely sure… and! The world sounds AWFUL after initial stimulation. To this day, I still get extremely annoyed when people whistle or crinkle plastic bags. It takes so much patience and practice to get used to the new world!

Hey Liz, have you read “Rebuilt” by Michael Chorost? If not, I highly recommend it!!

Alicia

April 27, 2009 at 9:37 pm

You definitely make a lot of good points, Liz, but I still feel like they did a pretty good job of portraying both sides of the argument, especially considering it’s only a 48-minute show that actually has to focus on medical conditions, too. The doctors’ argument in the beginning of the show, plus the argument between the patient and his girlfriend, show that there are many different views to this debate, even within the Deaf community. There are a lot of things that have to be twisted a bit to fit in with TV magic – how many of the other medical conditions can really be cured with 10 minutes of IV fluids, like they’ve done in other shows? And hopefully people don’t think those marks on his forehead were because of the CI – they’re been featured prominently in other episodes where patients have had brain surgeries or biopsies. The ripping it out of his head part was a bit much, though, that’s for sure. Oh, and I think when they were referring to “brain surgery” it was the biopsy they were talking about, right? I would hope they wouldn’t be classifying CI surgery as that.

You have to admit they did put on a pretty good show . . .

Alicia

April 27, 2009 at 9:38 pm

Also – is there any reason why he’d still be wearing a hearing aid, even after the CI had been activated?

Elizabeth

April 27, 2009 at 9:49 pm

Yup, it definitely has to be judged as what it is — television and entertainment, not a medical textbook! I don’t know what you mean by HA, but perhaps that’s because I was watching on a teeny tiny TV from a few yards away. Perhaps he had an earmold made to hold the CI in/on his ear better? Some people use a non-functional earmold (i.e. no sound is actually coming through it) to keep the CI on the ear better than with just an earhook. It really depends on your activity level and/or how your ear is shaped. Some people just have ears that are perfect for their CI brand, and others need a little adjustment or help to keep it on.

Katie

April 27, 2009 at 10:57 pm

Really interesting perspective! As a first year medical student, the school I attend has hammered into our heads that a family member should NEVER be asked to act as an interpreter. “Laypeople” are generally unfamiliar with medical terminology and are too invested in the health of their relative, the patient! This is especially relevant with a child or non-native speaker; this person may not be quite fluent enough to stand in for the physician. Dr. House also broke one of the cardinal rules of medical interpretation – standing next to the interpreter, not across from him/her, to keep the patient as the one he is communicating with. (But are we really surprised at that?) I suppose Dr. House should have to go take some sensitivity training : )

I’m not surprised that they didn’t keep in mind that you have to order a CI, considering that they have Chase, an intensive care doctor, suddenly able to do any and all surgeries! Without sterilization, at that! And I never really associated the brain biopsy screws with the CI, as we did see the stabilization apparatus in place. I also thought by brain surgery they meant the biopsy, not the CI. Not a major point, but I think that some of these “future myths” may just be in your perception… as someone with little to know experience with CI/prejudice-against-CI I had a completely different perspective.

The unwilling implantation aside (a completely inappropriate move with what I think was an unsatisfactory resolution), I think it was interesting that the House writers chose to do a case with CI. I can’t say I didn’t learn anything new, so that’s always good… I never really put 2 and 2 together and realized that you could only get a CI with some kind of acquired hearing loss. Although, considering everything, your blog entry definitely taught me more than the episode!

April 27, 2009 at 11:21 pm

I would be ranting all night long over all the gross errors in this episode…it was all so totally, completely false. I agree with all the points you made, Elizabeth. It’s scary because a show like this can really perpetuate false ‘truths’ with these sorts of episodes. It was pointless from the ‘educating people about CIs’ point of view because every single thing they did would never ever happen in real life.

I turned to my husband and said, “Basically, it’s like they showed someone doing open heart surgery with a butter knife…and the patient jogs home from the hospital the next day, with no scar.” It was pretty much that realistic. :P

Oh well — I had no idea they were even doing an episode revolving around a deaf patient (much less casually tossing a CI into his head during a brain biopsy) so it was an interesting surprise, if nothing else!

Rhi

April 28, 2009 at 12:34 am

As a filmmaker and CI user, I have to say that I understand both the media’s desire for dramatic plots and the D/deaf/HOH communities’ desire to be portrayed accurately. I will say this, though: deafness is always portrayed, but hard of hearing is not, unless it is grossly misinterpreted through comedic effect (the old man with hearing loss) or tragedy (a bomb blast). I’m tired of this–I’m ready to see an empowering and realistic depiction of hearing loss in the media–one that involves either hearing aids and/or CIs being worn by someone all their life. Not everyone who is deaf or hard of hearing signs, and these people are hardly ever presented in a positive light. As a filmmaker, I’m actively working to both have a dramatic and realistic mature story that involves a protagonist who wears CIs or uses hearing aids.

April 28, 2009 at 7:20 am

Your points are great! My husband nearly had to hold me down when they just threw in the implant procedure there at the end. They completely misrepresented the entire candidacy process. First off, he’d have to be confirmed as severe-to-profound to qualify, not to mention the psychological evaluation. Which he wouldn’t have passed (due to not truly wanting one- he was 17 years old and old enough to have had impact on the decision making process). And the medical evaluation, which he wouldn’t have passed.

When he “ripped” it out, I actually yelled, “oh, COME ON!” Sheesh.

Jessica Reidies

April 28, 2009 at 10:56 pm

Yes – it was egregious – but I never watch House so I don’t know if the inaccuracy of the episode is limited to just the CI issue…

I have a question for the writer of this blog (Elizabeth?) – you suggested product placement as the reason for going with Advanced Bionics. It’s certainly plausible…but AB is a reputable company with a strong following. Just because Cochlear has 70% of the market share doesn’t mean that people (in this case…irresponsible surgeons) would overlook AB and Med-El when making a decision about implantation.

So the AB implant was featured in both this episode and “Sweet Nothing in My Ear” – great – I don’t see the significance. How many times have you seen a Cochlear device featured in the media and thought “oh, that must be product placement?”

Elizabeth

April 28, 2009 at 11:19 pm

Jessica: Like I said, the brand portrayed doesn’t mean anything particularly “good” or “bad” to me, it’s just interesting because, as a person who has no idea about advertising/PR/business kinds of things, I’d love to be a fly on the wall during these decisions for TV shows and movies. I’d like to know what, if any, the terms and conditions were for using AB’s processor style — did AB get to consult on the story line? I wonder how they felt about it?

A few months ago, I posted about the movie “Step Brothers” which featured a Cochlear-brand CI processor lookalike. When that movie came out, Cochlear said that they did not have any control over how the CI was used/portrayed in the movie. However, that story was not CI-focused, the cochlear implant-related content in that movie was minimal, not a main plot point like in this episode of “House”, so maybe there were fewer opportunities for error. Also, I don’t think of “product placement” as a negative thing. Any time I see an identifiable product, I assume there was some thought/negotiation that went into it.

(see my posts on “Step Brothers”: http://cochlearimplantonline.com/site/?p=260 and http://cochlearimplantonline.com/site/?p=258)

So, no brand bias was intended. Though I do have my opinions, I think the biggest part of a cochlear implant, ANY brand, is the rehabilitation and listening and spoken language training that follow. It doesn’t matter as much WHAT you put in your head, it matters what you DO with it! I’ve seen children (and adults, but I see mostly children) do well with all 3 brands currently FDA-approved in the US.

Thank you to EVERYONE who has commented for your interesting points and insights!

April 29, 2009 at 9:52 am

Excellent discussion and responses. I’d like to add one more, though:

““He doesn’t have a CI because he’s comfortable with who he is. That’s admirable.” I dislike that statement because it implies that people who have cochlear implants are not accepting of themselves or their deafness. ”

Umm, Elizabeth, that statement made me think of many other statements made in d/Deaf blogs where someone gets unnecessarily ticked off at an interpretation.

Suppose someone said “He’s comfortable with being Italian”, another would get ticked off and say “That implies that non-Italians are not accepting of themselves.” Hey, that’s quite a leap.

Pam

April 29, 2009 at 2:16 pm

I was relieved to see that many folks reacted to the House episode as I did — I love this show, but PLEASE. I think it needs to be branded now not as a Medical drama/comedy — but as a Medical FANTASY show. It’s almost as if the writers did NO research whatsoever. I keep wondering why do all of these shows feature CIs?? What is the goal? Now I’m kind of freaked out because maybe they are being paid to write these shows for, as people pointed out above “product placement?!!!”
yikes

eridanis

May 9, 2009 at 8:12 pm

i thought it -was- offensive.

very.

the patient is an idiot, his mom is a moron? for signing, basically?

i don’t think so.

May 10, 2009 at 8:32 pm

[...] und Cochlear-Implantierte gegen sich aufgebracht (klicke zum Überblick hier, siehe die Diskussion hier). Zu [...]

May 1, 2010 at 3:21 am

Hello! Just wanted to leave a comment. I truly loved your post. Keep up the great effort.

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