Date: Sat, 24 Mar 2012 18:22:03 -0600 From: Pete McDonald Subject: TIME-TO-SEE-75- TIME-TO-SEE-75 The gathering, although quite large, brought itself to an immediate hush when the lights dimmed and Dr. Kavanaugh stepped up to the podium in the spotlight. "Ladies and Gentlemen, Good Morning and Welcome... I would like to welcome you all to our Second Stem-Cell Exploration seminar." The main session of the weekend's seminar on stem-cell harvest and cultivation for the replacement of aural nerve discontinuity and dysfunction was taking place in a large auditorium which comfortably accommodated 8,000, and that included an ample, over-flowing balcony. As a professionally managed venue, the proscenium was fitted with disappearing screen for video presentation, remotely controlled lighting and sound for the panel discussion, and intimate sound stage where the interview segment that centered on Hugo's personal experience of the surgical procedure and recovery events would take place. The various segments were seamlessly blended by production values that were clearly state-of-the-art technical support. This was quite a contrast with the earlier Dublin seminar where the approach was standard university lecture format. Dr. Kavanaugh continued, "We are privileged to have with us Dr. Lliam Watson from the Cambridge Medical Research Center at Cambridge University, United Kingdom, who is preparing a similar undertaking for optical nerve replacement, a breath-taking concept. We humbly offer to Dr. Watson whatever resources our enterprise might have that could inspire or support success in his own undertaking...." Dr. Kavanaugh paused for the applause... "And also with us is Mr. Hugo Ramirez, the subject of the world's very first hearing restoration by means of stem-cell re-growth techniques. Mr. Ramirez will be speaking directly of the experience of hearing after near-life-long deafness. Mr. Ramirez..." And the auditorium pulsed with loud applause, as Hugo stood and nodded modestly. "Then without further ado, I would like to begin our seminar with a video produced by the Dublin University Film Department cooperatively with our surgical and research teams who prepared for and then eventually went to the United States a bit over a year ago to undertake the stem-cell transplant project. After the video presentation, surgical and research team leaders will conduct a question and answer period along with a panel discussion." "And then, to conclude the day's events, I will conduct an interview with Mr. Ramirez, to give you the patient's view of the experience." After Dr. Kavanaugh's brief and succinct welcome, a large screen was deployed from the top of the proscenium, and a lively video depicting the team's every effort commenced. The boys sat speechless in the darkened auditorium. Of course, for Sean, Murph, and Artie, this was all new and at least a great science fiction video with their good friend, Hugo, as the star. Needless to say they sat totally absorbed in the video, even the sections that were indeed highly technical in nature, including short sections of the surgery itself. Nicky and Jilder, naturally, knew the story line, but this presentation was new even to them; so they were absorbed in the video and as involved as the other boys. When Hugo was shown undergoing the surgery Jilder leaned over Nicky to speak to Sean, Murph, and Artie, reliving the operation while explaining it in his version of a whisper. "You See... Nicky and me sat just outside of that big operating room looking in at Hugo through a really big window. (Hugo was under anesthesia... You know, he was asleep, and he didn't know what was happening..) But we could see everything. And we could hear Dr. Kavanaugh because he was describing the things he was doing as they happened... It was really cool..." Jilder exclaimed with obvious pride at being a footnote in history. Murph and Sean and Artie all heard Jilder but remained attentive to the video and didn't allow their attention to stray until the video was finished. ***** When the video was concluded, the house lights came up, and Dr. Kavanaugh announced that there would be a thirty minute pause before the panel discussion and Q & A began. With that, all five boys jumped up from their seats and began a sprint to the rear of the auditorium. Recall: no self-respecting twelve-year old can pass up a bathroom break. They're simply too much fun to resist... Kevin yelled out, "Hey! Jilder. Nicky: WHERE ARE YOU GUYS GOING?" trying to apply some kind of parental supervision over the free spirits... Jilder turned in the direction of Kevin's voice from the aisle but five rows back and replied somewhat patronizingly what to him was 'the obvious' at the top of his voice: "Dad! WE GOTTA GO TO THE BATHROOM!" complete with pained expression to dramatize the authenticity of his condition... and this was much to the amusement of everyone within those five rows between Jilder and Kevin. "WELL, GET BACK HERE BEFORE THE PROGRAM BEGINS... THAT'S IN 20 MINUTES!" Kevin countered, not to be intimidated by any embarrassment over the public discussion of the facts of life... Again, Kevin provoked more than one knowing-smile among the witnessing attendees. ***** Max sat up and turned to his right a bit to face Kevin. "I am most impressed with all that you and Hugo have gone through together. Hugo must be a terrific guy. I can't imagine living my life in total silence. It's actually quite frightening to me even to contemplate." Then Brandy, who was sitting right next to Kevin faced him and said, "How did you deal with the possibility that the procedure-- for all it's elaborate research and preparation-- might have failed? The obvious possibility of failure would have been more pressure than I could have handled." "Oh, Brandy. You'd be surprised. When life demands the maximum from you, the strength and resolve comes from somewhere. I'll admit that I was stressed out for nearly the whole time. BUT! Brandy, I WANTED Hugo to try. He was selected as the only candidate from a wide open field that included anyone and everyone in the world. I felt that this was his big opportunity in life, one that he just couldn't allow to pass without at least trying." Kevin continued to explain his way of dealing with the awesome stress of possible failure, "And I for one would have done ANYTHING to see that Hugo got that opportunity and had every possibility for success.... " "BUT! You know, Brandy," he went on... "I love Hugo so much, that IF he had never regained his hearing, I'd have felt we still had all of the blessings possible in life: wonderful family, a strong love for each other, good health, otherwise... Yes. I would not have been happy at the failure, but I would have had Hugo and our love no matter what..." Kevin paused and thought... "And you know. It was in this process that I realized that life is NOT about one's self alone. HUGO'S LIFE BECAME MORE IMPORTANT TO ME THAN ANYTHING I COULD THINK OF FOR MYSELF. I was truly MORE concerned for Hugo than for myself." Max shook his head and spoke quietly, "Kevin. You are the man behind the success that others except ourselves will never realize. Thanks for allowing us to see the experience in the raw." Kevin smiled, looked from Max to Brandy and then back at Max, "I am only living the life that God has been gracious enough to give to me." ***** Several soft chimes could be heard playing over the auditorium sound system thus signaling that the program would resume in five minutes. Kevin jerked his head around looking a little anxious that the boys hadn't yet returned to their seats. Without saying anything to Max or Brandy, Kevin rose and began to move down the aisle stumbling over other seated attendees. After stumbling over two people, Kevin stopped in his tracks, his gaze locked on the bold cadre of boys returning to their seats... Down the main aisle they strode: Jilder in the lead, Sean second in command, Artie sandwiched in the middle with Murph and Nicky pulling up the rear. "WE'RE BACK, DAD!" Everyone within ten yards could hear. "AND THE PROGRAM HASN'T BEGUN YET..." Jilder announced, wanting to be sure that he got credit for his perfect timing. Kevin answered, "YES, BOYS. THAT'S VERY GOOD. NOW TAKE YOUR SEATS AND WAIT QUIETLY FOR THE SEMINAR TO BEGIN..." And they did indeed do exactly as they were asked, no resentment, only a pleasant attitude that conveyed that they did enjoy their excursion to the bathroom... Go Figure? Boys??? And everyone within earshot of Kevin's parental ministrations smiled and nodded approval of how he had handled his boys... ALL 5 OF THEM! ***** When Dr. Kavanaugh returned to the podium, five panel members had already seated themselves on the stage along a table prepared for them. Name placards sat before each of them. "Welcome back, ladies and gentlemen. We will now begin our panel discussion with key research and surgical personnel from our teams." Dr. Kavanaugh introduced each person, then when he was finished, he recognized hands from the audience. "Will the ushers please provide a microphone to the gentleman standing in the forward center section?" Almost at once the gentleman was given a mike. "Good Morning, Dr. Kavanaugh," the gentleman said. "First I would like to offer my congratulations to you and all of your team for this remarkable accomplishment. I am, however, quite interested in how you were able to cultivate the stem cells and then implant them so quickly. It is inconceivable that there would have been sufficient advancement in the cells in the processing interval your team had between harvesting and then implantation. Can you shed more light on the preparation of the cells and then their assembly into the matrix that you eventually implanted. This process could not have used more than 30 minutes real time, if that," the questioner posed. Dr. Kavanaugh turned to the panel and asked, "Is there anyone who would like to address the questioner's concern?" A hand went up among the panel members. Dr. Kavanaugh said, "Yes. Dr. Sedley, Head of the Research arm of our organization, would like to begin..." "This was the primary obstacle that had to be overcome before we could even consider candidates who would provide us with the maximum possibility of success," Dr. Sedley began... "The seminal work that eventually led to the nerve augmentation that we were able to undertake, began ten years ago when Dr. Kavanaugh addressed this very question to each of us in stem-cell studies at the university. It was a very time-consuming process of learning the biochemical life processes of these cells, and then, after the basic research into their propagation, what ensued was a laborious process of trial and error to find means of hastening the earliest stages of their specialization, and just how the early-stage stem-cells could be aggregated and layered in such a way as to make them practically manageable. In a few words, we had to prep them and then manage them in such a way as to guide their development along the patient's own nerve bed. Only after some 5 years of basic research were we able to discover the needed nerve growth-stimulating enzymes that would signal the cells to begin their specialization, which had to be clearly manifest within 30 minutes of harvest. This was no small undertaking, but when we had solved this basic problem, then the remaining anatomy of the program could be sorted out logically-- if quite slowly as well..." "Thank You," the gentleman replied. "Would documentation of that basic research be available to interested research programs? My work has been underway in the Ontario, Canada, University for some years, and we would be most grateful if we could review your path to accelerating stem-cell activation and propagation." "Most assuredly, Sir." Dr. Sedley replied. "Please see me at the close of our program today, and I'll coordinate the media form that would be most suitable for your needs." "Thank you, Dr. Sedley," the gentleman replied. Dr. Kavanaugh recognized several other questioners who sought answers to questions from the panel. Each one was treated with maximum courtesy and cooperative spirit. If ever Hugo or Kevin wondered whether the arduous trip across the continents and the ocean to contribute to these medical seminars was worth the effort, they were convinced it was, after witnessing the wide-spread interest displayed by those in attendance to learn Dr. Kavanaugh's processes and procedures. The boys began to tire somewhat as the questioning persisted and the inquiries and replies became more technical. They did manage to sit relatively quiet, knowing that Hugo would be interviewed next. The question and answer section ran perhaps just short of an hour, truly testing the capacity of the boys to remain in one place. At that point Dr. Kavanaugh invited everyone to return for the interview of Hugo, after a second intermission, to explore the entire process through the eyes of the patient. ***** With everyone seated after the second intermission, the house lights dimmed. Hugo sat with Dr. Kavanaugh in a small sound stage modeled on the common style of the late night television talk show hosts. Dr. Kavanaugh sat at a desk, which was in front of a window that opened onto a huge and colorful depiction of the galaxy. Hugo sat on a bright orange, over-stuffed modern sofa just to Dr. Kavanaugh's right. Dr. Kavanaugh addressed the audience. "Good afternoon, ladies and gentlemen, and welcome back to our Second Stem-Cell Exploration Seminar. In this final segment, we will be speaking with Mr. Hugo Ramirez who was the recipient of the world's first hearing restoration by means of transplant of his own stem cells. We will hear first hand what the whole experience was like from the patient's perspective..." "Good afternoon, Mr. Ramirez," Dr. Kavanaugh said, looking over and smiling at Hugo. "Good afternoon, Dr. Kavanaugh.... I wonder whether I might ask a favor of you?" Hugo said. Although Hugo's question was not on Dr. Kavanaugh's agenda for the opening of the conversation, he answered looking quite pleasant and accommodating, "Of course, what did you have in mind?" "I am used to your calling me by my first name, Hugo. Would you mind using Hugo this afternoon?" A broad smile played across Dr. Kavanaugh's face, belying how pleased he was to be regarded in such a personal way by Hugo. "Of course, my boy, I must admit that it felt a little formal, using Mr. Ramirez, given our long and important relationship." "Thank you, Sir." Hugo replied, also with a smile on his face. A pleasant chuckle and a murmur could be heard running through the audience. "Let's begin with the selection process that we used to find potential transplant candidates. If I recall correctly, Hugo, we were first notified of your potential suitability by your employer's physician?" "Yes, Sir. I had worked for the San Diego Memorial Hospital in the United States for almost five years by that time. First I worked in the kitchen, and then I took on general orderly duties." Hugo replied. "Did you ask to be considered, Hugo?" "No Sir. I didn't. It just never seemed like it would ever be possible to hear again..." Hugo answered. "But you were willing to submit to examination and interview by our selection team, when we requested time with you, some two years ago now. Correct?" Dr. Kavanaugh asked, not to refresh his own memory, but to allow the process to unfold for the listeners. "Yes, Sir. I really didn't think too much about it. I'd been totally deaf since I was six years old. I pretty much thought that I'd never be able to hear again. I was just going along with the hospital doctor, because they were always so good to me as an employer, I just wanted to do it for them," Hugo answered. "The physical parameters of your hearing deficit made you a prime candidate for our work, because we were looking for the best possible chance to be successful. As I recall, some time passed before you responded to our offer to place you at the head of the list, as the first patient to receive the stem-cell transplant. " "Yes, Sir." Hugo replied. This time he didn't elaborate. "May I ask why you allowed so much time to pass before you made a decision to accept our offer-- it was 6-7 months between our issuing the offer and your response, as I recall?" Dr. Kavanaugh spoke with his voice modulating to a lower level, displaying genuine interest. "Well, Sir. At that time, my life wasn't going so well. I didn't do much more than work all the time; so I could take care of my little brother, Jilder. Jilder turned out to have a serious medical condition that would require the insertion of a steel bar inside his chest; just so he could breath. I didn't have the money for Jilder's operation. I hardly made enough money to pay the rent and buy our food," Hugo explained. "And what made it possible for you to accept our offer eventually?" Dr. Kavanaugh inquired. There was a very long gap of silence before Hugo spoke again. "I met Kevin Kramer." Hugo replied quietly. Speaking gently, Dr. Kavanaugh continued: "Mr. Kramer... I should say, Kevin, took the financial pressure off of you, and that made it possible for you to respond?" Dr. Kavenaugh queried. "Uh....." Hugo took another very long pause..." Uh... no." Hugo said. "What was it then that Kevin did which made it possible for you to respond to our offer?" Dr. Kavanaugh asked somewhat perplexed. "He saw me, and he loved me...." Hugo said looking down at the floor of the stage. Dr. Kavanaugh did not step into the silence after Hugo spoke. Eventually Hugo went on..."It was just that life was very difficult, and from time to time, I even ran out of money before I got paid, and I didn't have anything to eat.... I didn't tell Jilder..." Hugo was reliving as much as telling his life story at that time. "I hadn't eaten all day this one day," Hugo said. "And I went into a burrito shop and went begging for some change; so I could buy something to eat.... It was so humiliating..." Hugo's voice trailed off into silence while he continued to look down. Dr. Kavanaugh remained silent, giving Hugo time to return to the thread of his narrative... "Kevin gave me a $20 bill." Hugo whispered as he put his hands to his forehead, covering his eyes and dissolving quietly into tears. Dr. Kavanaugh thought for a moment that perhaps he should rescue Hugo by questioning him again, but his sense of Hugo allowed him to remain silent a bit longer. Hugo recovered quickly and continued: "Later that day, when I was at work, I went into one of the hospital rooms doing my duties, and found that Kevin-- the same man who earlier that day had given me money for food-- was in a coma, and the doctors didn't know what was wrong with him. He came in as an emergency and was in critical condition." Hugo said. Max and Brandy looked over at Kevin who was fixated on Hugo up on the stage. Kevin's eyes glistened, and he swallowed, choking back his feelings. "I wrote a prayer on the wall; so God would save Kevin." Hugo said. "A prayer?" Dr. Kavanaugh asked, clearly NEVER having heard this story before. "Yes, Sir." Hugo replied. "I wanted to do something to help Kevin because he fed me when I was hungry. But I couldn't really DO ANYTHING. I didn't understand medicine. But I COULD ask God to help," Hugo explained... "And you did!" Dr. Kavanaugh reiterated. "Yes, Sir." Dr. Kavanaugh had to bring this information together with the selection process, but he wasn't sure how to do it... "I still don't understand how Kevin's illness made it possible for you to join our stem-cell transplant program." Dr. Kavanaugh confessed somewhat perplexed. "Kevin's illness didn't." Hugo clarified. "But weeks later, after Kevin recovered, it was clear to us that we both wanted to live along with each other, together, as partners. And we started life over together. I kept on working while Kevin recovered. Then when Jilder had to have his operation, the two of us together made it possible, and then we even found a wonderful new addition to our family, Nicky. Nicky needed the same operation that Jilder did, and he needed a family too; so we wanted to keep both boys... And God made that possible..." Hugo said. "And we had a wonderful family then..." "What a remarkable story, Hugo!" Dr. Kavanaugh said. "I never knew the full story until today." "Yes, Sir." Hugo replied now completely composed. And Hugo continued, "My life was so good at that point, with Kevin and the boys, but I was still afraid of trying your stem-cell treatment. What if it failed? I thought..." Hugo paused yet again... "What would I do if I tried and the treatment failed? I wasn't strong enough to risk it by myself..." Hugo admitted. Then he said, "THAT'S where Kevin came in! If Kevin hadn't told me that he would be with me no matter whether your operation was a success or a failure, I couldn't have done it. Knowing that Kevin would be with me all the time... and hearing the boys tell me that they would not let me be alone through any of my operation....it was then that I decided I could try; and so I wrote to you.... Kevin encouraged me to try, Dr. Kavanaugh... I wouldn't have been able to do it alone on my own. It was just too scary..." Hugo admitted. Dr. Kavanaugh then began thinking out loud: "It is now abundantly clear that a potential cell-transplant recipient cannot undertake the process casually. It's a powerful life-changing force that the patient regards with profound respect, a measure of fear, and a deep sense of awe." "Yes, Sir," Hugo replied. "After we received your acceptance, I recall that there was a flurry of correspondence between our Project and you, Hugo, where we listed the variety of very specific compliances we would have to ask the patient to consent to perform: from details of the pre-op examination to the rules of behavior during recovery. As it turned out we realize that there are places that we can relax our rules in order to make the life of the patient much more pleasant." Dr. Kavanaugh explained. "Yes, Sir." Hugo replied. "I really didn't mind doing any of the things you required. They all seemed very reasonable to me. I was amused at how visitors to the clean-and-quiet room after the implant had to wear those space suits. They were actually under more stress than I was, because I only had to wear the huge earmuffs to protect the incisions, and all of my visitors, including medical personnel, had to put on those bulky hoods and breathing filters. Looking back it looked pretty silly, but I understand how deadly serious it actually was." "Indeed, my boy," Dr. Kavanaugh emphasized. "We were so concerned for your condition following the implant that we even considered total isolation at one point in our planning." "Well, actually, Sir. I'm glad you took the precautions. Who knows whether the precautions might have prevented my becoming infected and defeating the entire transplant effort." "Well, of course, you're right, my boy," Dr. Kavanaugh agreed. ***** "Hugo, can you describe to everyone the details of what acquiring hearing was actually like for you?" Dr. Kavanaugh asked. "Yes, Sir..." Hugo replied. Then he paused to think for a moment. "I counted the days after surgery. I didn't really expect anything to happen for the first day or two, but after that, I really started to worry as each additional day passed and nothing was different for me," Hugo confessed. And he continued: "Kevin and I knew that around the 7th or 8th day something was supposed to happen. Just nobody knew what that was." Hugo shifted around on the sofa and pulled his leg up on the cushion next to him... "I remember that it was Christmas, and the boys had brought in decorations, and Kevin and I and the boys decorated a tree right in my hospital room-- well, it was a really big room..." "That seventh evening I started getting clicking things in my head. I didn't call them sounds, because I didn't know what sounds were, and I didn't know whether I was hearing or not; so I got Kevin to call you on your cell phone," Hugo said looking Dr. Kavanaugh in the eye. "Yes, Hugo." and Dr. Kavanaugh picked up the narrative. "We were very excited when we heard that something was occurring for you that was different from the silence you were used to living with, but we didn't understand what was happening either; so we just had to accept your reports and then try to make sense of them. Our hasty analysis concluded that the axons of the newly-implanted cells were forcing their way into the nerve bed of the existing aural nerve channel, and that these clicks were connections that were taking place. The brain would not have known how to interpret these electrical nerve signals that were beginning to arrive. Everyone was in unknown territory, Hugo..." "Yes, Sir. I understood that. And, at first, I thought that maybe I was making things up because I wanted something to happen-- ANYTHING -- so bad, that maybe I was inventing these clicks. But I quickly dismissed that possibility because they really did keep happening... They got more and more annoying, and... I guess I could say ... LOUDER, but speaking about the attributes of sound was not something that I knew how to do at that point... I just realized that SOMETHING was happening that was NOT just my usual silence," Hugo said. "The boys had come to spend that night, Christmas night, in my hospital room along with Kevin. Kevin and I were sleeping in my bed, and the boys were using sleeping bags on the floor. Nicky had brought his X-box computer gaming system, but he'd loaded Christmas Carols in it, since it was Christmas night." "We were all asleep. Then I woke up for no reason, except I thought I HEARD something... I realized I DID! I DID HEAR SOMETHING!... And I listened not moving a muscle, and I heard a lovely sound that I came to understand was music. The first sounds I heard and understood as sound was the Christmas Carol, Silent Night..." And Hugo paused once again, recollecting that moment on that Christmas Night. Brandy reached over and took Kevin's hand and squeezed it. "The Holy Child was visiting Hugo. You and the boys were truly having a holy night..." Kevin turned and looked at Brandy through his tears. He smiled and nodded and turned back to look at Hugo up on the stage. Hugo went on speaking, "That's when I telephoned you, Dr. Kavanaugh, and I could tell you that I was hearing..." "Yes. My boy. I remember coming to your room and resting there with you until we were sure that hearing had been re-established." "Dr. Kavanaugh" Hugo said. "Yes, Hugo?" "Would you mind if I invited Kevin and the boys to join me here on the sofa right now?" Hugo asked. "That night was not just MY night to start hearing. It was NOT JUST my time to begin my new life. It was OUR new life that began; I'd like Kevin and the boys here with me." "Indeed, my boy." Dr. Kavanaugh said. Then he turned to the audience and indicated that the house lights should be brought up. Dr. Kavanaugh then rose and spoke: "Kevin, Jilder, Nicky, would the three of you please join Hugo and me here on the stage?" Max and Brandy looked over at Kevin and smiled. Max rose and offered his hand to Kevin to help him from his seat. Kevin looked back at the rows behind him until he made eye contact with Jilder and Nicky. Kevin indicated to the boys to follow him, and the three joined one another in the asyle and then walked together up to the sound stage where Hugo's interview was taking place. Hugo stood and held out both arms into which he took all three of them and hugged them all at once. He bent down and kissed Nicky on the forehead and then Jilder the same, and then he gave Kevin a brief kiss on the mouth. "Please, gentlemen, be seated. Make yourselves comfortable on the sofa with Hugo," Dr. Kavanaugh invited them with his arms stretched out. The audience responded with applause that was warm and supportive rather than laudatory. The house lights went back down and Dr. Kavanaugh and the others took their seats. Dr. Kavanaugh began, "I realize that it is only fitting to recognize that while the medical events that took place to recreate hearing were performed by a team, it is equally true that the reception of these medical events was also formed by a family team that culminated in success for us all." Hugo stood up and reached behind the sofa to retrieve a guitar. "And, Dr. Kavanaugh, my hearing has made possible the most wonderful life of sound and music for me, and I'd like to share just a few moments of this music with everyone." The audience applauded to express their encouragement. A spotlight pinned Hugo in his seat, as the remaining set lights faded and Dr. Kavanaugh and the others were in shadows. Hugo struck his guitar with the dramatic chords that gave introduction to the Malaguena. And with inspiration and motivation that had never formed in Hugo's breast, he poured out his soul to the most marvelous rendition ever of his favorite piece. Through the rousing rhythmical flounces and intricate fret work, Hugo's consciousness narrowed to include only the wonderful music he was making. And when this particular rendition came to its conclusion, Hugo silenced the instrument in his signature dramatic smothering of the strings. And the audience broke into exciting, exhilarating applause to return to Hugo the love that he shared with them by his unstinting honesty about how he came to acquire and accept his hearing, and now for everyone it was time to see what God and Hugo had done. *****