Father: An extraordinary journey of voice loss

Father by Susan Reagan

Is prayer spoken or is it felt?  When the voice is absent how are prayers expressed? Voice loss presents itself for many different reasons. In this case voice loss was the quiet warning signal that announced a greater challenge was yet to come.

As a 26 year old young man Michael Mondik felt a calling that could not be ignored. That calling was to serve God as an ordained Byzantine Catholic priest. At an early age Michael was a devout Catholic as a result of being raised in a religious home. Going into the seminary was the only logical choice; it was his greatest desire throughout his life. 

When asked what motivated him to join the priesthood, he was not sure what to say. He just knew it was meant to be. When his father dropped him off at the seminary he said, “Michael, it is okay to change your mind”.  As they said their final good-bye’s young Michael simply said, “It’s where I belong, Dad”.  His family was always supportive, encouraging of his choices every step of the way. Father Michael recalls never looking back towards the car for one last goodbye. Forty-two years later he still feels very strongly that he made the correct decision so long ago.   

Father Michael Mondik was the Pastor of Saint Thomas the Apostle Byzantine Catholic Church in Rahway, New Jersey until July1, 2015 when he retired from active Ministry. He was the parochial leader of one-hundred and sixty five families or roughly three-hundred parishioners.  Father Michael’s greatest joy was serving at the altar, conducting liturgical services with the perfection that Eastern Christianity strives to achieve. The Eastern Christian Divine Liturgy is for the Glory of God so every word is spoken with precision and every movement carried out with grace.   

Being a pastor is more than conducting services. He also enjoyed counseling parishioners when they came forward in need of help. Seminary training prepared him by offering coursework in counseling and psychology but they also taught him when he was in over his head. He learned how to make referrals to other more qualified professionals. He lamented, “Things are different these days society has changed a great deal creating a very litigious environment”. Towards the end of his tenure all priests were not permitted to counsel people outside of their parish.

Using one’s voice is the one common factor in performing both of these duties. Without a voice these tasks would be nearly impossible to perform. In 2010 Father presented with vocal issues that caused him to seek medical advice. He felt tightness in his throat and hoarseness in his voice. After a great deal of exploration and medical testing Father Mondik was diagnosed with multiple myeloma and amyloid sarcoidosis. Voice loss was the first warning sign well before being diagnosed with cancer.

 

  

By 2009 Father Michael noticed he was unable to control the pitch of his voice. This was a critical aspect of his ministry as Byzantine Catholic services are chanted without musical accompaniment. His face, throat and neck sporadically swelled but with medication could be treated. Eventually his doctor was unable to remove the protein rich fluids that engorged his lymphatic system creating permanent swelling in the area. He is grateful because the swelling could have occurred in his lungs and or heart causing the inability to breathe or cardiac arrest. He considered himself lucky looking at the possibilities.

Father Mondik had to make several changes in his service and life. He learned not to force his voice and realized no matter how much he pushed or strained it would make no difference in the quality of his voice. He reports feeling no pain in his throat but does admit to getting tired by the end of the day. Singing and chanting is difficult so he tries to keep both to a minimum. At times he heavily relies on the parish Deacon and the use of a microphone. He will recite prayers instead of chanting when optional.

It is terrifying to lose one’s voice when your career depends on that voice to be effective. It is unimaginable to cope with a diagnosis of cancer with a poor prognosis. Even though parishioners knew and understood his situation it was still very hard, as living is always the hardest part. While talking about mortality Father admits that quality of life is more important than quantity.  He questioned over and over how would he lead a parish without a voice?

When asked about faith and accepting the will of God and he responded “it is not a matter of faith it’s matter of knowing life is eternal in the kingdom of God.”  This life is temporary.

Currently Father Michael Mondik has retired and moved to Arizona to be surrounded by the comfort of friends. His condition continues to worsen with frequent hospitalizations. The eventual end not very far off, Father Michael is at peace in knowing that he served God in this life and will be with God in the next life everlasting.

Treating Muscle Tension Dysphonia

PART ONE

Walking the streets in a stupor getting news that was too tremendous to comprehend, I sat on the curb of a city street and wept.  Later dumbfounded in a suite high above the city I sat in complete and utter disbelief after visiting one of the world’s foremost authorities on voice.  Afraid to tell anyone about this new turn of events I sat there looking blankly at the walls.  The setting sun of early fall slowly turned to night but my shock and disbelief had not subsided.

Too excited to sleep I extinguished the lights, turned down the bed and proceeded to lay there alone in the dark for most of the night.  Eventually the bright early morning sunlight filled the room and stole the few hours of slumber that had managed to find me.  Giving a yawn and a deep stretch opening my mouth, “I could talk”.   After five long pain filled years of pursuing treatment for Spasmodic Dysphonia it was determined that I had Muscle Tension Dysphonia, a completely different beast regardless of sounding the same.    

Who to call first?  Of course mom was first then my best friend and then a long list of others; loving family members and friends that looked at me with pity as I tried to speak but could not.  As the first phone calls were made I had a nagging feeling that this newly found voice would not last.  I spoke with a loud clear voice but something inside said this was not real and not to be shared with the rest of the world.

Returning to the sleepy hills of eastern Pennsylvania staring out of the bus window the sudden change was too much to comprehend after five years of becoming near mute.  My voice remained strong over the next 6 days as I made sure not to strain while speaking, I only spoke when needed.  The psychology had not caught up with the reality just yet, as I was still unsure of what was going to leave my mouth when trying to speak.   Sadly, by day five into day six I could feel the familiar heart breaking hands weaving around my throat, choking me, taking my breath and stealing my words.  The feeling inside my heart was right; this was not meant to last.

PART TWO

After reaching into my purse to fish out the business card for the speech language pathologist I then called the number and made the first appointment for evaluation and treatment.   Gearing up in the old learned behavior, I rasped out my request, “I need to see Dr. Stewart”.   Accepting the fact that I was unable to talk once again I had to start the painful process of learning to speak with a qualified speech therapist.  There was no denying the fact that my only hope to recover my voice was through speech therapy.

Week One

In an attempt to release my perpetually tense body; to release the ever present pain that lived in my throat, neck, shoulders and back the doctor’s orders were to WIGGLE!   Imagining my spine as a jointed girder connecting the back, neck and head wiggling started to release all of the tension that had accumulated from the strain of speaking. 

Being in disbelief how this could ever help me to speak I continued to follow the doctor’s orders as the subtle motion did feel good.  For the next week every hour for a minute I wiggled without speaking.  Eventually the painful knots underneath each shoulder blade started to melt away; the tension that had been present for literally 5 years started to untwist. 

There is so much involved in the production of speech; body mechanics and neuromuscular coordination of the physical mechanisms of the throat all coordinating the production of speech.  To think so intensely about a skill that was acquired so easily as a child was overwhelming.  It is amazing that anyone speaks at all!

Week Two

More of the same wiggle and release the jaw and say “um-hmm” while feeling the vibrations travel from the lungs over the larynx and escaping the mouth.   The therapist cautioned, never ask the larynx to do for more than it is capable of giving.  Through the struggle of trying to produce voice over the past five years terrible habits of pushing my voice developed.  I learned compensatory strategies that were destroying my throat as well as my chances of ever speaking again.

The harder I tried to speak the greater the strain became, the greater the strain the harder it was to speak.  In other words the body’s initial reaction is counter intuitive, straining was not improving the situation.  The only way to recover was to release, relax without pushing and torqueing the musculature of the neck.  Seeing now the difference between this approach and past failed attempts; less is more. 

Prior therapists ordered me to push and use a full voice compared to the gentle efforts being used now.  The other therapists neglected to educate me about using the voice at the smallest possible range.   A voice without pushing, without straining, a voice that was used with practice and control allowed no effort voicing.  Voice and speech are different in the sense that voice are the sounds produced by humans and other vertebrates using the lungs and vocal folds.  Voice, it is not always speech, as it includes laughing, crying, singing, and babbling.  Speech is a series of complex oral movements used to express one’s self with the use of decodable sounds.

Week Three and Beyond

Finally permitted to speak, the shortest simplest phrases proved to be near impossible with the initiation of speech being the most difficult.  Being near tears wanting to speak so badly fighting the natural instinct to push I had only allowed what the larynx was willing to produce.  Hearing the words “dial it down” from the therapist, seeing those words pass by as if they were a cloud, the goal was to produce speech with as little effort as possible. 

As the weeks progressed and the outside temperatures began to dip into eventual winter I faithfully kept each appointment with the speech therapist.   There were more than a few sessions where crying was all that could be accomplished as there was such an enormous dam holding back all of the pain and frustration locked deep inside.  Being so highly educated with almost twelve years of college to my credit and 4 advanced degrees counting to three proved to be a monumental challenge. 

Over what seemed to be an eternity gradual improvements were noticeable such as the growing ease of initiation, the lengthening periods of “good” voice and the slow but eventual raising of the volume of my voice.  The entire process took about ten months to go from silence to speaking.   There are still good days mixed with bad, at times I still have trouble when I am tense, stressed or tired.  I have learned a great deal about vocal and muscular control and still fight to be heard at times.  

The key to curing and treating Muscle Tension Dysphonia is never giving up and staying the prescribed course of action regardless of how long it takes to recover.   The other key component is finding a speech therapist that has experience in treating this condition.  The patience, the will and the drive to recover are part of my inherent nature so giving up was never an option.

 

  

The First Few Moments (Part One)

Even though the onset of my voice disorder was in November of 2008 it took some time for the actual diagnosis to be made. My ability to speak was steadily declining without explanation while each doctor gave their best guess as to what was actually was wrong with my voice. Somehow I was still in denial that there was an actual problem and I was holding out for my voice to return back to normal.


I recall finally receiving the diagnosis of Spasmodic Dysphonia (SD) already knowing it was a non-curable neurological based vocal disorder. I was so overwhelmed with emotion bawling my eyes out and paralyzed by fear as to what the future would hold for me. I was sobbing uncontrollably while it felt like my heart was being ripped from my chest. The definitive word had been passed down that indeed there was a problem and there would be no magical return to the past.


The doctor did make sure to give me the phone number to the local SD support group leader. I will never forget sitting in the parking garage of his office choking on my tears making that first life-saving phone call. Surely my words were incomprehensible to her between my mangled voice and my strangled sobbing. Somehow she was still able to understand what I was saying having been in my shoes years before. I felt like my life was over but the simple act of her understanding gave me a glimmer of hope and the realization that my life was not over just changed.

The First Few Moments (Part Two)

It was a miraculously beautiful late summer’s day in uptown Manhattan the day I found out I was wrongly diagnosed with Spasmodic Dysphonia.  Having been granted the opportunity to meet with one of the east coast’s foremost authorities on voice disorders he declared I was one of the lucky ones having Muscle Tension Dysphonia which is a treatable muscular disorder, I staggered blindly through the streets of the city unable to comprehend this new information.  This determination was made quickly with a short conversation and a simple but painful manipulation of my larynx.


Life out on the streets of the city seemed to be passing by at a speed that my mind was not able to grasp.  My hearing was altered and the ground seemed to have a spongy quality underneath my feet. There were times that evening when I was so completely dumfounded by the news that I did not have SD I literally sat on a curb and stared blindly at whatever it was that was in front of me.   There were even a few strangers that had stopped to ask if I was okay to which I responded, “You could never understand how happy I am”.   This news was like having been granted a stay of execution.  Several hours had passed by the time I realized the sun had set and I should get safely back to my hotel room.


I sat for an additional few hours in the hotel room trying to comprehend this bizarre turn of events.  At that time I did the only thing I could think to do, write poetry!  The doctor had manually manipulated my larynx back into its normally seated position which restored my voice.   I was filled with disbelief and hesitated to share this new information with the people in my world.  I was consumed with a foreboding feeling that somehow this turn of events was too good to be true.  This new information was to be protected and guarded until I was sure it was real.


I woke up several times that evening to try out my new voice and stared blankly out to the twinkling lights of the city.  I was in shock, disbelief and awe.  The first order of events once the sun had risen the next day was to make the requisite phone calls to the people that loved and supported me through this epic battle.  Of course Mom was first, I felt though somehow I wanted to warn her not to get too excited as there was a gnawing voice inside of me saying this is not going to last and it was too good to be true.  Sadly, six days later my larynx had climbed back up into the learned posture and my voice had broken once again.

911, Please State Your Emergency

“Susan, call 911, your father is having a heart attack, HURRY”! Having picked up the phone then clumsily pressing each number cautiously, the bile was rising in my throat from the sheer fear and panic of how my voice would sound when the 911 operator finally answered the call. With shaking hands hearing the sounds from the other room I tried to dial the numbers correctly this time. Feeling the panic mounting around me from the stress and anxiety inherent to the situation I could feel my throat closing knowing that a clear voice would now be impossible. “Hello, this is 911, please state your emergency”.


Waking up in a cold sweat feeling a full on anxiety attack from the nightmare that just played out in my sleep, a panic set in; how would I manage to make a call to 911 during any emergency? Laying there in the middle of the night, heart pounding in my throat the real fear of being confronted with such a call was suddenly looming large, what WOULD happen, how WOULD I manage in a life or death situation?   How do you control your voice when your vocal condition is worsened by stress?   How do you get your point across in a potentially life or death situation?   How do you manage to communicate when you have no voice at all? These are very real concerns for people with a vocal disorder or for people that have completely lost the ability to speak. The fear of calling 911 for people with a vocal disorder can be paralyzing.


According to one 911 dispatch operator there is no formal training that specifically addresses taking calls from people with vocal disorders.   Many times if a voice sounds strange that caller is “misdiagnosed” in a way by the dispatch operator. The best way to avoid this misdiagnosis from occurring is to identify your challenge. “Hello, my name is…, I have a vocal impairment and my emergency is.”   If no mention is made of a vocal impairment at the beginning of the call it could be all too easy for an incorrect assumption to be made about the caller’s cognition, cognitive function or even a mistaken assumption about being inebriated.


Remember even in a state of emergency be concise, choose your words carefully. Tripping over unneeded words makes you, the caller more frustrated and increases the level of confusion for the dispatch operator. Take comfort in knowing that even if your words are inaudible or incoherent a police officer will be dispatched to the address associated with the number you are calling from (response times will vary depending on your geographical location). State as clearly as possible if an ambulance is required, making your needs known at the onset is critical to getting the proper help you need in a timely manner.


Calling from a landline will assist emergency personnel by giving your exact location negating the need to painstakingly repeat the address you are calling from, but keep in mind that billing address must be the same as the physical location. This option if available could also decrease your level of anxiety. What do you do if a land line does not exist? Cellular phones work as well but will be routed to the police agency of the nearest cell tower if you are away from home.


Another option to ensure people with a vocal impairment are able to access emergency services is through the use of a relay service as used by people with a hearing impairment. These options include the use of a TTY relay service; this service will automatically let the operator know where to dispatch emergency personnel. Voice Carry Over (VCO) for people who are deaf or hard of hearing who communicate by speaking and lastly a Hearing Carry Over (HCO) relay for people with a speech disability.However, relay services are not widely utilized by those with intermittent voice loss for a variety of reasons but could be a helpful option for those people with any voice loss.


According to 911.gov the use of a teletypewriter text telephone device (TTY) has its limitations as well. The technology is old, it is cumbersome and slow. While modern technological advances have greatly improved the quality of life for people with vocal impairments; texting, instant messaging, video chat and email is currently not compatible with 911 services. As public safety answering points (PSAP) implement Next Generation technology the need to relay messages will no longer be necessary as PSAPs will be able to communicate directly with people with communication impairments through text messaging and video relay. However, there is no information provided giving a timeline for these upgrades and changes.


Hopefully you will never need to access 911 services but if the occasion should ever arise keep the following in mind; stay calm, as that is your best bet to maintain a good voice, if you are living in a situation with the potential for an emergency to arise write a script of what you would tell the dispatch operator and then practice that script.   Accessing 911 emergency services does not have to create a sense of panic and fear, understanding how the system works and knowing your options will increase the sense of control and independence you have over a potentially life threatening situation.

Nuance of Voice

Subtle raises up or down give the listener a clue of how to interpret the sound.
Prolonged exasperation of one word can change the meaning from banal to profound.


Voice in its full range of verbal expression conveys joy, love, heart ache and depression.
Nothing can come close to meeting its perfection in an attempt at reproduction.


Voice adds warmth and dimensions to other wise literal translation.
Pitch, tone, volume and fluency all create a euphony that is pleasing to the ear.


Rate and speed can create great anticipation, excitement and intrigue. 
A hushed whisper in the heat of the moment can send a tingle down a spine.


Voice can change a statement to a question with a tiny hint of inflection.
One thousand thoughts can be conveyed or implied with the use of just one spoken word.


Many people without thought poise to speak and present their message taking for granted this beautiful instrument in its fullest expression.