In medical school, people started telling me something I had never heard before: “Shhh, lower your voice.” As someone who was naturally soft-spoken and constantly told to speak up, this was jarring. I remember thinking that maybe I was finally finding my voice and building confidence. But I did not feel any more confident, and being “shhh’d” just made me self-conscious. Even in quiet settings like a library or church, where I was purposefully trying to whisper, I was still told I was too loud.

Then, a confusing pattern began to emerge. I found myself asking people to speak up or repeat themselves — at school, the grocery store and at home. It was the exact opposite of what I was used to: instead of being told to speak up, I was the one asking others to repeat themselves, all while being told to lower my own voice. Because I did not feel loud, the repeated shushing made no sense. Why was everyone suddenly whispering? The tension was beginning to affect my marriage; my husband, Taylor, started getting annoyed when I asked him to repeat himself for the third time. He was the first to suggest I get my hearing checked, a notion I resisted at first. I had always had perfect hearing and consciously protected it from loud music and noisy environments. Why would that change now?

Eventually, it began affecting my education. I struggled to follow along in the classroom, so I started recording lectures on my phone to review later. Study groups became equally as difficult, especially when people’s heads were down or their backs were turned towards me. I remember a distinct moment of frustration during a study session, irritated that everyone was talking so softly, when the realization suddenly hit: I was alone in my frustration. Everyone else could hear well enough to respond to one another.

Maybe my husband was right. Maybe I did need a hearing check. I noticed the same pattern in other group settings — people around me were chatting and following along effortlessly, while I struggled to understand. Slowly, I began to isolate myself, no longer participating the way I used to.

When I finally had my hearing tested, the results confirmed it: I could benefit from hearing aids. My sister was born partially deaf and wore hearing aids most of her life. My dad and several others in my family wore them too. Nonetheless, I had always lumped myself in with my mom, assuming I had perfect hearing that just needed protecting. I had not considered that I could lose my hearing at such a young age. Later, I learned that my dad and grandfather both started losing their hearing in their late teens and early twenties.

After getting my hearing aids, my world changed dramatically. I could follow lectures, conversations and study groups again — and Taylor could stop yelling across the apartment. One morning, Taylor warned me that it was raining. As I put on my hearing aids before leaving, the sound of the rain suddenly flooded in — a sound I had been missing. Experiencing an epiphany, I turned to him and asked, “Wait a second, is this how you always know it is raining outside? You can hear it? I thought you just looked through the blinds or opened the front door!” He looked at me, confused, and confirmed, “No, I can just hear it.” It amazed me. On the bright side, because I had previously been an extremely light sleeper, Taylor joked that my hearing loss was actually a blessing for my sleep schedule since the morning birds no longer woke me up with the slightest chirp.

Unfortunately, I received my hearing aids around the time the COVID-19 pandemic hit and everyone began wearing masks. This also coincided with the start of my inpatient rotations in medical school, creating a perfect storm of vocal perception changes. To me, my own voice sounded like I was yelling — not only because of the new hearing aids, but because the mask trapped and amplified the sound. Without realizing it, I was autoregulating my voice based entirely on how loud I perceived myself to be. No one else experienced that amplification; it was only loud in my own ears.

Still stuck in the mindset that I needed to be quieter, and being naturally soft-spoken anyway, I began speaking quietly without realizing it. Soon, people were telling me to speak up again. It was incredibly disorienting. I felt like I was screaming into my own ears every time I spoke, with the mask projecting my voice straight back into my hearing aids. At first, I blamed the masks, since everyone was harder to hear and understand in a noisy hospital setting with masks on. Because I was constantly adapting to new environments during my third and fourth years of medical school, it took me months to fully grasp how much my hearing aids were amplifying my own voice, making it difficult to gauge how loud I sounded to others.

The volume of your voice is naturally influenced by the auditory feedback you get from hearing yourself. When someone has hearing loss, they often speak louder because they perceive their own voice to be quieter. For me, I had mild-to-moderate loss at the time — easy to follow one-on-one conversations in a quiet room, but just enough to struggle in noisy environments or in larger conversation. But with hearing aids, everything was louder, sometimes painfully so (like the sharp beep of patient monitors or medical suctions). Constantly rotating through different clinical environments, combined with taking my mask on and off, made it an uphill battle to adjust my volume to the level others expected.

Things improved with time, but everything shifted again when I started residency. Between medical school and residency, I took a few months off to move and welcome my daughter. We intentionally chose a house with an open floor plan to make communicating between rooms easier, and I fell out of the habit of wearing my hearing aids every day. As a result, my vocal autoregulation reset without my noticing. It was like reverting to the days before I had hearing aids, except I was not in a busy classroom; I was just at home with my baby. I rarely needed my hearing aids since I could easily hear her cry.  When I returned to work, I put my hearing aids back in and wore a mask constantly to protect my daughter from hospital germs. Again, I was immediately told to speak up. It was maddening; in my own ears, I sounded louder than I had in months. How could they not hear me?

I vividly remember an inpatient feedback session with an attending physician. They sat me down and began telling me a story about a friend of theirs who had “actual hearing loss” and spoke very loudly. Unsure where they were going with this story, I neutrally responded with, “Cool,” and thought, Good for you for having a friend with hearing loss? Are you trying to relate to me? What is the point of this story? I felt awkward, confused, nervous and had no intention of disclosing my personal medical history at that moment.

At the time, the main takeaway I had was that they did not think I had “actual hearing loss” since I did not speak loudly like their friend did. Though, looking back, I think they were simply trying to tell me to speak up. However, it ultimately taught me a valuable lesson in leadership and medical education. When the time comes to evaluate my own students or residents, I want to avoid invalidating a trainee’s experience or pressuring them to disclose personal matters on the spot. Instead, my goal is to be direct and transparent about my expectations. I want to offer genuine compassion and support without requiring them to justify their difficulties. I intend to invite open dialogue by asking how I can best assist them, offering space for a follow-up discussion after they have had time to reflect so we can collaboratively brainstorm strategies for improvement.

Over time, I have continued to adjust. Since graduating from residency, I found a balance as now I am rarely shushed anymore and I do not need to repeat myself as often. In fact, I now wear my hearing aids selectively since I am in a quiet outpatient clinic setting where I do not rely on them as heavily. Dropping the constant mask usage has also helped me immensely in accurately judging my own volume.

While most stories about hearing loss focus on the difficulty of understanding others, my unexpected hurdle was getting others to hear me. As a naturally shy person, being told to lower my voice before my diagnosis made me incredibly self-conscious. Conversely, feeling like I was shouting into my own ears through a mask and hearing aids, only to be told I was whispering, was deeply frustrating. I am glad to have finally found my balance, and I hope to use my experience to help future colleagues and patients who experience the world a little differently feel seen, heard and comfortable when communicating.

Image credit: Project 365 (Public Domain Mark 1.0) by comedy_nose