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A surgery to end all surgeries (or so we hope)
Heart attack, Part 9: One last implant
Bob Levin
Ninth in a series of articles about the author's heart attacks.
"We have to talk," said my cardiologist, Dr. M.
Adele and I looked at each other. We had expected my test results to have earned me at least a "Come back in a year."
Because I had twice lost consciousness and fallen, Dr. M had ordered me to take a stress echocardiogram and to wear a heart monitor for 24 hours. Probably I fell because I'd stood up too quickly to allow enough blood to reach my brain. Since I'm tall and on beta-blockers, I run that risk. Still, she had wanted to rule out heart misfunction.
I had aced the echo. A "normal" ejection factor— the percentage of blood pumped out by a heart on each beat— is 50. Mine, once a dangerously low 35, was now a stunning 48. And the monitor had shown no arrhythmia. But it had revealed that, for three-plus consecutive seconds out of the day's 86,400, my heart had not beat.
You would think a 99.99997% success rate would be fine. But skip another second or two, and— bang!— you're gone.
It could have been an anomaly. It might never happen again. But Dr. M recommended an Internal Cardiac Defibrillator.
No more cell phones
It would be simple, she said. A slit in the chest. The connection of one lead to the right ventricle and one to the right atrium. One night in the hospital. Pain for a week. I shouldn't raise my left arm overhead or lift more than ten pounds for a month. No cell phones in my breast pocket or security guards waving wands before me, forever. Avoid large magnets— or was it large mammals? I was too wobbly by then to be sure.
Adele and I loved my doctor. We felt blessed that I was walking and talking. But if we never saw another hospital...
Dr. M explained. The heart functioned through the steady pulsing of electrical impulses. The aging of the dead and damaged portions of my heart would increase the chance of its misfiring— and my risk of sudden cardiac arrest.
"I've given this a lot of thought," she said. "We should proceed while you are strong and fit."
Another delay
"We've already nominated you for sainthood," Adele told Dr. M. "We figure, with Bob as your first miracle, you only need one more. We will do whatever you say."
Dr. W, the "electrician" of Dr. M's group, would operate. Dr. M's influence got me scheduled within two weeks. Then a secretary called. The hospital did not have an anesthesiologist available then. The operation was delayed— and landed on my birthday.
I was cool with that. I figured God was less likely to fuck with me then. (It felt safer, like having nuns in line when you're boarding a plane.)
"You'll never get a more expensive birthday present," the secretary said.
Finessing Medicare
The operation would have one wrinkle, though. Some installations take an hour; mine would last three. And I had rehabbed my heart so well that Medicare would not automatically cover the cost. Dr. W would have to authenticate my need by running a catheter up through my femoral artery and stimulating a life-threatening fibrillation.
As a doctor friend explained, "The government doesn't mind sticking a $100,000 gizmo in the chest of some homeless junkie who'd just as soon rip it out and pawn it, but it won't let your doctor decide what's best for you."
"What if my heart won't cooperate into misbehaving?" I said.
"Don't worry. We've learned to be devious."
Terrifying dream
A few nights before I was to go in, I dreamt that Adele and I had bought a store in San Francisco's Mission District. On one of our first days there, I came back from the bank and couldn't find it. I walked back and forth, checking each storefront. Then I recognized that the portion of the block where the store had been contained rubble. One of the passersby explained that the site had exploded. Police and firemen and ambulance crews had come and gone. Nothing was left. No one remained.
I couldn't believe it. I expected to spot Adele's ankle-length yellow rain slicker in the crowd. But she was not there. An image materialized to tell me she wasn't in the hospital either. As the news sunk in, I lay face down and licked the sidewalk as if to absorb some remnant of her.
I awoke, terrified.
"Bob!" Adele called. She was already awake, terrified too.
Farewell, tight sweaters
The operation went smoothly, though my heart proved so easy to fibrillate that Dr. W threw in some fix-up work while he was up there. I was walking before dinner and home the next day.
The pain afterward was no problem. I was off Tylenol in two days. My inability to lift weights was annoying, but I was on the cardio machines full-bore within the week.
My biggest problem was the surgery's visibility. I'm thin, which is good for the heart, but it looked like someone had sewn a pocket watch inside my chest.
"No more walking around in tight Angora sweaters," I said.
"You'll get used to it," Adele said.
"Maybe I need another so I'm symmetrical."
"A tattoo would be simpler."
The extent of my vanity bothered me. I felt transformed into an alte kocker from the vital, vigorous 29-year-old I still deluded myself to be. Would the clothing cops confiscate my black leathers and order me into white loafers, lemon cardigans, and lime polyester slacks pulled above my navel? In the locker room, I kept a shirt on until the last second and cast a towel over my shoulder to and from the shower.
"'A built-in paramedic'
My next appointment changed my mood.
One factor was Dr. M's visible relief. She seemed to genuinely feel I was protected at last. Another was that after I confessed my self-consciousness, she told me of a vital, vigorous, 40-year-old woman who'd refused the Internal Cardiac Defibrillator. She went— bang!— while on her morning jog.
Then there were the wonders of the device. If the battery was low or a lead was loose, it would beep to warn me. If my heart beat went off-rhythm or slower or faster than Dr. M wanted, the Internal Cardiac Defibrillator would choose from a range of pulses and jolts to correct it.
"Think of it as having a built-in paramedic, who can reach the scene, diagnose the problem, and fix it, within 20 seconds," the medical assistant said, as she customized my settings. And throughout the day, the device would collect information on my heart's function, which it would transmit to the office, sparing me the trouble of traveling there.
"This is it," Dr. M said. "Modern medicine has nothing left to put in you."
The experience left me a-tremble. Within a few years, I recognized, even this technology might seem Paleolithic. Op-ed page columnists would debate whether taxpayers ought to keep septuagenarians like me sniffing instead of fertilizing roses.
But with clear conscience, bouncing step, hip-riding jeans, and engineer boots, I sallied forth. And the next morning at the café, when someone asked how I was doing, I whipped up my T-shirt to show everyone who cared to find out. ♦
To read the preceding episode, click here.
To begin the series at the first episode, click here.
"We have to talk," said my cardiologist, Dr. M.
Adele and I looked at each other. We had expected my test results to have earned me at least a "Come back in a year."
Because I had twice lost consciousness and fallen, Dr. M had ordered me to take a stress echocardiogram and to wear a heart monitor for 24 hours. Probably I fell because I'd stood up too quickly to allow enough blood to reach my brain. Since I'm tall and on beta-blockers, I run that risk. Still, she had wanted to rule out heart misfunction.
I had aced the echo. A "normal" ejection factor— the percentage of blood pumped out by a heart on each beat— is 50. Mine, once a dangerously low 35, was now a stunning 48. And the monitor had shown no arrhythmia. But it had revealed that, for three-plus consecutive seconds out of the day's 86,400, my heart had not beat.
You would think a 99.99997% success rate would be fine. But skip another second or two, and— bang!— you're gone.
It could have been an anomaly. It might never happen again. But Dr. M recommended an Internal Cardiac Defibrillator.
No more cell phones
It would be simple, she said. A slit in the chest. The connection of one lead to the right ventricle and one to the right atrium. One night in the hospital. Pain for a week. I shouldn't raise my left arm overhead or lift more than ten pounds for a month. No cell phones in my breast pocket or security guards waving wands before me, forever. Avoid large magnets— or was it large mammals? I was too wobbly by then to be sure.
Adele and I loved my doctor. We felt blessed that I was walking and talking. But if we never saw another hospital...
Dr. M explained. The heart functioned through the steady pulsing of electrical impulses. The aging of the dead and damaged portions of my heart would increase the chance of its misfiring— and my risk of sudden cardiac arrest.
"I've given this a lot of thought," she said. "We should proceed while you are strong and fit."
Another delay
"We've already nominated you for sainthood," Adele told Dr. M. "We figure, with Bob as your first miracle, you only need one more. We will do whatever you say."
Dr. W, the "electrician" of Dr. M's group, would operate. Dr. M's influence got me scheduled within two weeks. Then a secretary called. The hospital did not have an anesthesiologist available then. The operation was delayed— and landed on my birthday.
I was cool with that. I figured God was less likely to fuck with me then. (It felt safer, like having nuns in line when you're boarding a plane.)
"You'll never get a more expensive birthday present," the secretary said.
Finessing Medicare
The operation would have one wrinkle, though. Some installations take an hour; mine would last three. And I had rehabbed my heart so well that Medicare would not automatically cover the cost. Dr. W would have to authenticate my need by running a catheter up through my femoral artery and stimulating a life-threatening fibrillation.
As a doctor friend explained, "The government doesn't mind sticking a $100,000 gizmo in the chest of some homeless junkie who'd just as soon rip it out and pawn it, but it won't let your doctor decide what's best for you."
"What if my heart won't cooperate into misbehaving?" I said.
"Don't worry. We've learned to be devious."
Terrifying dream
A few nights before I was to go in, I dreamt that Adele and I had bought a store in San Francisco's Mission District. On one of our first days there, I came back from the bank and couldn't find it. I walked back and forth, checking each storefront. Then I recognized that the portion of the block where the store had been contained rubble. One of the passersby explained that the site had exploded. Police and firemen and ambulance crews had come and gone. Nothing was left. No one remained.
I couldn't believe it. I expected to spot Adele's ankle-length yellow rain slicker in the crowd. But she was not there. An image materialized to tell me she wasn't in the hospital either. As the news sunk in, I lay face down and licked the sidewalk as if to absorb some remnant of her.
I awoke, terrified.
"Bob!" Adele called. She was already awake, terrified too.
Farewell, tight sweaters
The operation went smoothly, though my heart proved so easy to fibrillate that Dr. W threw in some fix-up work while he was up there. I was walking before dinner and home the next day.
The pain afterward was no problem. I was off Tylenol in two days. My inability to lift weights was annoying, but I was on the cardio machines full-bore within the week.
My biggest problem was the surgery's visibility. I'm thin, which is good for the heart, but it looked like someone had sewn a pocket watch inside my chest.
"No more walking around in tight Angora sweaters," I said.
"You'll get used to it," Adele said.
"Maybe I need another so I'm symmetrical."
"A tattoo would be simpler."
The extent of my vanity bothered me. I felt transformed into an alte kocker from the vital, vigorous 29-year-old I still deluded myself to be. Would the clothing cops confiscate my black leathers and order me into white loafers, lemon cardigans, and lime polyester slacks pulled above my navel? In the locker room, I kept a shirt on until the last second and cast a towel over my shoulder to and from the shower.
"'A built-in paramedic'
My next appointment changed my mood.
One factor was Dr. M's visible relief. She seemed to genuinely feel I was protected at last. Another was that after I confessed my self-consciousness, she told me of a vital, vigorous, 40-year-old woman who'd refused the Internal Cardiac Defibrillator. She went— bang!— while on her morning jog.
Then there were the wonders of the device. If the battery was low or a lead was loose, it would beep to warn me. If my heart beat went off-rhythm or slower or faster than Dr. M wanted, the Internal Cardiac Defibrillator would choose from a range of pulses and jolts to correct it.
"Think of it as having a built-in paramedic, who can reach the scene, diagnose the problem, and fix it, within 20 seconds," the medical assistant said, as she customized my settings. And throughout the day, the device would collect information on my heart's function, which it would transmit to the office, sparing me the trouble of traveling there.
"This is it," Dr. M said. "Modern medicine has nothing left to put in you."
The experience left me a-tremble. Within a few years, I recognized, even this technology might seem Paleolithic. Op-ed page columnists would debate whether taxpayers ought to keep septuagenarians like me sniffing instead of fertilizing roses.
But with clear conscience, bouncing step, hip-riding jeans, and engineer boots, I sallied forth. And the next morning at the café, when someone asked how I was doing, I whipped up my T-shirt to show everyone who cared to find out. ♦
To read the preceding episode, click here.
To begin the series at the first episode, click here.
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