Posted by: wrmcnutt | September 20, 2011

Life With a Temporary Pacemaker

After my epic fail Friday night, things started to turn around for me.  First of all, after all the drama and angst involved in getting a temporary pacemaker installed, I barely used it.  That first night and next morning it fired a few times when my heart rate dropped below 40, but for the next three days, my heart rhythm was “all me.” Mind you, none of the rhythms were “normal,” but they were all mine.  Living with a temporary pacemaker has all manner of entertainments.  You see, it’s not implanted.  There were two wires coming out of my neck leading to a box hanging next to my IV.  As you might imagine, I was really, REEEALY careful of those wires when rolling over in bed.  In fact, some entertainment ensued the next day when my surgeon dropped by to check in on me.  It went something like this.

Me: “So anyway, I understand that that arrhythmia is all me, right?”

Doc: “Yes, and . . . hmmmm.   You know, I don’t think we’ve tried that.”

Me: “Tried what?”

The doc didn’t answer me.  He took my pacemaker off of the IV stand, popped open the safety panel, and started fiddling with the dials.

I looked like an old Looney Toons character.  My eyes bugged out.  Then they crossed.  I flopped like a fish.  I didn’t hurt per se, but it felt decidedly odd to have my heart rate and rhythm adjusted on the fly like that.  He was, of course, trying to jar my ticker into a normal rhythm.  But my heart was having none of it.  I would remain in afib for another three days.

Eventually there appear a very frustrated Cardiologist.  This is a different doctor than the surgeon.  Dr. H was put out.  This was not normal.  He’d been involved in over a hundred of these procedures, and this had never happened before. Cut here, cook here, close.  Switch sides.  Cut there, cook there, close.  And when something does go wrong, it’s never at the “switch sides” point. Almost losing an entire patient left him feeling quite annoyed.  He kept looking at my afib on the monitor, and saying, “There’s no reason why I can’t ablate that off . . . ”  The poor man had to have the conversation with me no fewer than five times, but was eventually able to make me understand that it wasn’t the ablation that my heart had taken exception to, but the breathing apparatus and switching lungs after one side was completed.  Then he confessed: he wasn’t sure what to do. “Normally, when I give advice, I stand on the shoulders of giants.  Doctors who developed this procedure and have done thousands of them, plus my own experience.  But as far as I can tell, this have never happened before in quite this way, and I don’t know what to tell you.  I’m going to take the tapes, the video, and the notes, study up, and recommend something tomorrow (Friday) morning.”

I was not comfortable with my specialist not knowing what to do.  But I knew what my decision was going to be, anyway.

I was going to be offered four choices:

First, we could go back in the way we went in the first time.  They’d already done my right side, so they could start in on the left side without having to shift me over like before.  This approach would offer the same advantages as before: high chance of success, lower chance of stroke.  Unfortunately, I’m now five days in recovery from that surgery, and I know exactly the depth and breadth of pain I’m in for if we do that.  Further, and more importantly, I’m not at all confident that my heart will keep breathing if they deflate that lung, since they can’t tell me what went wrong in the first place.

Second, we could break out the bone saw and crack my chest.  Use the BIG rib spreader to flay me open like a butterfly.   This would allow them to work with nothing in the way and they wouldn’t have to deflate a lung.  There were two problems with this:  first, the scarring.  You wouldn’t think it’s the case, but even when making life and death decisions, vanity weighs in.  I already look like a rough draft of Dr. Victor Von Frankenstein’s undergraduate project.  Adding a huge scar down the center of my chest was not going to help me in the personal attractiveness department, except within a fairly narrow segment of the fair sex who dig scars.  Second, though, is the Big Hurt.  This is going to be even more painful than the work I’ve already had done and from which I am barely recovered.  It would suck the most suck in the history of sucking.  I find that I am not interested in this approach.

Third, we can go with the low-invasive procedure I was initially offered.  Not needing an incision, or to deflate a lung, this approach offers the least pain, the least scarring, and as a bonus – I wouldn’t have to go on the breathing apparatus.

Finally, we can do nothing, install a permanent pace maker, and attempt to get on with my life.  This will be the safest option; my ticker has already illustration, quite graphically, that it is not trustworthy, and could quit at any moment.  A pacemaker would bang away for 10 – 15 years without needing maintenance.  Of course, these things are implanted on the outside of the rib cage in a sort of pocket they make in your chest.  That’s so they can change them out easily when the batteries wear out. (It’s funny – they call it a “battery replacement,” but they really replace the entire pacemaker.)   But that means that getting hit with a hammer is contra-indicated.  No more SCA-heavy combat.  Not even combat archery.  Probably no fencing, although we could consider wearing a chest plate.    But I had been thinking since Friday night. I could easily see myself with more time for woodworking, teaching more classes, and in general finding more non-combat stuff to do.  There are lots of sports I could participate in that are low and non-contact.    So if we have to do this, it’s  not as bad as it might have been ten years ago.

They next day he came back with his recommendation, and it was what I expected. Option 3, the non-invasive ablation.  We scheduled a time Friday afternoon, a week after my full-on cardiac arrest and, conveniently, the next day.  There was, of course, an emergency the next afternoon after I’d been fasting all day, and my procedure was put off until Monday.



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