Don’t Stretch That Pacemaker Arm!

Since this is not supposed to be a mystery story, I will immediately reveal that my pacemaker ventricular lead became defective. Very rare, I was assured by my cardiologist, Dr. C. But, somehow, many of my friends remembered similar cases, and that this fantastic system is vulnerable to all kinds of “accidental” and deadly defects.Three years ago, my heart paced itself at 30 beats/minute on its own. (Since this is abnormally low, it was the reason for the pacemaker.) Now, without the pacemaker signal, the heart didn’t do a damn thing. Just sat there stupidly waiting to be kicked. It is a great way to die: There is an overwhelming strange feeling that something is terribly wrong. Muscles relax. Fear sets in for 10 seconds. After that, my cardiologist assured me, you lose consciousness.

My pacemaker has two leads: An upper lead to the right atrium, and a lower one that passes through the tricuspid valve and into the right ventricle. Typically, to duplicate a normal heart beat, the leads deliver a 3.5-volt shock, with the ventricular pulse lagging 0.15 second behind the atrial pulse.

Here is the chronological sequence:
Monday, 1 April, 2002: (This narrative is not an April Fool’s joke.) While doing nothing in particular, I got hit with a short near-fainting spell. Although this wasn’t supposed to happen, but it only lasted a few seconds, I ignored it.

2 April: Attacks continued. In the afternoon I drove (with Ruth by my side) to Dr. W’s office. Because the defect didn’t show up, he couldn’t find anything wrong. But he did point out that the wheel has been invented, and perhaps I should use a rolling suitcase instead of the arm-supported he-man variety.

3 to 5 April: I kept driving the car, convinced that the fainting spells were caused by abnormally low systolic pressure. I was confident that each attack would only last a few seconds. I didn’t have the heart to deprive my passengers of restaurants, plays, concerts, and so forth. And everybody was lucky; I got away with it!

On Friday afternoon, 5 April, I noticed that raising my left arm, which pulls on the leads, usually brought on an attack. So that’s what caused it, a defective lead! The timing was perfect: I wouldn’t dream of calling the cardiologist late Friday afternoon (which is when these discoveries are always made). It would have to wait until Monday morning. In the meantime, Ruth tied my left arm close to my body to keep me from inadvertently raising it. I continued to drive, of course.

Until Sunday, 7 April. As every electrical engineer knows, bad connections get worse. I had a long-lasting frightening attack in the morning. Ruth was too upset to drive, so I asked a friend, MH, to drive us to Emergency.

They wheeled me into the room (patients are never allowed to walk into Emergency). I proudly told the staff that I had diagnosed the problem. They hooked me up to an electrocardiogram (ECG) monitor. “Raise your left arm over your head. Yup, you have a defective lead, alright.” I was soon surrounded by clinicians along with the cardiologist on duty, Dr. K.  The pacemaker manufacturer’s representative also appeared out of nowhere; in retrospect, perhaps this was to “calm me down” to keep me from suing them for negligence.

Ruth and MH went home. After a while, Dr. K sent me to the Heart Patient section, Intensive Care,  where they could keep an electronic eye on me.

I was hooked up to a Shocking Machine, commonly known as a defibrillator. At one point, I watched myself die as my heart stopped for nine seconds and the ECG trace became a horizontal line. Alarms went off and everybody came running, but the heart recovered. Dr. K set the controls on the Shocking Machine so that it automatically gave me a shock (yes, it was painful) when the pacemaker failed. The only way to avoid the shocks was to remain absolutely still. I became a sort of celebrity: The usual patient in Heart Intensive Care is half, or about to become fully, dead. The nurses, even from other departments, came in to stare at this guy who sat up in bed shaking every once in a while, told them how great they were, and was reading the IEEE Spectrum.

8 April: At 1 PM, just when I got used to the painful shocks, Dr. C snaked a temporary lead from my groin to the heart, attached to a temporary pacemaker. The temporary shocked the heart without pain because the signal was inside the heart. At 4 PM I received a new pacemaker and new ventricular lead. The faulty lead was disconnected but left in; it was too dangerous to remove it. So what went wrong? I am not volunteering to get that question answered. I think it was not a complete break, which would have been deadly, but an electrical leak that sometimes reduced the pulse level below threshold. The manufacturer’s representative assured me that some patients eventually end up with five leads side-by-side (one active, the others unused). Not to worry; plenty of room in the vein.

9 April: I was discharged, completely cured! I was asked to take an antibiotic (8 monster pills at $9 per pill). A friend drove me home.

What has happened since the April episode? How could I sue Drs. W and C for negligence? – After all, they saved my life three years ago. Instead, I filed a “MedWatch” complaint with the Food and Drug Administration:

“The entire industry is at fault. The cardiologist, and the instruction booklet that the patient gets, should be required to caution the patient to minimize stress on the leads; try to avoid stretching the arm (on the pacemaker side) above the head. It is negligent to omit mention that the leads can become defective. The 2002 booklet has a figure that shows a patient swimming and stretching the arm; this should be avoided.”

[I changed my life style. Now I swim on my back, using the right arm to propel the body, and fellow-swimmers are happy because I no longer make waves. With the new swim stroke I can watch the birds and airplanes flying overhead, none of that chlorinated water gets into my eyes, and my dentures stopped falling out. Since I can’t see where I am going, I keep bumping into other pool occupants (mostly women, as luck would have it, since the men folks and their pacemakers are gone.)]

Yes, Food and Drug  sent a form-letter acknowledgment that my report has been received. There the matter rests, perhaps RIP.

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