Heartbeats, Part Next

I’ve written about my balky heart and the smart, capable people who attempt to keep it and me ticking. I’m beyond grateful for their efforts and for the fact that in many other places I might have expired by now. My heart doesn’t beat synchronously or efficiently, and I have an abnormally low heart rate, a red flag trifecta that’s resulted in numerous tests, procedures and installation of a pacemaker in June 2022. 

Recent photo of OBX Dave. 
Should get more sun.

To look at me, you wouldn’t immediately think: ‘I hope that guy has his affairs in order.’ I’m not overweight. I eat relatively well. I walk a mile or two almost daily. I do yard work and housework without issue. I’m always up for trips and outings and the occasional pub crawl. Over the past 15-18 months, however, I’ve begun to tire more quickly when I exert myself. 

When I informed my cardiac docs, they suggested that a pacemaker upgrade may be in order. Which is how I landed at the Norfolk (Va.) Heart Hospital recently, on National Tax Deadline Day for what it’s worth, for a procedure that the experts think will help. Check that: for the second time this year for a procedure that the experts think will help. 

I was supposed to have the procedure in January. The electro cardio specialist who performed two ablations on me was going to do the pacemaker upgrade. But when I was on the operating table and he opened me up, he discovered a blockage and tissue tangle that made extracting the thin wire leads and inserting new ones trickier than he was comfortable performing. So he simply closed me back up. He apologized profusely afterward, but that didn’t lessen the frustration and WTF? Factor, starting with: You geniuses had no way of determining that there was a blockage or that you couldn’t perform the operation *before* you sliced me open? 

Anyway, he referred me to a specialist’s specialist, a colleague who was comfortable and experienced with more complicated extractions and procedures. During a consultation with him in March, he said that pacemaker technology had made significant improvements, even since my first installation less than three years prior. He believed that a new device would help my heart beat more in sync and thus improve blood flow and limit fatigue. He allowed that, yes, there are ways to determine if a procedure might be more complicated than expected before surgery, but that doctors don’t employ them often enough for his liking. That said, he was completely on board with his colleague aborting rather than attempting something he wasn’t comfortable with. I was sold, which is how I ended up in Norfolk on April 15. 

A few words about my doctor, a gent named Erich Kiehl: early 40s, about 6-2 and thin, tousled brown hair, boyish face covered by about two weeks’ worth of stubble and facial hair flecked with gray; Brown University medical school; residency at the University of Virginia Medical Center; two fellowships at the Cleveland Clinic, where he studied under the guy who developed many of the techniques currently used for pacemaker extraction and installation; Master’s degree in clinical research from Case Western Reserve University; settled in Hampton Roads and said he's performed about 350 procedures similar to mine, and he and his cohorts have done more than 500; a reassuring confidence in his work and his ability; engaging and persuasive. In short, a professional badass. You want him handling your heart. 

We had hoped for a relatively speedy day that instead became a 15-hour slog, due largely to emergency situations in-house that pushed back my operation, as well as the fact that what the doc optimistically estimated would be an approximately two-hour procedure became 3½ hours. He also paved the way for me to be part of a National Institute of Health-funded clinical trial that will gauge the effectiveness of two different pacemaker install procedures. There's no compensation or costs waived, but patients in clinical trials, he said, statistically do 30 percent better than regular patients because of more diligent monitoring. 

Sure, sign me up. 

We left our house on the Outer Banks at 7:30 a.m. and didn’t arrive back home until 10:15 that night (it will forever be mind-boggling to me that a heart-related procedure can be an outpatient practice). The heart is a marvel, a mechanical pump and electrical organ and if poets and songwriters are to be believed, a wellspring of love and sorrow that makes life worth living. A lot to ask from a 10-ounce organ that’s about the size of a closed fist, don’t you think? No wonder it needs an assist from time to time. 

There’s no telling how my new little battery pack will affect me. I don’t need to run half-marathons or swim 50 laps a day. Even if it only keeps me vertical for a few more years, I’ll count that as a win.

Pacing Myself

My heart is a wondrously robust organ that periodically reminds me of its flaws. I have an irregular heartbeat, what’s called atrial fibrillation. The electrical circuitry of the upper chambers, or atria, isn’t sync’d with the lower chambers, or ventricles, for regular, rhythmic pumps. 

I’ve had three procedures to try to remedy the condition, but none of them have held. My docs assure me that plenty of people have a-fib and with medication and regular checkups live well into their 70s and 80s. I’m not in a-fib all the time and I’m mostly asymptomatic, so it’s not a burden. Me and my heart get along fine, without incident. Usually. 

In a span of 32 hours, I went from a guy who was uncommonly fatigued to a guy with a pacemaker. Jarring doesn’t begin to describe the process. Hospitals, tests, transport, absurdly quick turnarounds, exceptionally gifted doctors and nurses. In and out in two days, with a piece of medical hardware embedded in my shoulder. Crazy. 

I had felt lethargic for a few days. Walking and jogging around the neighborhood, climbing steps, I tired more quickly than usual and my breathing was a bit labored. I told my wife one morning that something was off. Called my primary care doc, and knowing my history and condition, he said, go to the ER. They can do more tests than I can in my office. Went to the ER at the hospital here on the Outer Banks. They hooked me up to monitors, drew blood, gave me a COVID test (I wondered if that’s what it was). Blood work came back fine. COVID test was negative. 

But it turned out that I had a baseline heart rate of a hibernating bear – low 30s. Normal is between 60 and 100. Over the course of the next few hours, it occasionally spiked up into the 50s and 60s, but then fell back to the low 30s and even upper 20s a few times. My a-fib was unrelated to the low heart rate, which docs said almost certainly caused my fatigue and shortness of breath. Yay, an entirely different issue. 

Late afternoon, a cardio doc’s assistant came to the room and talked up the sequence of scheduling a cardiac consultation, then a stress test, and a subsequent evaluation of data, with the possibility of a pacemaker some time down the line. Twenty-five minutes later, an emergency room doc to whom I am forever grateful came in and said that after speaking with cardio specialists, no point in postponing the inevitable, that I needed a pacemaker ASAP. 

She contacted Norfolk’s heart hospital to secure an open bed and got in touch with the office of my electro cardio doc who had performed previous procedures on me to see if they had an opening the next day, which they did. A few hours later, a county EMS ambulance with a three-person crew schlepped me to Norfolk. 

Late-night check-in. Monitors (heart rate still in 30s). Blood drawn. Little sleep. Nurses and doctors stopped in overnight and the next morning to check vitals and explain what was up. No food all day because I was scheduled for a procedure that afternoon. Around 5:30 p.m., wheeled into operating room, where an engaging, genial doc performed the procedure. Gave me a fist-bump before he scrubbed and we both said, “Let’s do this.” 

One unsettling development among many, I was mostly awake for the procedure. They covered my face with a couple of cloths, I’m guessing so that I didn’t see the liberal amounts of blood involved. I felt zero pain, but definitely felt the doc pushing and pulling in and around the incision. A few times, somebody lifted a cloth, peeked in and said, “Hey Mr. Fairbank, how you doing? You OK in there?” 

I answered yeah and told them that it was some damn wizardry they were pulling off. The procedure normally takes about an hour, I was told. They finished me in 31 minutes. So, in the time it takes for an oil change, I had an electronic device inserted that would help keep me alive. 

They make an incision in the front of your upper left torso, just below the shoulder. The pacemaker itself is about the size of an Oreo cookie. Mine is a two-wire lead, with one wire fished into the heart’s upper chamber and the other in a lower chamber. The battery lasts 7 to 10 years, depending on how frequently it’s needed. The baseline heart rate is set at 60, so any time my rate dips below that, the device kicks in. It comes with a monitor that you plug in bedside. Once or twice a day, the pacemaker transmits data to the monitor (how I spent my day), which then sends info to my cardiologist’s office. The cardiologist will call if something peculiar shows up. 

They kept me overnight for observation. The next morning, various docs came through and said I did well and looked good. I was signed out by late morning and home early afternoon. My left shoulder is sore. I can’t lift anything with my left arm, nor raise my left arm above my shoulder for a couple weeks. I cannot drive for a couple weeks, either. Sleeping is interesting, because if I even think about rotating onto my left side, my shoulder lets me know it. But everyone assures me that I will gradually get back to normal, including one of the Norfolk cardio docs who also has a pacemaker and let me feel the small lump where his was inserted. 

One amusing part of the entire process was that at each stop along the way, I drew double-takes and quizzical looks and pleasant surprise from almost everyone, based on advance information they had before actually seeing me. Sixty-something male, a-fib, a-flutter, heart rate in low 30s. It was as if they expected me to be comatose or at death’s door. When I walked and talked and goofed with people, it was a bonus. “You’re doing great,” they told me, or in phone conversations with colleagues they said, “No, he’s not like that at all. He’s doing really well. He’s up and around and talking to everybody.” More than once I said, “Not bad for a cadaver.” 

All this said, I’m well aware that I’m blessed beyond explanation. There are plenty of places where it wouldn’t have played out the way it did. Even here it might not have worked out. Maybe a bed isn’t available at the Norfolk hospital. Maybe none of the electro cardio wizards have an opening. Maybe I’m wait-listed for tests and consultations, and dragging around wheezing for weeks or months. Maybe my ticker limps to a halt. Instead, me and my heart, and my heart’s new buddy, have more ahead.