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.