I think I have a love hate relationship with my cardiac device known as a cardiac resynchronization therapy defibrillator (yes, that is a mouthful). I love it because it keeps my lazy little heart beating at a steady rate. Without it, I would have an incredibly low heart rate and be subject to intense bouts of dizziness and lethargy. In other words, I would be an uncharged Energizer Bunny.
But I also hate it because it also can function as a defibrillator. The plus side is that if it works as described, it will keep my heart from going into cardiac arrest. In other words, it will keep me from dying which right now is my ultimate goal. But it also scares me because I don’t know what I will feel when the defibrillator activates. Will it be painful? Will it be so bad that I will live in fear that it might activate again?
It doesn’t help that the medical professionals sometimes ask me if my defibrillator has “fired” since the last time they saw me. The word “fire” has never had the best connotation for me. In general employment law terms, fire means that you are out of a job if the removal action is successful. So that is not a good thing.
While fire has a good meaning in that a fire can warm you on a cold day, if the fire goes out of control, it can destroy property, and can lead to the death of people who are trapped in a building where there is a raging fire. When you work for 30 years for an agency that investigates arson, It goes without saying that fire is not a good thing.
Guns are also referred to as firearms. A firearm is defined by the federal Gun Control Act as: “(A) any weapon (including a starter gun) which will or is designed to or may readily be converted to expel a projectile by the action of an explosive; ***. When the projectile is expelled it has the potential to cause damage, injury and even death.
So the meanings of the word fire in my opinion, are not only bad, they are scary. This is why when I am asked if my defibrillator has fired, my mind automatically goes to a very forbidding place. Geez – why can’t they just ask me if my defibrillator has activated since the last time they saw me? The result of the defibrillator activating is still significant and even serious, but at least it sounds better!
Or here is an idea – why can’t the medical community use the term “ spring to life” when they are talking about a defibrillator that is about to activate? The term says to me that the device is about to take on super powers and save my life!
But for now, I have to hear questions about whether my defibrillator has “fired”. So how do I keep from being in a perpetual state of panic by knowing that this little gizmo in my collarbone region may at some point “fire”? Well first, I remember that the reason that my cardiologist advised that I have my pacemaker upgraded to include a defibrillator was that my low ejection fraction indicated that I was at risk for going into cardiac arrest. Unlike arrest by the police, the risk was not that I would be placed in jail for a time. No, the risk was much more serious – involving perhaps sudden death. That isn’t a risk that one takes lightly.
The positions I held as an attorney and later as a manager, involved assessing the risks to the agency and determining steps that could be implemented to either eliminate or mitigate the risk. It appeared to me that cardiac arrest could be most directly and effectively handled by having a defibrillator that would automatically sense an erratic heartbeat and take action. This seemed preferable to waiting for an emergency medical team to show up with an external defibrillator. And let’s remember that I am single.
When you live alone, there is always the possibility that no one will be there to know that you are having a heart episode and call 911 – and the erratic heartbeat might cause me to blackout and be unable to dial the phone on my own.
The Mayo Clinic website has a page on “implantable cardioverter defibrillators (ICDs)” that says this even better than I can:
It did not take me more than a minute of thought to conclude that the sensible and safer course of action seemed to be switching to a “cardiac resynchronization Therapy Defibrillator” that would both pace my heart on a regular basis and shock it into a normal rhythm should I ever experience an erratic, life-threatening heartbeat. In other words, it could keep me from dying. Not a bad investment.
After having this device inside me for 5 years, I can tell you that it has never activated (or in Melanie speak, it has never “sprang to life”.) But it has provided me comfort that it is there just in case the worst happens. But I thought it might be useful to see what various resources say about what happens if the defibrillator ever does spring into action.
The University of California at San Francisco’s Health webpage includes frequently asked questions about implantable cardioverter defibrillators. In the section “Do shocks from an ICD hurt?”, it says:
“Most patients who have received shocks from their ICDs describe them as startling, jolting and unsettling, but not painful. It's easy to understand why. The ICD delivers a shock to prevent a dangerously fast heart rhythm. The device recognizes the rhythm, which may cause discomfort — dizziness, lightheadedness, palpitations, an "about-to-faint" feeling — and then suddenly, the ICD shock brings the rhythm back to normal. The jolt is a powerful one to control the heart without delay.”
I like the fact that the jolt activates without delay, and figure that startling, jolting unsettling and discomforting feelings are a low price to pay for something that has the power to save my life.
My device is made by Boston Scientific. Here my device instruction manual (a publication of Boston Scientific) says about what may happen if and when my defibrillator activates:
After reading this paragraph, my preference would be that I either become unconscious, or find the shock reassuring. But I am also comforted because it says that the other patients may be upset for a “short” time. I would hope that if I fell into this category, that as time passed, I would realize that the fact that I felt anything would be a blessing because the alternative would be death where I wouldn’t be feeling anything.
So I continue to take the position that risk avoidance when it comes to death is the best course of action. But even when my OCD mind is overwhelmed with the fear of what might happen if my defibrillator “fires”, “activates” or otherwise jumps into action, common sense eventually kicks in. In my life, the anticipation of what might happen is always more frightening and daunting than the actual event. As my Mom used to be fond of saying, this too shall pass, meaning that if I just have faith, my apprehension will fade. So it would seem that the best defense is a good jolting offense from my defibrillator, one that will likely keep me from passing away.
Melanie discovered that she had heart failure in 2013. She spent the next 7 years learning how to live with the condition, and how to achieve balance and personal growth. Then in October 2020, she received a heart transplant. This blog is about her journey of the heart.