The Manual...

There is a picture on the cover of the Manual given to me by St. Jude Medical.
The cliche of the cover is, of course, classic Viagra or Cialis. Here is this oldish (not too old) man, bronzed, fit-looking, walking the beach hand in hand with his beloved and giving her a knowing look, as if to say, "Later, my dear." Designed to answer what St. Jude Medical seems to think would be the masculine concern uppermost in the mind of the recipient of their cardiac pulse generators: namely, "Will I still be able to ....." Fill in the blank.
For me, there were much broader questions--how much longer have I got to live? Is this really going to fix the problem?

   Apparently, one has to forget the word 'pacemaker.' The name is PULSE GENERATOR, or so it is referred to throughout the Manual, which starts with quite a long description of "The Healthy Heart." It gets into the atriums, the ventricles, the sinoatrial node, the AV node--with cute little cut-away pictures of the heart. Then we are into Arrhythmias--too slow, too fast--and ventricular fibrillation (which was the initial diagnosis for me).
   The Manual explains that the first pulse generators were the size of a hockey puck and the battery lasted less than a year: they are now about half the size, and the batteries can last up to ten years. Frankly, that does not make me much happier: whether hockey puck size or match-box size (my surgeon's description), I am not at all pleased at having anything stuck inside me, let alone with wires led down through the veins into the heart, giving it a nudge every second. We can skip over the descriptions of the operation itself and the warnings about avoiding stretching, lifting, and sudden movements. I liked the warning: "Do not play with or move the pulse generator under your skin. Try not to hit it it or bump into it." I found that wording somewhat odd: play with it, hit it, bump into it? Somewhere else I read, "Do not twiddle with your pacemaker: you may disconnect the leads." The warnings extend to boxing, wrestling, horseback riding, bumper cars, rugby, softball, weightlifting..the list goes on.
    But now we come to the the more interesting section: Living With Your Pulse Generator, in which are set out all the various manifestations of Electromagnetic Interference, or EMI as we insiders call it. Well, arc welding is simply out. Watch it with your electric razor or your vibrator. Don't hold handtools (they mean power-tools) directly over the pacemaker. Live in a home that has a properly grounded electrical system. Ask your doctor about using a mobile phone. Try to avoid security systems in shops, or go through them quickly (at a trot?). Better to avoid sleeping on the pacemaker, apparently.
   The final question in the Manual is, "What is a Patient Notifier?" I do not know if I am so equipped: I have to ask my doctor. But a Patient Notifier will notify you if something is going wrong, either by a vibration or a tone. "It may go off for a number of different reasons," says the Manual, "like a low battery or a fast heart rate."
"Is that your phone?"
"No, is it yours?"
"It's probably my pacemaker. Put your ear to my chest and listen."
"Yup--you're ringing like a bell. Where do we go to get it fixed?"

    Now for the Warranty--you didn't think of that, did you? But of course you have to have a warranty, one on which I am sure that legions of lawyers worked long and hard.

     Of course, if something goes wrong, I'll have to go into hospital and presumably have the defective pacemaker out and a new one installed, or a new battery installed, which will be expensive. The Warranty concedes the following: "Additionally, reasonable unreimbursed medical expenses of up to six hundred dollars ($600) associated with that replacement are offered for the benefit of the patient. The obligation of St. Jude CRMD to pay reasonable expenses shall be limited to $600 even if both the lead and the pulse generator are replaced." The use of the "unreimbursed" formula suggests that St. Jude Medical hopes that your own insurance, or Medicare, will cover the costs.

     This thing has now been in place for ten days, and in a week's time I have a "wound check" appointment with the surgeon. That will probably be the basis for my next entry.

This a bit of Cutler computer art.