Brave New World of Medical Technology

Lucky me, I have a pacemaker.  Actually, very lucky as when I was fifty four I was running around the office one day, feeling a little dizzy, but going about my business, preparing to get on an overseas flight to the Frankfurt Bookfair, and my wise wife forced me to see my doctor before we departed (she was going with me). My doctor took an EKG and looked startled, saying that my heart was beating at only 30 BPM.  I should have passed out long ago and he wondered how I was able to get through the day.  So I said, isn't there a pill I can take, I have to be in Frankfurt tomorrow. He replied, the only place you're going is to the ER.  Had I gotten on that plane, ignoring the symptom, I was told I would have died.  So, lucky me, indeed.

After ER, I was admitted to the cardiac unit and they thought I had an advanced form of Lyme Disease, which can attack the heart's electrical conduction system. I was put on heavy duty antibiotics and meanwhile they warned me that if my heartbeat dropped below 30, I'd have to have a temporary pacemaker wired through my neck.  That evening a team of medical personal came bursting into my room, monitors beeping, indicating my heartbeat had dropped to 28-29.  Look, I said, I'm conscious.  Please don't put a temporary pacemaker in unless it drops further.  So they watched me that night and I was at least stable.

After almost a week of medical treatment, and no improvement of my condition, a cardiologist informed me they would be prepping me for a permanent pacemaker the following day.  They had no idea why, at my age, my electrical system was failing.  Lousy genes they speculated (a favorite explanation offered by medical personal when they have no clue). So, into the operating theater I was wheeled and was told I'd be sedated but hazily conscious as the surgeon would have to ask me questions as he placed the leads into the heart.  A representative of the pacemaker manufacturer was present and I remember he and the surgeon joking during the procedure.  The surgeon said this is a piece of cake as he's relatively young and in good shape so I piped up, I ought to qualify for a discount then!  Fat chance he replied.

In any case, I have lived with a pacemaker, now, for sixteen years.  Actually, I'm now on my third such device as when the battery runs low, it's not like replacing a couple of double A's.  A new pacemaker has to be inserted in my chest. 

I know, it's an awful looking picture, but that's what my chest looked like five days after getting the last one.  It actually looks worse than it felt.

My third generation pacemaker is high tech.  The older devices needed monitoring, usually in the cardiologist's office.  But now the monitoring is done remotely, as the pacemaker transmits the information wirelessly to a receiver that sits by our bed, one that is plugged into our phone system, and it dials out the data as I sleep.  Every three months if does a "pacemaker interrogation" the same one I had in the office and transmits the data (it will also send data immediately if it detects any serious irregularity such as a ventricular tachycardia).  Our phone system is now digital, so the information goes out via our cable company's broadband.

But wait, more high tech.  Our telephone answering service is provided by the cable company as well; not only are messages recorded, they are transcribed using voice recognition, and then sent to me via email.

And yesterday I received the following email:

From: Voice Services@-------.com

Sent: Tuesday, January 15, 2013 1:04 PM

Subject: You have a new Voicemail

    "Hello this is your implanted cardiac device clinic calling to let you know we received your follow up data and it looks normal. We look forward to your next appointment. Thank you and goodbye."

Thus, from an implanted pacemaker with a computer chip transmitting on a proprietary band, to a receiver that dials out via broadband to a computer that analyzes the data and, if normal, then places an automated call which is recorded and then transcribed via voice recognition, finally being emailed back to me.  A full circle without human interaction!

Any sufficiently advanced technology is indistinguishable from magic.....Arthur C. Clarke

But there are serious issues with all this technology, both positive and negative.  My pacemaker is transmitting at all times.  Anyone within 10 feet knowing the frequency and having the right equipment, in a public place, can have access to the data which raises privacy issues.  I have no problem with that but it also means that same person would have the ability to reset or even disable the pacemaker.  Pacemaker (and implantable cardioverter-defibrillator) manufactures say that is nearly impossible, but it seems to me that almost any "techno-magic" is feasible today.

Thinking more macro-medical technology, we have the ability to build a national database of medical information, at least for Medicare recipients, that would obviate the endless duplication of medical record keeping for the same patient at multiple health care facilities and doctors' offices.  Again, privacy issues have been a stumbling block, but imagine the significant cost savings (and improvement of data accuracy).  I have less concern about the privacy issues than I do about rising health costs and the burden it puts on taxpayers.  Surely there is a techno-magic means of satisfactorily addressing the matter.

A Little Anesthetic Drip

I'm turning 70 soon. It seems like only yesterday I was reconciling myself to my 65th birthday, fortunate of course to make it to both milestones, but knowing that time is steadily running out of the hourglass.  It's not as if I come from hearty stock where everyone lives healthily into their nineties and then has the good fortune of just not waking up one day.  And I've had my issues, most recently open heart surgery just last year.

The older I get the more I seem to "work" for Doctors who take charge of my body with tests, medications, procedures, just about any time they want. And I'm not in it alone: friends, some from childhood or college days, are going through the same thing, that is the ones who have made it thus far.

Speaking of college, for some reason, unknown to me now, as a student (that's my college yearbook photo to the right) I had memorized John Masefield's graceful poetic masterpiece, On Growing Old.  Masefield wrote the poem when he was only 41, as if some sudden, unexpected  poetic insight into his own future materialized.  I still know the words today.  One of our first boats was named 'Spindrift' because of a line from the first verse:

Be with me, Beauty, for the fire is dying;

My dog and I are old, too old for roving.

Man, whose young passion sets the spindrift flying,

Is soon too lame to march, too cold for loving.

I take the book and gather to the fire,

Turning old yellow leaves; minute by minute

The clock ticks to my heart. A withered wire,

Moves a thin ghost of music in the spinet.

I cannot sail your seas, I cannot wander

Your cornland, nor your hill-land, nor your valleys

Ever again, nor share the battle yonder

Where the young knight the broken squadron rallies.

Only stay quiet while my mind remembers

The beauty of fire from the beauty of embers.

Whatever compelled me to commit that to memory more than fifty years ago?  Was it a perverse acknowledgement that I too would one day be the subject of the poem although at the time I would have thought 70 an eternity away?  But the day is arriving and ironically I don't feel like that at all -- I'm not nearly ready to "gather by the fire." If anything, my mind tells me I'm a kid, defying the image in the mirror, belying the health issues.

But my literary hero, John Updike, most perceptively describes the process of aging and the collateral inevitability of one's demise in one of his last short stories, "The Full Glass." The main character is thinking about his grandfather and Updike writes: “As a child I would look at him and wonder how he could stay sane, being so close to his death.  But, actually, it turns out, Nature drips a little anesthetic into your veins each day that makes you think another day is as good as a year, and another year as long as a lifetime.  The routines of living – the tooth-brushing and pill-taking, the flossing and the water glass, the matching socks and the sorting of the laundry into the proper bureau drawers—wear you down.” 

No truer words were ever written.  So, onward into my 70's!

And Happy Holidays as celebrated in Florida.........

Aging and Writing

Marking the passing of a great American novelist, The New York Times Weekend Review carried an outstanding essay "John Updike’s Mighty Pen" by Charles McGrath http://www.nytimes.com/2009/02/01/weekinreview/01mcgrath.html?emc=eta1

Especially interesting was the Video A Conversation with John Updike, taped in October 2008, with Sam Tanenhaus, the editor of the Book Review, “about the craft of fiction and the art of writing.” Disquieting to think he died only a few months later, but listening to the interview I was struck how much he ruminated about aging and writing. He said that he was currently working on an historical novel set in the 1st century, but not knowing much about the period he was trying to educate himself, lamenting, though, that “maybe I’m too old to be educated.” He also said he was thrilled that the New Yorker had recently accepted two of his short stories as he was “trying to keep [his] name in the New Yorker after a long draught.” “It makes me feel like a real person to get a short story in the New Yorker.”

He went on to observe (and much of this is paraphrased here) that there comes a moment in a writer’s life when you are full of material untouched in your mind and seemingly urgent and it merges with enough skill to get it down, but this skill tends to peak in an American writer’s late 20s or early 30s. In those years I could bring a naiveté and therefore a sense of wonderment to my writing. “I’m not ashamed of my later work, but feel there is an unforced energy in the earlier work.” We never idolize anything beyond youth in this country. Consequently, we’re all failed youths, as we don’t believe in the wisdom of the ages especially now that so many people live forever in old age homes. Some of our greatest writers were Hemingway and Fitzgerald; “their idea of happiness is to be young.” And those words concluded the interview.

I closely identify. In Florida that sense of aging, a feeling of irrelevancy, is particularly pervasive. As Updike says in Rabbit at Rest, “There’s a lot of death in Florida, if you look. The palms grow by the lower branches dying and dropping off. The hot sun hurries the life cycles along….Even friendship has a thin, provisional quality, since people might at any minute buy another condominium and move to it, or else up and die.”

I thought my feelings might be confined to those of a retired businessperson living in the “sunshine state.” But my friend Bruce, a teacher and a writer living in Massachusetts, to whom I sent the New York Times link, seems to have had a similar reaction. This business of aging, still trying to stay productive, moving forward with learning as being the very essence of living, is something I would like to think we share with Updike. Here are Bruce’s comments on the Updike interview:

I listened to the interview and was, of course, attentive to his remarks about aging and youth. Naturally, I immediately applied what he said to myself to see if I thought it was true. My conclusion about me is that I am profoundly and forever naive. Thus, I'm surprised that because I am old I am invisible. I am surprised that my students don't realize that I am wise and learned. Oh, they do to a degree, but their best perceptions of me are ones that leave out my age. I'm surprised that young teachers with a few exceptions do not seek me out. I am surprised I am not valued because I have so much experience. Perhaps, I am, but it's not apparent to me. I like what Updike said about the unforced energy of youth. I think that's true, but an older man needs to seek to find what imparts an unforced energy to his own endeavors. I keep returning to Bronte's remark about being appreciated and expecting to get credit for what you do. Don't she says, or you will spend your life waiting. Then again in our own conception of ourselves we are never appreciated enough. Thus, we are back to Ecclesiastes and vanity. In any case, I liked the interview, especially the remarks about America and youth

See http://lacunaemusing.blogspot.com/2008/02/old-friends.html for more about Bruce.