Presently, I find myself on the path with a few more steps in front of me. I am a second-year general cardiology fellow at Creighton University with aspirations for an electrophysiology fellowship in the upcoming year. The path to this place has not been conventional; however, this path is what fuels my passion and desire.
I was born in Tucson, Arizona, in the early 1980s. At my 6-month checkup, the physician noticed that my heart rate was slower than it should be. An electrocardiogram was performed that immediately diagnosed a congenital third-degree heart block with a junctional escape rhythm. From that day, I took my first step on the path; I became the patient.
I spent the next 9 years of my life making frequent visits to the pediatric cardiologist. I spent a significant amount of time as an infant, toddler, and young child having noninvasive tests performed on me. At that age, I never truly understood what made me so different from the rest of my peers, but it never bothered me. Shortly after my ninth birthday, I was admitted to Phoenix Children’s Hospital for implantation of a permanent pacemaker. I did not understand what a pacemaker was or the fact that I would be living with a device connected to my heart for the rest of my life. Living with a pacemaker as a child and teenager was not all that different though. Other than 6-month telephonic pacemaker checks and the yearly office visit, I went about my adolescent years like normal. When I was 16 years of age, I started to think about what my future career might look like. I was set on joining the military to become a pilot, as this had been my childhood passion. A short time later, I got the shocking news that my pacemaker would indeed prohibit me from going down that path. As I pondered what my new path might look like, I recall looking at myself in the mirror, focusing on the scar located on my upper left chest. I realized that I wanted to work with the pacemaker.
The older I became, the more interested I became in the relationship between the pacemaker and my heart. I was fascinated that this device was smart enough to restore normal rhythm to my heart through a series of timers and algorithms. This led me to my undergraduate biomedical engineering degree, MBA, and my first career with one of the largest pacemaker manufacturers. I was hired as a technical service representative and was involved in troubleshooting and implanting cardiac rhythm devices. I was taking care of patients with very similar cardiac rhythm disorders as myself. I had envisioned this as being the career I was meant for. I was on the second part of my path; the device engineer. However, this path was also about to make a turn.
The patient encounter began like most others. I sat across from the patient to interrogate her newly implanted pacemaker. The dual-chamber pacemaker was implanted 7 days prior for symptomatic third-degree heart block, and this was her first office visit post-implant. I gently wrapped the interrogation wand around her neck but could not help but notice the tears rolling down her face. She was noticeably anxious and frightened by the very process. I removed the wand from her neck and placed it back on the programmer. Not only was I experienced in interrogating cardiac devices, but I was also experienced in the vast array of emotions that patients exhibit with the first interrogation of a newly implanted pacemaker. I gently held her hand and said, “I know how you feel.” The patient looked back at me with a face of confusion and replied, “How do you know what it feels like?” I unbuttoned the top of my dress shirt and revealed a very similar scar in the exact position as hers. She immediately got up from the chair, still with tears streaming down her face, and gave me a hug saying, “Thank you for taking care of me.” She was relieved of her initial anxiety and fright. She took comfort in knowing that someone who was taking care of her had actually experienced the same disease process and had the same cardiac device implanted. I spoke to the patient not only from the perspective of the pacemaker manufacturer, but from a point of empathy, something she had lacked prior to and post-implantation. She expressed that much of her anxiety stemmed from not receiving adequate information pre-operatively on how the pacemaker would interact with her native heart and what life would be like living with a pacemaker. Fortunately, I could answer the technical questions about the pacemaker and its interaction with the heart as well as the questions about how to live life with a pacemaker.
At this point in time, I had been pacemaker-dependent for 17 years and was on my second pacemaker. I had already lived more than one-half of my life with a pacemaker inside of me. There were not many aspects of life that I had not already experienced with the pacemaker: everything from traveling in airports to learning how to ride roller-coasters with it.
The patient had spent the prior 7 days searching the internet about how to live life with a pacemaker. The information that she obtained during this time came from a variety of sources, and as I can only imagine, were not all from trusted sources. By the time of her first office visit, she was so confused about the new pacemaker and even had doubts about wanting to continue living with it. She had thought that her native heart was no longer even functional, as the pacemaker had taken over all of her heart’s functions. It was the combination of knowledge and empathy that I conferred that made all the difference to her. At the end of the office visit, as she was leaving the room, she gave me one last hug and said, “You should become a doctor and take care of all us pacemaker patients.” That patient encounter set me on my next part of my path: to become an electrophysiologist.
A few months after that patient encounter, I left the world of pacemakers and embarked on the 12-year journey to become an electrophysiologist (which I am still on). Since joining the world of medicine, I have had countless interactions with patients who were receiving newly implanted cardiac devices and those who have had them for years. Each encounter is different, yet very similar in that patients appreciate knowing that someone else also knows what it feels like. I initially thought my career path was to work with just the pacemaker. I was wrong. My path is to work with the patient.
My goal is to use my 3 different perspectives in life, as the patient, the device engineer, and the electrophysiologist, to establish and maintain patient connections. I am the physician who also knows what it feels like to be the patient, because ultimately, my path began as the patient. I know what it feels like to be on both sides of the scalpel.
Footnotes
The author has reported that he has no relationships relevant to the contents of this paper to disclose.
The author attests they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Case Reportsauthor instructions page.