I pull violently out from a dream: Someone is smothering me, a pillow stifles my airway. But there’s no pillow covering my face. I sit up, try to catch a breath. I can’t. Barely enough air passes through to my hungry lungs. I will myself to fully waken and open my mouth wide to take in a big, deep stream of air, then another, and again another. Air gets through, sweet air fills my lungs; I rejoice. I tell myself: this is an aberration, an unusual occurrence, a nightmare, nothing to worry about. We are, after all, in the year of the new millennium; Y2K has come and gone with none of the apocalyptic doom. A conspiracy theory was all it was.

I’m fifty-two years old; something’s not quite right with me. I’ve swum only two laps, and I’m already gasping as I push forward, stroke by labored stroke, toward the end of the pool. It looks so far away. When I reach the end, I rest awhile, gulping big mouthfuls of air.

I look for workarounds. I try different swimming techniques, hoping to increase air flow. I move my head to the right and throw a big breath out. That helps. Or is that just an illusion or hope? Then something else: I vary my stroke. It works, sometimes, but not every time. Slow down a bit. Even so, my heart pounds heavily, my breath becomes more labored, I swallow water. I just don’t want to have to stop. I am determined to swim my habitual number of laps. Nevertheless, I must stop. I can’t go on. So I climb out of the pool and head for the showers. Maybe it was just lack of a good night’s sleep? Yes, that’s what it was. Tomorrow will be better.

A week later I have another nightmare, much like the first. Then a few more, but less
severe. I’m better now at waking myself up earlier in the distress. I’ll keep a diary of these incidents.

And then I don’t.

How difficult it is to decide whether a symptom is serious enough to seek a remedy or if it’s just part of the natural aging process! Little aches, itches, fatigue, rashes, bouts of insomnia—these could all be a part of living, or they could indicate some more serious, unwanted condition. Every new discomfort that arises is like a bird at your window: it gives a little chirp, testing the ledge, unsure of its footing, then flies off. Next time the bird comes along, enough time has gone by so that you’ve nearly forgotten it had perched there before. After some initial wavering, it stands firmly on the ledge announcing its reappearance with loud, confident chirps until you acknowledge it and say, “Yes, I know you are here, I can feel your presence. You look somewhat familiar although I can’t place you. Fly away, bird.” And it does. But the next time it arrives, you know something’s up. Its chirps are louder, its footing is firm, its persistence stronger, its stay longer. And after it goes away, you stand at the window looking for the bird’s next arrival, wondering how much strength it will have accumulated during its absence.

I rifle through the medical literature in print. Too obscure and inconclusive for my comprehension. I turn to more simple, online accessible health and wellness sources. My Google search for “shortness of breath” gets lots of hits. Among possible causes, I decide that my nose is stopped up. The furnace-heated air is drying out my nasal passages, causing blockages. I buy a humidifier, leave it on all day and all night long. “I think it’s helping…some,” I tell my husband, Paul. I give it a few weeks. But nothing changes, it’s something other than dry air.

Back to the research. In the incomprehensible medical literature, I find technical explanations, pictures, and diagrams. I want an easy answer. I turn to Google again. Asthma comes up. I settle on that condition as the culprit, focusing on symptoms that match—difficulty breathing, trouble sleeping, weakness, tiredness—and ignore the ones that don’t. I am warned that not everyone has all the symptoms, nor the same symptoms, at all times. That covers it.

Am I sure about my self-diagnosis? By this time, I’ve become accustomed to my new way of labored breathing. It becomes ordinary, almost. I’ll mention my suspected asthma condition to my doctor next time I see him. He’ll be proud of me for having done my research and educating myself.

By the time my annual physical comes up in January 2001, I am used to my new normal. I’ve become accustomed to waking before the onset of nighttime bouts and so I almost forget about them. I focus on wanting to please my doctor and showing how healthy I am—why is that? I want to believe there’s nothing wrong with me. I want to dismiss my breathing episodes. I don’t want him to think I’m a hypochondriac. He checks my heart with his stethoscope. He checks again. There’s an alarmed look on his face.

“Your pulse is low,” he tells me.

“I know, but that’s not new. You know I tend to have a low heart rate.”

“Yes, Vivian, but this is dangerously low; below forty beats per minute.”

I admit to my breathing difficulties and tell him my research points to asthma.

But I can tell he doesn’t agree with my self-diagnosis. He orders tests: echocardiogram, electrocardiogram, and a Holter monitor. I wear the Holter to measure my heartbeat over a period of days. It’s a heavy device, the size of my old Walkman. I carry it 24/7 for four days like a crossbody purse.

Sinus bradycardia is the diagnosis: My heart rate is slower than normal. My self-diagnosis conclusions were not even close. The sinus node—the heart’s natural pacemaker—is lazy, not doing its job well enough to generate the electrical impulse to activate the heart. The results show that my heart rate goes down as low as twenty beats per minute at night. No wonder I can’t breathe.

Later that January, I am scheduled for a pacemaker implant. Just an overnight hospital stay, nothing major. No general anesthesia, just a local and a relaxant. Still, it’s hard to relax. If I’m awake, will I look into the surgeon’s eyes for some sign of a situation gone awry? What if the anesthesia is not potent enough, or didn’t penetrate thoroughly?

During the procedure, I feel pushing on my chest, and move in and out of sleep. When I fully awaken from the surgery, back in the hospital room, I take a breath. And another, and another. How easy it is! How deeply the air penetrates, no obstructions to delay the rush of fresh air filling my body. Is it supposed to feel this good? I indulge in deep breathing until I feel giddy. All this time, I have been missing out. It’s like night and day. A happy Bionic Woman am I.

But what do I think about this new version of me, now dependent upon an alien, bionic implant to power a primary and essential organ whose accurate functioning is needed for life? Am I now living an artificial life? Maybe I should wear a protective aluminum shield so as to block harmful signals sent by malicious entities to throw off my pacing. My mind reels with philosophical and even theological thoughts. Am I fully human? What does it mean to be alive? Is this device my fountain of youth? What if I’m on my deathbed, the pacemaker chugging along, single-mindedly intent on prolonging a life I no longer desire nor deserve? A mere mortal should not—I, the declared agnostic believe—artificially extend a predetermined life span. I’m fooling with destiny. “It’s not nice to fool with Mother Nature,” chimes the Chiffon margarine commercial.

Yet, I feel thankful and lucky for the science and technology that keeps me alive.

My cardiologist tells me, “Don’t go near Hoover Dam, don’t have an MRI, don’t hold a cell phone closer than six inches to the heart, and do not operate a jack hammer. You can pass through airport and library security systems quickly, but don’t linger.” O.k., I get it. Electromagnetic fields can throw my pacemaker out of whack.

But when I board BART on my commute home, the car is jam-packed with people holding their cellphones at my heart level. I shield my chest from invisible rays with my purse, my book, whatever I’m carrying. That makes me feel better but, am I safe? I vow never to board a crowded car again.

Pacemakers have been around for a long time. The technology has evolved considerably since Arne Larsson received the first implantable pacemaker in 1958. Today, a pacemaker’s size is about 1½ inches long, its battery lasting six to ten years. Remote monitoring units transmit data from the device to one’s doctor. Over three million people worldwide have implanted cardiac pacemakers. Although new to me, they are well-established in the world’s history.

As years pass, I acclimate to my bionic life. I become protective of my device. It gives me life. It has become a friendly companion to my body; I don’t even feel its presence.

Yet, over time a familiar sight, the little bird, approaches. I close the window. My pacemaker cannot malfunction. It’s all in my imagination. Nevertheless, I am highly attuned to changes in my breath. In my late 60s, I begin to feel winded with exercise at times when I didn’t before. Climbing stairs and swimming leave me exhausted rather than exhilarated.

I wonder, has my vigilance become hypochondria? The little bird returns and stays too long on my window ledge.

“Does the pacemaker record show any incidents since you last checked?” I ask the technician reviewing the pacemaker data since the last six-month checkup.

“Yes, there are a few.”

I look at the screen of the specialized computer he uses to communicate with my pacemaker. The technician, with the cardiologist’s assistant’s approval, turns a computer dial slightly clockwise and slides a track bar to the next notch. One setting adjusts the heart rate by sensing the level of body movement, the other adjusts the timing of the heart’s contractions.

“Try that,” he says, “and let us know if you feel a difference.”

And I do feel a happy difference.

I’m now seventy-four years old and have been living with my bionic device for twenty-two years. “How about that,” I say to myself, “twenty-two years of borrowed life.” My device works, it keeps me going, it keeps me active. I’ve—or rather, my heart has—come to depend on it more and more over the years. It seems my old heart is getting weaker with age and pooping out. But my bionic machine won’t let it. Yet.

Since that first time, my pacemaker has been adjusted a few more times to increase its sensitivity to my body’s need for faster pacing. Even so, again my heart feels like it’s about to explode after swimming a few laps. Sure, I get out of breath, but it’s not the same as being winded after a good workout. My little bird and I are becoming regular companions now: It comes, stays a while, then flies away.

I’m currently on my third pacemaker replacement, each a newer version of the last. And I now have an automatic, in-home monitoring system that sends data from my device remotely over the Internet to my cardiologist, Dr. K. And so now, how do I feel about that? My mind races through scenarios and settles on one: a malicious hacker penetrates my device and changes all its well-calibrated settings. By severing its remote monitoring capability, Dr. K. receives no alarm signal. Two decades later, a Y2K-like disaster falls on me.

No one has hacked my life-sustaining bionic device. Yet.

The little bird returned eight months ago on a bright morning in 2023 and persisted. It chirped loudly while I swam, but not when I was hiking or climbing hills. True, those activities exhausted me: My breath struggled, my muscles protested, but my heart felt like it was pacing along, keeping up as required. I felt cheated. I couldn't silence that bird while swimming.

Dr. K. had my pacemaker adjusted, again. The next day, I swam with ease and faster too. I was on a roll. Until a few months ago. So, I pondered, am I supposed to have it adjusted again, and thereafter every six months? How many adjustments are possible? How close am I to reaching the bionic device’s capabilities? And why do I feel this need for faster pacing only when swimming?

My yearly cardiologist appointment scheduled in November 2024 arrives. He reviews the data. All is well. The pacemaker’s historical record shows no abnormalities, but it does show, to Dr. K’s delight, that I’ve been keeping active. Physical activity, he says, is one of the best ways to attain a healthy heart and lungs. Dr. K. then speculates that when swimming, unlike other physical activities, the breath is even and steady. Movements are smooth as the water-buoyed body glides along. Therefore, the device’s sensors may not detect the exertion as easily and thus don’t prompt the pacemaker to send the electrical signal for the heart to ramp up pacing. And so I, when swimming, suffer the consequences.

O.K. I’ll trick it into action. I’ll breathe hard and fast and I’ll flail my arms and legs to kick start my sleepy device into life. Or, if I want to continue swimming—and I do—I will just come to terms with slower swims. My former 35-minute swim now takes 50 minutes. No matter what, I’m determined to keep swimming until the device can’t tolerate more tricks or adjustments. Bionic or not, the pacemaker’s intelligence does not quite match mine. Yet.

I wait at my window for the little bird. I know it’ll come; I expect it to do so. And when it does, I’ll tell it, “Let’s be friends. You tell me by the insistence of your chirps when I should take caution, and when I should just get out of the pool. I will heed your advice. You and my bionic device keep me alive. I thank you both.”

Arne Larsson’s first pacemaker failed within three hours of implantation and the second lasted one week. Until his death at 86 due to unrelated causes, Larsson had twenty-six pacemaker replacements. I’m fortunate; I’m no test case. I’ve learned to trust my bionic device yet listen and heed to my body’s commands.

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