Opinion I’ve been living with a pacemaker since I was 19. Here’s what I’ve learned about life, technology, and heartbeats

How big was small, I wondered uneasily. Soon after, a 14-year-old was admitted to the ward, due for a pacemaker change. The surgery later, he was jumping around the ward like a monkey. The sight of it was reassuring, so I stopped worrying. The first operation lasted three hours, as they carved out a cavity under the shoulder blades and threaded the wires into the heart. It felt big and lumpy and uncomfortable, but as the wound healed, I got used to it. Its batteries would last two-two-and-half years, after which I would require another one. (They change the whole hermetically sealed unit, not just the batteries.) In the event, it lasted me just a year-and-a-half — one of the leads came adrift or broke, and I was back to square one.

Subsequently, the next one was placed in the abdomen, but its successors (six so far) were placed in the right side of the chest. I could do pretty much everything, though, yes, the list of restrictions was long and varied: Stay away from magnetic fields and metal detectors; do not fiddle with electrical equipment; keep away from microwave ovens; inform airport security. Those first pacemakers were paper-weight heavy, and I had to clutch my chest while running to catch a bus, because they tended to bounce.
Happily, with advancing battery technology, their lives grew longer and now pacemakers last more than six or seven years, or even more with care. (My best has been 10 years). Get yourself checked regularly, especially if you are 100 per cent dependent on them, as I am. They may need to “tune” it depending on your requirements. Also, pacemakers have become smaller and lighter – my current one barely tips the scales at 30 gram, less than the average love letter that sped up your heartbeat (except that no one writes those anymore), and at most times I am unaware of its presence. The operation now lasts about 1.5 hours, done under local anaesthesia because they need you to cough during the course of the surgery to ensure that the leads have been affixed properly. For a day, you are told to hold still as it settles down. A week in hospital later to ensure there is no infection, you are back home and to life as usual.

Years ago, the manufacturers had introduced a “free-replacement” for life scheme, which meant that I have been the recipient of several replacement pacemakers free of cost. Otherwise, they can cost, I believe, anything from Rs 2 to maybe Rs 15 lakh. The latest ones are “‘pill pacemakers” — tiny, wireless and slotted right inside the heart via a vein. For the conventional type, it takes about three to four weeks to become comfortable after surgery. After that it is pace on!

Apart from sensing when it needs to step in and provide a shock (all the time for me) pacemakers have become “rate responsive”. Which means if they sense you are jogging, or saying playing tennis, or want to say hello to an attractive member of the opposite sex, they catch on and increase the heart rate accordingly. This can however have unforeseen consequences.

Reclining in the back of a juddering auto rickshaw at the Delhi Gate traffic lights one morning, I suddenly realised that my heart was hitting around 120 beats per minute and there was not a potential romantic interest in sight. The pacemaker had picked up on the engine vibrations and concluded that I was exercising. Wow, I thought, I’m giving myself a cardio workout without having to move a muscle. Surely, I should patent this knowledge and sell it to the Americans (with a 200 per cent tariff)?

Lal is an author, environmentalist and birdwatcher