Imagine living with a device, day in and day out, that could mean the difference between life and death.
The implantable defibrillator is exactly that for the cardiac patients who wear it. But it's a medical miracle that also carries with it some serious emotional baggage.
Most Americans first heard about the device last June, when Vice President Dick Cheney became one of the roughly 50,000 heart disease patients last year to have one implanted.
The pager-sized defibrillator is implanted under the skin of cardiac patients and connected by wire leads to the heart. It detects rhythmic disturbances of the lower heart chambers that can cause sudden cardiac death. And when it does, it jumps into action, shocking the patient's heart back to normal with a jolt of electricity.
Pete Dorton, 34, is grateful for his own internal insurance policy. Just three weeks ago, he thought he had the flu. But it turned out to be something far more serious. A virus had attacked his heart, and as a result he had to have a defibrillator implanted.
"I basically would have dropped dead," says Dorton. "You hear about it all the time, athletes, young guys, you know, at the gym suddenly dropping dead of a heart attack, cardiac arrest."
Now the device brings him peace of mind. But it also brings concerns.
"When I first had it put in, I thought, 'Did they set it right? Did they turn it on? Is the battery working?' All those fears go through your head," he said.
Overcome With Anxiety
For some patients, it's when the device actually does function properly that they have problems.
Take 72-year-old Lorraine Flood, for example. Flood suffered a heart attack 12 years ago, and years of irregular heart rhythms lead her doctor to implant a defibrillator in her chest.
She describes what it felt like the first time her implantable defibrillator delivered its shock: "It happened in my sleep, and I thought the house caved in on me. I didn't expect the intense pain."
By now, she has had many episodes of irregular heartbeat, and many shocks. "I think in nine days I had 16 shocks," says Flood. "But not all of them were powerhouses. Some of them are very mild, leading up to the stronger one. And it just unnerved me."
Flood found herself overcome with anxiety. She had been given a second chance at life, but said she was afraid to go out, afraid to live. Flood said she was preoccupied with only one thing — the next shock.
From Kick to the Chest to Hiccup
The pain of the shock varies, with patients reporting feeling everything from a hiccup to a kick to the chest.
"They say it's a pretty powerful punch to the chest, but you know, if that's the worst-case scenario, that's great. It's better than being dead," says Dorton.
Experts say every patient is different, and the number of shocks they receive vary. The average is one or two shocks a year, although some patients never have it go off.
"The only time we get worried is when patients have multiple shocks," says Dr. Larry Chinitz, director of electrophysiology and the heart rhythm center at New York University Medical Center. "And multiple shocks imply either a very resistant arrythmia or it implies that the defibrillator is sensing something normal that it thinks is abnormal and it's not. "
Fine-tuning Flood's defibrillator stopped the frequent shocks. But her anxiety lingered for years. What helped was sharing her experiences with other patients.
"There is no other way to effectively prevent sudden death. Drugs will not do it. And this is truly a lifesaving therapy," says Chinitz.
Three weeks post-surgery, Dorton is running and feels truly lucky to be alive. Flood hasn't had a shock in a year, and she says she's finally enjoying the gift of her life.
"I'm thankful I have the defibrillator. And I think I'd be more frightened now without it than I was with it."