An excerpt from A Fullness of Uncertain Significance: Stories of Surgery, Clarity, & Grace.

“None are so old as those who have outlived enthusiasm.”
-Henry David Thoreau

My mother, bless her ninety-year-old heart, is slowing down. The things that made her happiest — getting to church, visiting friends, taking walks, and wandering the aisles in the grocery store —are increasingly difficult. She worries that her lack of energy will soon make every activity impossible.

It is 2005 and she is living alone in Chicago, about ninety miles from where my wife and I live. My father died suddenly the year before, and she is settling into the life of a widow. She has always been very healthy and upbeat, but she’s become more and more fatigued. “What do you think it is?” she asks. “Do you think it is my heart?”

“Let’s find out.” We arrange an appointment with her internist. Sure enough, her heart rate is uncharacteristically slow and does not speed up when she walks or moves about.

“I believe you need a pacemaker,” her doctor confirms. “I’ll arrange a visit with a cardiologist.”

This gives my mother something new to worry about. “I’m too old for any procedures, don’t you think?” she says. “Do you think I could tolerate having a pacemaker?”

We calm her fears and wait for the appointment. Within a few days, and after a couple of tests, we learn that she might, indeed, benefit from a pacemaker. In a few more days, she is at the hospital and on the schedule. I drive the two hours, pick her up, and help her check in at the hospital.

Everything goes perfectly. The rest of the day, she naps off and on. “I’m a little sore,” she decides. “You can go home. I’m fine.”

“That’s OK, Mom,” I tell her. “I’ll stay with you. You sleep today. Tomorrow, I’ll take you home and get you settled.”

The next morning, she is alert, sitting up in bed and looking well-rested. Before discharge, she needs a teaching session with the cardiologist’s nurse practitioner.  “It’s like a little computer that you wear under your skin,” the nurse says. She explains how it monitors my mother’s heart rate and stimulates the muscles to contract if there is too much time between heartbeats. She tells us how to send information from her pacemaker to the company. She shows my mother how to care for the stitches and helps arrange a follow-up visit for any needed adjustments in the pacemaker programming.

After the nurse leaves, my mother and I study the brochure that she has received from the company that manufactured the pacemaker. We carefully review the warnings she must keep in mind. For example:

• My mother should not hold a cell phone closer than six inches to her new pacemaker.
• My mother should not stand closer than twelve inches to a slot machine.

These are good and reasonable suggestions. Although she rarely uses her cell phone, she does own one. The company suggests that she hold the phone on the ear opposite the device when she needs to make a call. We make a note of that.  Since my mother has never been inside of a casino or a tavern, she doesn’t need to worry about slot machines. She decides that the company believes that it is safe to play the slots, but big jackpot winners should avoid hugging the machine.

We continue reading:

• My mother should stand no closer than twelve inches to a chainsaw.
• My mother should be no closer than two feet from an arc welder.
• My mother should never use either a stun gun or a jackhammer.

These also seem to be very reasonable suggestions, although I tighten my grip on her hand and lock eyes with her. I question her closely, and she repeatedly assures me that she has long ago given up her aspirations to become a lumberjack, welder, peace officer, or construction worker.

“Can I trust you?” I ask. “Promise that you will let me know immediately if you feel an urge to take up any new hobbies that involve heavy equipment or high-voltage generators.” She nods solemnly and we shake on the promise, her skin smooth in my hand, her fingers cool to the touch, her joints swollen, her grip weakened by arthritis.

Despite her insistent claims to the contrary, I continue to monitor her hobbies and activities. Even after she moves to senior apartments close to our home, I ask her whether she has been to a casino or visited a logging camp.

For the rest of her life, I surreptitiously check the hallway closet for stun guns and her garage space for jackhammers. She always throws up her hands in mock denial but, with all of that enhanced energy she gained from her new pacemaker, I tell her that I need to be certain.

Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror. He is the author of A Fullness of Uncertain Significance: Stories of Surgery, Clarity, & Grace.

Image credit: Shutterstock.com