The patient laid unconscious in the intensive care unit bed. The cardiac monitor beeped extra loud. I was here with the Cardiology team to shock this patient. Yes, I mean electrocute. He was in atrial flutter, which meant his heart was beating at an abnormally fast rate and we planned to revert that. Applying a shock to the heart is similar to pressing the reset button on your phone. I had never done one before, and I was eager to earn my stripes on this one. The patient's daughter walked up to me, and asked for the thirty seventh time, "Doc, is his heart rate going to be normal after?". And for the thirty seventh time, I answered "We cannot tell if we would be successful, but we will try. I'll let you know soon as we're done". Since I was the one pressing the button, she assumed I was more important than the intern that I really was.
My Attending directed me to set the defibrillator energy at 200 joules, and the mode to sync. We again checked that the patient was deeply sedated. I pressed the charge button. "All clear on three, two, one" Bzzzzzzzzz. The power surge forced him to twitch once. The monitor went flat line for 2 seconds. Then, "Beep, Beep, Beep, Beep, Beep". Yes, we did it!!! He was back in sinus rhythm (normal heart beat). That was the coolest thing I ever did. I have done two more since then, and they both felt as good as the first time.
I have only shocked unconscious patients, so I don't know how they felt getting electrocuted. One day, I asked a patient who received a live shock. Live shocks can happen in patients who have defibrillators implanted in their chest because of a weak heart. Anytime the device senses a ventricular fibrillation (a fatal abnormal heart rhythm), it delivers a shock. Sometimes, the defibrillator senses wrongly and shocks the patient inappropriately. So, I met this patient who had received 3 inappropriate shocks in 2 weeks. "How does a shock feel, Mr. J", I asked. "Doc, each time, it feels like a horse kicking me in the chest, and it knocks me down flat. I feel the pain for one week". Okay, lesson learned. Now I'm a believer. My Attending had told me that patients that get shocked alive can get post traumatic stress disorder. Maybe he was making it up. Or maybe it's true.
I have made up my mind, I want to be an electrophysiologist. I would have the license to shock people. We had a patient the other day who had abnormal heart rhythm. The EKG recorded a wide complex tachycardia (fast heart rate). To find out the source, the electrophysiologist took him to the lab. He paced the heart and induced the same tachycardia. He then shocked the patient back to sinus rhythm. Coolest human experiment ever.
The heart pumps because it is supplied by electricity. The electricity is produced by a generator called the sinus node. It then travels to the rest of the heart via cables, called the conduction system. Abnormalities can occur in either of generation or conduction of electricity in the heart. The problems are fixed by an electrophysiologist. So, an electrophysiologist is basically an electrician. He works with electrodes, fuses, pliers, and screwdrivers. Okay I'm joking about the last three.
For now, I am a second year resident. At least five or six years separate me from my dream. But I eagerly wait for that day when I will fill out a form. And in the occupation section, I will write "Electrician".
Hakeem Ayinde, MD
