Guarded, but grateful for shocks of a lifetime

November 06, 1994|By Jonathan Bor | Jonathan Bor,Sun Staff Writer

The electric shock that stunned Daniel Smedley in the aisle of a grocery store could have been the jolt of his lifetime, except it's happened to the retired car salesman no less than 75 times over the past nine years.

He's been shocked while driving, shocked while watching television and shocked while lounging in his beach house. One day, the White Marsh man was walloped six times in the ambulance and five times in his hospital bed.

"It's like somebody took a hammer and hit you in the chest," said Mr. Smedley, 63. "It hits suddenly and then it's gone. But it's the shock of it that makes people nervous -- shaking and worried that it's going to happen again."

Mr. Smedley doesn't complain. Without a surgically implanted device that issues a massive jolt each time his heart races irregularly, he probably would have succumbed long ago to the phenomenon known bluntly as "sudden death."

Fatal arrhythmias claimed basketball stars Reggie Lewis and Hank Gathers in their athletic prime. But high-profile cases such as theirs tend to overshadow the massive toll that sudden death takes on society as a whole -- a quarter-million deaths each year in the United States alone.

Abnormal heartbeats plague some survivors of coronaries that cause long-term disturbances in the way electrical impulses travel through the heart and trigger contractions. Others had viral illnesses that cause similar irregularities.

Since the mid-1980s, the automatic implantable defibrillator has worked miracles for tens of thousands of people who have gone to the brink, only to be rescued by jolts seemingly from nowhere.

All told, at least 150,000 Americans wear the device today.

The gadget, invented by the late Dr. Michel Mirowski of Sinai Hospital, revolutionized the treatment of severe rhythm abnormalities.

Once, therapeutic shocks were available only through "paddles" handled by doctors and rescue personnel. Paddles remain an excellent means of shocking a racing or fluttering heart into normalcy, but they are useless for patients who will die without immediate help.

The implantable defibrillator makes the same therapy portable and nearly immediate. Weighing about a half-pound, it delivers 750 volts of electricity -- more than three times the force of household current -- seconds after a heart lapses into a life-threatening arrhythmia.

A box about the size of a cigarette pack is surgically implanted under a person's skin beneath the rib cage. It contains a battery and computer chips capable of sensing when the heart beats too fast or flutters.

The box, or pulse generator, is wired to the heart by means of electrical leads that can be threaded through a vein to a place deep inside the heart or surgically placed on the muscle itself. The wires transmit signals in two directions -- communicating the heart's electrical pattern to the computer, and delivering the therapeutic jolt.

In rare cases, the shock is futile. These are usually instances in which fluttering is the immediate result of a heart attack. But usually, the heart recovers its normal beat.

As it saves lives, this remarkable device leaves an eerie legacy.

Those lucky enough to get shocked infrequently often shake off the experience like a person who once stepped in the path of a speeding bus and escaped just in time. But those who have been shocked again and again -- and there are many -- say they tiptoe through life both grateful and afraid.

"Almost all patients understand what would have happened if they had not been shocked," said Dr. David Schamp, an arrhythmia specialist at Sinai Hospital. "But it's really frightening for them, not knowing when it's going to happen."

Albert Goodman, 86, voices a sentiment shared by many patients.

"I can do without it!" he said, waving his hand in disgust. "It's like somebody put dynamite in you. It goes off when you least expect it, just like somebody sneaks up behind you and hits you over the head with a hammer. No warning."

Then, chuckling, he added: "But I'm here to tell you about it."

Mr. Goodman of Pikesville never knew anything was wrong with his heart until the late 1980s when he fainted while working as a cashier at a carwash.

At Sinai, doctors found that he had survived an episode of ventricular tachycardia, in which the heart's lower chambers beat too rapidly to pump adequate supplies of blood.

Recognizing that further episodes could prove fatal, surgeons equipped him with an automatic defibrillator.

The first firing was unforgettable. On a cold night, he accompanied his stepson to the Baltimore Arena for an evening of professional wrestling. With the house lights darkened and the behemoths preparing for battle, Mr. Goodman was hurrying up and down the aisles looking for his seat.

"I was holding my heavy coat, all excited. Finally I found my seat and bingo, the thing went off. It almost knocked me over. It's a terrible feeling, a very powerful apparatus."

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