Posted on 10/25/2004 11:28:13 PM PDT by neverdem
CASES
It was 5:30 in the morning. I noticed an elderly man being whizzed into the emergency department on a stretcher. What was unusual were his movements. He seemed to occupy a fourth dimension, oscillating in several directions at the same time.
The year was 1956, and I was a fledgling intern, working in the emergency room at a hospital in New York, trying to survive the 8 p.m. to 8 a.m. shift.
This was my first encounter with a patient who was having continuous convulsions, and I was stunned into inaction. Finally, I was dislocated from my paralysis by the suggestion of a nurse that it might be a good idea to start an IV, a daunting task to perform on a windmill, and one that took half a dozen attempts to complete.
Of the two of us, the nurse was clearly the only one who knew what was happening. It took me awhile to realize, after checking the patient's pulse (30 beats per minute) that not enough of his blood was getting to his brain.
After a consultation with the Merck Manual, I gave him intravenous atropine and probably a few other medications to speed up the heart rate. Alas, none of the drugs appreciably increased his pulse for more than a few seconds. Fortunately, the patient remained unconscious as he continued to convulse.
By this time, his EKG looked liked a slow march to hell, and I felt as if I were heading for the same location. A groggy medical resident arrived, and bravely suggested repeating the same drugs to no avail. What mystical messenger put into my mind the thought of a pacemaker I do not know, but it remains my muse to this day. Internal pacemakers were not well developed at that time, and the only machine we could find in the hospital was an external device twice the size of a breadbox. (Try to find a piece of rarely used equipment in any hospital before the day shift arrives.)
Placing the unit on a food cart, we wheeled the device to the patient's bed, and then attached to his chest a series of external electrodes, each the size of a large radish.
Normally, current would be expected to flow from the pacer to the electrodes through the chest wall into the heart, eliciting a beat. But when the machine was first turned on, there was no response: the convulsions continued.
This patient had a chest as thick as Muhammad Ali's in his good days. The electricity could not reach his heart until the voltage was turned up to the maximum, so high that it caused muscular contractions of the entire chest wall. Ten minutes later, benefiting from a heart rate of 80, he awakened to ask why his chest was hurting so much, adding, to my chagrin, that he had not been bothered with chest pain before he had been brought to the hospital.
We had fixed one set of convulsions but at the same time we had given him new ones, which were more intolerable to him than the old ones were, since he was now conscious.
Desperate for a solution, I called the senior surgical resident, who could not understand why I was bothering him with a medical problem at 8 a.m. when he was on the way to the operating room. But I begged, and he helped.
The thinking between us went something like this: What do you do to solve an electrical problem when no union electrician is qualified to plug in the heart? Go to the hardware store.
It had to be the coldest day of the year in the Northeast as I waited for the shop to open. When I asked for a six-inch-square piece of chicken wire and 15 feet of lamp cord, the salesman asked me what I had in mind. The items, to the best of his knowledge, did not seem to be useful as a unit. I was then being paid $25 a month and his price for the material, 55 cents, was not to be casually spent. But by now I had stretched his imagination to the limit, and I wasted no time, arguing that his goods might save a life, and thus should be considered a charitable contribution.
Only the sterilization of the chicken wire and lamp cord slowed down the operation we had envisioned. I am sure that this man was the first patient ever brought to the operating room in that hospital followed by a kitchen cart with a pacemaker on it. We had to take the food elevator to get him and the cart up to the operating suite.
After convincing the anesthesiologist that we were not up to some bizarre joke, we were able to proceed. Through a small left chest incision, we exposed the front of the heart. Several silk sutures sufficed to hold two segments of chicken wire to the heart's surface. The two copper wires of the lamp cord were bared and attached to the chicken wire with a few more sutures. The insulated portion of the lamp cord was then threaded through the space between two ribs and attached to the external pacemaker.
When the machine was switched on at the lowest possible voltage, it produced a regular heartbeat of 80, with no twitching of the chest muscles. The patient was returned to the recovery room in good condition.
Pacemaker heck! I'm gonna search to find what '56 EKG machine looked like.
Chicken wire?
An early Medtronic pacemaker that operated on alternating current. This is most likely the type in the article.
Thanks for the pics.
FReepmail me if you want on or off my health and science ping list.
Was that a pic of an external pacemaker from the 1950s?
Wow.
Thanks!
Excellent! Thanks for the link.
I had my tonsils out in 1947, when I was 9 years old. The doctor used ether. Almost killed me, too. Overdose.
PS ... But by 1956 when I had my first child, "gas" was used.
Just think what the trial lawyers would do with this today.
1956? There must not have been any trial lawyers around back then...
About the same time for me, at age seven I think. It was the icecubes and popsickles afterwards that almost killed me. I wanted FOOD!
LOL!
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