I woke up, late one Friday night, feeling like the Long Island Railroad thumpingat top speed over a patch of bad roadbed. Doctor-fashion, I took my pulse and foundit too

fast to count accurately. I heaved out of bed and sat in a chair, gloomy, wonderingwhat next. A while later the train slowed down, nearly stopped, and my pulse rate hadsuddenly dropped to 35. I decided to do some telephoning.(5)Next thing I knew, I was abed in the intensive care unit of the hospital down thestreet, intravenous tubes in place, wires leading from several places on my chest andfrom electrodes on my arms and legs, lights flashing from the monitor behind my bed.If I turned my head sharply I could see the bouncing lines of my electrocardiogram, atotally incomprehensible graffito, dropped beats, long stretches of nothing followed by(10)what looked like exclamation points. The handwriting on the wall, I thought. Andilliterate at that.Now it was Sunday, late afternoon, the monitor still jumpy, alarm lights stillsignaling trouble, all the usual drugs for restoring cardiac rhythm having been tried,and handwriting still a scrawl. The cardiovascular surgeon at the foot of my bed was(15)explaining that it would have to be a pacemaker, immediately, Sunday late afternoon.What did I think?What I thought, and then said, was that this was one of the things about which aman is not entitled to his own opinion. Over to you, I said.About an hour later I was back from the operating theater. Theater is right; the(20)masked surgeon center stage, wonderfully lit, several colleagues as appreciative audience,me as the main prop. The denouement was that famous deus ex machina beinginserted into the prop's chest wall, my gadget now, my metronome. Best of all, myheart rate an absolutely regular, dependable, reliable 70, capable of speeding up ondemand but inflexibly tuned to keep it from dropping below 70. The battery guaranteed(25)to last seven years or thereabouts before needing changing. Plenty of time to worryabout that, later on.Home in a couple of days, up and around doing whatever I felt like, up and downstairs, even pushing furniture from one place to another, then back to work.Afterthought:(30)A new, unwarranted but irrepressible kind of vanity. I had come into the presenceof a technological marvel, namely me. To be sure, the pacemaker is a wonderfulminiature piece of high technology, my friend the surgeon a skilled worker in hightechnology, but the greatest of wonders is my own pump, my myocardium, capableof accepting electronic instructions from that small black box and doing exactly what(35) it is told. I am exceedingly pleased with my machine-tooled, obedient, responsive self.I would never have thought I had it in me, but now that I have it in me, ticking along soundlessly, flawlessly, I am subject to waves of pure vanity.Another surprise:I do not want to know very much about my new technology. I do not even want(40)to have the reasons for needing it fully explained to me. As long as it works, and it does indeed, I prefer to be as mystified by it as I can. This is a surprise. I would have thought that as a reasonably intelligent doctor-patient I would be filled with intelligent,penetrating questions, insisting on comprehending each step in the procedure, making my own decisions, even calling the shots. Not a bit of it. I tum out to be the kind of(45)patient who doesn't want to have things explained, only to have things looked after bythe real professionals. Just before I left the hospital, the cardiologist brought me a manila envelope filled with reprints, brochures, the pacemaker manufacturer's instructions for physicians listing all the indications, warnings, the things that might go wrong. I have the envelope somewhere, on a closet shelf I think, unexamined. I haven't, to be honest,(50)the faintest idea how a pacemaker works, and I have even less curiosity.This goes against the wisdom of the times, I know. These days one reads everywhere,especially in the popular magazines, that a patient should take more responsibility,be more assertive, insist on second and third opinions, and above all have everything fully explained by the doctor or, preferably, the doctors, before submitting to treatment.(55)As a physician, I used to think this way myself, but now, as a successful patient, I feel different. Don't explain it to me, I say, go ahead and fix it.I suppose I should be feeling guilty about this. In a way I do, for I have written and lectured in the past about medicine's excessive dependence on technology in general,and the resultant escalation in the cost of health care. I have been critical of what I(60)called "halfway technologies," designed to shore things up and keep flawed organs functioning beyond their appointed time. And here I am, enjoying precisely this sort of technology, eating my words.Pacemakers have had a bad press recently, with stories about overutilization, kited prices, kickbacks to doctors and hospitals, a scandal. Probably the stories, some of them(65)anyway, are true. But I rise to the defense of the gadget itself, in which I now have so personal a stake. If anyone had tried to tell me, long ago when I was a medical student,that the day would come when a device the size of a cigarette lighter could be implanted permanently over the heart, with wires extending to the interior of the ventricle, dominating the heart's conduction system and regulating the rhythm with perfection, I would have laughed in his face. If then he had told me that this would happen one day to me,I would have gotten sore. But here it is, incomprehensible, and I rather like it.LewisThomas