Resilient Cyborgs

Living and Dying with Pacemakers and Defibrillators

Nelly Oudshoorn

• Publisher: Palgrave Macmillan
• Year: 2020
• ISBN:
  9789811525292
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

This book examines how pacemakers and defibrillators participate in transforming life and death in high-tech societies. In both popular and medical accounts, these internal devices are often portrayed as almost magical technologies. Once implanted in bodies, they do not require any 'user' agency. In this unique and timely book, Nelly Oudshoorn argues that any discourse or policy assuming a passive role for people living with these implants silences the fact that keeping cyborg bodies alive involves their active engagement. Pacemakers and defibrillators not only act as potentially life-saving technologies, but simultaneously transform the fragility of bodies by introducing new vulnerabilities. Oudshoorn offers a fascinating examination of what it takes to become a resilient cyborg, and in the process develops a valuable new sociology of creating 'resilient' cyborgs.

Part IIntroduction: Theorizing the Resilience of Hybrid Bodies

© The Author(s) 2020

N. OudshoornResilient CyborgsHealth, Technology and Societyhttps://doi.org/10.1007/978-981-15-2529-2_1

Begin Abstract

1. Rematerializing the Cyborg: Understanding the Agency of People Living with Technologies Inside Their Bodies

Nelly Oudshoorn¹

(1)

Department of Science, Technology and Policy Studies, University of Twente, Enschede, The Netherlands

Nelly Oudshoorn

Email: [email protected]

End Abstract

Implanted heart devices transform lives. Consider , for example, the story of Joan, a lively woman who works in a pharmacy in a small Dutch village. At age 43, she collapsed in the street because of a sudden cardiac arrest when she was shopping during her lunch break. Because it was just before Christmas, it was very crowded in the street. Therefore, one of the passers-by who noticed her collapse was able to resuscitate her, which saved her life. In the hospital, they told her that they would give her an internal cardioverter defibrillator (ICD), because she might be at risk of another cardiac collapse. Because she was not familiar with this technology, she asked the cardiologist what kind of implant it actually was. Reflecting on what happened then, she told me that it was not a real choice. ‘You cannot tell them, no, I just want to go home and see what happens.’ At home, her husband instructed their children to be careful not to hit mama on her chest, because she had received a device to protect her: ‘a kind of watch dog.’ Joan had very vivid memories of how it felt when her ICD fired for the first time. She was changing clothes in her bedroom before going to work and felt a bit dizzy and then the ICD hit her. ‘I remember that I turned around because I thought that someone gave me a smash on my back, maybe one of my children; it was really weird.’ Unfortunately, Joan had to endure unnecessary shocks as well. The first time this happened was during the implantation of her ICD. Half a year later she experienced another series of unwanted shocks because of a short circuit caused by a fragmented lead of her implant, which required the replacement of her ICD. For the first year and a half after the implantation, the very fact that she had a device inside her body had preoccupied her greatly. Joan told me that she felt its persistent presence all the time: ‘It did not belong to me.’ Nevertheless, she learnt to view her implant as a ‘reassurance’ and ‘safeguard’ because her life did not depend on human assistance to resuscitate her in case of another cardiac arrest. For Joan, the implant gradually became a technology that enabled her to live ‘with a calm heart,’ a device ‘she did not dare to live without.’ She also realized that the ICD affected the way she would die because it diminished the chance of an ‘easy death’ caused by a cardiac collapse. She wondered whether her dying ‘would not become a deep suffering’ and if she would eventually ask for the removal of her ICD.¹

The story of Joan exemplifies some of the drastic changes people may experience when they have internal heart devices that regulate their heartbeats. Although there are many differences in the ways in which ICDs and pacemakers affect people’s lives and deaths, the agency of these devices, and the reasons why they were implanted in the first place, the experiences people having these devices shared with me included detailed accounts of the problems they faced in learning to live with their materially transformed, cyborg bodies. They learnt that ICDs and pacemakers act as potentially life-saving technologies by intervening into their heart-rhythm problems but simultaneously transform their fragile bodies by introducing new vulnerabilities, of which unwanted shocks or broken leads are only two examples. Listening to their sometimes painful accounts, I was impressed and touched by the resilience of people living with implanted heart devices, which became my major incentive in writing this book. What does it take to become a resilient cyborg?

Pacemakers and Internal Defibrillators as Ordinary Medicine in the Global North

Pacemakers and ICDs as Invasive Technologies

Introduced in the early 1960s, pacemakers can best be described as small, battery-powered generators that supply electric pulses to the heart when the heartbeat is too slow.² They consist of three parts: a metal case containing a battery and electronic circuitry; one or more insulated wires, called leads, connected to the generator at one end and the heart muscle at the other; and electrodes on the end of each lead for monitoring the electric activity of the heart stored on an electrocardiogram (ECG; Fig. 1.1) The pacemaker uses an algorithm to detect possible heart-rhythm irregularities and is programmed in such a way that it gives electrical pulses to increase the heart rate when it is slower than the programmed limit. This agency of the device is called pacing, hence the name of the device. Slow heart rhythms can cause dizziness, tiredness, and even fainting and make it difficult for people to live an active life. Because pacemakers bring the heart back to a normal rate, they contribute to improving the quality of life and may even increase longevity. Pacemakers can be programmed externally by a technician to select the optimum pacing modes for each person (Snipes et al. 2011, 1). The ICD looks very similar to a pacemaker but is designed to do the opposite.³ It may give very fast pulses (called over-pacing), a small electric shock (called cardioversion), or a larger one (called defibrillation) to bring the heart into a regular rhythm in the case of very fast, life-threatening heart rhythms, as exemplified in the story of Joan.⁴ Nowadays, most ICDs include a pacemaker function as well.

Fig. 1.1

Pacemaker (Picture of pacemaker. Images courtesy of Olafpictures via Pixabay. Free download 14 October 2019)

Pacemakers and defibrillators are invasive technologies surgically implanted in patients’ bodies. During surgery, which is performed under local anaesthesia, the leads are placed first by guiding them, with the help of X-ray images, through a vein into the lower heart chamber, the ventricle (Fig. 1.2). The cardiologist then connects the leads to the device and programs it. Then the pacemaker or ICD is inserted in a so-called pocket, a space that is created by the cardiologist between the muscles, usually beneath the left collarbone. Finally, one of the technicians present during the surgery tests the device to ensure that it is working properly. People usually stay in the hospital overnight and go home the following day. Because pacemakers and ICDs work on batteries that cannot be charged from outside the body, they will be replaced by a new device when the battery loses too much power, which requires another surgery. Because batteries last approximately 5–10 years, many people have to undergo multiple implantations during their lifetimes.⁵ The clinical care for people living with pacemakers and defibrillators is not restricted to the implantation of these devices but also involves regular follow-ups provided by specifically trained technicians, nurses, and cardiologists in specialized clinics.

Fig. 1.2

The site of a pacemaker in the body (Drawing of an illustration of the site of a pacemaker in the body as included in https://​www.​cwz.​nl/​patient/​behandelingen/​pacemaker/​. Accessed 13 November 2018. Images courtesy of Rob Vrakking)

The production of pacemakers and ICDs is dominated by three large medical device companies in the US and one company in Germany, which are continually engaged in the further technological sophistication of these devices, including remote monitoring,⁶ thinner leads, wireless devices,...

Table of contents

• Cover
• Front Matter
• Part I. Introduction: Theorizing the Resilience of Hybrid Bodies
• Part II. Technogeographies of Resilience
• Part III. Resilience and Difference
• Part IV. How Hybrid Bodies Fall Apart
• Back Matter