Abstract
Pacemakers and ICDs can best be considered as devices that are embedded in a techno-geography of care: the working of these implants depends on situated care acts, which are dispersed over different spaces and involve a (re)distribution of tasks and responsibilities. One of the spaces that matter in enhancing the material resilience of wired heart cyborgs is the cardiac policlinic. People implanted with pacemakers and defibrillators are instructed to visit the policlinic twice a year for a check-up of whether their devices still work properly. This chapter extends the notion of gazing introduced by Foucault to include the role of wired heart cyborgs in assessing what is wrong with their hybrid bodies. Because of the transformed materiality of their bodies, people living with pacemakers or defibrillators may become aware of new sensory experiences, which enable them to play an active role in gazing into their hybrid bodies. Although both technicians and wired heart cyborgs are actively engaged in creating the material resilience of hybrid bodies, the techno-geography of resilience that emerges during the control visits illustrates that these actors are not equally situated in sustaining these bodies. When conflicting gazes occur, the gaze of the technician is prioritized over the gaze of the patient.
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Notes
- 1.
See Chap. 2, endnote 15, for a detailed explanation of the sources used in this chapter.
- 2.
At least for the devices produced since 2005 (Interview technician 1, 2012).
- 3.
The instructions patients receive before and after implantation of the ICD include an explanation of the beeps that signal an almost empty battery.
- 4.
Problems with hearing the beeps that signal empty batteries might be solved by setting the alarm function on vibrate, a feature that is included in the newer generations of pacemakers and ICDs. Among the patients I interviewed, only one of them was informed about and used the vibrate alarm (Interview, ICD patient 12).
- 5.
ICD companies are aware of the problems with the beeps. One of the main ICD companies in the US decided to explain the beeps in the Question and Answer section on their website, where they advise patients to contact their doctors immediately (Questions and Answers section of Living with an implanted cardiac device, website Medtronic consulted on 21 February 2014). http://www.medtronic.com/patients/tachycardia/living-with/questions-answers/
- 6.
See Chap. 5 for a detailed analysis of how magnetic fields of technologies in the near environment of people with pacemakers or defibrillators can interfere with their implants.
- 7.
Website of the ICD User group consulted on 16 February 2014. http://icdusergroup.blogspot.nl. http://icdusergroup.blogspot.nl/2009/08/that-little-beep-could-be-telling-you.html
- 8.
This implantation was done in another hospital than the VUMC (Medical Centre of the Free University) where I did my observations.
- 9.
In the case of frequent reports of damaged leads, manufacturers often adopt the policy of a so-called re-call in which hospitals and media channels are used to invite patients to visit their cardiologists to plan operations to replace their leads (Interview technician 1, 2, and 3). This happened for example in 2012 with the Riata lead produced by St Jude Medicals in the US, which led to a worldwide advice to hospitals to investigate the leads by Röntgen radiation each year (Interview technician 1).
- 10.
See Manyena (2006, 439), for similar conclusions about the processes involved in achieving resilience for communities stricken by disasters.
- 11.
I noticed this active involvement of patients’ partners during my observations of the control visits and interviews as well (Control visit 7; interview ICD patients 10, 11).
- 12.
Technicians are not allowed to prescribe or change medication, which is the domain of cardiologists.
- 13.
For this debate, see, for example, Hsia et al. (2000).
- 14.
Despite the many innovations in ICDs in the past two decades, there is not much improvement in increasing the discriminatory potential of the ICD to differentiate between fibrillations of the atrium and the ventricle (Interview technician 2).
- 15.
Observation of VU ICD patient education meeting at VUMC hospital, Amsterdam, 11 February 2013.
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Oudshoorn, N. (2020). Creating Material Resilient Cyborgs: Sensing and Tuning Agencies of Pacemakers and Defibrillators. In: Resilient Cyborgs. Health, Technology and Society. Palgrave Macmillan, Singapore. https://doi.org/10.1007/978-981-15-2529-2_3
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