Summer 2026 - Vol. 21, No. 2 During my brief time as a geriatric consultant, I was asked to see a 94-year-old man who had fallen off his tractor and broken his right arm. He was living with his son’s family; his son had found him under the tractor and brought him to the emergency room.

He apparently needed some sort of hardware to fix his arm, so the anesthesia service was asked to see him before he went to surgery. An EKG was performed, and it showed some sort of potentially ominous rhythm. The cardiology service was consulted by the anesthesiologist and recommended the placement of an implantable defibrillator; they subsequently asked me to see the patient. While the patient’s son had already consented to defibrillator placement, the cardiothoracic team wanted my opinion regarding whether he was a reasonable candidate for their services.

The hospital record indicated that Mr. Landis was “demented and confused.” I entered his room and introduced myself. He stared at me, alert but mute. I reached out with my left hand to shake his, and he took it readily with a firm grip. Heartened, I spoke in my nursing home way, several decibels louder than my conversational tone. He said, “What?” I got within a foot of one of his ears and shouted, “How are you doing?” He brightened and replied, “Everybody I can.”

In those days, I carried a small amplifier with earphones sold by Radio Shack as an “eavesdropping device.” I plugged the phones into his ears, turned the amplifier up to 10, and shouted into the device’s microphone. We then had a normal, albeit very loud, conversation, and he scored 28 out of a possible 30 on the Folstein Mini-Mental State Examination.

I explained that the proposed defibrillator placement would prevent his heart from stopping both during his orthopedic surgery and from then on. He listened carefully and thought about it. “Wait a minute,” he said, “you mean that if my heart stops, this thing will start it up again?” I told him that it most likely would. He was aghast. “Why would I want that?”

The defibrillator placement was canceled, his arm was fixed without incident, and he returned home to his tractor, where he resumed mowing the yard once his cast was removed.