My heart hurts in my shoulder – 10/16/2023 – Suzana Herculano-Houzel

“Can it be without anesthesia?” I asked my cardiologist. Our relationship had just been “promoted”, as he put it: I had finally agreed to consider letting him do (just like that, four verbs in a row) the heart ablation he had been trying to convince me to agree to for seven years. And as he had already known me for seven years, he took a deep breath, closed his eyes, shook his head slowly while making that face like “oh my bag, treating a neuroscientist is hard work” and nodded.

Yes, he could thread catheters through my groin to record the electrical activity inside my heart, electrically stimulate beats as they pleased during the procedure, map the heart’s excitability and then discover and cauterize, with another electrode, the supernumerary pathways that were messing up my heart rhythms and causing tachycardia attacks that left me out of circulation for the rest of the day when they happened. With my children now adults, moving house and wanting to start my new life as a newlywed (yay!) without the risk of having to find the nearest emergency room on the other side of the world on my business trips, I accepted the procedure. —as long as I didn’t need general anesthesia.

Let’s be clear: I think general anesthesia is one of the wonders of science, which makes transformative surgeries possible that would otherwise be unthinkable. But I’ve heard from all my colleagues who study anesthesia that they themselves refused anesthesia whenever possible, because of the non-zero risks of cognitive damage and other consequences — including extreme mental confusion upon waking up. This part of general anesthesia is still a game of Russian roulette: the only way to find out how you react to anesthesia is to go through it.

Not only did I not want the risk, I was excited to be part of the process. If someone is going to have fun experimenting with my heart, I want to be part of the fun too, come on. And, as a bonus, take notes in the first person: how else would I find out what it feels like to have someone poke my heart inside?

The anesthesiologist and her team were lovely and agreed to put up with the neuroscientist on duty being awake, with just an opioid to alleviate the pain — and I gained three hours of unique experience for my classes.

For example, I now know that the only sensation of catheters passing through veins is pressure on the inside of the skin. My vessels and heart don’t feel anything, as they don’t have mechanoreceptors. The burning of the three dozen places on the right side of my heart, those I felt — but not as pain in the chest, in the place of the heart itself, but rather as the pain of a finger stuck with all its force just below my right collarbone .

It is called “referred pain”: in the absence of a sensory reference —because what other sensation do we have in the heart, to serve as an anchor?—, the brain attributes the pain to the closest neighbor in the sensory pathways, which, in the case of the side right of the heart, is the right shoulder. My heart doesn’t stay on my shoulder, but that’s where it hurts.

LINK PRESENT: Did you like this text? Subscribers can access five free accesses from any link per day. Just click the blue F below.