

…alternatively titled, “How Your Myocardium Gets Its Swerve On.”

When I teach, I’m always looking for new ways to make the material meaningful to my students. I can gauge an audience fairly well, and I adapt my presentation accordingly. I can be dry and reserved (although I don’t like to be) and fill my presentations with as much technospeak as the audience can stomach. Complexity is not a problem.

Oddly enough, some groups actually like that shit.

However, I’d much prefer to take a rather complex subject and break it down into terms my audience can not only understand, but laugh at. I’ve said it before, and I’ll say it again:

Learning is best accomplished between fits of laughter.



If I’m teaching cardiovascular hemodynamics to a bunch of firefighters, I talk in terms of pumps and hoses, flow rates and closed systems. If I’m explaining heart healthy living to a mechanic, I’ll do it in terms of engines and the importance of using good fuel and routine maintenance.

If need be, I can blather on at length about ion pumps, membrane thresholds, and the propagation of action potentials along conduction pathways.

And a few people actually appreciate that. Their enjoyment of the lesson, however, is significantly lessened by the snores of everyone else in the room.

So, being the shameless approval whore that I am, I play to the crowd. I seek to educate and entertain, and invariably that mean couching my lesson in terms to which anyone can relate.

Like sex.

If I have learned anything about emergency medical providers in thirteen years of teaching, it is this:

1. If you put two firefighters alone in a room with two steel ball bearings, in fifteen minutes one ball bearing will be broken and the other missing, and neither firefighter will have any idea of how it happened.

2. Firefighter medics are suckers for softcore cardiology porn.

3. Female ER nurses are even raunchier than the firefighter medics.

4. Seventy-five percent of the ER nurses and medics, even after years of experience, still struggle understanding AV blocks.

So without further ado, I give you Ambulance Driver’s Tale of The Marital Spat:

Sidney Sinus Node and Virginia Ventricle were a happily married couple. Sidney worked hard every day, Virginia stayed home and took care of the household. At the end of each work day, Sidney rushed home on the cardiac conduction freeway, past the AV node turnpike, came to a screeching halt in the driveway, rushed through the door and, well, depolarized Virginia, if you know what I mean (wink wink, nudge nudge). One might even say they had a Normal Sinus Rhythm kind of relationship. Some times, depending on Virginia’s willingness to wear a little something slinky and Sidney’s libido, it might even qualify as a sinus tachycardia kind of relationship.

Like all things however, relationships cool. It’s not that Sidney doesn’t appreciate Virginia, not at all. It’s not that he doesn’t still find Virginia attractive, either. It’s just all these bills and all this stuff, and well, someone has to bring home a paycheck, right? So Sidney throws himself into his work and puts in longer hours, but being a somewhat steady and reliable, if altogether predictable husband, still comes home every night and depolarizes Virginia, just like he used to when they were newlyweds.

And Virginia appreciates it, she really does. She knows how hard Sidney works. It’s just that he comes home late every night, and he seems so tired, and their depolarizations lately have become well, predictable. On the surface, nothing much has changed. Sidney still comes home every night like he used to. He just comes home late. But Virginia knows there is something missing. There’s no spontaneity any more, even when she meets him at the door naked and slathered in conductive gel. Their relationship has degraded into a First Degree Block kind of relationship, and Virginia just wants the spice back in her marriage. She’s even been considering doing a little self-depolarization, you know, because she has needs too, but the kids are getting to be that age, and she’s afraid they’d recognize those PVCs emanating from the bedroom.

Meanwhile, Sidney, being like most men, is not the most attuned to Virginia’s needs. All he sees is the mounting bills and the mortgage payment and college tuition and the inordinate amount of D batteries Virginia seems to be going through and I mean, really, does she have any idea how much those damned things cost???

So he works even longer hours, and still the work piles up. Mondays aren’t so bad, but the work piles up as the week progresses, until by the time Friday rolls around, he’s so overwhelmed he just sleeps over at the office in a vain attempt to get caught up. Every day of the week, he comes home a little later, until finally he doesn’t come home at all. Virginia, as you might expect, has become accustomed to regular, if slightly boring, depolarization. When she doesn’t get it, she gets bitchy.

So you can bet your ass that the very next night, Sidney drags his ass home on time. But men don’t get the easy lessons, so you can also be assured that this cycle will repeat itself. This Second Degree Type I Block kind of relationship is evidence of some serious cracks in this marriage.

Pretty soon, despite all signals from Virginia that she ain’t happy, Sidney has convinced himself that he is indeed the master of this relationship. He wears the pants. He’s got a toupee, he’s wearing the Mister T starter kit, he’s driving a red Miata, and he’s got a pneumatic little twenty-year-old secretary named Wendy Wenckebach who giggles at all his lame-assed jokes and says things like “Ooooh Mr. Sinus, you are so cute! I just adore older men. They’re so…experienced.”

So Sidney develops the disquieting habit of just not coming home on some nights, totally without warning. He doesn’t call, he doesn’t text, nothing. He just stays gone all night long, while Virginia stays home alone and cries herself to sleep.

Who knows what he’s doing on those nights? Certainly not Virginia. Sidney always has an explanation, and he doesn’t do it all the time. Not at first, that is. And on the nights he does come home, he’s always on time and bearing flowers. But eventually, he goes from an intermittent Second Degree Type II Block to a fairly regular one. After a while, it’s gotten so bad that he’s gone every other night, and the other night while he was depolarizing Virginia, he called her Wendy, that fucking tart!

I think we can all see where this is heading. Virginia is still a young woman, she’s got lots of young male admirers, and she doesn’t have to live her life like this. So one day, Sidney comes home to discover that the locks have been changed and all of his shit is laying out there on the front yard. Taped to his golf bag is Virginia’s official petition for AV Dissociation.

Yep, it’s come to that. Divorce. Splitsville. Third Degree Block. Sidney can do his own thing if he wants, but he’s just kidding himself if he thinks he has anything to do with Virginia any more. She has somebody else to depolarize her from now on, thank you very much.

The sad thing is, Virginia has options, but Sidney doesn’t. He doesn’t even have Wendy any more. It turns out she was only attracted to him when he was attached, and having a needy old man around all the time just isn’t her idea of a good time. And so Sidney comes to the bitter realization that he and the rest of his atrial impulses don’t even matter that much in the greater scheme of things. Women like Virginia can do just fine without him.

So he winds up reduced to a bitter old divorced man who drives by Virginia’s house every day and wonders who is depolarizing his wife these days.

He hears rumors, of course. A mutual friend told him that Virginia had taken up with Jimmy Junction, the hunky pool boy. Jimmy is young and vigorous, so he can depolarize fairly often, but being young, he can’t depolarize for very long, even though the frequent depolarization seems to agree with Virginia. With Jimmy, her QRS complexes are as narrow as they were in her twenties, back when they first married.

Sidney isn’t quite convinced, though. Last week he saw Pete Purkinje’s van parked in front of the house. Pete’s an old man, and not all that stable, and he can’t depolarize very often. Of course, old men usually take a very long time to depolarize, and Virginia’s QRS complexes are starting to look a little wide in the hips, if you know what I mean. Virginia is starting to look her age. Hell, even Viagra atropine doesn’t work much on men like Pete Purkinje. He just doesn’t have the nerves for it. Never did, really.



Sidney, the petty bastard, finds it mildly comforting to think of Virginia relying on tired old Pete Purkinje for her depolarization these days. Serves the bitch right. If he had his way, none of the men in the neighborhood would have anything to do with Virginia, and she’d have to really solely on battery-operated mechanical depolarization to fulfill her needs.

That’s where I come in, of course. I’m a stud that way.