The problem, Bramstedt went on, was set in motion when the devices first went in. Patients should be informed then, she said, how long their devices would last, and that the time might come when they wished to have them turned off. That could be done painlessly, she said in an aside, without surgery.

That was news to me.

* * *

I made more calls and discovered that a white ceramic device, functioning like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump beneath my father’s collarbone. Someone could press a few buttons and the electrical pulses that ran down the pacemaker’s spiraled wires to his heart would slow until they were no longer effective. My father’s heart would probably not stop. It would just return to its old, slow rhythm. If his aging heart had deteriorated since the pacemaker was put in, he might die within weeks. If he were unlucky, he might linger for months.

If we did nothing, his pacemaker would not stop for years.

Like the tireless charmed brooms that bedeviled the sorcerer’s apprentice in Disney’s Fantasia, the pacemaker would prompt my father’s heart to beat after he became too demented to speak, sit up, or eat. It would briefly keep his heart twitching after he drew his last breath. If he were buried, it would keep sending electrical signals to his inert, dead heart in the coffin. If he were cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.

I thought about the Cruzan case. If a feeding tube was medical treatment, wasn't a pacemaker? Surely my mother and I, as my father’s “designated health care surrogates,” had the legal and moral right to request its deactivation. It sounded eminently reasonable. But it didn't feel that way.

When my father had his first stroke, I knew at once my parents’ world had been struck by lightning. Now I understood that the pacemaker had equally cleaved their world. For the want of a nail, the horseshoe was lost; for the want of the horse, the rider was lost; for the want of the rider, the battle was lost; for the want of the battle, the kingdom was lost. And all for the want of a horseshoe nail. If only my mother had asked for my opinion. If only I’d flown home. If only I’d known what to ask when I got there. If only my mother hadn't hidden her angst so skillfully and groomed my father so perfectly that he looked more functional than he was to Dr. Rogan, and she less desperate. If only someone had asked my father—who only a year later said he was “living too long”—whether he wanted to live to be 90. Yet whom could I blame?

I made more calls. I learned that in an ideal world, doctors told their patients about the pros, cons, and alternatives to any proposed medical treatment. I learned that the pacemaker could have been avoided altogether if my father’s hernia surgery had been performed another way, using a local anesthetic less risky to the heart. I learned we could have signed a waiver accepting the risks. I learned that the surgeon could have hooked my father’s heart up to a temporary external pacemaker—a procedure that a leading cardiac surgeon told me was perfectly safe—and removed it after the hernias were sewn up and my father safely out of the recovery room.