Three nights before Christmas 2016, I was standing in my bathroom when a gallop broke out across my chest. It was ventri

I don’t have to do this anymore. Remote-monitoring pacemakers were first sold to the general public around 2007; currently, the industry standard for remote monitoring involves routers paired via Bluetooth to wireless-enabled cardiac devices. These routers sit in a patient’s bedroom and run constantly, pulling data at regular intervals and transmitting it straight to their doctor via the internet. No phone calls and no magnets involved. Ideally, a patient never even knows their data is being collected.

For as long as I’ve had one, I’ve been acutely aware that a pacemaker is a sensitive machine and can be derailed by plenty of things: airport security; laser tag vests; the seats in 4D amusement park rides; store security towers; cellphones; and still, somehow, microwaves. All of these things could disrupt the pacemaker, reprogram it, even stop it cold. As a child in the grocery store, I ran through the theft towers quickly, like I was trying to shoplift. I sat on the sidelines while friends ripped through laser tag arenas at birthday parties. Fewer than two years into post-9/11 hysteria, I panicked as a nine-year-old when a TSA agent came toward me with a security wand. I bolted, running farther into the terminal at Boston’s Logan Airport. I only made it a few yards before I was stopped by a knee to my chest, a muscled agent pulling me to the ground. My panic had made me into an apparent security threat.

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ny forms, including sexual harassment in the workplace and in public spaces. Take a stand by calling it out when you see it: catcalling, inappropriate sexual comments and sexist jokes are never okay. Create a safer environment for everyone by challenging your peers to reflect on their own behaviour and speaking up when someone crosses the line, or by enlisting the help of others if you don’t feel safe.

When I came across an FDA safety notice warning that some ICDs, namely those made by a company called St. Jude, could be hacked, I was only days away from surgery. Once hacked, the devices could allow an external actor to gain control of the ICD, reprogram its functions, and inflict all kinds of damage—even trigger death.

Having now lived with an ICD for more than three years and a pacemaker for the preceding 14, I understand intimately the consequences of being a body paired to the grid. If your smart fridge loses connectivity, maybe your food goes bad a few days early. But if a wireless ICD experiences a failure, the result could be lethal. I am stalked by the fear of the device misfiring and have wondered endlessly whether the documented security risks posed by these devices could end up harming me.

In the past 13 years, these devices have also been fully integrated into the so-called Internet of Things—millions of everyday consumer items being programmed for and connected to the internet. Once connected to the internet, the devices ease the work of physicians and hospitals, who can now manage the device and monitor the patient’s condition remotely. Patients are typically charged each time their device sends data to the hospital. Think of it as a subscription—for your heart.

“[The benefits of remote monitoring have] been held up over the years with just being able to diagnose something early,” said Dr. Leslie Saxon, a cardiologist and electrophysiologist who runs the Center for Body Computing at the University of Southern California. In 2010, Saxon led a study in partnership with device manufacturer Boston Scientific that found improved survival rates for patients who were monitored with remote monitoring, as compared with patients who were only followed with periodic in-clinic visits. “We also learned that we could learn how to program and make these devices a lot better if we were looking at all this data all the time,” she said.

When they first came to market in the 1980s, ICDs (implanted cardioverter-defibrillators) were implanted rarely, mostly in patients who had already experienced a life-threatening episode of ventricular tachycardia or even cardiac arrest. They were often called “secondary prevention” tools — meaning a patient has already experienced a life-threatening event and the device had the potential to stop a second event. In the 40 years since, clinical guidelines have changed dramatically, and the use case for ICDs has broadened. The United States has become the biggest market in the world for ICDs, with new ICD implantations increasing almost ninefold from 1993 to 2006. Doctors now implant at least 10,000 new devices each month in the United States. Many of these devices are now used for “primary prevention,” meaning a patient hasn’t yet experienced an event that could be stopped by an ICD, but they might be at risk for one.

The week before surgery, I texted my nurse practitioner about the FDA warning. She responded quickly, “Don’t worry. We’re using a different brand,” as if the issue was settled. In the blur of acute disease, I ignored the instinct to dig further into what exactly these cybersecurity concerns might mean or what other concerns might be hiding just below the surface.

ICDs are just one increasingly popular medical gadget in a rising sea of clinical and commercial wireless health devices. Whether it is the growing suite of cardiac-monitoring devices available at home and on the go or an Apple Watch outfitted with diagnostic software, we are outsourcing more and more of our health to internet-enabled machines.

Doctors also posed a risk to my new device. During regular office checkups, ominously called “interrogations,” they would place a large magnetic wand over the pacemaker to take control of it. Between in-office interrogations, every three months, my physicians mandated that I do “home monitoring,” which involved a complicated and archaic process. I would hook myself up to a transmitter box that would screech out a dial-up tone to a stranger sitting in a call center somewhere via the receiver of a landline phone. And just like in-office interrogations, I needed to place a heavy round magnet over the device. Because a heavy magnet disrupts a pacemaker, I would sit in a wave of dizziness and nausea while a distant tech received the information. The whole process often lasted 15 or 20 minutes. When it was done, I would sit back in the kitchen chair, spent, waiting for the blood to return to my head.

Months of testing followed. I started taking drugs that would help reduce my arrhythmias, but in addition, my doctors suggested they replace my pacemaker with something called an ICD. The ICD would be a fail-safe, a tiny defibrillator inside my body that could go everywhere that I went.

The first cardiac device I had was a pacemaker, implanted when I was nine years old. Though pacemakers and ICDs have overlapping patient demographics and are sometimes bundled in the same device, they have drastically different functions. Pacemakers help a patient’s normal heart rhythm cycle, while ICDs are tiny defibrillators meant to terminate dangerous arrhythmias and prevent cardiac arrest. In everyday life, defibrillators wait in hospitals and public spaces (gyms, churches, movie theaters) for disaster to strike — they are tools you seek out in an emergency. But an ICD brings the emergency response to you. It is watchful, an active listener. I think of a pacemaker as a heartbeat assistant; an ICD is an arrhythmia assassin.

The pain was overwhelming, like being grilled alive. It ran out from a center point in my chest and flowed into every organ, every limb, into my fingers and toes. Later, waiting in the trauma section of the Mount Sinai emergency room, doctors shocked me again.

Clinically, the benefits of remote monitoring are twofold: The patient doesn’t have to enter a medical setting to be monitored, which reduces the likelihood of iatrogenic disease — illness caused by the interference of the medical system. At the same time, doctors get more data than they’ve ever had access to, allowing them, ideally, a window to disease prevention. (I, along with many other patients, take issue with the second proposition, given that we cannot access our own data; there’s a substantial activist movement toward data liberation that includes cardiac patients who have fought for more than a decade to gain access to the information generated by wireless-enabled pacemakers and ICDs.)