15 years ago, an otherwise healthy 19-year old college sophomore was referred to me from out-of-town for pacemaker implantation. She had blacked out after a night of hard partying. She fainted again in the Emergency Room and long periods of asystole were documented. She then had a positive tilt-table test. Back then, pacemakers were in vogue for so-called “malignant vasovagal syncope”. She came to the consult with her two parents. The three of them were scared. After careful analysis, I recommended against pacemaker implantation. I told them that if she were my daughter or my niece I would not give her a pacemaker. They insisted that they wanted the pacemaker anyway, and that they wanted me to implant it. (Maybe the only time in my career in which framing the decision in such personal terms did not succeed.) I proceeded with the implant next day. I thought that if I did not do it, she would get the surgery elsewhere. At least, I could do a cosmetic implant from the axilla and place reliable leads in good sites. I wanted the pacemaker to be the least disruptive to her life. Surgery went well. I lost track of her after a while. I often wonder if she ever came to regret the decision.