Vaccines, Pacemakers and Worship

Zack Duncan
15 min readMar 31, 2021


I recently paid a visit to the home office of Dick’s Sporting Goods. The office is now the region’s largest vaccination center and I had an appointment for my first shot.

I felt butterflies walking in, a kind of mixed-up nostalgia of both gratitude and regret. The gratitude part made sense. I was getting a vaccine for a virus that had upended the prior year and is still creating havoc in the world. My life had been far less disrupted than many others, but the family challenges, tested relationships, and drumbeat of mental fatigue were nonetheless real and hard. A vaccine felt like a chance to hit the reset button for a new year.

The vaccination site was well organized, staffed with helpful volunteers, and equipped to deliver thousands of shots a day. It felt nice to be around humanity in such numbers — people who were working to make the world a safer place than it has been.

The regret came from thinking about how I had felt when I walked out of that same office 6 years ago, after my last day of work there. I had been frustrated and confused after a career journey that had seemed to start with such promise had sputtered and self-destructed.

The slower pace of life in the intervening years had provided space to reflect on things that had long been avoided in my busy mind. My newer perspective on these older events was jarringly different.

Contributing to the emotional gymnastics flipping and twisting in my brain were old thoughts and feelings about the heart condition that qualified me to be vaccinated in the first place.

Sports and Heart Defects

I have a genetic condition called hypertrophic cardiomyopathy (HCM). About 1 in 500 people have it. Some have heard of HCM because of Reggie Lewis, the former Boston Celtics player who collapsed and died on a basketball court in 1993. The condition causes the walls of the heart to thicken which can create fast and irregular heartbeats when the heart is under stress. If the heart can’t regain its rhythm, it can begin to pump faster and faster with less and less efficiency. This can lead to death. Death is not an especially common outcome for those with HCM, but it is still the most common cause of heart-related sudden death in people under 30.

I was diagnosed early in life. My dad has HCM as did his mom. But as a young person, it didn’t affect my life outside of regular cardiologist visits. I was allowed to play sports…which I did all the time.

I loved soccer and especially basketball. I was always playing in the neighborhood, in my driveway, and on teams. It isn’t overstating things much to say that these sports felt like my life. I was an athletic kid and was taller and faster than other kids my age. I formed friendships through sports, and like many of my friends, I was convinced that I was going to play in the NBA one day (ha!). But in the short term of childhood, I settled for playing as much as possible with my friends. Sports were what I loved most, what I was best at doing, and what I dreamed about.

But my sports story ended when the HCM medical guidance abruptly changed, at least according to the cardiologists my parents listened to. The new guidance said that the risk of sudden death due to exercise was too high, and I couldn’t play organized sports any longer. It was right in the middle of the basketball playoffs, and I was suddenly done. I couldn’t finish out the season with my team. I was just at home, confused and feeling sorry for myself and angry at everyone else.

I know my parents hated pulling me out of sports, but they also didn’t want their son to do something that carried a risk of such significant consequences. It wasn’t a discussion at the time, or afterwards. I didn’t know how to be different, how to enter this new reality without the thing that had defined life to that point. So, I made up excuses and lied to my friends about why I wasn’t playing sports. Eventually, I settled on, “my mom won’t let me play” which somehow sounded better than “I have a heart condition that I don’t understand and can’t play sports anymore.”

Not only were organized sports off the table, but so was gym class.

Gym! What had always been the redemption of the school day was now deemed unsafe. But there wasn’t a free pass for kids with heart conditions to head to an extra study hall. I still had to go to gym class with everyone; but I couldn’t actually take part. So, when the class was playing soccer, I’d be the referee. When it was basketball time, I’d get the ball if it went too far out of bounds. It actually sounds like it could have been really nice — a creative idea to keep me involved with the rest of my classmates. And I am sure it was intended that way by thoughtful people. But it didn’t feel that way, largely because I still never told anyone why I was no longer participating. I remember feeling humiliated and different and alone, while pretending that I actually wanted to be the soccer referee instead of running around and having fun with everyone else. It kind of worked too, at least as far as distracting from the real reason. I remember some kids complaining to the gym teacher because they didn’t get a turn being the referee.

Gym class was 3 days a week in middle school. Every night at home before a gym class day, I remember being filled up with a middle schooler’s anxiety as I’d dread the next day and wonder how I could get through while continuing to pretend that I was “normal” like everyone else.

It felt like my only periods of hope were when we’d drive down to see the cardiology team at the National Institutes of Health for testing and medical guidance. Each time I hoped and prayed that the medical team there would reverse their guidance, or at least that my parents would find someone else to listen to. I did a lot of bargaining with God before and on these trips. I’d find Bible verses for justification and prayed them continuously. It didn’t seem to work, because I was always angrier and more lost on the long drive back home.

High School

Life got a lot easier in high school because I didn’t have to go to gym. Students all had different schedules, so no one really had to know what classes I was attending, or not. By then, I had different friendships that hadn’t been formed on the basketball court or the soccer field. I missed competitive athletics terribly, but it wasn’t as painful as it had been.

HCM was still a part of life, but something that I could relegate to a back corner of my brain and sullenly deal with cardiologist visits when they needed to happen. I still remember silent car rides with my dad to Yale New Haven Hospital for checkups. I don’t know if we ever spoke much more than a few sentences to each other. There didn’t seem to be anything to say.

Just before leaving high school and going off to college, I got one more life change from HCM. I had surgery to get wired up for a pacemaker, or more accurately, an implantable cardiac defibrillator (ICD). Technically, mine had dual functions both for actively regulating the heart’s pacing and also a defibrillating function should the heart ever enter a fatal rhythm and need to be shocked back to one compatible with life.

Life with a Pacemaker

I could write a book about my adventures with my defibrillator after I moved out to college and beyond.

There was the Penn State vs. Nebraska football game, when the crowd was going crazy after a big touchdown and all a sudden, I was knocked to the ground by my defibrillator booming in my chest (the settings had somehow gone haywire). For those who haven’t had the experience, getting shocked by a defibrillator on its highest setting while you are fully conscious feels like what I’d imagine it feels to get kicked by two horses at same time. One jolts your sternum and the other smashes into your back. You just kind of jerk your arms up in the air and then collapse on the ground. By then, I had come to terms with my condition and no longer felt like I had to pretend. And that’s a pretty good thing because I’d imagine it’s tough to come up with a good excuse for why you’re flopping around on the ground while everyone else is standing and cheering.

There was the time it just randomly started beeping because the battery was getting low, and I walked around like a human alarm clock for a little bit each day until I could make an appointment to a cardiologist who could turn it off.

There was the time, or should I say, most times when I’ve gone through airport security or any other place that has a metal detector and requested an alternate screening. “I’m sorry sir or ma’am, I can’t go through the metal detector because I have a pacemaker (I don’t say ICD, more people know what you’re talking about by sticking with pacemaker). Can I please go through that other device over there that I don’t know the proper name of? Or can I request the VIP screening you generally reserve for those you worry might be smuggling drugs or explosive material aboard?” If I had a nickel for every time I heard, “Wow, you know, you’re really young for having a pacemaker,” I’d be up at least two sodas by now.

There was the time that the casing of the wiring that extends from the ICD into my heart became cracked. This disrupts the ability of the wires to send clear messages to the ICD unit about what the heart is actually doing, which allows outside interference to get involved. In my case, it was my cutting of a cucumber that served as just such interference. My ICD thought the cutting sound from my knife was actually my heart accelerating to an unsafe and irregular rhythm. Cue the kicking horses coming for my upper torso. I involuntarily threw the chef knife as I yelled out in surprise and flailed to the ground. Right after this happened, an ambulance sound (you know the “weeee wooooo, weeee woooo” right?) began loudly emanating from my chest. By this time, I was married with a child, so my daughter thought her dad was extra weird. So did the Uber driver who took me to the ER while she listened to the guy doing his best ambulance impression in the seat behind her.

Along the way, there have been a number of surgeries (each time the device runs out of battery power, or is defective, or the wiring needs to be redone), and eye-watering medical bills that would not have been possible without insurance.

Even with insurance, it seemed pretty crazy. It all seemed quite ridiculous, right up until it didn’t.

The one time it saved my life and the bonus 7 years I’ve had on earth since.

Cherry Blossom

I was running the Cherry Blossom 10 Mile race in April 2014 with my wife. She is a fast runner, and I am a slow one, so she was long since done when I went down just a couple tenths of a mile before the finish line.

People who were watching in the crowd apparently thought I was having a seizure as I lay on the ground with my defibrillator kicking away, trying to get my heart back into a living rhythm. Someone called an ambulance, and they took me to George Washington University hospital.

running shirt cut off
This is what a running shirt looks like after it’s been cut off by a paramedic.

My next memory after thinking, “oh man! I’m going to finish this race” (false!) was waking up in a hospital bed hours later with my wife next to me. A thoughtful EMT had gone through my phone while I was blacked out in the ambulance and eventually got in touch with her.

That spring day would have been my last one on earth without that defibrillator.

I guess we’ll call it even, pacemaker

That was 7 years ago.

It was also the beginning of the end of my time working for the company whose office / vaccination site I was returning to.

A New Identity

It was my first job post college, and I loved the majority of the 9 years I spent there. It’s a sporting goods company after all, and the basketball and racquetball games at lunch time literally felt like a return to grade school without a pesky gym teacher monitoring my activity. As a recent college grad, it sometimes seemed almost too good to be true that I actually got paid as well.

I learned a lot from very smart people and had success in my early years. It wasn’t uncommon for me to head into the office on weekends to do some work, and then run on the treadmill or meet a co-worker for racquetball. I worked a lot, but I loved the work.

I don’t know exactly when, but at some point, my job became a more grown-up version of what sports had been to me as a child. It was my hopes, my dreams and my primary framework for measuring progress and success. It was my validation for my life; my reason to believe I was somebody who mattered.

At least, I had loved it. After a few different stops on the career journey where my career direction always seemed to be turning in a way I would have hoped, things felt like they were sputtering, and I found myself feeling stuck and frustrated.

I had liked to consider myself a thoughtful and competent independent decision maker, and I struggled as a more senior role increasingly required operating in the gray where the rules of corporate decision were more complex. I was also impatient and proud, an unfortunate combination for times in life when humility and perseverance are especially needed. But I wasn’t especially aware of that. I was highly aware of my strengths (and why I thought they should have more room to run) and far less aware of my weaknesses.

My mind was perpetually running to try and figure out what I needed to do to get things back on track. I thought about it at work. I thought about it when I got home from work. I thought about it going to sleep. And I thought about it when I woke up. My job mattered intensely to me, and I was desperate to try and turn the situation to something more positive for me. But instead of having success, I spiraled deeper and deeper into mental fatigue and burnout.

Making a Change

Even as my frustration grew, I never really imagined that I would stop working there. At least, not until that visit to the hospital following the nearly completed Cherry Blossom.

For the first time, I had a thought like, “Listen dude, you almost died. You can keep complaining about your situation if you want, but you’ve got no one to blame if you keep making yourself miserable and then you really do die.”

Even after that first thought, it took more convincing to get to a place where I could truly reflect on such a momentous change. But finally, I began to consider what it would look like to work elsewhere. Perhaps it seems kind of silly to say that this was a painful process, but it was excruciatingly so. In a way, it felt just as it had in grade school when I realized that I no longer had athletics to define me. It felt like a part of me was dying, the part I needed most to validate who I thought I was.

Now, it’s 6 years later. I don’t have it all figured out, but I do think I have a bit more perspective than I did then. I’m starting to learn that there are some things I can control and some things I can’t. I’m starting to learn that there’s a difference between acting humble and learning to live with humility. Most of all, I’ve learned that I don’t have it together on my own.

The times I’ve looked like I had it the most together in my life have often been the times when I was the most lost. The more successful I was in creating a narrative of someone who had it together, the less resemblance that person had to who I really was inside.

There is a reason that vulnerability is so scary. For a lot of my life, I wasn’t comfortable even being honest with myself, let alone anyone else, about how desperate I was to find somewhere to anchor my sense of who I was.

I Need Something to Worship

To regard with great or extravagant respect, honor, or devotion. That’s worship. This story is about two things that have functioned as my ultimate objects of devotion: athletics and career. But there have been others as well. I’m wired that way. I’m built to set up something in my life that is not only my primary pursuit, but my sense of identity and my reason to be.

The cerebral, controversial, and intensely brilliant author David Foster Wallace thought that we all face the same situation. Here’s his take on worship from his commencement address at Kenyon College, a few years before he died.

You get to decide what to worship.

Because here’s something else that’s weird but true: in the day-to day trenches of adult life, there is actually no such thing as atheism. There is no such thing as not worshipping. Everybody worships. The only choice we get is what to worship. And the compelling reason for maybe choosing some sort of god or spiritual-type thing to worship…is that pretty much anything else you worship will eat you alive. If you worship money and things, if they are where you tap real meaning in life, then you will never have enough, never feel you have enough. It’s the truth. Worship your own body and beauty and sexual allure and you will always feel ugly…

Worship power, you will end up feeling weak and afraid, and you will need ever more power over others to numb you to your own fear. Worship your intellect, being seen as smart, you will end up feeling stupid, a fraud, always on the verge of being found out. Look, the insidious thing about these forms of worship is not that they’re evil or sinful, it’s that they’re unconscious. They are default settings.

They are the kind of worship that you just gradually slip into day after day, getting more and more selective about what you see and how you measure value without ever being fully aware that that’s what you’re doing. And the so called “real world” will not discourage you from operating on your default settings, because the so called “real world” of men and money and power hums merrily along on the fuel of fear and anger and frustration and craving and the worship of self.

Our own present culture has harnessed these forces in ways that have yielded extraordinary wealth and comfort and personal freedom. The freedom all to be lords of our tiny, skull-sized kingdoms. Alone at the center of all creation.

What Then, to Worship?

For much of life, I’ve functionally been alone at the center of all creation. Self-directed and self-focused as I constructed a story featuring myself squarely in the middle. I’m always the protagonist, whether the story is about athletic success, career progression, or any number of things.

As I think about vaccines, pacemakers, and the near-death experience in Washington DC on April 4th in 2014, there’s another April 4th on the calendar in 2021. It makes me think about developing a new perspective where the main story isn’t about me.

It makes me think about a man who lived and died 2,000 years ago. A person whose life, by any objective measures, should not have been remarkable. He was born poor. He died with less. His active work took place over a period of only 3 years. He honored the weak and rebuked the powerful. He rejected cultural norms about identity, declined to pursue political authority, and refused any attempts to make him into a celebrity.

But somehow, this penniless indigent sits at the very top of lists of the world’s most important people. How?

He was either a liar perpetuating the world’s greatest fraud, or he was who he said he was.

If Jesus of Nazareth was only a man who lived and died, there aren’t any real implications for my life. I can still go to church and pray that God will give me “better” answers to my prayers, to help me get closer to achieving whatever is the next thing I choose to worship. But those actions matter only as far as they make me feel better about my life. I might pray or I might bring out a lucky rabbit’s when times get tough. It’s functionally the same thing.

But if he was a man who lived and died, and then lived again, the implications are exhilarating, terrifying and limitless.



Zack Duncan

Zack lives in Greensboro, North Carolina with his wife and daughter. He enjoys golf, Abraham Lincoln books, Tim Keller podcasts, na beer, and real conversation.