9 Years
It resolves to itself. Every time.
Clinical dates, procedure counts, rhythm figures, and quoted report language are drawn from my own medical records. This is not medical advice.
Nine years ago today, a catheter went into my heart for the first August 3, 2017. Posterior right ventricular outflow tract. They found the focus and burned it. The exit site moved. Residual beats remained at the close of the case.
I went home on propafenone and got on with it, because the working diagnosis was the benign one, and that is what you do with a benign diagnosis.
I want to start before that.
Swimming Fish
I was a closet geek for a long time before I was anything else.
Technology came naturally to me for most of my life. In high school I was in an engineering, science, and technology magnet program, and it was the first place anyone treated the instinct as a subject instead of a distraction.
My claim to fame there was a Telnet exploit. I used it to spoof an email from my Cisco networking teacher to my pre-algebra teacher across the hall.
Ten days of in-school suspension.
Worth it.
I was a gamer, and in some form I still am. At sixteen I was one of the best-equipped clerics on our EverQuest server, and the actual work of that was math, run live, under pressure. Heal rotations. Damage per second. Buff auras. How much aggro a tank could absorb before a pull went sideways and the whole raid had to recover at once.
Nobody called it orchestration.
That is exactly what it was.
By 2011, that instinct had turned into paid work. I was on staff at a restaurant on Disney property, and that is how I got in the room at all: not as a vendor, not as an agency with a portfolio, just as somebody already trusted to be in the building.
I built responsive wine menus for first-generation iPads. Responsive design was not what it is now.
I read a book years later called The Third Door, by Alex Banayan. It was published in 2018, long after any of this happened, so I want to be honest that I did not have the language for it at the time. But I have thought about it since, because it names something I had already lived without knowing what to call it.
There is the front door, where everyone waits in line with the credential the line requires. There is the door for the people who never have to wait at all. And there is a third door: the one you find because you are already inside the building for some other reason, and nobody has thought to lock it.
That is how I have entered nearly every room I have ever been in. I did not have a credential to present at the front door, so I kept finding the side one.
Stack Overflow was my bible. Copy and paste was legendary. Three months, several iterations, some of which I am not proud of, and about twenty-five hundred dollars. No-code before no-code was a thing. A lot of sleepless nights, and I loved it.
The IT director for the property asked how I had finished her Food and Wine Festival web app so quickly. She asked whether I had used Dreamweaver.
I laughed and said, What’s that?
I had built it in Notepad because I did not know there was another way, and it had not occurred to me to stop and find one. She wrote me a letter of recommendation. I still have it.
Then the client asked whether I could make animated fish swim from iPad to iPad, in sequence, across the dining room.
For the aesthetics.
That became the benchmark. Not whether a guest could find a wine. Whether the fish swam.
Getting in through the side door has a cost. I felt it for the first time right there. The same lack of credential that got me into the building meant I had very little to stand on once I was inside it. No portfolio. No letters after my name. Nothing that made a client take my judgment over their own.
So when the client decided the benchmark was fish, I had no standing to tell them it was not.
I lost my ambition for the whole thing while the field was still small.
I did not yet have the eyes for what I was looking at. I have it now. It was the first time I read an incentive structure and understood in advance what it would do to something I cared about. It is also why I have never been able to take credentialism entirely seriously.
To be a founder is to solve problems.
To solve problems, you do not need a credential. You never have.
Natural at this
A family member told me I would be a natural in healthcare.
She worked at a large ambulatory surgery center and told me to come see. So I did. I got the job, and I spent six years there at the top of enterprise production. Every company award. The CEO award. The COO award.
Inside the building, I had a brand: patient first, always.
People had our facility wrong from the outside. We were out of network, a model that deserved scrutiny because it could expose patients to significant cost. It also meant we were not bound to a particular insurer’s contracted terms in the same way an in-network facility would be. Inside that structure, I watched people build a clinical experience they genuinely believed in.
We had minimally invasive spine surgeons doing four and five cases a day, some of them in the building at four or five in the morning because that was simply their life. I saw their cars in the lot before I arrived. Every time, I thought the same thing: if people carrying that scope of responsibility could be there that early to care for patients, I had no excuse not to be early too, helping them deliver more of it.
High volume, yes. I will not pretend otherwise. People called it a mill more than once, and I understand why the word gets reached for. Numbers alone can carry that reading from the outside.
But I lived on the inside of it. I spoke with patients before their procedures and heard from them afterward. I watched people return saying they could walk, sleep, or work with less pain. That is lived experience, not comparative evidence, and I will not make it carry more than it can. What I can say is that I believed the skill and experience of our surgeons were exceptional. I still do.
The way I measured it then was cockpit hours. You want gray hair in the left seat. Ours had plenty.
My directors will tell you I was the most robotic-sounding sales consultant that they had ever met. That was not a complaint about tonality. I had inflection. I had a conversation. It meant the order was always the same because the order was a framework, and I have written that framework out elsewhere.
Credibility. Commonality. Problem. Solution.
I watched the numbers constantly. I changed one thing at a time on purpose so I could still tell what had worked.
One of my directors came to me about the price.
Matt, it’s a big number. Take their mind off it. Clap. Just clap after you say it.
I did that one time.
Then I built the other thing. I normalized financing. I told people plainly that most patients who chose us chose to finance, because this was a real investment.
Third-party story. Old tactic.
It worked because it did the one thing that actually matters in that room: it told a frightened person that they were not the only one, and that needing a way to pay was normal.
That is what those years looked like from the outside. Present. Reliable. Consistent. The happy dad. Too often the life of the party. Light up the room, all of it.
And underneath that, the arrhythmia started.
Just arrhythmia
I want to be exact about who filed me first, because it was not a facility, a family member, or a chart.
It was me.
It’s in your head. It’s no big deal. Keep going hard. This is who you are, so keep on going.
I said that to myself for years. Out loud, sometimes. I said it every time my chest did something I did not like, and it worked in the sense that it kept me moving.
It is also the exact gesture I have spent this year writing about other people making at me. A handle is easier to hold than a person. I reached for mine before anybody else got the chance.
In December 2016, I was admitted to Pepin Heart Institute for observation. Bigeminal premature ventricular contractions for the better part of a day. Then a stress test.
I need to say something about that team, because I am going to be hard on systems later. I have seen the ugly end of American healthcare from the inside. And then there are these people, who are simply the best of it. Whole-person care. They have been with me at every step, and they still are.
Real treatment started there. Propafenone. Bisoprolol. Metoprolol. Come to think of it. Pretty much anything ending in olol was part of the journey.
The first ablation was expensive.
That fact did something I did not understand at the time. The arrhythmia did not stop when I got home. Early post-procedure beats did not by themselves establish that the procedure had failed. It was described as successful, and I still believe it was.
But the beats continued after that too.
A lot of people had watched me suffer. A lot of money had been spent. I could not find a way to say it was still happening.
The cost bought silence out of me.
Nobody asked for that. It is just what a large number can do inside a house.
That is where the fog starts. Dissociative. Forgetful. Distracted. Present in the room and not in it.
And still: it’s just arrhythmia, and this is who I am.
The wizard
After the spine center, I moved through healthcare wherever the moment took me: a recruiting role, then a marketing agency where I learned paid media from genuinely talented people, then a call to help stand up a private orthopedic practice from nothing.
That was the most professionally complex problem I had ever tried to chew.
Half-million-dollar operating line. Full staff on payroll. No insurance contracts. No hospital credentials. No Medicare provider number. Months away from being able to perform a procedure.
And the instruction was: figure it out.
So I did what I do. I took the lead-generation funnels I had just learned at the agency and pointed them at chronic pain. I built a seminar-marketing program for satellite locations to put us on the map. Then I learned, at a dead run, how commercial contracts work, how provider contracts work, Medicare fee-for-service and capitated models, preauthorization - everything standing between an open door and a dollar - because the burn did not care that I was new.
Rabbits out of a hat, for months.
That is where the word wizard got applied to me.
Here is what wizard actually was: a man learning capitated payment models at a dead run while his own heart was coming apart, and doing it well enough that nobody looked closer.
I started isolating. I was there, and I could not stop it, and I was not willing to admit that I was breaking.
I took golf lessons around then. I remember being furious that swinging a club left me completely drained. That is not an excuse for being bad at golf. I own that entirely.
But that is the hard part. You know you are coming apart. You suspect everyone can see it. So you find somewhere to be for four hours where nobody has to watch.
I golfed much more than I should have, and it was rarely joy. It was distance from the guilt of not being all the way there.
Then COVID happened, and I will be honest about it.
For me, the timing could not have been better. We were told to isolate.
I thought: perfect. I do not have to be on stage.
Six cards
I needed work I could do from a chair at home, so I went into insurance telesales.
I was good at it. Top of the leaderboards. On the final day of one annual enrollment period, I wrote more than twenty applications.
But the reason that job matters is a woman I had met years earlier at the orthopedic practice, in tears from pain, digging through her purse and trying to work out which of six insurance cards was still active.
Swapped out every quarter. No end to it.
I remember thinking: Why is this happening to her?
Then I went to work inside the thing that produces it, and I found out.
That is the whole method, and it is the only one I have. See the effect. Go work inside the cause. Come back with the mechanism.
Incentive eyes are not a temperament. They are discovery, run on the system instead of the patient.
Eight days
On April 19, 2021, I went to an emergency room with abdominal pain.
A stomach ache.
While I was there, somebody looked at a monitor and saw runs of ventricular tachycardia.
That is how the next phase was caught: not during a scheduled rhythm evaluation, but during an unrelated complaint, in front of a person who happened to be watching.
Three days later, they put a patch on me. It recorded from April 22 through April 26.
In four days: 235 runs of ventricular tachycardia. The longest ran eleven beats, averaging 196 beats per minute and reaching 218. The fastest ran six beats, averaging 212 and reaching 250. My premature-beat burden was 2.83 percent: 9,081 isolated beats and 734 pairs. Unifocal. Bigeminy.
On the intake for that report, under heart disease, somebody had written None known.
Nearly four years after an ablation.
The line was technically defensible in one narrow sense: the arrhythmia was known; the structural disease was not. It is also exactly the gap this essay is about.
The monitoring company flagged the result as critical and called my electrophysiologist at 6:27 that evening. I was clearing trees on our property when the phone rang and I was told to stop what I was doing.
An echocardiogram followed. A treadmill the next morning.
Eight days, from a stomach ache to a stress test stopped for sustained ventricular tachycardia.
That is how fast it went.
And it is worth saying what that means: what changed in eight days was not necessarily the disease. It was the visibility. After three years and eight months, the heart finally had a room’s full attention.
Tuesday
April 27, 2021, was a Tuesday. I have checked.
Bruce protocol. Eleven minutes and six seconds. Maximum heart rate 203, which the report puts at 109 percent of my predicted maximum, at 13.7 METS. Blood pressure appropriate throughout. Palpitations and shortness of breath during the test.
After stage three, the extra beats came faster. Then the rhythm became sustained monomorphic ventricular tachycardia, and the study was stopped. It ran one to two minutes into recovery before terminating on its own.
I remember the technician’s eyes.
I watched the panic land in her face when the rhythm climbed. She went for the nurse practitioner. Somebody called for Lopressor. I was told to sit down and bear down.
And I sat there thinking: What are you all freaking out about?
Because it was Tuesday.
Because it was one more Tuesday in a long run of them, and I had a stack of Tuesdays exactly like it going back years, and not one of them had ever produced this much movement in a room.
Two accurate readings of the same heart. She was trained on a population and reacting correctly. I was calibrated to my own life and reacting correctly. Nobody in that room was wrong.
I did not have a reference point.
She was the reference point.
I watched a stranger have the appropriate emotional response to my life, and I was confused by it.
There is one more line on that report that I did not use for years, and it is the one that explains everything.
The patient’s functional capacity is average for age.
On the day my heart went into sustained ventricular tachycardia on a treadmill, the same page documents that I performed. Hemodynamically stable. No chest pain. One hundred and nine percent of predicted.
I was not faking fine.
I was achieving fine.
That is worse, and it is why it worked on everybody, including me.
What the instruments could see
On April 26, an echocardiogram described my right ventricle as normal in size and systolic function.
On August 17, a cardiac MRI reported a right-ventricular ejection fraction of 44 percent, an indexed end-diastolic volume of 103 mL/m², and a microaneurysmal, accordion-like pattern in the right-ventricular free wall - the wall moving out of time with itself.
Under the 2010 Task Force framework used for arrhythmogenic right ventricular cardiomyopathy, the regional wall-motion abnormality plus either quantitative threshold can satisfy the minor cardiac-MRI structural criterion. The report contained all three components. They are not three independent diagnostic categories, and I will not count them as if they are.
Same ventricle. One hundred and thirteen days apart. Very different information.
That does not make the echocardiogram an error. The right ventricle sits behind the sternum, has complex geometry, and is difficult to quantify by two-dimensional echocardiography. Cardiac MRI is the reference standard for right-ventricular volumes and systolic function. The echo answered the question that instrument could answer. The MRI showed what it had not.
Between those two imaging reports, on May 20th 2021, they brought me in for another ablation attempt. The arrhythmia did not appear, even with provocation. There was nothing to map and nothing to burn.
You cannot treat what will not appear.
On September 10, after another electrophysiology study, a defibrillator was implanted in my chest.
The house
I need to tell you what was in my home during those years, because it was not only me.
A nonspeaking autistic child I loved lived with us for a time. His story is not mine to publish. What I can say is what knowing him taught me.
At first, I understood too little. Then I started to see the patterns: gaze, behavior, repetition, proximity. I learned that communication was happening whether or not I had yet learned how to receive it.
It was language.
The obligation was ours to attempt to understand it, not his to become easier for us to read.
I was, at the same time, a man steadily losing his own ability to be understood by the people around him. Both of us carrying something real. Both dependent on whether anyone on the receiving end would do the work.
Everything careful I have built since comes out of that. Every principle about not putting words in a person’s mouth. Every rule against a system announcing what somebody means while holding only a probability. Every insistence that the person being described must retain a veto over the description.
That is not an abstraction I arrived at. That is a child I know.
We were also building: a new home under contract, and a decision to live in a tiny house on the land while it went up.
That project was joy. I loved working on the house and the ground. I took a chainsaw to every invasive tree on the property and enjoyed all of it.
By then, focus only came if I made it come. So I made it. I worked that land on purpose, with intent, because intent was the only thing that would hold my attention long enough to finish something.
It was my peace in all of the storm.
Which is why it happened there.
December 9, 2021. Three months after the implant. Hot. I had not taken my morning medication. I was waist-deep off the shore of the pond, the one place I went specifically to stop thinking about my heart.
The first shock came before I understood what was happening. The second put me on my knees. After the third, I lay down in the dirt and said I was sorry over and over.
That moment was one of the most frightening of my life. It was not the shocks, to be certain. Absorbing pain and uncertainty is not something foreign to me. The thought of my life ending and not having accomplished anywhere near what I had expected of myself - that was the frightening part.
So, I kept going. Because it was just arrhythmia and that is just who I am.
The framework in the wrong room
In July 2022, I took a consultative role covering sales and marketing. On my first day working alone, I set a record for the location.
Within months, they were asking me to run it.
I want that standing where a reader can see it because it proves something I have said across this body of work: the framework works almost anywhere.
Credibility. Commonality. Problem. Solution.
Run those steps properly in front of somebody who is suffering, and they will move.
The framework has no opinion about what they move toward.
I became morally conflicted about what I was seeing. I left in November. I have preserved what I know and made it available where appropriate. The rest is not mine to publish here.
I will give you one detail that is not flattering, because leaving it out would make the rest less true.
I did not walk out the day I knew. I waited until a loan closed on the pool.
Both things are real. I left on principle, and I timed it around money.
I did not sit quietly through the months in between. I started doing something the sales culture I had learned had trained me not to do. You did not put the word think in front of a prospect. The pitches I had been taught were designed to keep that word from entering the room, because once somebody began thinking, they might stop moving.
I put it in the room anyway.
Are you sure you don’t want to think about this?
I asked it - sometimes insisted on it - when I could see somebody moving past what they could actually afford, carried by a sales process that had not left them much time to ask the question themselves.
My numbers went down.
I was fine with that.
Somewhere in that stretch, I developed atrial fibrillation. I am not going to tell you stress caused it. I think stress may have contributed. It may also have been progression of the underlying disease. I do not know.
What I can tell you is that fibrillation was a different animal from the extra beats. The beats broke my focus and cost me the thread. The fibrillation took my breath, in a specific way, from a man whose job was to talk for long stretches without stopping.
On January 9, 2023, they went in for it. A cryoablation, and a great many more large needles than I was accustomed to.
It worked. The fibrillation resolved and has stayed resolved. I can say that my atria has continued to do other things since, and I will not overstate a win. The fibrillation is the part that got fixed.
It gave me a real lift anyway. The ventricular beats had been unsolvable for so long. Then this new thing arrived, and they solved it.
Something in me could still be fixed.
Sixteen cylinders
I spent 2023 in remote roles, and my own résumé started to make me angry.
Narrow field, broad capability. I would read a job description, run it forward, and see where the incentive went. I will have to be compliant in this specific way, and because of that, this specific person may not get the best outcome.
Every time.
That was not disillusionment. It was a man who could no longer stop reading the incentive before he applied.
They took me back into the lab for another ventricular procedure in January 2024.
The next month, I took a job with a device distributor a few miles from my house.
For a while, it was exactly what I needed. Pump the brakes. Be on a sales floor. Young, hungry professionals around me. That is my happy place, and it always has been.
The arena - surplus and overstock medical-device inventory - is a nebulous one. The work sent me into group-purchasing contracts, spend commitments, manufacturer pricing, and the rules that determine what can reach a hospital shelf. I saw how a product can be available at a steep discount and still remain commercially difficult for a supply chain to use. I also saw good people trying to protect clinical operations inside those constraints.
I learned enough in one year to owe somebody an essay about supply chain. That essay is coming at a later date.
But the arrhythmia was back, and it was back with force.
There was a day on the golf course with my friends. Florida, midsummer. I looked at my watch. I had a love-hate relationship with that watch because it let me monitor and also made it possible to know.
I was in ventricular tachycardia.
My friends were having a good time.
I was in a panic and said nothing, because it was Tuesday, because it was just arrhythmia, because that was who I was.
So I kept going. That is what I do.
By September, the device in my chest was reporting a heart running erratically and doing a great deal of work that was not mine to do.
That was also the year my colleagues started calling me MattGPT because they wanted to know what I would say before they said it themselves.
I laughed. It is funny.
It is also the year my memory was failing in front of the people who named me after a machine that remembers everything.
Of all of the labels and names that have ever been applied to me, MattGPT is my favorite.
The people who understand my entire body of work in healthcare would tell you themselves - I am a machine.
The scheduling sheet
My electrophysiologist had concluded that another thermal ablation carried too much risk to tissue that had already been treated repeatedly. He elected to attempt pulsed-field ablation in the ventricle.
The scheduling sheet came through and said PFA.
I had spent seven years becoming fluent in this. Every acronym. Every criterion. Every number on every report. I knew my own disease better than most people know their address.
I had no idea what PFA meant.
So I looked it up.
At the time, the FDA-approved indication for the system was pulmonary-vein isolation for drug-refractory, recurrent, symptomatic paroxysmal atrial fibrillation. Our target was in the right ventricle.
That is what being an edge case actually is. Not rare. Not interesting. You read everything you can find and the scheduling sheet still comes back with a word that has no established evidence base for your exact use, because the procedure being proposed sits outside the approved indication.
Thinking outside the box stops being a virtue and becomes a requirement.
The team could recommend. The decision could be shared. The consent was still mine.
That is lonely, and the weight is real.
I went anyway.
December 9, 2024. Anterior right ventricular outflow tract. Thirty-three lesions.
Three years to the day since the pond.
The device did not hand me matching experimental windows. It handed me the windows it had.
A 399-day summary ending in February 2025—and therefore crossing the date of the final ablation—counted 3,131,975 premature ventricular contractions. Salvos of three beats or more: 1,399. That is roughly 7,850 premature beats per day across the report window.
A later report covering 353 post-procedure days counted 2,296 premature beats, roughly 6.5 per day. Salvos of three or more: zero.
The windows are not perfectly symmetrical. I am stating that because the asymmetry belongs in the record too.
Across the device’s own report windows: more than three million premature beats to 2,296. Roughly 7,850 a day to 6.5. Salvos from 1,399 to zero.
Different windows. The exact counts are above. The scale survives both.
A man I trust achieved that with an off-label use of a technology that, at the time, was approved for a different rhythm in a different chamber.
The quiet
On December 9, 2024, the rhythm quieted.
Here is what the quiet felt like.
Clarity returned. The fog lifted - not gradually, the way it had arrived, but with a speed I still struggle to describe. Several symptoms elsewhere in my body resolved in the same period. The rhythm medications later came off.
Underneath all of it was a sense of safety I had not felt in so long that I did not recognize it when it arrived.
I had energy. I had joy. I had resolve.
My experience was recovery.
Some people around me experienced those same changes as evidence of illness. A man who had barely reacted to anything was suddenly reacting to everything. There was a framework available in an old file, and it was reached for.
Mania.
That was the interpretation. I understand how it looked.
So that is how nine years ends. Not in a lab.
Thirty days out from the best medical outcome of my life, in a building in Florida.
That is the next essay. It is called Thirty Days, and it is the hardest thing I have written.
What happened in those thirty days was going to change the course of my life forever.
Nine
I do not believe luck can carry an argument.
I believe in merit: whether the work holds when somebody else tests it.
As to my own, I have produced at an expert level across multiple domains of healthcare while carrying an edge-case heart through years of procedures, shocks, medication, and fear. I know what exactly what I am capable of..
I am not a man I would bet against.
I have said this before, and I will say it again: I do not give a fuck about the odds.
Which is not entirely true, and I am not going to let it sit uncorrected in the same paragraph where I said it.
Professionally, the odds are nearly the only thing I have ever cared about. My whole career has been odds: conversion against resistance, risk against reward, probability against a deadline. I have run that math live, under pressure, in every domain I have worked in.
What I refuse to do is let the probability of failure decide whether the attempt belongs to me.
Failure exists. It does not get a veto.
Nine is my number. It always has been. Born in the ninth month, on the 18th day, weighing in at nine pounds.
There is a property of nine I have known for most of my life and never registered properly until recently.
Take any positive whole number, multiply it by nine, then keep summing the digits until one digit remains. It returns to nine.
Nine times two is eighteen. One and eight.
Nine times nine is eighty-one. Eight and one.
Nine times ninety-nine is eight hundred ninety-one. Eight plus nine plus one is eighteen. One plus eight is nine.
Mathematicians call that final value the digital root.
This is not a prophecy about my life. It is modular arithmetic. Nine sits one below the base: in base ten, a number and the sum of its digits leave the same remainder when divided by nine. Every positive multiple of nine therefore reduces to the digital root nine.
It is a property, not a coincidence.
I am choosing it as a metaphor because I recognize myself in it.
I have spent this year writing about labels applied to me across forty years.
Gifted. Addict. Bipolar. Genius. Wizard. Delusional.
Every one was an operation performed from the outside. Some contained truth. None contained the whole input.
The years transformed the way I looked to other people. They transformed the way I looked to myself. They did not remove the underlying thing.
That is the part of nine I take.
And here is the other half, which I like even more.
Nine is the brink. In single digits, it is as far as you can push. One more and the place value turns over and the count begins again.
I will not say the years took nothing. They took time. Memory. Health. Money. Parts of relationships that cannot be restored.
They did not take the one thing I was ever actually good at. The ability to reason under pressure. The confidence of knowing that I if my back is ever flat on the dirt, I am going to get back up and keep going.
Because its just arrhythmia and that is who I am.
Nine years. Seven trips.
Still here.
Still nine.
— Matthew J. Adams
ad astra per aspera