Whenever I do a cardioversion, I think about purgatory.

A cardioversion shocks a patient’s heart out of an abnormal rhythm. You’re seen it on TV: someone yells “clear,” presses a button on paddles, the dying patient jolts, and lives. In the movies, it seems so cool. I think James Bond even cardioverted himself once but didn’t yell “Clear!” because that would have been over the top.

The usual cardioversion is a little less exciting. Unlike when someone is in cardiac arrest, we often electively cardiovert patients out of atrial fibrillation because they just hate how atrial fibrillation makes them feel. We arrange for an anesthesiologist to put the patient to sleep before delivering an electric shock across their chest.

What does this have to do with purgatory? I’ll get to this later.

Doing procedures and prescribing medications is always with the intention of doing good, of fixing a problem or preventing one. And yet, every day, the medications and procedures cause side effects. I have probably ruined more romantic evenings with medications I prescribe. In one recent week, I had two different men who didn’t know each other tell me almost identical stories and who said, almost word for word, the same thing. Blood pressure pills made these otherwise healthy gentleman less “attentive” in the romance department, clearly an upsetting new problem. In both instances, the patient’s wife correctly concluded it was the med and suggested to “call Dr. Gaudio.” Both fellows reported this to me and then both said, almost verbatim, “Doc, no offense, but if there was any glimmer of hope, thinking of you just killed the moment for sure!” (Please take note: Candles and soft music are romantic. Mentioning your partner’s doctor’s name is definitely not romantic.)

With all these side effects I cause, I wonder if, when I meet my maker at the end of my life to go over my life’s report card, I will have more wins than losses in the medication prescribed and procedures performed. Which brings me to purgatory and cardioversion.

The anesthesia used in cardioversions dissociates patients from consciousness. It does not remove pain reflexes and, to me, it does not seem to remove an instantaneous perception of pain, even if there will be no recollection of the event two seconds afterward. So after the patient is anesthetized and unconscious and I press the button to jolt the electricity through the patient’s chest, the spasm is followed by an dramatic wince of what appears to be pain and sometimes even an “ouch.” Almost immediately, the patient drifts back into that a perfect, peaceful slumber. And even though they later assure me that they don’t remember feeling anything, I am sure that in that one instant there was, even if for a moment, real pain.

I’m neither theologian nor scholar, but my understanding is that purgatory is a place to pay for, and purge, the sins on Earth before eternal bliss. Once the price is paid by suffering in purgatory, it’s all eternal bliss with no recollection of the pain. And yet, it still happened, just like the moment after I deliver the shock to someone in atrial fib. In the overall scheme of eternity, purgatory is nothing more than a moment of pain.

I fear that my own time in purgatory will be with all those patients I have cardioverted lining up to press the button and shock me over and over until I’ve paid for all the side effects I have caused.