Some summers ago, I had a very particular morning routine: I would wake up, take a caffeine pill, take some variation of Adderall, take Wellbutrin, vape enough nicotine salts to outrun the Wellbutrin, and then stare at the notification that would inevitably pop up on my wrist: "Apple Watch detected a heart rate that rose above 120 BPM while you appeared to be inactive during the ten minute period between 7:10 a.m. [the moment when I sat on my couch and began waiting for the shoe to drop] and 7:20 a.m. [the moment when it did]". I was convinced that I was practicing magic, that I had somehow figured out the special combo of chemicals that allowed me brilliance of mind at the cost of only some small part of my body. I, with my unfinished degree in a field that made no promises, was gripped with the fear that I wasn’t good enough (whatever that meant) to make it. I was not a writer at that point, I was not a particularly successful student, and I was not employed. So, I made a contract with myself: destroy myself a little bit every day in the hopes that what was left will be somehow smart and collected enough to hold down a steady job in a field that I could live with.
The new Apple Watch has an electrocardiogram, designed to pick up signs of atrial fibrillation. Though Apple is quick to brag that it’s obtained clearance from the Food and Drug Administration, left out of its keynote is its specific hedge that “the user is not intended to interpret or take clinical action based on the device output without consultation of a qualified healthcare professional”, or the FDA’s identified concern, among others, that “misinterpretation and/or over-reliance on device output” could lead to “failure to seek treatment despite acute symptoms.”
The fear is that people will learn to put more trust in their $400 phone companion than they do in their own bodies — you can’t breathe at night and it feels like there’s a moth trapped in your chest, but the watch hasn’t said anything, and so you absolve yourself of having to spend the money you don’t have on a doctor visit. My experience with my watch is a data point.
I learned very quickly, however, that this course of action added up. I had learned to think of my body as merely the frail thing that shook around my heaving, anxious heart, but it felt like my chest had become smaller on the inside, with a dull presence (perhaps imagined) lingering in my right bronchi. Was this the moment to stop? This was the same summer that “Carin at the Liquor Store” came out, and my tastes being what they are, I was haunted by the image of a man burdened with the weight of discovering dead John Cheever, a writer who was arguably brilliant, inarguably celebrated, and undone by a body that cared little for his legacy and that he cared little for. In 1982, John Cheever took the stage in Carnegie Hall to accept the National Medal for Literature, and amidst applause, his form betrayed the fact that two months from then he’d be dead from the cancer that began in his right lung. I didn’t think of this as glamorous — in fact, the idea terrified me.
In an attempt to convince myself that I wasn’t drowning mentally, I invented the belief that something had been wrong with my heart since the beginning; I even met with my doctor to try and convince her of this. I had an embarrassingly modern sort of conversation with her, the kind where you try to convince a medical professional that the consumer wristwatch that you bought is an accurate bellwether for your (clearly!) defective heart because of the graphs that it produces. The line goes up, and the line goes down just so, you see. (Surely, you see?) The truism is that you can tell any story you want with statistics, and while I was telling the story of a defective body absolving me of my behavior, she told me the far more plausible story that my behavior was responsible for my body. She said that she could order a test that could produce even better graphs, but those graphs would likely tell me what she already knew after five minutes of talking with me: The only thing actually wrong with my heart were the bricks I was dropping on its accelerator.
And she was persuasive. At that moment, I wasn’t talented enough in self-deception to keep the whole charade up, and instead I went for the easier goal. Instead of denying my role in my body’s state, I would tell myself that I was, in fact, destroying myself, but at an acceptably slow pace. I turned the metrics my watch was feeding me on their head: through the divination of medical alerts and point-shifts of my abysmally high resting heart rate any given day, I could tell just exactly how close I was to sudden death. But a drum beat doesn’t betray the fact that it will end until the exact moment that it does; luckily, after several months of my routine making me no more of a success than I already was, I decided to quit most of these things before my heart did - watch included.
The new Apple Watch obtained its clearance from the FDA “de novo” - that is, it argued the watch’s relative risks and benefits without comparing itself to existing medical technologies by positioning it as an unprecedented technological advance. To its credit, Apple chooses its words very carefully to describe this new technology in its promotional materials - “the data is for your doctors, the peace of mind is for you.” I, with the imagined authority of the watch on my wrist, played a game of existential chicken, trusting that the watch on my wrist would tell me the exact moment when I needed to hit the breaks. Unprecedented things tend to be used in unprecedented ways, and we, either through hubris or necessity, are all too likely to play doctor.
