The emergency room was busy that afternoon. I had just started my shift and was making my way through a scrum of frantic doctors, nurses, and orderlies when I heard yelling coming from the ambulance bay entrance. “Put her down now!” I recognized the stern voice of Herb, one of our security guards. “Get a stretcher, stat,” said Ellie, the head nurse. “You’re hurting her,” a woman yelled. I ran to the ambulance bay, rounded a corner, and saw a huge man, seven-foot-something, holding a petite woman, maybe five feet tall, by her feet, her head dangling down. “I have to hold her this way,” the man insisted. “This is my wife,” the giant shouted. “Let go of me.” He glared at Herb, who kept pulling at his biceps and wrists. A large group of ER personnel was now watching them from a distance. “Let’s everybody take a deep breath here,” I said. “What’s your name, sir?” Herb released his grip on the man and took a step back. “Jason,” he said, more calmly now. “Okay, Jason,” I said. “Why are you carrying your wife by her feet?” “Hi, Dr. Janeira,” said the upside-down woman. “Remember me?” “No,” I said. “Have we met?” “Yes, I was here yesterday,” she said. “Remember? With the slow heartbeat?” And then it came to me. Her name was Mary, a woman in her mid-60s. She had arrived at the ER the day before with complete heart block, caused when the electrical system connecting the atria to the ventricles fails because of scarring, infection, or heart attack. As a result, the heart slows dramatically. Mary’s heart rate had been under 40 beats per minute instead of the 60 to 80 that would be considered normal in her age group. She was having recurrent fainting spells and seizures. This giant hadn’t been with her then, and I had called a colleague for urgent implantation of a pacemaker, which generates rhythmic electrical pulses that prevent slowing of the heartbeat. Within minutes she had been taken from my ER to a laboratory where she was fitted for the device. I approached the couple slowly. “I didn’t expect to see you so soon,” I said leaning over, trying to see her face. “Didn’t you have your pacemaker implanted yesterday?” “Yes,” she said. “I had the surgery yesterday. Everything went well, and I went home this morning.” “Everything was good until about half an hour ago,” Jason said. “She coughed and then collapsed.” “But I don’t understand why you’re keeping her upside down,” I said. “I picked her up and put her on our bed,” Jason explained. “She regained consciousness for a few seconds. She tried to get up but went out again and fell behind the bed. I picked her up by her ankles and she came to.” “I still don’t get it,” I said. “If Jason puts me in bed or upright, I faint again,” Mary told me. “We’ve tried it four times now, and every time he changes my position, I go to la-la land.” “So you’re conscious upside down but not right side up?” I asked. Mary’s upside-down head nodded vigorously.