Matters of the heart: cardiologist explains the workings of our most vital organ
- Heart surgeon Sandeep Jauhar explains and exalts the heart in equal measure in his new book
- He traces the recent history of heart medicine, and reflects on a death in his own family
Heart: A History by Sandeep Jauhar pub. Farrar, Straus and Giroux
Sandeep Jauhar opens his new book, Heart: A History, with the story of a patient – himself. Shortness of breath while climbing the stairs to his office led to a slew of tests and eventually the discovery of a blockage in the main artery feeding his heart.
After relating the story of his own heart, Jauhar dials back to 1953, when his paternal grandfather died suddenly one sweltering summer day in India.
In the morning, he was bitten by a snake of an unknown type. That afternoon, he was feeling fine until neighbours arrived bearing the corpse of a black cobra, claiming it was the culprit. He took one look at the snake, collapsed and died.
Some were convinced that it was that very cobra that killed him, but his grandson the cardiologist believes it was a heart attack, pure and simple, possibly induced by the fright of seeing the snake. “My grandfather had succumbed to the most common cause of death throughout the world,” Jauhar writes.
In these first scenes, Jauhar, who is director of the heart failure programme at Long Island Jewish Medical Centre in the American state of New York, sets a tone at once intimate and detached. And over the ensuing pages, he is our trusty guide through a compelling story about what makes each and every one of us tick.
Both primer and ode, Heart: A History is a fascinating education for those of us who know little about the organ. The heart, we learn, is the first major organ to develop in the human body. It starts beating three weeks into fetal life, even before there is any blood to pump. And it is the last major organ to stop working.
A mechanism of remarkable reliability and endurance, the heart beats around 3 billion times in a lifetime. The amount of blood that passes through an average adult heart in a week could fill a backyard swimming pool.
Jauhar, whose previous books include Doctored and Intern, embraces the notion of the heart as a vessel imbued with meaning. He reminds us that it is linked to bravery: the word “courage” derives from the Latin “cor”, which means heart.
English playwright William Shakespeare often referred to the heart as the locus of romantic love. Centuries later, in 1982, when Barney Clark received the first permanent artificial heart, his wife of 39 years asked the doctors: “Will he still be able to love me?”
Like the biological heart, the metaphorical heart has size and shape. To be big-hearted is to be generous. Small-hearted people are selfish. Hearts can be warm, cold, gold, stone. Jauhar points out that extreme emotional states can lead, quite literally, to a broken heart. Loveless marriages, researchers have found, can bring chronic and acute heart disease. Depression and stress have been found to be strong risk factors for heart attacks.
As a small boy, Jauhar was obsessed with his own heart, in no small part because of his family history. Little Sandeep lay in bed monitoring his heartbeat. “I was fascinated by the heart’s dichotomous nature: muscular, constantly toiling, and yet so vulnerable at the same time,” he writes.
He decided to pursue cardiology. He sees heart shapes in everything from strawberry slices to raindrops on his car’s windscreen. Ever the fluid writer, Jauhar even employs the metaphorical heart to describe what it took to face the devastated parents of a young patient who had just died: “Once, it was difficult to witness the grief of loved ones. But my heart had been hardened.”
Yet when he began his cardiology fellowship at New York’s Bellevue Hospital in 2001, all metaphors were suddenly beside the point. “The heart in disease was best understood as a complicated pump,” he writes. Everything, he was told by one curmudgeonly mentor, depends on pressure differences.
“He would encourage us to think about blood flow, lung congestion, and even human affairs in those terms.”
Innovations in cardiac procedures, we learn, are surprisingly recent. In the middle of the 20th century, more than 600,000 Americans were dying of heart disease every year.
As it happened, President Franklin D. Roosevelt’s blood pressure was rising in step with the tensions of the second world war. By the time American soldiers landed in Normandy, France, in 1944, his blood pressure was measured as life-threatening. But there was precious little that could be done for Roosevelt, and he died in 1945, of congestive heart failure. Three years later, Congress passed the National Heart Act, and the pace of advancement accelerated.
The world’s first coronary bypass surgery, Jauhar reports, was performed in 1967 using veins from the leg to bypass coronary obstructions. That decade also saw the first decent survival rates for patients with pacemakers. In 1977 came the first coronary angioplasty. By 1994 the US Food and Drug Administration had approved the use of coronary stents.
As Jauhar describes them, cardiologists are a decidedly odd bunch, with a penchant for self-experimentation. In 1929, Werner Forssmann, a German, famously risked his life when he put himself under local anaesthesia, inserted a catheter into a vein on his arm and managed to thread it into his heart.
In the 1980s, Andreas Gruentzig, a pioneer in balloon angioplasty, had a coronary angiogram done on himself. “He climbed onto the cath table at 5pm, underwent the procedure, and then went to pick up his wife, arriving at the department’s Christmas party by 7pm,” Jauhar writes.
Jauhar ends the book as he begins it, as a patient. Now 49, he imagines he will eventually repeat the CAT scan that first revealed coronary plaque to see if it has progressed.
But, he writes, he is not afraid of what he will find, so reassuring is the knowledge that has accumulated in his field since the day his grandfather slumped in cardiac arrest to the floor.
In the meantime, Jauhar has made lifestyle changes – exercising more, eating better, spending more time with his family and friends. And even after all these years in the business, he still sees heart shapes everywhere.