Introduction: Biography of the Heart
The heart I learned about in medical school was a simple mechanical pump, a ten-ounce, fist-size organ that beat an average of 72 times a minute, more than 100,000 times a day. It was a four-chambered muscle, similar to those in whales and sparrows, whose sole purpose was to transport oxygenated blood to the brain and other organs.
I was trained to view the heart as a distinct, isolated organ that could be easily diagrammed and modeled in plastic, that could be regulated by a pacemaker, transplanted with a donor's, and bypassed during open-heart surgery with the help of a machine.
I was taught that while people might sing of broken or stolen or wounded hearts, in fact this hollow muscle had no relationship to the emotions, intellect, or soul.
My job as a cardiologist was to sit in my office and wait for someone to have a heart attack, then rush in and try to save him. I was trained to be a cool, heroic figure who swooped into the emergency room, found blockages, and opened them.
My role was technical; my tools were catheters and stents, plastic and stainless steel. In the cath lab, where I spent most of my early doctoring years, I worked on patients in the most intimate way possible on their living, beating hearts yet they were in a large sense invisible to me. They passed by, a blur of indistinct faces, with lives I rarely had the time to consider. I spent my days propping open their arteries with metal sleeves called stents, without considering why they had closed in the first place.
I was taught that other parts of my patient's body were for different specialists to manage. Renal, pulmonary, and neuro doctors all had their own regions of expertise.
The mind and spirit were no one's territory. Ministers, psychologists, massage therapists professionals in the outside world would be the ones to deal with whatever trauma, heartache, grief, or other emotions plagued my heart patients.
No one spoke of the other layers of the heart that didn't appear on a stress test or electrocardiogram: the mental heart, affected by hostility, stress, and depression, the emotional heart that could be crushed by loss, the intelligent heart that has a nervous system of its own and communicates with the brain and other parts of the body. No one lectured about the spiritual heart that yearns for a higher purpose, the universal heart that communicates with others, or the original heart that beats in the unborn fetus before the brain is formed.
Yet other cultures and spiritual traditions have shared more complex views about the nature of the heart. The Greeks believed the spirit resided in the heart. In traditional Chinese medicine, the heart is believed to store the spirit, shen. The idea of the heart as an inner book, which contains a record of a person's entire life emotions, ideas, and memories appears in early Christian theology, but may have ancient roots that go back to Egyptian culture.
No other part of the human body has been so widely commemorated in poetry, so commonly used as a symbol for love and the soul, so frequently appropriated for religious purposes. The heart shows up in ancient stained-glass windows, on Victorian valentine boxes, in Shakespearean sonnets, and in a thousand love songs.
Yet from an early age, I knew that the human heart held our deepest powers and secrets. Heart disease, with its layers of grief and guilt, stress and love, had blasted a hole through the center of my own family.
On an evening when I was eight years old, my vivacious forty-year-old mother told me she had pain in her chest, then got into bed and died of a heart attack. That my mother so young and alive could simply cease to be was a defining event for me, the shock of my young life. My father's subsequent death from heart disease at fifty, almost a decade later, was surely hastened by this tragedy in our family.
Part of the reason I became a heart doctor was to overcome the powerlessness I felt as a young girl that night in Brooklyn when my mother was taken from me. Perhaps by becoming a cardiologist, I was trying in some symbolic way to reach back in time and heal the hearts in the middle of my family that had stopped beating far too soon.
This book, then, is the story of how I was trained to see the heart as a simple mechanical pump and was led by my patients to appreciate it as a center of great complexity and power.
I view the heart now as a flower, one exquisite layer opening to the next. It is to this large, multilayered heart of feeling and poetry, intelligence and spirit that I have dedicated my life.
Listening to the Heart
It is difficult for most of us to imagine the heart, since until recently, it's been impossible to actually see.
We're more familiar with the functioning of our laptops, the operating instructions for our DVDs, than we are with this powerhouse, pounding in the center of our chests. In fact, we rarely even consider the heart unless a doctor warns us that it's weak or sick or about to fail.
This may be why the sudden sight of her heart on an echocardiogram monitor made my patient, a buttoned-down accountant, burst into tears: "There's my heart! Oh God, look at it!" she exclaimed, as if she were coming face-to-face with an unexpected wonder or marvel, which indeed she was.
Through imaging technology such as echocardiograms, it is now possible to view what was previously left to dry academic description or floating formaldehyde specimens our own living, beating hearts.
Yet the total heart in all its complexity and power cannot ever be fully fathomed by simply looking at a screen.
Clearly perceiving the heart involves more than studying an echocardiogram; listening to it requires more than a stethoscope.
Each heart has its own biography, language, and method of revealing its truth, if we know how to listen.
In The Heart Speaks, I will explore what patients have revealed to me about the true nature of this multilayered and complex organ by sharing their stories and their lives as well as the new science that puts the heart at the center of our intelligence, decision-making power, and memory.
Copyright © 2006 by Erminia Guarneri, M.D.