The Man Who Touched His Own Heart Read online

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  To Monica, Lula, and August, for whom my heart beats

  I counsel you not to cumber yourself with words unless you are speaking to the blind.… How in words can you describe this heart without filling a whole book?

  —LEONARDO DA VINCI

  THE HUMAN HEART

  Today, one in three adults in the world will die of a disease of the cardiovascular system: a stroke, a heart attack, or another disorder of the heart, blood, arteries, or veins. In children, the most common congenital diseases are those of the heart. In the coming years as the Western world ages and the rest of the world begins to better escape (one can only hope) pathogens and parasites, diseases of the heart will be even more common. Our hearts are our weakness. They are also our strength. This is their story.

  Introduction

  Heart diseases are so common that it was almost inevitable that someone I knew well would suffer from a problem heart while I was writing this book. I just didn’t think it would be my mother. On January 4, 2013, my mother, who lives in Wasilla, Alaska, went to her doctor. Her doctor took her blood pressure, ran an electrocardiogram, and then took immediate action. My mother’s heartbeat was irregular (arrhythmia) and her heart rate was extraordinarily high (tachycardia)—184, the sort of heart rate more often associated with a small bird than a human. Her blood pressure was up too. There was no telling how long she had lived with these conditions. Months? Years? Immediately, my mother was put on a cocktail of drugs to lower her heart rate and blood pressure and to sort out the wriggling arrhythmia. Both of the problems from which my mother was suffering at this point in the story are common. Arrhythmia affects as many as one out of three adults over sixty, tachycardia fewer, but still hundreds of thousands. This very commonness was, to a son many miles away, reassuring.

  What was not reassuring was that the cocktail of drugs that were given to my mother did not seem to fix her problems, at least initially. Slowly, her heart rate began to come down. This seemed like progress, but her arrhythmia did not go away; it seemed to get worse. Inside her body, her heart flopped and then flopped again.

  On January 15, my mother was scheduled for a more extreme intervention. Doctors were going to shock her heart. They would stop it in the way that lightning can, electrically. The hope was that, when her heart’s rhythm resumed, it would be normal. Such a procedure is the medical equivalent of kicking the TV when it flickers in the hopes that whatever is loose will reconnect itself. It works about half the time.

  My mother was terrified. The doctors seemed to have been told by someone to avoid using the word shock in describing the treatment. My mother asked, “So you will shock me?” The doctors replied, “No, no, it is not a shock. Do not worry.” No one, however, told the technician about the party line, and so, in the moments before the procedure, he asked my mother, “Are they going to shock you? They shock people all day every day in here.” Lightning is lightning, whatever you call it. They shocked my mother’s heart. It stopped, restarted, and then resumed the fumbling beat it had had before the procedure, still arrhythmic.

  My mother went home, her heart slowed but still skipping beats, sending blood irregularly through her body. She was worn out. Maybe she had been worn out for a while and had not realized it. She slept for twelve, and then more, hours a day. It could have been, it seemed, the effect of not getting enough blood through the body. It could have been other things. It was, it would turn out, other things.

  On February 5, after about a month of feeling terrible (and probably a number of months before that of feeling poorly but not knowing why), my mother went to the doctor again. When she did, they took her blood pressure. They measured her heart rate. They ran an electrocardiogram, an EKG. Once again, the doctors, this time a different set, were alarmed. My mother was admitted to the ICU.

  My mother had, unwittingly, been given too much of one of her drugs by her first heart doctor. The first doctor had prescribed a version of digitalis. Digitalis lowers heart rate, but its effects are highly dependent on its dosage. Too little, and it has no effect; a hair too much, and it can prove dangerous, deadly even. My mother had been given too much. The first symptom was yellowed vision (everything seen as if through amber-colored glasses). The second, although she didn’t know it was a symptom, was sleepiness, an intense sleepiness that made her sleep at first ten and then twelve and then ultimately sixteen or so hours a day. The third symptom was a lack of appetite; my mother, it turned out, was not eating much at all and had been losing weight quickly. Then there were cognitive problems that reached their peak on the day my father took her back to the doctor. She could barely form words and even when she could, she could not seem to put them in the right order. Digitalis, a drug that should have made her better, had become her poison.

  In the ICU, doctors put my mother on four IVs. They watched her constantly. They did test after test. Nothing seemed to make her better. It took a while for them to realize that all of her symptoms, apart from the heart-rate problems, were due to the digitalis, and even some of the heart-rate problems seemed to be related to the digitalis. Whereas her heart had once beaten too fast, it now beat too slowly, far too slowly, akin to the rate of an elephant: thump, da, thump, da. And the original arrhythmia was still there, but now worse.

  Before the symptoms of poisoning emerged, the doctors planned to treat my mother’s arrhythmia by ablation, a procedure in which the part of the heart responsible for the abnormal rhythm is destroyed. The hope is that this destruction of heart tissue will stop extraneous signals from causing the heart to misfire. Ablation is primitive medicine. It works, but we don’t understand it well. In this, it is like shocking the heart.

  But the primitiveness of the ablation would not matter to my mother for the simple reason that, after the digitalis poisoning, the condition of her arrhythmia was viewed as too extreme—too tenuous, too erratic—to be fixed by a burn to the heart. She would, the doctors agreed, need a pacemaker if she got better. Suddenly, the doctors were talking about if she got better.

  She did get better, slowly. As the digitalis was washed out of her system, my mother’s odds of getting a pacemaker went up and up. Her magnesium levels were getting closer and closer to normal (though they would stay high only if she continued to be on a drip). Her potassium went up too. Slowly. And maybe, it seemed, maybe her cognitive impairment was diminishing. Though maybe not. By February 10, five days after she entered the ICU, my mother was deemed well enough for a pacemaker.

  Unfortunately, the cardiologists at her small hospital were not equipped to implant a pacemaker. She would have to move. But there weren’t any beds at the nearest large hospital, in Anchorage, where pacemakers were regularly implanted. She waited, we waited, for hours, then days. I contemplated flying to Alaska to drive her to… well, there was nowhere else.

  After several days, thanks to a change in someone else’s story—an improvement, a death; who can say?—a bed opened up. She was driven to Anchorage. Once she was settled in, the doctors operated. Though it was hardly an operation. A small slit was made in the skin beneath her collarbone, and through it a catheter was inserted into her left subclavian vein. The cat
heter was threaded through the vein and into the right side of her heart, where it was followed by another piggybacking catheter, this one carrying an electrode that would be implanted directly on her heart, an electrode to which the pacemaker would send signals telling it to beat, beat, beat. Here, in the pacemaker, was unbelievable modernity. The tiny device contained a rhythm, a battery, an artificial piece of humanity to be inserted into her body without major surgery, without ever really opening her up. It was a device that would run her rhythm, if everything worked, for the rest of her days, with the only necessary tweak being the potential need for a new battery in five or ten years.

  The pacemaker was implanted under the skin of my mom’s chest. Then, later that day, she, unceremoniously and half mended, was sent home to be with her cats, her dog, and my father. Everyone hoped she would continue to improve.

  My mother’s story is simultaneously terrible, ridiculous, fraught, and modern. It is also, in many ways, typical. Tachycardia and arrhythmia are two of the dozens of heart problems common today; nearly all of us will encounter at least one of them at some point. Cardiovascular diseases, particularly strokes, are the most common cause of death in the United States and in most developed countries around the world. And even when there are ways to treat these deadly problems before they kill us, such as with my mother’s arrhythmia, they do not disappear entirely. They remain chronic weaknesses, the fragility just beneath the skin’s surface.

  Here I tell the story of the heart. I confront the question of why our hearts—ones like my mother’s, but also yours—break so often, more than any other part of our bodies. Our heartbreak is an ancient story, one that begins hundreds of millions of years ago when our ancestors were just single cells, but the story of the science of the heart is more recent. It begins just six thousand years ago. As for the mending of our hearts, that does not begin until the end of the nineteenth century, when the very first nick to a living heart was made with the aim of repair, a nick that led to all the subsequent ones, a nick with a knife nearly identical to the one that cut into the skin of my mother. Then there are the mysteries of the heart, mysteries we have only begun to unravel, mysteries at the center of who and what we are.

  In the 1400s, it was often said that the story of each lived life was written on the inside walls of the heart by a scribbling and obsessive God. When the heart was finally opened and examined in detail later in the same century, no such notes were discovered. Still, each mended heart bears the mark of a different kind of narration. Each mended heart beats out a conclusion to the struggles of the scientists, artists, surgeons, and writers who, with heroism, hubris, and insight, have done battle with the heart’s mysteries for millennia. Each mended heart beats out a story of frailty but also of possibility.

  As for the specific conclusion to my mother’s story, it is, like many others’, a patchwork and only partially resolved. It is a patchwork in that the mending of her heart depended on a mix of incredibly sophisticated tools as well as more ancient ones—the pacemaker and the stethoscope, 3-D scans and cauterization. But it is a patchwork that also reflects an approach in which the symptoms are tended to with very little attention to why things have gone wrong. Her story, in this way, is reflective of the broader story of the heart, a story in which every person’s heart is influenced by ancient problems that have to do with the heart and the heart’s evolution meeting up with modern circumstances.

  My mother’s story is only partially resolved in that she continues to recover. When she left the hospital, she was still very sick, but her heart rate was suddenly just right, eighty beats per minute, beats set by a tiny pulse of electricity from the new pacemaker, her own personal lightning. She was still weak. Her words still failed her. She was still dizzy. Her potassium was still far too low, as was her magnesium. Slowly, though, things seemed to get better. After a week, she could converse normally, more or less. By two weeks, she felt as good as she had in a month. By three weeks, she felt better than she had before the whole ordeal started. Now, she says she feels better than she has in years. Her improvement is due to the understanding we have gained of our most central organ, an understanding that remains humble and yet has advanced enough that my mother is back up and walking around, advanced enough that many people with similar problems are up and walking around—impelled by the collective lightning of pacemakers, discovery, mechanical parts, and much, much more.

  I could begin to tell the heart’s stories at any moment in the past, either four billion years ago or four seconds ago, but the odyssey of the heart pivots on a moment one hot day in 1893 when a man in a poor hospital in a rough part of Chicago decided, for what seemed to be the very first time in history, to cut into a heart in order to heal it. It took nearly six thousand years for scientists and practitioners to understand enough for him to lift that blade, cutting loose a bold era of discovery that continues on into this century, one that depends on an understanding of biology, evolution, art, plumbing, nuclear physics, and nearly everything else. In the end, more so than for any other part of the body, understanding the heart has required every tool that humanity has developed, and even so, the meat in the middle of you, pounding right now, is only partially understood.

  1

  The Bar Fight That Precipitated the Dawn of Heart Surgery

  Any surgeon who would attempt an operation of the heart should lose the respect of his colleagues.

  —T. H. BILLROTH, GERMAN SURGEON

  It was July of 1893, and the city of Chicago was melting. It was the summer of the World’s Fair, when inventions from around the world began to transform America. By fall, the first hamburger would arrive in Chicago, as would the first machinery for making chocolate commercially and the first tinny version of Alexander Graham Bell’s phone. It was also the summer in which Daniel Hale Williams (1856–1931), a young doctor from the rough side of town, would make the biggest decision of his life.1

  Williams was born of African American–Scots–Irish–Shawnee parents, but he was viewed by the society in which he lived, the society of Hollidaysburg, Pennsylvania, as African American. Williams’s father died when he was young, leaving his mother to care for him alone. She was sufficiently overwhelmed that she sent Daniel to be an apprentice to a shoemaker in Baltimore when he was just eleven. That might have been the end of the story, except that young Williams decided to go to Wisconsin, where he began working in a barbershop. The store’s owner took an interest in helping Williams finish high school, where he excelled. Then the owner helped him apprentice in medicine, at which he also excelled. Finally, in 1880, the owner helped him apply to the Chicago Medical College at Northwestern University, where he was accepted and where he, once more, excelled. Williams was the first African American student in the program.

  In 1883, the new Dr. Williams set up a small practice on Michigan Avenue in Chicago. He also taught anatomy at Northwestern University and worked as a doctor for the City Railway Company and, later, the Protestant Orphan Asylum. He was one of just four African American doctors in Chicago at the time and yet his abilities were so obvious that in 1889, just six years into his career, he was appointed to the Illinois Board of Health. Williams wanted more. He wanted to do something more for the city and himself. He was aware that African Americans in Chicago often received poor care from white physicians and nurses. He also watched as African American doctors and nurses struggled to get training and positions, due to racism in hospitals and universities. The challenges facing young African Americans were not waning. At just this moment, a man Williams knew and respected, the Reverend Louis H. Reynolds, came to Williams asking for his help. Emma Reynolds, the reverend’s sister, had recently applied to various Chicago hospitals to train as a nurse (she was the first African American to attempt to do so), but she was refused by every hospital because of her race. Her story moved Williams. After discussions with the Reverend Reynolds and other community members, Williams decided there was only one thing he could do: he would open a hospital.2 At that ho
spital, he would train African American nurses.

  The hospital would come to be called the Provident Hospital and Training Association. It was a bold dream, one in which Williams persuaded other doctors, white and black, and even donors to believe in. Donations came from many sources, including both Frederick Douglass and the Armour meatpacking company (which would also supply the hospital with many patients due to injuries workers incurred on the job). In 1891, Williams signed the lease on a three-story, twelve-room redbrick house at the corner of Twenty-Ninth and Dearborn. Its living room was turned into a waiting room, and a small bedroom at the end of a hall would serve as a surgery ward. In its first year, this makeshift hospital trained seven nurses, one of whom was Emma Reynolds.3 It also treated hundreds of patients.

  Nothing was ever easy at Provident Hospital, but the doctors and nurses made do with what they had. They had to improvise, because of a lack of supplies and the fact that, more than other Chicago hospitals, they dealt with a large number of trauma patients. Everything was difficult, but Williams and his team persevered. His was a story of a hardworking man who overcame and the hardworking nurses who helped him.

  But elsewhere in the city, events were conspiring to change Williams’s story. James Cornish worked as an expressman, a person charged with the care of packages on trains. The job was a good one, but July 9, 1893, was a bad day. The heat left him soaked with sweat, from morning until six. Worse, the heat did not fade, not even when the sun set. It was the kind of heat that called for a whiskey, which is just what Cornish proceeded to order that night at his favorite saloon. While others in Chicago sampled the best of the world at the White City, as the World’s Fair had come to be called, Cornish settled in across town from the fair, among friends. He got his whiskey, took a sip, cracked a flirty joke to the waitress, and walked over to play poker with two friends who were already seated. He felt lucky. A song called “Daisy Bell” was playing loudly from the player piano. He bounced a little as he walked, eager to laugh, wager, needle his friends, and laugh some more. Then things changed irrevocably.4