Book Reviews - Autumn 2018

The House for the Soul

Investigating the rhythmic beat at the center of our lives

By Raj Telhan | September 4, 2018
An operation at the Texas Heart Institute, where during the 1960s more heart surgeries were performed than at any other facility. (Texas Heart Institute)

Heart: A History by Sandeep Jauhar; Farrar, Straus and Giroux, 288 pp., $27

Ticker: The Quest to Create an Artificial Heart by Mimi Swartz; Crown, 316 pp., $27

The human body is decked with clocks—chemical, hormonal, molecular, neuronal—that govern the operation of organic life: proteins and genes turn cyclically on a microscopic scale and oscillations abound, marking the passage of cellular time. Two new books make a study of one such biological clock, taking as their subject the organ that keeps time to life itself.

Any consideration of the heart must inevitably grapple with the matter of metaphor. In Heart: A History, Sandeep Jauhar, a cardiologist at the Long Island Jewish Medical Center, considers how the biological heart “instigates metaphor,” describing it with a clinician’s eye for the poetry of physiology as a “vessel that fills with meaning.” The metaphorical heart, he writes, “can be made of gold, stone, even liquid (for example, being poured when we confess something).” Jauhar goes on to survey a host of symbolic descriptions of the heart, ranging from ancient Egyptian burial practices (hearts were left in bodies during mummification to aid in rebirth in the afterlife) and Aztec sacrificial rituals (think flint knives and hearts beating outside their chests) to Western fairy tales (“witches seeking immortality consumed the hearts of innocents”) and Christian mystics (who saw the heart as a house for the soul).

Jauhar’s point is deceptively simple: the heart may function biologically as a pump, but it is never free of representational overlays; its very physiology is a kind of written record of our emotional life. From heart rate and blood pressure to arrhythmias and myocardial tissue damage, Jauhar writes, the biological heart is extremely sensitive to the metaphorical one.

Whereas Jauhar pays close attention to the deeper meanings of the heart, Mimi Swartz focuses on the pioneering cardiac surgeons who stripped away all semblance of metaphor in their quest to create an artificial heart. Denton Cooley, for example, an innovative surgeon and founder of the Texas Heart Institute, whose ethically questionable practices (he purloined and implanted an untested artificial heart) also led to censure by the American College of Surgeons, disapproved of, as he put it, the “contention of some people that the spirit or the soul or what have you resides in the heart”—a posture that he saw as a barrier to the work of transplanting donor hearts and, eventually, developing their total mechanical replacements.

Swartz suggests that for surgeons like Cooley and Michael DeBakey, Cooley’s legendary mentor at the Baylor College of Medicine—and later, his archrival (the artificial heart Cooley stole was DeBakey’s)—flensing the heart of metaphor was a means of “minimizing its power.” Their ability to reduce the heart to being “just a pump,” Swartz tells us, demystified the organ and made it “something challenging but ultimately conquerable.” But for this, the study of artificial hearts might not be where it is today: testing prototypes of an implantable, fully autonomous, pulseless artificial heart in anticipation of future human trials.

By 1957, direct cardiac intervention was increasingly successful, and the heart had become, as The New England Journal of Medicine put it, an “object of surgical assault.” Both Jauhar and Swartz tell the story of this assault by introducing us to the imperfect individuals who catalyzed it. Their losses, lunacies, hopes, insecurities, terrors, grievances, and blind spots served as the volatile reagents in a chain reaction fueling medical advances from ancient Greece to the present day.

At the center of Swartz’s book is heart surgeon Oscar Howard “Bud” Frazier, who came of age playing Texas football with near-religious fervor before stitching up soldiers as a flight surgeon in Vietnam. He took a copy of Marcus Aurelius’s Meditations with him to Saigon and now walks around the corridors of his hospital reading Plutarch and Shakespeare. The director of an implantable cardiac device research lab at the Texas Heart Institute, he trained with DeBakey and Cooley, the towering contenders who launched the dream of the artificial heart that Frazier is now trying to forge into reality. Through him flows not only the audacious history of the field of cardiac surgery, but the promise of its tantalizing future.

The most compelling character sketches, though, are found in Jauhar’s book. Take the story of Daniel Hale Williams, who, after his father’s death when he was 10, worked his way out of poverty and toward the “epoch-making moment” in 1893 when he became one of the first to perform open pericardial surgery. Williams, an African American, later founded the first racially integrated facility for young black doctors and nurses, championed by none other than Frederick Douglass, to offer blacks in Chicago an alternative to overcrowded charity hospitals.

Jauhar also introduces us to 13-month-old Gregory Glidden, stricken with a ventricular septal defect. He weighed just 11 pounds and was on the verge of circulatory collapse because of a hole between his ventricles. C. Walton Lillehei, a cardiac surgeon at the University of Minnesota, proposed an operation that would employ an experimental technique called cross-circulation: the boy’s blood would circulate through his father’s body. Linking “vein to vein, artery to artery,” Lillehei would use the father’s heart and lungs to keep the boy alive during the operation. The catch, he explained, was that the method had been tried only on dogs. The desperate father gave his consent. Technically, the procedure was a success: both father and son survived cross-circulation, and although Gregory later died from a chest infection, the autopsy showed that his repair remained closed.

Jauhar’s writing blends pathos and playfulness and is suffused with an elegiac tension, haunted as it is by the specter of his own mortality. Early on, he recounts seeing a CT scan showing a 50- percent blockage in the main artery feeding his heart. “Sitting numbly in that dark room,” he writes, “I felt as if I were getting a glimpse of how I was probably going to die.” Jauhar invites the reader into the resonant chambers of his heart, narrating the history of an organ while also offering a stirring personal tour of his sorrows.

For her part, Swartz seeks to recount a quest of epic proportions. Her reporting is often engrossing and granular, but her tight focus on Texas (she is a San Antonio native and an executive editor of Texas Monthly) constrains the scope of the narrative. Moreover, she describes her subjects variously as “the hippest, hottest heart surgeon on earth”; “another heart surgeon who gave healthy women palpitations”; “uniformly attractive”; “virile Texas good ole boys”; “dashing”; “raffishly handsome”; having “a cock-of-the-walk stride”—language that carries the whiff of hagiography.

Such descriptions contrast curiously with some of Swartz’s portrayals of DeBakey, the son of Lebanese immigrants, who Anglicized their surname, Debaghi. “Ostensibly brilliant”; having “a nose a toucan would envy”; “homely”; and the “opposite” of Cooley, who “embodied certain mythic characteristics thought to be deeply embedded in the American DNA”—these depictions of DeBakey, perhaps gleaned from his rivals, perpetuate the stereotypes promulgated by the 1960s TV show Ben Casey, based on DeBakey and Cooley, which Swartz tells us portrayed DeBakey as “peculiar and ethnic.”

Despite these flaws, Swartz’s Ticker offers a lot to ponder, not only about the lost and seemingly limitless world that gave birth to modern cardiac surgery, but also about what the existence of an artificial heart would mean. Would we be one step closer to realizing the dream of eternal life, to casting off our mortal coil? Maybe. More likely, such a heart would become an instigator, as Jauhar would put it, of its own symbolism: a metaphysical engine, whirring silently, pulselessly toward infinity, all the while haunted by new metaphors that have come to replace the old ones.

 

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