The Source of All Things

by Reinhard Friedl

  * * *

  Over and over during this time I noticed discrepancies between medical and figurative accounts of the heart. I talked to others about this. “The heart is only ever allowed to be good,” an acquaintance once objected after I had listed a few expressions about the heart. “But there is also a cowardly heart, a cold heart, an ice-cold heart, one made of stone, and a frozen one.”

  At first, I was speechless. She was undoubtedly right; instead of dismissing her point, I had to address this issue. Had I fallen victim to my own longing? Then I thought of a sick heart, one no longer properly supplied with blood, which had thus become cold. Its fear, having extracted all courage from it, had let calcium turn it to stone. I knew suddenly that her objection confirmed my sentiment. The heart itself is strong, life-affirming—positive. Fear is stagnant flow, frozen energy.

  * * *

  Sometimes it is necessary to take a step back in order to see the whole picture. As a scientist I learned that successful women and men, great personalities, always use heart and mind. It is not only permitted, but indeed our essential purpose, to take nothing for granted, to question everything, to think anew. It is from the realm of the inconceivable that science draws its most interesting questions.

  In the following pages, I reveal the miracle that is the heart. I explain how I arrived at my findings and how they may change our lives for the better. The heart is with us from our mother’s womb until we rejoin Mother Earth at the end of life. We speak about it so often, but this essential organ is nevertheless strangely foreign to many of us, and some are even afraid of it. Some people are glad when they don’t feel their heart, as that must mean everything’s okay, mustn’t it? That is what I, too, thought for a long time—until I was proven wrong. Today I believe medicine should acknowledge that the heart is not merely a pump but a source of life and consciousness and also plays a role in many disturbances and illnesses; this conviction would grant us deeper understanding of the body’s logistics and lead to healthier and more joyful lives.

  * * *

  While searching for the heart’s true nature I also rediscovered my own heart. It seems that health professionals lean toward a certain heartlessness, perhaps believing that we need to close our hearts off because we are confronted with so much suffering. Society rewards us for this with recognition and high status, preferring the ice-cold surgeon to the compassionate one whose hands may shake. Today I know that my compassionate hands do not shake: no, they have eyes. The holistic reawakening of my heart has altered my life dramatically, changing the way I approach myself and relate to my fellow human beings and of course my patients. They are not vessels whose pump is on strike but holistic human beings on whom I bestow sympathy as well as medicine.

  * * *

  Nobody would deny that love exists. But can we measure it? We can sense and feel inner phenomena that we can’t measure objectively. We can’t verify their existence in a lab or completely explain their molecular formation. But we sense them intuitively. More and more people look for answers, maybe because they “sense” that a life based solely on technology and acceleration does not make us happier or more content. Is it possible to return to our selves and into our hearts? Body-oriented therapies and spiritual movements try to give people awareness of their body and thereby “open their hearts.” Something seems to be missing from our comfortable, modern, but also performance-oriented and increasingly mechanized lives. Our Western way of life, so rational and yet hardly sensible, does not correlate with the idea of a holistic existence.

  * * *

  In the following chapters I tell the story of a heart surgeon who set out to rediscover his missing heart. I have compiled both age-old and up-to-date findings from various scientific disciplines, especially concerning the secret connections of heart and brain and their influence on emotions and consciousness. This will result in new insights for the health of the whole heart and its therapy—for the whole human being.

  Listening to the heart

  Ba-boom, ba-boom, ba-boom—the healthy heart makes two sounds, of which the first one sounds a little shorter. It is not a monotonous military march, not a boom-boom, boom-boom; rather, its shortened first sound creates a light, dance-like rhythm. We can hear the ba-boom if someone allows us to put our ear on their chest. As a child I loved to listen to the heartbeats of my siblings and parents. The first sound, the “ba,” is created when the heart contracts and the valves open; the second, the boom, comes when the heart relaxes and the valves close. We know from embryology and prenatal diagnosis that this is the first sound we hear in our lives, long before we are born. It is immensely important for the relationship between mother and child.

  Being allowed to listen to another person’s heart is a very intimate and special experience. Listening to a heart requires closeness, even in medicine. “Please take off your shirt.” What happens after that—I hear your heart!—is a diagnostic measure that is used less and less often. In earlier centuries and decades it was considered a doctor’s greatest skill to be able to distinguish the fine tones and sounds of the heart and make the correct diagnosis. Even when I was training, one of the most highly regarded medical journals, The New England Journal of Medicine, published an article detailing how auscultation of the heart—experienced experts listening to it—can result in highly accurate diagnoses.4

  Thirty years later it is sobering for heart surgeons when a patient tells them immediately before an operation: “You are the first doctor to listen to my heart.”5 For most patients, a doctor listening to their heart represents the highest intimacy between medical professional and patient. I strongly believe this also points to a deep desire of human beings for their inner sanctum to be listened to.

  * * *

  Today the moving image has replaced sound. I have observed that cardiologists these days listen to their patients’ hearts only rarely. I mean not only the tones and sounds generated by the heart’s mechanics, but also the heart’s other voice, which comes from the spheres of wisdom and compassion. Heart researchers, psychologists, and spiritual teachers increasingly agree: this voice is inextricably connected with the organic heart.

  * * *

  When did you last hear it?

  * * *

  I want to invite you to consciously perceive your heart. Put your right hand on your heart and feel your heartbeat. Breathe steadily and perceive what your heart has to tell you.

  * * *

  Whatever it is you hear or don’t hear, it is right. Don’t lose your patience and don’t judge. There are many different kinds of meditation. The aim is always the same: pause, breathe more slowly, sense what’s inside, and observe the present and all thoughts and feelings.

  You may feel, after a while, how your heart gives you life with every ba-boom. Now. From moment to moment, endowing life with new vitality.

  When I practiced this meditation for the first time more than ten years ago, I heard nothing. I was at the very beginning of my journey to the true heart. Back then, the heart was still a pump to me, albeit not a primitive one but one that was a miracle of precision and strength.

  THE SIX-CYLINDER BIO-TURBINE

  Every day the heart transports 9,000 liters of blood and beats about 100,000 times while doing so. The heart’s large muscle strands twist around each other like spirals and form fantastic cave systems connected by valves and separated by septums. Inner and outer layers of muscle rotate simultaneously in order to discharge blood, following a finely synchronized choreography.1 Physically, you could therefore view the heart not merely as a pump but almost as a turbine, an engine. And if you sometimes feel as if your heart is jumping in your body—that, too, is understandable. If you see it when the chest is opened, it jumps rather than runs. A heart reveals a lot about its condition to a heart surgeon through these jumps and turns and their rhythm. The geometric shapes of this dance of the heart are as unique as a fingerprint. You could use them for identification, as there are no two people in the world with an ident
ical heart. Researchers from the University at Buffalo used this discovery and developed the prototype of a heart radar. In the future people may log onto their computer using their heartprint, use it to pay in the supermarket, or check in at an airport and prove their identity with their heart.2

  * * *

  Usually, though, the heart likes to hide from overly curious examination. For heart surgeons to be able to see it, they first have to gain access to its engine room, which is the pericardium (also known as the heart sac). The pericardium forms a wet cave for the heart to glide in without becoming sore. It supports the heart without constricting it. It also prevents it from becoming too full—and helps it remain where it belongs in stressful or energizing situations. There have been instances, after heart operations, where the heart has herniated into the lung cavities—a deadly complication if it is not immediately recognized and corrected.

  * * *

  If the heart has been injured or has survived inflammation, its home may form a hard shell. First, pericardium and heart stick together, which is known as pericarditis, or inflammation of the heart sac. Later, calcium deposits massively restrict the movements of the heart; it is no longer able to fill properly and becomes hopelessly trapped in a stranglehold. Its once-cozy home becomes a deadly trap, the custom-made suit a straitjacket. This situation is fittingly called an “armored heart” (constrictive pericarditis). Armor has no place around the heart—it impedes rather than protects it, trapping it in many ways. Biologically, this means the heart loses its ability to receive enough blood. This can lead to death.

  * * *

  A healthy pericardium, then, protects the heart and provides it with its own space in which it can beat freely, without impediment or constriction. The heart needs both protection and freedom. In traditional Chinese medicine, the heart sac is called “the mother of blood and protector of the heart.” Our academic medicine validates this view, as the pericardium also improves immunity and protects the heart from infection. The versatility of the highly flexible and simultaneously tear-proof pericardium is a huge help for heart surgeons during an operation. Occasionally we even use a tiny piece of it during our operations; a few square centimeters of “pericardial patch” (as heart surgeons call it) are extracted, for example, to repair a valve or close a hole when treating an innate heart defect.

  * * *

  The heart functions as a pump, and in order to transport blood, its base and tip move toward each other in a smooth motion. Its liquid freight is conducted through labyrinthine caves—polymorphous and fantastically formed cathedrals of life featuring muscular pillars, distinct ledges, and fine sinews. They provide stability and strength and generate the difficult mechanics of the six heart valves, which ensure that the blood in the cave system flows forward and never backward.

  Yes, you read that correctly. There are six valves, the smallest of which have the longest names: valvula thebesii and valvula venae cavae inferioris (which feature mainly in high-level questions in anatomy exams). They help pass on the low-oxygen blood that is sucked into the right atrium. The bloodstream must not stop. Patients become very ill if valves are leaky or severely calcified, or if there are faulty connections.

  In a healthy heart, the body’s low-oxygen venous blood flows from the right atrium through the tricuspid valve into the right ventricle; from there it is passed on to the lungs, which have a capacity of several liters. Breathing now comes into play. Every time we breathe out, the lungs draw carbon dioxide from the blood and release it into the air. When we inhale, our red blood cells are charged with oxygen atoms. Thus refreshed, the high-oxygen blood is now sucked into the left atrium and is ready for the big trip into our body’s most remote cells. With the next heartbeat, it will pass through the mitral valve, flood the left ventricle in a flash, and then leave the heart through the aortic valve.

  The left ventricle is a muscular powerhouse which builds the pressure we feel in the arteries as our pulse. Blood circulates in a closed circuit. This was first discovered only 360 years ago by English doctor and scientist William Harvey. Previously, for more than 1,400 years, doctors had followed the erroneous teaching of the ancient Roman physician Galen, who claimed blood is generated in the liver and trickles from there to other organs. He viewed the heart as a kind of oven in which a flame burned to cleanse the blood; the smoke was said to be discharged via the lungs. Harvey had the courage to doubt the predominant doctrine of his time—and was ridiculed by many. However, he laid the foundations for our modern understanding of body and heart; it is thanks to him that today we know blood circulates and returns to the heart via the veins.3

  Thus, the heart not only gives—it can simultaneously take. With every contraction, blood is not only pumped out but also sucked in. Giving and taking is the heart’s most fundamental principle, and also the essence of love and balanced interpersonal relationships and partnerships. This muscle receives and distributes eight to ten tons of blood every day in an adult. Imagine you had to carry nine tons of blood across the street and back again. That would be 900 ten-liter buckets. How long do you think you would keep going? The heart goes one better still: it doesn’t just “carry” your blood across the street but rather pumps it through a blood vessel system that is 100,000 kilometers long. All of this happens with every heartbeat inside your body, and yet we rarely think of the heart’s downright supernatural accomplishment.

  Perhaps you wish to pause again at this point and place a hand on your chest’s left side? Don’t be shy! You can sense what human beings have felt since the dawn of their evolution. Something alive dwells within you: your heart. It creates life of its own accord. Simultaneously it is at home in your whole body, linked to every single cell. The heart is the mother and the well, whose bloodstream supplies all cells with vital ingredients. And it is the launching pad for the cells of our immune system, without which we would quickly die from infections.

  * * *

  A lively heart is deeply rooted in the body, and its blood vessels are connected to every single cell—the many thousands of billions of cells in our gut, genitals, arms, legs, and sensory organs. These vessels reach deep inside us, all the way up to our brain, which they surround with millions of fine and ever finer branches. Unfortunately, this is not recognizable in the completely mutilated depictions of hearts we see in anatomical drawings and health magazines. They remind me of pictures of trees whose roots and crown have been cut off. If you want to get a picture of the whole heart, you must not separate it from its pulsing roots and crown. An unobstructed, strong, powerful stream of life and blood flows inside it. It is animated by electric energy; its highly energetic electromagnetic field is measurable over a meter away from a human being.4 Sometimes it seems to me that we humans understand far more about trees than about our own hearts.

  * * *

  With every contraction of the heart a pulse wave rushes through our arteries, and the brain pulses continuously to the beat of the heart. No organ is as dependent on the heart-driven blood flow as the brain. If this flow is interrupted for more than a few seconds, we faint.

  We know the pulse mostly from the media and TV shows such as ER, House, or numerous crime thrillers. “Is the patient still alive?” And then the obligatory fingers to the throat to check for a pulse, and sometimes the call: “Quick! Get a doctor!”

  HEART ON THE TABLE

  It is a bone-chillingly cold winter night. I turn into the clinic’s car park twenty-nine minutes after receiving the call. The large windows of the operating wing are brightly lit, and I know my team is making all the preparations necessary for a lifesaving intervention. The connection where the aorta emerges from a patient’s heart threatens to tear. It is a race against time, which had already begun when the phone call woke me in the middle of the night.

  “Are you awake?” the assistant doctor asked me.

  “Yes,” I replied, already alarmed and on my way to the bathroom.

  There are two types of calls. The more pleasant one starts
with: “Good morning, nothing serious, I just have a question.” “Are you awake?” calls do not usually bode well. And so it was with this one: “We are about to receive a Type A dissection; the helicopter will land in fifteen minutes. The patient is sixty years old, I don’t know any more yet.”

  “I’ll be there in thirty-five minutes,” I said. If such an emergency is not operated on, mortality increases by 2 percent per hour in the first twenty-four hours. In other words, 2 percent of patients die within the first hour, 4 percent within two hours, and 48 percent within twenty-four hours.

  * * *

  In the operating room I familiarize myself with the case. I learn from the emergency doctor’s report that the patient had mentioned an extreme pain in the chest that afternoon. This excruciating pain is likened to an elephant sitting on someone’s chest, and it often reaches into the back. The farmer had been working in the forest felling trees. It took a while until the emergency doctor reached him, and he was admitted to the emergency department of a clinic thirty kilometers away with a suspected heart attack. More precious time passed until it was established he was not having a heart attack. The images from the CT scans are unmistakable; the aorta is enlarged to nearly double the normal diameter, now measuring eight centimeters. It is separated by the clearly visible dissection membrane, a rag of tissue that now hangs on the inside of the aorta like part of a burst tire. With this illness, the innermost layer of the body’s biggest blood vessel will tear and the powerful bloodstream from the heart will use the wrong channel.