The Source of All Things

by Reinhard Friedl

  “What’s happening?” I asked.

  As if by command, everyone was suddenly busy. Irmgard was rummaging through papers, Klaus was preparing medication, Sarah was typing into her mobile, and two others made their way to the door. Only Bettina was grinning like the Cheshire cat. She had been the heart of the intensive care department for decades. With a big smile she told me the latest from the grapevine: “Yücksel and Huyen are a couple!” she burst out.

  “Oh, I’ve known that for a while.”

  “You have?”

  “Yes, of course.”

  “Have they told you? How do you know? Klaus saw them smooching yesterday. You didn’t hear that from me. Or did you catch them as well?”

  “No,” I smiled. “I diagnosed it from their hearts.”

  * * *

  Since time immemorial, people have entered into romantic relationships. Worldwide, 147 out of 166 societies have a word for “love,” and scientists assume the remaining nineteen possibly have just not been asked the right question yet.1 While Adam and Eve in paradise displayed a rather earthly disposition, tried forbidden fruit, and produced offspring, Mary and Joseph were more inclined toward “immaculate,” divine love. There might be a difference theoretically, but the practical result was the same. Reproduction is the true reason for the evolution of love, scientists say. During orgasm, we discharge a very special essence of the heart, the love hormone oxytocin. It is one of the oldest substances of life that we know of today; it was active on Earth over 600 million years ago.2 Love is a universal, connective force. Some say it is very old and everlasting, the origin, the beginning of the beginning.

  That may be the reason why lust and love are by no means absent in the later stages of life. Islamic scholar Hamza Yusuf once asked his 84-year-old father if physical lust ceases in old age. His father answered humorously: “Yes, about a half-hour after the cadaver is cooled.”3

  I believe that too, and current scientific inquiries confirm it. Love, physical closeness, and sex are not only beautiful but also healthy.

  * * *

  A large study has shown that the frequency of sexual intercourse is an important factor for the mental and psychological health of both men and women.4 Involved here is an old acquaintance from earlier in this book, which coming from the brain also visits the heart and travels further to the genitalia. It is the vagus nerve, the stray and vagabond. Even though it is a brain nerve, it wraps around the vagina and the cervix with its sensitive fibers and transports their messages directly back to heart and brain, without a detour through the spinal cord. That is why women with spinal cord injuries may experience orgasms.5 For men, too, the vagus nerve regulates arousal. It makes arteries wide and allows blood to flow into the penis so that the spongy tissue fills and the penis becomes erect.6 High oxytocin levels influence the data flow between heart and brain and make the vagus nerve flexible.7

  When it receives sensual signals, the heart begins to dance, the heart rate variability rises; this has positive effects on our health.

  The heart rate variability of 143 men and women was measured, and they were asked how often they had had sex in the last month. Women and men with a high heart rate variability had more sex and more frequent orgasms. Vice versa, orgasms increase the heart rate variability. Coitus increases the activity of the parasympathetic system—that is to say, of the vagus nerve—and the more relief they achieve, the more likely further meetings of penis and vagina become.8 (Unfortunately, at the time of preparing this manuscript, I am not aware of any studies concerning homosexual couples.)

  * * *

  The voice of the heart, which finds its expression in heart rate variability, is a voice from inside the body—from the part of the body that has no other voice. It expresses what the tongue can’t say, and it is the result of the complicated cooperation of various different organ systems. Strictly speaking it is therefore not one voice, but a multitude, a polyphonic canon of all cells. We humans have so far not managed to decode these voices completely. Expecting to decipher the heart’s messages from an analysis of its frequency is as unrealistic as filtering thoughts from an EEG. As a scientist, I am astonished by the many voices that come through when one measures heart rate variability—a canon whose tones have such deep effects on our sexuality. These sounds cannot be played “on demand”; we can only feel them. They create themselves, they stem from our very own biological existence. They are made anew in each moment.

  The measurement of love and the rediscovery of the heart’s involvement are very interesting scientifically, but they measure something that goes beyond what apparatuses can detect: being alive. Sexuality, love, and the voice of the heart are highlights of life, but they are also changeable and cannot be categorized. If we lose them permanently, that can lead to depression, anxiety, eating disorders, overconsumption of alcohol and drugs, and personality disorders. Too much stress can be enough to hinder the experience of an orgasm,9 as happened in Rüdiger’s case.

  The mechanics of love

  Rüdiger was a good friend of mine, and a successful manager. Once every year we went hiking in the mountains or spent a weekend sailing on the Baltic Sea. During one of these sailing trips we were anchored in a bay and he started to have chest pain. The previous evening, he had told me that his wife had a lover. They had been married for nearly twenty years and had three school-age children. Rüdiger was terrified of losing his wife and made an effort to fill their love life with lust and imagination. But his wife desired him less and less, and the more he tried, the limper his penis became.

  * * *

  I was swinging in my hammock on deck and watching the night sky, where a spectacular storm was brewing.

  Suddenly Rüdiger stood before me, both hands on his chest.

  “Reinhard, I am not well. There is a strange pulling in the heart area.”

  After taking a thorough medical history and conducting an examination with simple on-board equipment, a diffuse clinical picture emerged. I could not exclude coronary heart disease, meaning a narrowing of the coronary arteries. From my ship’s pharmacy I administered a dose of Nitrolingual Pumpspray under his tongue. Nitroglycerin widens the blood vessels around the heart. While Rüdiger, still very pale, lay down in his bunk, I considered how dangerous this situation was. If I had learned one thing in my twenty years as a heart surgeon, it was this: one must never underestimate a heart. But chest pain can have many causes. I studied the sea charts, the wind, and the weather and thought about how we might be able to reach a port. Unfortunately it was not looking good; we had crept deep into the Swedish archipelago, into a bay that was completely sheltered, as strong winds from changing directions had been predicted for the next days. All in all, the situation did not appear definite enough to raise an alarm. Following an inner voice, I decided to wait. Two hours later, Rüdiger crept from his bunk. “I’m feeling better again,” he grinned.

  “That’s good,” I replied, relieved.

  “This stuff is the shit,” he added, and pointed between his legs with unmistakeable pride. “It still feels warm here. I haven’t had an erection like this in a long time. What was in that?”

  With a smirk, I explained it to him.

  “Isn’t nitroglycerin an explosive?” he asked. He was himself again, no question, but I was not sharing his euphoria quite yet and observed him with a doctor’s eyes.

  “What about your heart?”

  “Nothing. No pain. All gone.”

  * * *

  Heart and penis are an inseparable couple. Their arteries are of similar size, have a diameter of about two to three millimeters, and react to the same substances. The penis, too, fills with blood and discharges it again after ejaculation. In this it follows its very own rhythm of the tides of love, and yet it is inseparably connected with the heart.

  Viagra, knight in shining armor for weakened male desire, was originally developed as heart medication to widen the blood vessels around the heart. However, a “side effect” was far stronger.
Viagra also widened the blood vessels in the penis and created staunch erections. Thus, its fame as a potency-enhancing drug came about, and it rescues many men worldwide from their distress.

  * * *

  The better the heart rate variability and the more relaxed the man, the more durable is his erection. This is due to the vagus nerve being active and opening the gates; the hydraulics of the erection are set in motion: maximal influx of blood with simultaneous minimal efflux. When men are stressed and believe they have to perform in bed, the heartbeat becomes rigid, the vagus nerve loses its desire and man’s best friend droops.

  The penis’s biomechanical qualities also make it a desired object of investigation for engineers. Like the demands on the wings of a plane, those on the penis are immense: it must be flexible and elastic, but must not bend or break.10

  * * *

  When the dams break and everything flows, men as well as women reach a fulfilling climax. Maximum exertion and at the same time the biggest possible relief are united in a heavenly sensation. Hearts race and thoughts stand still. For a moment, “Radio Nonstop Thinking” is switched off.11 The ego is silent, the self ceases to exist in this union, we are pure self again—heart consciousness. Some also describe it as a state of deep meditation, as a transcendental experience. Buddhist traditions compare the climb toward the orgiastic experience to the eight stages of dissolution one goes through when one dies. The disintegration of the I, the release of all control, is sometimes also called a small death.

  * * *

  However, it is statistically highly unlikely that we really die when we have an orgasm. In one study, 536 patients who had suffered a heart attack were examined, and only three of them had had sex within the hour before the heart attack.12 A group of pathologists, too, examined “love death” and concluded that physical love rarely ends in fatality. In 38,000 post-mortems, the pathologists found hints of a natural death during amorous play in only ninety-nine cases, or 0.26 percent,13 even though the heart has to make quite an effort when we love to a climax. The pressure necessary for the man’s erection is four to ten times higher than normal blood pressure. Women, too, need an increased supply of blood from the heart when they engage in sexual activity.

  The heart not only gives life in the form of blood, but also takes care of the physical pressure of desire, which increases with the degree of arousal. It ends in the uncontrollable, ecstatic, rhythmical contraction of our muscles in the genital area which we call orgasm. The heart also performs an unwitting rhythmical contraction. Every single heartbeat is an orgasm of life! And maybe after twenty-two days there will be a sound coming from the silence. Ba-boom, ba-boom, ba-boom …

  Sick of heart and listless

  If the heart is permanently sick, potency may drop. The risk factors for coronary heart disease and erectile dysfunction are the same: high blood pressure, stress, smoking, diabetes, lack of exercise, and obesity. Heart and penis act in concert, and with the progressing illness of the blood vessels, the blood supply for both decreases. Sometimes, though, it is the other way around, and the missing erection can be a harbinger of a stroke or heart attack. A study published in 2018 exposed erectile dysfunction as an independent risk factor for cardiovascular diseases. The study (Multi-Ethnic Study of Atherosclerosis; MESA) was mainly concerned with the risk of atherosclerosis, and over 6,000 men and women were the subjects. Of the men, 1,914 were interviewed about possible potency disorders; 877 had erectile dysfunction—their average age was sixty-nine. Over an observation period of four years, the risk of a stroke or heart attack was two and a half times higher for the men with potency disorders.14 It seems to gravely affect the hearts of men when their penises fail. And vice versa. They obviously become sick. Repercussions of heart diseases and circulatory disorders on women’s sexuality are unfortunately much less researched. Moreover, heart disease in women continues to be more rarely diagnosed than in men, which is also due to the different symptoms. To what extent risk factors for the heart also include risk factors for the functioning of female sexual organs can, at the moment, not be said with any certainty. However, illnesses such as diabetes or severe obesity appear to also affect women’s sexual health.15 The question of whether reduced blood supply to the sexual organs constitutes an independent risk factor for apparent cardiovascular diseases in women, as it does in men, cannot be answered at present—although there are hints that it might indeed be the case.

  We smell with the heart

  Smell influences our choice of partners, and our nose likes to join our amorous play. But not just the nose! In 2017, receptors were discovered with which the heart can smell.16 However, it doesn’t smell “raspberry” or “cedar,” but fats in the blood. And when they do not agree with it, it will slow down and beat less powerfully! When I was at university, if someone had speculated that the heart could smell, they would not have been taken seriously. The scientists who have now discovered the heart’s nose suggest that scent molecules may also get into the bloodstream via the skin and then be perceived by the heart.17 For millennia we have known that essential oils can calm or revive our senses. A few drops of oil on the chest, rubbed in with loving movements: a little massage can be a balm and open lovers’ hearts. And not only their hearts …

  * * *

  It is sometimes already visible in the eyes. If they are wide and the cheeks red, this can be a revealing and promising sign. Then adrenaline, which also comes from the heart, will get to work. To imitate this “look of love,” Venetian women used to swallow the juice of the poisonous Atropa belladonna. This supposedly rendered them irresistible to men, and that may be a reason for the botanical name of deadly nightshade: bella donna means “beautiful woman.” People’s longing to help love along with potions is age-old, and in honor of the goddess of love, Aphrodite, they are called aphrodisiacs.

  Many aphrodisiacs have been examined predominantly for their neurobiological effect on the brain. On the question of whether oysters, shark fins, ginseng, or a specific “chicken soup cooked with love only for you” will promote or hinder the release of dopamine, serotonin, oxytocin, or endogenic opiates, the results are inconclusive. In an interesting scientific analysis on the pharmacology of love, the authors come to the conclusion that it is different for every couple. Too many unknown factors play a role. The authors contend that it is impossible as yet to anticipate the “magic moment” of falling in love and then immediately put the subjects under a scanner.18 I deeply respect my colleagues, but allow me one remark: maybe they are looking in the wrong spot. For if hitherto unknown receptors on the heart were only discovered in 2017, that shows that the final chapter in heart research is far from written.

  THE LONELY HEART

  Kordula was a petite woman in her mid-thirties, with an alert mind and dark curls. She ran a successful business and was a caring and loving mother to her two small children. She combined work and family seemingly effortlessly: her husband, an engineer, supported her in both fields. Kordula and Achim greatly valued self-fulfillment and freedom. She did not mind that he quite frequently went on climbing trips for several days with his mountaineering friends. She was more the ocean type, preferring scuba-diving trips and walks on the beach. To please Achim, she had tried climbing, but remained afraid of it.

  Even though the children would have liked to do something with their father on the weekends, he increasingly preferred to make conquests—and not just in the mountains. Kordula had a hunch, and in her heart sometimes felt a tightness, a heaviness, a pulling. When her hunch turned out to be true and she found proof of Achim having affairs, she was immeasurably disappointed and furious. But as a business leader she had learned to control her emotions, especially when she had a specific goal. And she had one: she wanted to save her family. After careful consideration she decided to continue with her marriage, even though it would be mostly in the interests of her children. Surely her husband would change one day, it was only a phase—and until then she would accept his escapades. She made a r
easonable decision, as she was used to doing in her work—a decision in favor of the project “family.” And then she got back to her everyday life and made an effort to pretend nothing had happened. Achim, too, made an effort, but Kordula doubted he was faithful to her. He was probably just more careful. At one stage she thought about employing a private detective. But that would have been very expensive. So she decided to remain true to her decision to keep her family together and look the other way when necessary. It would surely end at some point. Achim would come to his senses; despite it all he loved his children more than anything and would never jeopardize his relationship with them.

  * * *

  After a few weeks, Kordula’s heart began to palpitate, at first only at night. Then it would beat in her throat and hammer irregularly in her chest. She slept badly, sometimes for only a few hours. But she was disciplined and stayed in bed. Her body had to recover, as she had to get through long to-do lists every day. Her strategy seemed right, as the palpitation started to abate or get shorter. But then her heart started making itself known during the day too. This began during an important meeting. It was beating so hard Kordula had to leave the room. She could not accept this anymore. She had to be fully operational at the firm. That same evening, she confided in a friend who was a doctor. A little bit. She spoke about stress and sleeplessness. She kept the trigger, Achim’s unfaithfulness, locked up in her heart. Her ECG, her blood pressure, and other results were normal, and the doctor recommended relaxation techniques and more rest periods during the day. She kept to this assiduously. She listened to meditation music before going to sleep, and that seemed to work: the racing of her heart occurred less often.