The Source of All Things

by Reinhard Friedl

  * * *

  This worked until Easter Monday, when her heart did not want to calm down anymore, even though everything was perfect. Together with Achim she had hidden Easter baskets for the children in the garden. They laughed and tussled while they searched. The light children’s voices mingled with the ringing church bells. A mighty bell clapper struck her heart, whose beats were more violent than ever before, and she had trouble breathing. You have to calm down, she commanded herself, but it did not work.

  “Mama, what’s wrong with you?”

  “It will be better in a second,” she replied. But that was a lie, and she knew it. She feverishly wondered what she should do. Then she called a taxi. Achim wanted to come. “Do everything as planned,” she told him. “The children have been looking forward to it. Go to the zoo without me. I’m sure I’ll be back soon.”

  The alarm system

  In the clinic, she was diagnosed with atrial fibrillation. With this kind of arrhythmia, the two atria no longer beat in sync with the rest of the heart: they flutter and no longer transport blood into the ventricles. The heart’s performance decreases by 15 percent. Patients no longer feel productive and get out of breath quickly. Often the heart also starts to race and beats like crazy, as was the case with Kordula. Today we know that strong emotional strain, fear, and being generally overwhelmed quite frequently lead to arrhythmia.1 If we neglect our needs over a longer period and do not succeed in finding a balance, the heart will at some point sound the alarm. The consequences may be severe—in the fluttering atria, blood clots will occur which may cause a sudden stroke.

  * * *

  In the clinic, Kordula was examined thoroughly. Illnesses of the heart valves—or occasionally even too much alcohol—can also cause atrial fibrillation or high blood pressure. But neither the ultrasound of her heart nor any other tests showed changes in the heart to match the symptoms. Her valves and the size of the heart chambers, her blood test results, and her inner organs—all appeared normal with Kordula. And when someone asked her how she was, she always answered truthfully. But she remained on the surface, describing only the racing of her heart, forgetting her hurts, the disappointment, anger, and worries. She was in a hospital, after all. Apart from that, wasn’t it the best strategy not to pay any attention to Achim’s infidelities? She did not want to give them too much weight. And surely the tablets would help to normalize the rhythm of her heart. But they didn’t. Only their side effects hit Kordula really hard. She felt more fatigued, and her general condition was abysmal.

  * * *

  There are many drugs for arrhythmia, but nearly all of them share one feature: they block certain channels to the heart, for example for ions such as sodium and potassium, or they block heart receptors and thus the heart’s ability to sense bodily states. In a healthy heart, everything is in flux and in a very fine balance. It is sometimes possible to force the heartbeat back into its proper rhythm by blocking certain feelers, for example with beta blockers. Millions of people take beta blockers or other such substances daily, often for decades. But they not only affect the heart, but the whole body, and can lead to fatigue, listlessness, bad moods due to depression, memory disturbance, and loss of libido.

  * * *

  The doctors decided to administer an electric shock to Kordula’s heart so that it would finally behave once again. Under anesthetic, she was connected to various heart monitors. Electrodes the size of a palm were stuck on the right and left sides of her thorax and connected with strong cables to a defibrillator. To be able to see exactly what was going on in the heart, an ultrasonic probe was placed very close to her heart via a tube through the esophagus. And she was tied to the table.

  It is important that the electric shock is synchronized and is fired at a point during the heart excitation when it does not produce a fatal fluttering of the ventricles but the correct rhythm. The software of the device takes care of that. The red button with the lightning symbol was pressed, and Kordula’s body twitched violently, her face grimacing, her head jerking. The monitor showed a flat line.

  I know this moment very well; during many heart operations or afterward the heart needs to be defibrillated. After the electric shock it is still for a second or two, shocked in the true sense of the word. Until the heart catches itself again and the new rhythm sets in. I have often experienced this stillness and realized with astonishment, after the defibrillation, how long one second can feel. Sometimes it seemed to me as if my own heart had stood still as well.

  * * *

  Unfortunately, the rhythm of Kordula’s heart did not change, even after two further attempts with increased voltage. Only her body twitched ever more violently while the heart remained unfazed. And so she was discharged from the hospital, as often happens with arrhythmia, or more specifically atrial fibrillation with an unknown cause. Ironically, this is also called “lonely fibrillation” as no illness has been found in the heart. In addition to the tablets to regulate her heart’s rhythm, Kordula was also given blood-thinning drugs to avert the danger of a stroke.

  When she was back at home, she felt as if she had aged many years, and felt very, very ill. It seemed to her as if the world had lost its color. Suddenly everything was only black and white. Melancholy thoughts afflicted her and she perceived many things she would usually do effortlessly as an insurmountable struggle. She did not recognize herself. Her family doctor prescribed a mild antidepressant. It worked in that she cared even less about things. What mattered was that she was able to function in her business and at home. With incredible self-discipline she managed to look after the children and lead her business. At 9:00 p.m. she would fall into bed exhausted, while Achim would often stay awake until after midnight, playing poker on the computer—his new hobby, he said. Kordula did not even want to know. She felt deep inside that something had lost its beat in a fundamental way.

  Then she heard about a method that had been successful for 50 to 70 percent of patients with similar symptoms, and full of hope she made an appointment at a heart center.2 There she was advised to undergo a procedure called catheter ablation. Using local anesthetics and fluoroscopic imaging, a catheter would be pushed, through the blood vessel in the groin, to the heart. With this method, cardiologists disable faulty electrical signals in the lung veins close to the heart and in the atria; circulating excitations are interrupted. However, the heart can also be badly damaged by such a procedure. For example, the flow of blood from the lungs may be hindered, or in rare cases life-threatening bleeding may occur. Kordula would possibly need a pacemaker, as the subtle control and permanent adjustment of the heart speed via the nervous system and the communication with the brain and the other organs may of course also be impeded.3 Imagine it as if we had cut a telephone cable. The patient would have more peace but would also not be able to receive calls anymore.

  “I’ll think about it,” she said.

  Achim did too. He was greatly worried, and a voice inside him (maybe coming from his heart) told him he was not completely free of blame for his wife’s arrhythmia. He wanted to change and assured Kordula of his support. Those were well-intentioned words, and she believed him, but her heartbeat remained unfazed.

  * * *

  In the days that followed, she talked to many people about the imminent decision—and that is how I got to know her. A friend told me about her case and asked me to advise her over the phone. She wanted my opinion.

  “You know all about the heart. What should I do?”

  In the course of our conversation I found out that she was placing her highest hopes at the moment on homeopathic therapy. An experienced GP, who had been recommended to her, had long been devoted to homeopathy and wanted to try this path. Dr. Herbst told me so herself when I spoke with her on the phone. She had all of Kordula’s results. She seemed reputable and competent to me; I also liked the way she spoke. “What heals is right,” she said quite a few times.

  During the consultation, Dr. Herbst had listened to Kordula for a long
time and asked a lot of questions no other doctor had asked before. Among other things, she inquired if something in her life had recently changed dramatically. Kordula burst into tears and spoke of her husband’s infidelities.

  Diagnosis of atrial fibrillation is as common as that of depression, and the risk increases with age. Often both illnesses occur together. They are nowadays both considered to be widespread. At an international heart congress in 2018, there was intense discussion about how closely the health of heart and brain are connected. It is not only the case that atrial fibrillation can lead to depression—a very recent study proves that it can also be the other way around: in patients with depression the risk of atrial fibrillation rose by about 30 percent.4 Dr. Herbst told me that she was convinced she would be able to help Kordula. “I am sure that my remedy will hit home. I am confident, dear colleague, that you will not have to operate on this heart.”

  Years ago I probably would have shaken my head at such a claim. But I had learned a lot recently. “What heals is right,” the doctor said again, as she bid me farewell.

  To heal the beat

  In my opinion, the word “healing” is a big word and therefore rather rarely used in medicine. Generally it is understood to mean the restoration of someone’s physical and mental health, or at least a restoration to the initial condition before their illness. To heal hearts was my profession, but I left considerable scars, and an operation can also have serious side effects—so the term “repair” might possibly be more accurate. Sometimes I also repair the rhythm of a heart, as atrial fibrillation doesn’t always occur by itself but can happen together with a defective heart valve, which has to be repaired in open-heart surgery. In such cases I also try to get the badly disturbed beat of the heart “back on track,” as in the case of Mr. Laschek.

  * * *

  I looked into his open chest and directly into his heart. It lay motionless before me; the heart-lung machine was softly humming. I had first repaired his leaky mitral valve. Of all the valves, I like this one the best, because its two valvular cusps give it the appearance of a smiley when they come together with their half-moon shapes. When the cusps of the mitral valve can no longer properly direct the blood flow because their geometry has changed, the valve becomes leaky and its smile vanishes. With several cuts and stitches I had given the cusps a new shape. Now a ring was also implanted, and the face got an outer frame which gave it extra stability. Of course this isn’t plastic surgery but a vital intervention—but the mitral valve was looking friendly again. To check if it was still leaking, I filled the left ventricle with a sterile saline solution and observed if it would flow back to the atrium. No leaks. Good. Now I could take care of the atrial fibrillation by ablating certain nerve pathways. When doing this I always felt like an electrician, as with atrial fibrillation the heart produces something like short circuits which backfire. I could emit high-frequency radio waves at the push of a button with a device that looked like a pen. With the resulting heat, it is possible to sever nerve tracts in a subtle way. I could not see them as they are very delicate and hidden in the heart wall. But in my mind’s eye I had a map of the heart with all nerve tracts marked. I put my heart pen on the spots where I visualized the tracts. It looked a bit as if I was scratching signs into an old tree. I wished the truth about the heart would trickle out like resin, but instead I only left scars which electrically separated the heart from the lung (pulmonary) veins. Then I sutured the “heart ears” (atrial auricles). Yes, the heart has ears. That is what the excrescences of the atria are called which look like two big ears. They are what makes the heart heart-shaped, and in them the ANP (atrial natriuretic peptide) is produced. During the operation concerning atrial fibrillation the heart ears are closed off from the inside with stitches, because otherwise dangerous blood clots may occur. Sometimes they are simply cut off because we believe that a large amount of the nerve tracts involved in the atrial fibrillation run inside the ears. I feel sorry about that every time as I like the heart ears. Maybe we will one day find that we hear more with them than we can prove today. Who knows, perhaps that was what the old anatomists were thinking, too, when they gave the heart ears their name. After I had closed them off, I also sutured the atrium and opened the blood flow to the heart. Mr. Laschek’s heart started to beat again after a few seconds, and to my great delight it was pumping with the right beat.

  * * *

  Most illnesses of the heart lead sooner or later to arrhythmia. Sometimes the brain is involved, too, with stress, fear, or depression. Whatever the causes, at the end comes a disruption of the energy flow through the heart. It can be treated in different ways, from the finest energies of homeopathy to high-frequency surgical isolation. Both methods treat the heart’s energetic disturbances with energy. To treat like with like is also the fundamental principle of homeopathy. Perhaps the medical worlds of healing the heart are not as far apart as it appears at first glance. “If your only tool is a hammer then every problem looks like a nail,” said the well-known psychotherapist and scientist Paul Watzlawick. That is why I, as a heart surgeon, deem it important to be familiar with a big repertoire of tools for the heart. Sure, only surgery can help with a gravely ill, anatomically deformed heart valve. However, when arrhythmia is of a mental or psychological kind, it makes less sense to tackle it at the heart. In such cases we can work with more subtle energies which involve the whole person. We should have the courage to lose the blinkers: what heals is right!

  * * *

  Four months later, I heard that Kordula’s arrhythmia had vanished. I was curious, called Dr. Herbst, and inquired about the name of the homeopathic remedy she had prescribed. It was a high-potency mineral salt, strongly diluted and then exponentiated by vigorous shaking. Homeopathy acts on the assumption that the dissolved matter becomes immaterial, energetic information. For many people that is incomprehensible. For this question of faith, a professor of experimental surgery always comes to my mind, who gave me the following advice in my last year of studies: “You can’t be a good surgeon if you haven’t understood the nature of matter. Inside you, matter is energy, and both can merge into each other. If the surgeon who you want to be one day, a surgeon to whom patients entrust their bodies, has not grasped that, he has also not understood the nature of wounds and healing.”

  In the black hole

  I am glad whenever I have time for my Porsche’s six-cylinder boxer engine. I love its roar; its heart is already a little older and air-cooled. On this mild summer evening I drove not only through the beautiful landscape near the Baltic Sea, but also through my own past. I could even hear the voice of my former professor. Back then he was a pioneer in his field who had devoted himself to the development of new surgical techniques. In his free time, he organized homeopathic seminars, held in a small lecture hall. These events were not printed in any university calendar. It was a quaint bunch which gathered late in the evening, as if for a conspiratorial meeting. There were country doctors, veterinarians, students, philosophers, and professors from different fields. I especially remember a biochemist with long white hair and a big bushy beard who found homeopathy downright “logical” and also tried to enthuse us all about quantum mechanics.

  After a few months of attending this circle I lost interest. I wanted to become a “proper” surgeon, to cut and stitch, to lay bypasses and replace valves. But had I understood the nature of matter and the energy of the heart? Of course I was familiar with the most famous equation in the world, Einstein’s theory of relativity: E = mc2. But what was behind it? According to the theory of relativity, little amounts of mass can become large amounts of energy, and vice versa. All you need to do this is the square of the speed of light. A speed which the heart of my Porsche was not capable of. Unhurriedly “we” were roaring home. In the evening I became lost in literature. It seemed to me as if I was comprehending some things in a new way. I was no longer the student, the young doctor from back then. I was a heart surgeon in search of the true heart. Matter and en
ergy are the essence of all being, inextricably connected, from the smallest parts of atoms to gigantic galaxy clusters.5

  That night I sat over my books for a long time, surfed the Internet, and when I finally fell asleep had wild dreams. At the speed of light I rode on atoms through galaxies that were expanding further and further and were eventually gobbled up by black holes. In these black holes, light was kept prisoner, and so was I. In the morning I woke up soaked in sweat and with a madly beating heart. I was confused. Where was all this going to lead me?

  * * *

  Some weeks later I became acquainted with the British sense of humor: subtle eccentricity and exquisite learnedness. Two world-renowned Oxford professors, heart researchers Denis Noble and David Paterson, converse about the future of heart medicine in a series of video interviews.6 Paterson shares my view that the greatest challenge for modern medicine is to bring back together the fragments of the human being (examined in every genetic detail) and integrate them in holistic medicine. This, he said, is the task of an interdisciplinary, transnational medicine—at the intersection of mathematics, physics, chemistry, information technology, engineering, social sciences, psychology, and philosophy. These intelligent words impressed me enormously, and I decided to further extend my search for the secrets of the heart and to think “bigger” than I had been trained to do. During my studies and in many places still today, cardiologists taught about the heart, neurologists about the brain, and psychiatrists about the soul. This reductionism of modern medicine has disassembled the human being into organ disciplines and molecules. On the one hand, that makes sense in order to understand functions in detail. On the other hand, the connections and important interrelations are neglected. The whole is, after all, more than the sum of the parts, and this “more” lies in the complex interactions of organ systems, body, psyche, and of course the environment. But which share could the heart have in the whole? Even though we sense them within us, we have so far not found any sensors in the heart for compassion and love. If you look very closely, the lovely German word wahrnehmen (to perceive) contains a very meaningful first part, namely wahr (true). So far I had never asked myself this question—is what we perceive (wahrnehmen) with our senses, what we hear, see, smell, taste, touch, and feel, actually the truth?