Excerpt: Haider Warraich’s ‘Heart of the Matter’

The American physician and clinical researcher explores the history, science, and future of cardiac disease
By TVO Current Affairs - Published on Jul 26, 2019

Comments

X

I was sitting in a coffee shop with my wife and baby daughter, our table awash with sunlight, when the barista tiptoed over, delicately balancing the latte my wife had ordered. As he placed the large ceramic cup in front of her, something instantly made us smile. Beneath the reams of steam rising from the coffee, he had drawn an immaculate and whimsical heart in the foam. It made our day.

The heart is as much an organ that keeps us alive as it is a metaphor that helps define some of the most powerful, at times irrational, impulses we feel. It aids songwriters at their wits' end, helping finish unwritten songs. It helps lovers put down in words what only the other can see, the other can feel. One doesn’t even need to know how the heart works, how the heart comes to be formed, and all the beautiful mechanics that constitute its immaculate design to be bathed in its self-evident splendour.

The heart, though, is not just a symbol of beauty or love; the more you understand its actual function, its day-to-day existence manifest in every beat, the more its actual living beauty is actualized. Cardiologists dedicate their lives to appreciating what the heart is and then using that understanding to mend people’s hearts — as much in allegory as in actuality. Between medical school and clinical training, it takes more than a decade to gather all the knowledge needed to be able to diagnose, prevent, and treat all the afflictions the heart can gather over a lifetime of hard, incessant labour.

There are many perks to being a cardiologist, but the one thing that unites us all is our fascination with the sheer, untainted beauty of the heart. Like a labyrinth that goes deeper and deeper, like a code that can never be cracked, the heart is so obvious in its magnificence that it is in its enigmatic details that its intricacy emerges. On any given day, using several different advanced imaging technologies, we get to see the hearts of many beat away, in radiographic loops that seamlessly flow in infinite cycles. At the same time, we talk to patients and their families at length about their cardiac health, the treatments they may or may not be able or willing to get. Interventional cardiologists who do invasive procedures, including inserting miniscule metal stents to open up the blood vessels supplying the heart, get even more up close and personal with the heart. And perhaps no one is closer to the human heart, and more aware of its maze of vessels and chambers, than the surgeon who can hold the heart of another in their hands with the human chest splayed wide open.

There are a variety of reasons behind why many choose to go down this path of training, and most of them are less romantic. During the first year of my cardiology training, in the middle of the night in Durham, North Carolina, while I slept, on the very other end of the planet in Pakistan, a man in his mid-60s started to sweat profusely early in the morning. He then felt light-headed and had to sit down to gain composure, not knowing what was going on. His wife, my mom, knew: my dad was having a heart attack. There was no one else at home. She didn’t call the ambulance. She put him in the back of the car and rushed him to the nearest hospital.

About an hour after they had reached the emergency room, my mom called me. During that hour, he’d had an electrocardiogram, which was read by a cardiologist, who immediately knew that he was having a heart attack — a serious one. The cardiologist activated the cardiac catheterization lab team, who swooped in and took Dad right in. Within minutes of him getting there, through a small puncture in his leg — using a long, slim, plastic-based catheter — they had made it all the way up to his heart, where they saw a blood clot completely obstructing the main blood vessel supplying it. They deployed a small metallic stent in the blocked blood vessel, restoring blood flow.

When I talked to Dad only moments after the procedure was over, he told me how everyone seemed so calm, that there was no commotion, that they just went ahead and did their jobs. In this instance, their job saved his life, and their timely response ensured that his heart was not affected in any way. All this happened while I was still asleep 7,000 miles away. In modern medicine, where chronic disease dominates, there are few moments one can look back on and truly feel like they saved a life. For those taking care of patients with heart disease, moments like these are not an exception — it is their very job. More than anything, it is for moments such as these that many embark on this journey.

Not all love stories have happy endings, though. My first memory of being in a cardiac hospital is very vivid to this day. I was around six or seven when one of my uncles was admitted to that very same hospital my mom drove my dad to after his heart attack. When I went with my parents to visit my uncle, a curious sign greeted us at the entrance: children are not allowed in the hospital, it proclaimed. It was too late for us to turn around, so my parents snuck me in, something that was perhaps not so out of the ordinary back in Pakistan. I was walking down the main hallway when suddenly, I heard a loud shriek. Ahead of us, I saw a young woman wrapped in a large shawl who was running from side to side in the hallway, flailing her arms, until she collapsed to the ground. Her family rushed to her and tried to lift her off the floor, but she fought for her right to stay down. She was wailing in a way I could never have imagined would be possible. I had never heard sounds like that coming from a human being, and that traumatic sight lives with me to this day. She had not been as lucky as I would be almost two decades into the future. Her dad never called her after the heart attack — and he never would again.

For physicians and romantics alike, the heart has always been an irresistible, shimmering mirage on the horizon, forever drawing both toward it. The connection between us humans and our hearts always come down to anguish or elation, agony or exhilaration, affliction or enchantment. Many have trodden this path to unlock the secrets of the heart so as to conquer it, through words and verse or analysis and experiment. Walking back down this path leads us all the way back to ancient Egypt, where the first records of our study of the human heart were unearthed.

Copyright © 2019 by the author and reprinted by permission of St. Martin’s Press.​​​​​​​

Related tags:
Author