Fri Aug 20, 2004

A Man After His Own Heart

Draft review of A Man After His Own Heart, by Charles Siebert. (Final version to appear in The Drawing Board.)

The language of the heart is all-pervasive. Art and everyday life are full of emotions expressed through talk about the heart, be it given or joined, singing or broken, closed or kind. The Ancient Greek view that the liver is the seat of the soul can seem plausible on a good Friday night, and Descartes’ case that it’s our head that matters may be felt with some force the following morning. For sheer range of metaphor, though, the heart has no serious competitors. But what about the thing itself? The cheerful curve of a Valentine’s heart does not convey what a real heart looks like. A heart ache is not a heart attack. We all know that the heart is a pump that moves blood around the body, but very few of us could give an accurate account of how it happens. The dynamic interplay of all those chambers, arteries and valves is difficult to picture, hard to explain, and took a very long time to discover.

Yet, at the same time, we are more familiar than ever with the risks of cardiac arrest and the danger of heart disease. Coronary bypasses are routine and a heart transplant these days is a standard (if difficult) option rather than an exotic experiment. So there are two ways of talking about the heart: as a metaphor for ourselves and our innermost feelings, and as a key bit of internal plumbing, in need of maintenance and regular upkeep. Advances in medicine over the past century or so, and especially in the last thirty years, have made it difficult to keep the two separate. The real heart intrudes more and more on its imagined counterpart.

An early example is Robert Louis Stevenson’s short story “The Bodysnatcher,” written in the 1860s. It was inspired by the crimes of Burke and Hare, the “Resurrection Men” who procured corpses for use in Scottish medical schools. The usual way to do this was to trawl for the unwanted bodies of the indigent poor, or to rob graveyards. The medical faculty put a premium on freshness. Burke and Hare did very well because the corpses they procured were in unusually good condition. But it turned out this was because, rather than waiting for Edinburgh’s down-and-outs to die of their own accord, they had taken to murdering them instead. It was certainly more efficient. The horror of the resurrectionists persists in films like Dirty Pretty Things, whose characters fall into the world of illegal organ procurement, and in the still-common fear that medical staff might be tempted to rush to procure the organs of prospective donors on life-support machines. Two other recent films, Return to Me and 21 Grams, address (as comedy and drama, respectively) the connection between the recipients of heart transplants, the new heart beating inside them, and the survivors of the dead donor.

Charles Siebert explores this territory in his book. A Man After His Own Heart begins with Siebert lying in bed in New York waiting for a call to accompany a procurement team on a “heart harvest,” the process whereby a heart is removed from its donor, then packaged and rushed to the operating theatre where its prospective recipient lies waiting. This chain of events is usually hidden from public view, and the literature on transplantation contains few descriptions of it from an outsider’s perspective. Like the surgeons, the procurement co-ordinators and the transplant recipients, Siebert had to wait and wait, beeper in his pocket, for the call that a donor had been found—that is, for the news that someone had died in a car crash or some other terrible circumstance, had been found in time to be placed on a respirator, and whose next-of-kin had consented when asked to donate their organs. Siebert takes the length of the book to bring the reader from this waiting to the final moments in surgery when the donor heart is cut out of its chest.

Along the way, he digresses. His father suffered from hypertrophic cardiomyopathy (HCM) and died when his weak heart finally gave up after years of struggling and near-failure. The heart attacks his father suffered were mirrored—or parodied—by Siebert’s own hospitalizations for what turned out to be anxiety attacks. But HCM is a hereditary condition and he is faced with the prospect of a test to discover whether he carries the defective gene that causes it. As Siebert takes us through the heart harvest, we also follow him through his past and his difficult relationship with his father. His fear that he might suffer his father’s end leads him to follow up on current science about HCM and the heart in general, as well as the history of efforts to unravel its function and document its failings. These themes are intercut with each other in a way that initially seems a little disorienting, but brings home Siebert’s conviction that “the heart is not only the mirror but also the mime of our ever-shifting physical and psychological states.” Both personal experience and scientific research, he believes, confirm that the heart itself—and not just its poetic representation—reflects and expresses our emotional life.

The central drama of the book—the heart harvest and subsequent transplant—is compellingly told. Siebert’s description of how a surgeon took his hand and placed it on the donor heart as it beat in its new body is remarkable. Considered as a piece of surgery, a heart harvest and transplant is not nearly as complex as the same procedure for a liver. But the heart has the shortest survival time outside the body, so its recipient must be ready and waiting for it. The heart is then harvested first and immediately transported to its destination. This can lead to a certain amount of tension between the heart surgeon and those in charge of the other organs, as procurement is delayed a little in order to prep the recipient. Even in the operating room, the heart retains its place at the top of the pecking order.

Siebert’s prose style is rich and allusive, and sometimes book’s arteries clog up and clot. The drama of the harvest suits his writing well, but small episodes from the author’s past are made to bear a little too much weight, and some observations become a bit too thick with references and significance, like Proust in need of a pacemaker. But Siebert’s account of the science of the heart is engaging, with unlikely links between fly wings and heart muscles and walk-on appearances by the Spanish Inquisition and highly-strung transplant surgeons. He visits patients waiting for a heart, clinging to life while hoping someone else will die in time for them to get a second chance, as well as the lucky ones with new hearts. Recipients sometimes say they have new cravings or habits post-transplant that they attribute to the personality of their donor. This might sound fanciful, but Siebert’s chilling description of the depressed and empty psychological state of some of the patients who received Jarvik-7 artificial hearts certainly gives one pause.

Just a few months ago, a grey, shriveled object encased in a cut—crystal egg was reverently transported to France and buried in the royal crypt at the Saint Denis basilica, having been identified through DNA testing as probably the heart of the dauphin Louis Charles, Louis XVII as he would have been, who died during the French Revolution. The ritual of removing the heart and burying it separately from the body is very old, and was common enough into the late 19th century. The actions of a few sentimental French royalists may seem like an odd survival, a bit of self-indulgence, but the work of transplant surgeons and organ procurement organizations gives us a new twist on the practice. We might think that, as transplants and related treatments become more and more common, the image of the heart as a simple pump would displace the older notions. A Man After His Own Heart suggests instead that the gap between the heart and its metaphors is narrowing not because the one is replacing the other, but because they are in the process of being stitched tightly together.