LESSONS FROM THE HEART

With evidence that intangible things such as strong emotions can affect the heart more than metaphorically, the wise words of a psychiatrist delivered decades ago have taken on new resonance.

“I COULD HAVE SWORN MY FROZEN MYOCARDIUM WAS SET TO CRACK INTO A MILLION PIECES.”

Many years ago, my medical class at university was treated to a surprise. A half dozen or so various specialists filed into our lecture theatre and took their seats on the stage. Then one by one, they took their turn at the lectern to share their tales of adventure, feats of heroism and hysterical anecdotes all aimed at enticing us into their particular field. One by one each had me convinced that theirs was the specialty for me.

Then a psychiatrist ambled up to the microphone. The lanky doctor fixed the audience with kindly eyes and waited for the residual giggles and chatter to die down. He spoke, choosing his words carefully. Words I remember as clearly now as the moment they left his lips over three decades ago. Of all the classes in medical school, his short speech taught me the most about being human; lessons I still abide by today. “Why is it that when we are grieving,” he asked, “we say our heart is broken?” He then went on to paint a poignant clinical portrait of a mourning widow before asking another, more provocative question: “Is a broken heart just a metaphor or can strong emotions actually break the organ itself?”

Before he could get out another word, a dapper cardiologist on the panel jumped up and edged him away from the lectern, muttering something like, “Sorry, out of time.” But we all knew he wasn’t. An awkward silence fell over the audience. Finally, an immaculately suited surgeon sprang up and launched into a lively spiel about his raucous student days; we had tears in our eyes from laughing so hard. Unlike the broken heart story though, his didn’t survive the decades.

I left class that day feeling sorry for the lanky doctor. Not only was he surely wrong in his hypothesis, but he’d embarrassed himself by even asking it. I made a mental note to cross psychiatry off my list.

LOVE (REALLY) HURTS

One cold, grey afternoon a few years later I had cause to recall that lecture. The woman with whom I was hopelessly in love, took my hand, looked me in the eye, and said, “It’s over.” The earth shifted and my heart froze as if she’d poured ice into my chest. There was no metaphor about it. I could have sworn my frozen myocardium was set to crack into a million pieces. Around about the same time as my heart was beginning to thaw, a group of Japanese scientists were researching what they called Takotsubo cardiomyopathy.

They discovered that in some extreme cases, sudden, severe stress – as in a relationship break-up – can shock the cardiac muscle, causing it to swell and develop all the signs and symptoms of a heart attack (most victims, however, recover normal function within a month). The

condition is now better known as broken heart syndrome. Soon more information began filtering out about the heart and emotions. Major depression was revealed to be a risk factor for heart disease, and now there is evidence for other mental health conditions affecting myocardial function, too. That rangy doctor was right. Strong emotions can indeed harm the heart more than just metaphorically.

So, my first lesson was this: the folly of hubris, to presume my frame of reference about the human body is the one and only perspective. I had been on the side of the elegant cardiologist who’d shepherded the psychiatrist off the stage. The dapper cardiologist was after all a highly respected expert in all matters of the heart – all physical matters. Where he saw blocked arteries and arrhythmias however, the psychiatrist saw trauma and tragedy. As it turned out, both were right. Stay open, I often remind myself. Who knows what future research will uncover?

BEYOND THE TANGIBLE

I also came to understand that as a profession we focus much of our time and attention on tangible things – in this case the physical pathologies of the heart – because in part these are the ones that can be readily targeted by pills and surgeries. Yet the things that grip us the most as human beings, that can make our spirits soar or drive us to despair, are the strings pulling on our hearts. Some of the greatest causes for our miseries are the unseen ones. Hence, my second lesson was this: relationships and emotions can be much more powerful than we think. Indeed, the more I practised in the world of feelings (I’d since reversed that earlier career mental note), the more I witnessed their influence. And yet many of my medical colleagues discounted the usefulness in doing so because there was, in their words, “limited evidence”’ of the effectiveness. They were talking about scientific studies which by their very nature measure what is measurable.

But what of the immeasurable? Things like the myriad kinds of love, the complexities of investing in an emotional relationship, the hot stab of betrayal ... yes, these phenomena have surrogate measures (rating scales and the like), but their intangibility makes them difficult to study in a quantifiable way. Science likes the objective, and these things just aren’t. They are subjective. Hence my colleagues’ reticence.

Thus, my third lesson: just because something cannot be quantified does not render it insignificant (in fact, it is usually the converse). Meaning is what is important, more so than measurement. Subjective phenomena require different methods of inquiry. My own break-ups, betrayals, grief – you name it – drove me to look into my heart. But I acknowledge now that it could do with more peering into during the good times, too.

So, my last, ongoing lesson is that I need to pay more attention to the things that really matter; make time to listen to my heart and those of the people I love. Don’t take the strings for granted.

I often wonder what I’d say to that long-limbed doctor if I could go back in time. I’d probably tell him that he was right. To wait just a few years and his question would be answered and he would be vindicated. Or I’d tell him not to let what others think bother him (I don’t think it did anyway). Or that science would eventually feel its way into describing the immeasurable.

I would also tell him that although we never met, his prescient words and kindly eyes have been tugging at my heart for more than half a lifetime.