A cardiologist on matters of the heart

Being a cardiologist, Sandeep Jauhar beautifully weaves his own experiences with the defining discoveries of the past to tell the story of our most vital organ.

In Richard Selzer's fictional story "Whither Thou Goest," a widow searches for the man who received her late husband's heart. The liver, kidney and corneas were in other people, but she needed to be with the heart. When she and the stranger ultimately connect, it's as if she's recovered lost love. I, on the other hand, always considered the heart a pump, much the way a doctor explained it to Sandeep Jauhar during his cardiology fellowship. "In the end," the doctor said, "cardiology is mostly a problem of plumbing."

Jauhar quickly learned otherwise. His gripping new book, "Heart: A History," had me nearly as enthralled with this pulsating body part as he seems to be. The tone — a physician excited about his specialty — takes a sharp turn from his first two memoirs. The first, "Intern," was filled with un- certainty; the second, "Doctored," with disillusionment.

Jauhar hooks the reader of "Heart" in the first few pages by describing his own health scare — an exam showed obstruction in the main artery feeding his heart. We don't hear more about his condition again until the final chapter, when a further assessment reveals premature ventricular contractions, "a mostly benign condition in which my heart flutters or does a sort of flip-flop when an extra, unexpected beat comes in." Sand- wiched between his own heart tests is his journey to understand this organ that has mystified and frightened him ever since he was a child and heard about his grandfather's sudden death from a heart attack.

Most chapters launch with a riveting scene: a patient in the thick of getting a heart transplant, say, or having open-heart surgery. You feel as if you're watching an episode of a medical television drama. Before we find out what happens, Jauhar takes us back in time to explain the discoveries that made all of these advances possible.

That's where the stories get particularly strange and capti- vating. We read about Werner Forssmann, who attempted one of the first cardiac catheterizations in 1929. He did it on himself. Forssmann threaded a thin tube through his arm until it pierced his right atrium. Colleagues called him a quack. Almost 30 years later, he won the Nobel Prize in Physiology or Medicine.

We go into an operating room where a young girl is having open-heart surgery, tethered to a heart-lung machine. Then we learn that the concept for this machine began with one doctor's brazen idea of connecting a patient to another person's blood supply. He was inspired by the way a fetus feeds off its mother. Six of seven cases ended with a death.

Eventually, the heart-lung machine replaced the volunteers. The machine got off to a rough start too: 17 of the first 18 patients died. As one of the mid-20th-century researchers remarked, "You don't venture into the wilderness expecting to find a paved road."

Being a cardiologist , Sandeep Jauhar beautifully weaves his own experiences with the defining discoveries of the past to tell the story of our most vital organ. Amid gripping scenes from the operating theatre, Jauhar tells stories about the patients he has treated. And he relates the moving tale of his family's own history of heart problems, from his grandfather's sudden death in India – an event that sparked his lifelong obsession with the heart – to the first ominous signs of his own mortality.

He also confronts the limits of medical technology and argues that future progress will be determined more by how we choose to live than by any device we invent.

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Aster Medical Journal
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