Pump On: A 'Sublime' Biography Of The Human Heart
SCOTT SIMON, host:
The heart is no mere metaphor. But what a metaphor its become for that part of ourselves that holds our deepest dreams, most precious hopes, validates love and, not merely coincidentally, sends the blood of life through our bodies.
A novelist and cardiologist have co-authored a book about the heart in science, history, culture and our bodies. Thomas Amidon, MD, is a cardiologist in Montana, and as been medical director of the Hope Heart Institute. And Stephen Amidon, a novelist, whose books include The New City and Human Capital. Yes, they're brothers. Their new book is The Sublime Engine: A Biography of the Human Heart. Dr. and Mr. Amidon join us from New York.
Gentlemen, thanks very much for being with us.
Mr. STEPHEN AMIDON (Author, The New City): Thank you. Its great to be here.
Dr. THOMAS AMIDON (Cardiologist; Medical director, Hope Heart Institute): Thank you, Scott.
SIMON: And let me ask you both and if the novelist could go first, that heart symbol we're seeing a billion ways this week, the Valentines hearts, Valentines candies, of course, I heart New York, doesn't much look like our hearts at all, as it turns out, does it?
Mr. AMIDON: No, it doesnt. Of all the theories about where that symbol comes from, my favorite is that it's a representation of a sixth century B.C. aphrodisiac from northern Africa. And I kind of like that history because it sort of suggests that early on, people understood the connection between love and the heart.
SIMON: And Dr. Amidon, would you change it if you could?
Dr. AMIDON: Ironically, I did an angiogram on a patient last week who had very calcified and hardened arteries that were almost precisely in the shape of the Valentine heart. But I don't think the early depicters of that heart shape had access to the same view of the heart that I have.
SIMON: I want to get both of you gentlemen to tell us the utterly amazing story of Hugh Montgomery.
Mr. AMIDON: Well, Hugh Montgomery was a 17th-century young Irish nobleman who as a little boy was out riding on a horse and he jumped over a fence and fell off that horse and landed on the fence and opened a hole in his chest. And nobody knew what to do about it. They couldn't close it and, you know, but he didnt die. He remained he actually got better. And yet, he had a hole in his chest which exposed some inner workings thereof. And as he grew older, his father had a metal plate put over it. But if you took that metal plate off, you could actually see something in there.
And up until his young adulthood, people thought that was his lung. And so, he toured Europe and was quite a sensation. He actually sold out theaters, you know, where people would take off this metal plate and look at the inside of his body working.
And it wasn't until Sir William Harvey, the greatest of all cardiologists, took a look inside his chest that he realized that it wasn't the lung at all that they were looking at - it was the heart. And this was really the first time anyone had seen the actual working of the heart.
SIMON: Dr. Amidon, one of the things that absolutely amaze me in this story is that people would touch his heart. He wouldn't feel anything. I mean the heart doesn't feel anything.
Dr. AMIDON: And, in fact, I encounter this on a regular basis when I perform procedures on patients. When I put catheters inside them, they're amazed to realize that they're not going to feel it inside their body. They may feel the initial needle puncture when I put a catheter in their artery, but when I'm up inside - placing catheters inside the heart, taking pictures of the heart, there is no innervation on the inside of the heart. You don't feel it at all.
SIMON: Um-huh. Reading this book I guess underscored for me for the first time why it's so difficult to operate on the heart. It's a little bit like trying to fix a car engine while the car is roaring around Le Mans.
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How do you operate on a heart that's beating and keeping your patient alive?
Dr. AMIDON: Well, that's a good question. And one of the remarkable advances and one of the technologies that allowed us to operate on the heart was to be able to stop the heart. And then you operate.
Well, of course, the body can't go without circulation or oxygen. And so it really was the development of the heart-lung machine in the 1950s that allowed surgeons to stop the heart and operate on it. The irony, of course, is that now in 2011 we're working diligently on techniques to operate on the heart without having to stop it.
SIMON: Yeah. I was intrigued - before we jump immediately to heart-lung machines. There was a doctor in Minnesota named C. Walton Lillehei. Dr. Lillehei operated on an 11-year-old boy at one point.
Mr. AMIDON: This is one of the reasons we wrote this book. When Tom told me this story about Lillehei, who actually took the circulatory system of a very sick boy and attached it to his father. So the father actually became the heart-lung machine that allowed Lillehei to have the 18 minutes or whatever it took for him to fix the hole in that boy's heart.
And Lillehei went on to perform this operation on a number of patients, where he would take very sick, you know, dying children - some of them babies - and actually take their veins and their arteries and attach them to those of a parent.
SIMON: How close is medical science, Dr. Amidon, to perfecting an artificial heart?
Dr. AMIDON: The difficulties aren't in devising a pump. That's been pretty well worked out. The difficulties are not having the blood that flows through the pump cause problems. So bleeding and blood clots tend to be the limiting factors with artificial hearts. But we have patients with assist devices that are basically externalized pumps walking around outside the hospital these days.
SIMON: Since heart transplants have now become ubiquitous, since we can foresee a time when some kind of pumping mechanism can function as an artificial heart, does the heart lose any of its metaphorical significance, culture significance?
Mr. AMIDON: One of the things that surprised me during the course of writing this book and that I came away from was how durable the heart's metaphorical power has been. Not just in the past 50 years, in the great explosion of cardiology that Tom talks about, but in the past 500 years since the Renaissance. Great anatomists of the Renaissance began opening up bodies and looking at the physical heart. Even as all this was happening the heart retained its metaphorical power.
So perhaps there'll be a day when we no longer touch our chest and kind of nod and people understand we're talking about qualities that can't be explained by medicine, we're talking about courage or devotion or inspiration.
I mention at one point in the book that you can have a situation where someone receives an artificial heart and, you know, afterwards goes to their surgeon and says I thank you for this from the bottom of my heart. And, you know, this will make complete sense to us. So as of now I don't see any diminishment whatsoever in the heart's metaphorical power.
SIMON: Well, gentlemen, thanks both very much for being with us.
Mr. AMIDON: Well, thank you very much.
Dr. AMIDON: Thank you.
SIMON: Thomas Amidon, M.D. and Stephen Amidon, novelist, brothers, whose new book is "The Sublime Engine: A Biography of the Human Heart."
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