Laura: Eighty percent of Americans between sixteen and sixty-four have the beginnings of coronary artery disease. Sophia: Hold on, say that again. Eighty percent? That can't be right. That’s basically everyone. Laura: It’s not a typo. Most of us, right now, are walking around with the early stages of the world's number one killer. And today's author, a cardiologist, was one of them. Sophia: Wow. Okay, that’s a hook. A heart doctor with heart disease. Laura: That shocking reality is at the center of Heart: A History by Sandeep Jauhar. Sophia: And Jauhar is the perfect person to write this. He’s a top cardiologist, but what really drives the book is his own family history—his grandfathers both died suddenly from heart attacks. It’s deeply personal for him. Laura: Exactly. That personal stake, combined with his medical expertise, is why the book was longlisted for the prestigious Wellcome Book Prize. It’s not just a medical text; it’s a human story. And it starts with a moment of terror for the doctor himself.

Laura: Jauhar’s story begins when he, a heart doctor, gets a CT scan for a persistent cough. He's worried about his lungs because he was a first responder on 9/11. The scan comes back, and his lungs are fine. But there's a small, incidental note at the bottom of the report. It says: "Coronary artery calcifications are noted." Sophia: Oh man. That sounds ominous. What does that even mean? Laura: It’s a sign of plaque buildup in the arteries of the heart. Atherosclerosis. He describes getting spam emails every Father's Day with the subject line: "Make sure Dad is not among the hundreds of thousands of men in America who appear healthy but are actually a ticking time bomb." And suddenly, he realizes he might be that ticking time bomb. Sophia: A cardiologist getting this news must be surreal! He knows exactly what it means. He can't just brush it off. Laura: He can't. He uses the standard risk calculator, which tells him his ten-year risk of a heart attack is low. But he knows those calculators are flawed, especially for people of South Asian descent like him, who have a higher genetic risk. So he opts for a more advanced scan, a CT angiogram, which gives a 3D view of his arteries. Sophia: And what does it show? Laura: It's worse than he thought. He has significant blockages. One is a 50 percent blockage in a major artery. He’s in the dark room with the radiologist, looking at these images of his own heart, and he writes, "Sitting numbly in that dark room, I felt as if I were getting a glimpse of how I was probably going to die." Sophia: That gives me chills. The expert becomes the patient. It forces him to see the heart as more than just a clinical problem. It becomes this source of personal mystery and fear. Laura: Precisely. And that personal fear connects him directly to his family's past. He tells this incredible story about his paternal grandfather in India in the 1950s. His grandfather was bitten by a snake in his shop but seemed fine. Later that day, his neighbors bring in the dead cobra that supposedly bit him. Sophia: Oh no, I can see where this is going. Laura: The moment his grandfather sees the snake, he turns pale, clutches his chest, and collapses. The official cause of death was a heart attack, likely triggered by pure fright. The family always said he died of a broken heart. Sophia: Wow. So the emotional heart and the physical heart collided in that moment. We still use that language today, don't we? We say someone is 'heartbroken' or has a 'heavy heart' or needs to 'have the heart' to do something difficult. Laura: Exactly. For most of human history, the heart wasn't just a pump. It was the seat of the soul, of courage, of love. The ancient Egyptians believed the heart was the only organ left in the body during mummification because it would be weighed against the feather of truth in the afterlife. The Aztecs offered still-beating hearts to their gods. The metaphor was the reality. Sophia: It’s amazing how that symbolic weight has stuck around. When Barney Clark got the first permanent artificial heart, the Jarvik-7, his wife’s first question to the doctors was, "Will he still be able to love me?" Laura: A perfect example. She wasn't asking about blood pressure or circulation. She was asking if the machine in his chest could hold what his real heart held. This deep, ancient mystery of the heart is the backdrop for the entire history of cardiology. For centuries, it was considered untouchable, sacred. Sophia: So if the heart was this sacred, untouchable thing for so long, how on earth did we get to the point of operating on it? How did we go from metaphor to machine?

Laura: That transition from metaphor to machine is one of the most dramatic stories in medicine. For centuries, the heart was considered off-limits. The famous surgeon Theodor Billroth wrote in the 1800s that any surgeon who tried to stitch a heart wound would lose the respect of his colleagues. It was seen as surgical madness. Sophia: So who was the first to try? Laura: One of the most incredible stories Jauhar tells is about Dr. Daniel Hale Williams in 1893 Chicago. Williams was a pioneering African American surgeon who founded one of the country's first racially integrated hospitals. A young man named James Cornish is brought in after a saloon brawl with a stab wound to the chest. He's bleeding internally, his heart is failing. He's dying. Sophia: And no one has ever successfully operated on a heart before. What does Williams do? Laura: He does the unthinkable. He opens the man's chest, finds the pericardium—the sac around the heart—is torn, and he sutures it. He saves the man's life. James Cornish lived for another twenty years. It was a landmark moment that proved the heart wasn't some mystical, untouchable organ. It was a piece of anatomy that could, with immense courage, be repaired. Sophia: That is an incredible story. It’s a medical breakthrough and a story of breaking racial barriers at the same time. But that's repairing the sac around the heart. What about operating on the heart itself? Laura: That was the next, even bigger, hurdle. To do complex repairs, like fixing a hole inside the heart, you need the heart to be still and empty of blood. But the brain can only survive for a few minutes without blood flow. This was the central problem of cardiac surgery for decades. Sophia: It sounds impossible. How did they solve it? Laura: Well, before they solved it cleanly, they tried some truly audacious and ethically terrifying things. Jauhar tells the story of Dr. C. Walton Lillehei at the University of Minnesota in the 1950s. He was a surgical cowboy, a true maverick. He had children dying of holes in their hearts, and he was desperate. Sophia: What did he do? Laura: He came up with a technique called "cross-circulation." He would take a child patient and, in the operating room, hook their circulatory system up to one of their parents, usually the father. The father's heart and lungs would oxygenate the blood for both of them, keeping the child alive while Lillehei stopped the child's heart to repair the defect. Sophia: Wait, they hooked a child up to their father's circulatory system? In real time? That is unbelievably risky. It sounds like something from a sci-fi movie! Laura: It was. They were essentially using the parent as a temporary, living heart-lung machine. The risk was enormous—if anything went wrong, you could lose both the parent and the child. The first patient, a little boy, died of pneumonia eleven days after the surgery. But Lillehei didn't stop. He kept refining the technique, and he started having successes. He fixed the hearts of dozens of children this way. Sophia: That's just mind-boggling. The desperation of the parents, the audacity of the surgeon. It’s a perfect example of that quote Jauhar includes from another surgeon: "When a condition is recognized as offering only a fatal or hopeless outlook, desperate measures seem less desperate." Laura: Exactly. It was a brutal, high-risk solution, but it was a bridge. It proved that open-heart surgery was possible and paved the way for the invention that would make cross-circulation obsolete: the heart-lung machine, which could finally take over the heart's function mechanically. And that led to pacemakers, defibrillators, transplants... the whole modern arsenal. Sophia: So we went from seeing the heart as a sacred soul to a complex but fixable machine. A pump with wires and valves that could be tinkered with. Laura: Yes. But as Jauhar argues, that's not the end of the story. These machines and surgeries were incredible breakthroughs, but they treat the heart as just a pump. Jauhar argues the next frontier is understanding the heart's deep connection back to our minds, back to that metaphorical, emotional self.

Sophia: What do you mean? How does the emotional side come back into play once you have all this amazing technology? Laura: Jauhar explores this through the paradox of the implantable cardiac defibrillator, or ICD. This is a device, like a pacemaker, that's implanted in patients at high risk of sudden cardiac death. If it detects a fatal arrhythmia, like ventricular fibrillation, it delivers an electrical shock to reset the heart. It's a lifesaver. Sophia: Okay, that sounds great. A little guardian angel in your chest. Laura: In theory. But Jauhar tells the story of a patient named Lorraine Flood. She gets an ICD and at first feels a huge sense of relief. But then, it starts going off. And the shock isn't a little jolt. She describes it as feeling like a donkey kicking you in the chest with all its might. Sophia: Oh, wow. I never thought about what the shock would actually feel like. Laura: It's incredibly painful and terrifying. Lorraine gets shocked sixteen times in nine days. She gets shocked in her shower and is thrown against the wall. She develops a Pavlovian fear of places where she's been shocked. She becomes anxious, isolated, and lives in constant dread. She says, "I still wake up every morning and pray to God and say, ‘Lord, please, no shocks today. Please, no shocks today.’" Sophia: That's a terrible paradox. The thing keeping you alive is also the source of your trauma. It creates this vicious cycle, right? The fear and stress probably make arrhythmias more likely. Laura: You've hit on the core of it. That's the mind-heart connection in its most brutal form. Jauhar cites the work of another cardiologist, Bernard Lown, who did experiments with dogs. He found that just by putting them in a stressful environment—a sling where they felt helpless—he could dramatically increase their dangerous arrhythmias. The psychological stress made their hearts physically more vulnerable. Sophia: And Jauhar saw this firsthand, didn't he? After 9/11? Laura: Yes. He was volunteering at the makeshift morgue at Ground Zero, an experience he describes in harrowing detail. Later, he learns about a young woman who was rescued from the rubble. She had no physical injuries, but in the weeks that followed, she started having recurrent, life-threatening ventricular arrhythmias. The trauma had rewired her heart's electrical system. Sophia: It's such a powerful, and tragic, illustration of how the emotional heart and the physical heart are the same thing. This focus on psychosocial factors is so important. It's a shame, as some critics noted, that the book doesn't also explore how these factors, and heart disease itself, affect women differently. That feels like a missed opportunity. Laura: That's a very fair critique. The book focuses heavily on the historical narrative and the author's personal experience, and a deeper dive into gender disparities would have made it even stronger. But his central point remains incredibly powerful: we've spent a century perfecting the heart as a machine, but we're only just beginning to grapple with its vulnerability to our own minds.

Sophia: So after all this history, from metaphor to machine and back again, what's the big takeaway from Heart: A History? Laura: I think Jauhar's journey shows us that the future of heart health isn't just in a better stent or a new surgical technique. A study he cites found that as we've gotten faster at opening blocked arteries during a heart attack—shaving minutes off the "door-to-balloon" time—the actual survival rates haven't really improved. We may have hit a point of diminishing returns with technology alone. Sophia: So the next great leap forward isn't mechanical? Laura: It's likely not. The next leap is in bridging that ancient gap between the metaphorical heart and the physical one. It’s in understanding and managing the emotional life that the heart, for thousands of years, was believed to contain. It's about addressing stress, depression, hopelessness, and social connection. Sophia: It makes you think about the "small satisfactions" the book mentions. Maybe the best preventative medicine is less about a perfect, stressful diet and more about genuinely managing stress and finding joy. Laura: I think that's exactly it. Jauhar ends the book by reflecting on his own diagnosis. He starts practicing yoga and meditation, not just for the physical benefits, but to learn, as his friend tells him, to "get out of his mind." He realizes that his mindset, his coping strategies, his capacity to love—these things are also a matter of life and death. Sophia: It’s a powerful idea. The heart isn't just a pump we carry in our chest; it's the organ that carries us. Laura: Beautifully put. We’d love to hear what you think. What does the 'heart' mean to you beyond just biology? Find us on our socials and share your thoughts. Sophia: This is Aibrary, signing off.