Photos by Georgia Krause
Dr. Sandeep Jauhar grew up with a healthy fear of unhealthy hearts. His grandfather died unexpectedly of cardiac failure in front of Dr. Jauhar’s father. Growing up in the Jauhar house, the biological heart was a source of fear and mystery. Seeking to not only understand his fears, but alleviate those of others, Dr. Jauhar became a cardiologist.
After years of looking at other people’s heart problems, Dr. Jauhar had a problem of his own. This experience re-oriented his perspective: he now understands the human heart to be intricately connected with our emotional states. Through this exploration of heart as metaphor and cardiology as hard science, Dr. Jauhar authored the book Heart: A History. CONVICTS sat down for a hearty chat with the cardiologist and got his word on broken heart syndrome, the violent impact of stress on our bodies and the spookier qualities of transplanted hearts.
Hey there, doctor. To begin could you tell us who you are and what you do?
My name is Sandeep Jauhar. I’m a cardiologist. I direct the heart failure program at Long Island Jewish Medical Center. I’m also a contributing opinion writer at The New York Times and the author of Heart: A History.
So what does a day in the office look like for you?
My daily work mostly involves seeing patients with congestive heart failure because I am a heart failure specialist, but I also see patients with general cardiac conditions. I’ve always been fascinated by the heart. Actually, a lot of that is driven by my family history. My father’s father died when he was in his early 50’s, very suddenly. He had a heart attack while having lunch in the presence of my father, so that really impacted my father and by extension all of us. Growing up we had this sort of…fear of the heart.
Can you talk a little bit more about this ‘fear of the heart?’
Sure. It’s the sense that the heart can kill quickly. It can kill you even when you’re healthy. So people can be walking around doing their their normal activities and then suddenly be stricken with a heart attack or a life-threatening arrhythmia and pass away.
So when I was a kid I just thought of that as such a profound thing and also as kind of a cheat. When someone has cancer, for example, they tend to slowly get sicker and sicker and sicker. You have a chance to say goodbye. With the heart, it’s different. The heart is really the only organ that can precipitate a sudden unexpected death. From that standpoint, it was something to be held in awe and fear.
Can you tell us a bit about your own experience having a heart condition?
I was a first responder at 9/11 and many years later, for still unclear reasons, I would get a little short of breath and get a bit of a cough. So I said this is bothering me, maybe I should get a CAT scan, which basically never uncovered why I was feeling a little short breath. What was important about the CAT scan was that there was an incidental finding that I had calcium in my coronary arteries. It was one of those weird things where I had seen hundreds or possibly thousands of cat-scans over the course of my career…but mostly of in older people. But I was 45 years old and you can’t have coronary plaque without having calcium. So there seemed to be something there. Of course, that led to another scan which dedicated to the heart. It looked at the the blood vessels and I found that I had some degree of blockage in all three arteries. It was one of those things where I had spent a lot of my life worried about the heart, worried mostly about how it might affect my father, wondering whether he had the same predisposition to an early cardiac death and then I found out that I myself have coronary disease.
So it was really very upsetting. It was unexpected. But at the same time I thought it was sort of fated. We have this long history of cardiac problems in my family. Not just my paternal grandfather but also my maternal grandfather also died of a heart attack and ultimately my mother also died of heart attack. So it was one of those things where I thought “Well, you know, I’m next. It was really a recognition that this was part of my biology and part of my family history and inspired me to make some changes.
How did that experience change your relationship to work?
There’s no question that it made me think a little more deeply about the heart and my patients experience of their own disease. No question: it inspires empathy for the patient experience when you become a patient yourself.
The experience nourished my sensibilities as a doctor, but at the same time you know, I did a deep dive into what it was about my life other than a genetic predisposition – which I can’t change – that may have caused some of this coronary disease. I started looking deeply at the how our emotional lives affect our hearts, how the heart has always been considered the seat of the soul, the repository of our emotions.
Where did that search lead you?
I became fascinated by how the metaphorical object–the emotional heart–intersects with the biological heart. In other words, I wondered how our emotions affect our hearts biologically. I came to learn how strong that connection is when I started asking my patients about what was going on in their personal lives and relationships. Questions that I didn’t ask as much in the past.
It’s actually scary that during most doctor patient interactions, the doctor will interrupt the patient within about twelve seconds. And I was probably no different. I’d just start asking questions about chest pain and shortness of breath and symptoms whereas the patient might just want to talk a little about what’s going on in their life and how it’s affecting them. Now, I’m much more apt to let my patients talk without interrupting. I’ve developed a greater appreciation of of how their emotional lives affect them clinically.
So how do our emotional lives impact our heart health?
So we know that emotional stress deeply affects the heart. It affects the heart acutely. Classically, there is a condition colloquially called ‘broken heart syndrome’ in which patients who have an acute emotional disruption in their lives – typically grief over the loss of a romantic relationship or grief over the death of a loved one – have an emotional reaction that actually physically changes the shape of their heart.
I see cases of broken heart syndrome every year. The scientific term is takotsubo cardiomyopathy. Takotsubo is a special Japanese pot and under acute emotional stress, the heart can change into this the shape of this pot. That’s why it’s called takotsubo cardiomyopathy. It acutely weakens the heart. A patient can develop signs of congestive heart failure and life-threatening arrhythmias. They can even die. Now in most cases the patient gets better, but we see it every year. It mostly affects women for reasons we don’t understand, but it can affect men as well. It can affect children. It’s fascinating because we don’t really know what causes it. All we know is that an acute emotional reaction can cause the heart to to weaken.
Do you see emotional changes in heart transplant patients?
That’s a fascinating question. So the heart normally receives signaling from the brain. But a transplanted heart has nerves coming from the nervous system cut during the transplant and those nerves can’t be re-implanted. So a transplanted heart actually doesn’t respond to emotional stress the same way as a native heart does, because that signaling between the brain and the heart is cut.
Ancient philosophers used to say: you can’t transfer the soul of one person into another. I’m reminded of that when I see patients who have had transplanted hearts whose hearts don’t speed up when they’re experiencing emotional reactions, emotional stress, or great happiness or whatever. Transplanted hearts really do stand alone. They don’t react to our emotional lives like normal hearts do.
What, overall, do you think about the endless metaphorizing of the human heart?
The human heart is probably the most metaphorized object in human life. That stems from the emotional meanings we attribute to the heart…they come out in metaphor.
We can take something to heart. We can speak from the heart. We can learn something by heart. My favorite is to take heart. In other words, to be brave. one of the reasons why I find that so compelling is that it was sort of my father’s prescription for life. After he witnessed my grandfather’s death he went off to college. In 1950s India being without a patriarch was, you often put a family into poverty. And my grandmother was busy taking care of six children. So the family really struggled and my father liked to say he walked uphill both ways.
He had to stay up late at night reading textbooks that he borrowed from his friends because they couldn’t afford books. When he would complain, my grandmother would say would say in Hindi, “himmat na haarana” which means basically: take heart, be brave, you will overcome this. So I find that a very compelling metaphor.
How does the heart differ from other organs?
Well, the the heart is a very unique organ in that, it’s the only organ that can precipitate sudden death. That creates a lot of fear, even among doctors. You’ll see general physicians manage patients with kidney problems or anemia, or diabetes and not necessarily send those patients to a specialist. A diabetic doesn’t always go see an endocrinologist. For example, the anemic patient doesn’t always see a hematologist.
But if a patient has heart problems, I’ve yet to find a general physician who feels comfortable taking care of that patient. You know, even a patient with a slightly abnormal EKG will very often be sent to a specialist and I think that speaks to the respect and fear that most doctors have with respect to the heart. It’s unique in the sense that all other organs depend upon the heart’s function. The brain needs a functioning heart. The heart actually doesn’t need a functioning brain. The heart can continue to beat in patients who have brain death. More than anything, the heart wants to beat. If you culture heart cells in a petri dish they will congregate together and start beating spontaneously. the heart is really the hardest working organ in the body. It’s constantly moving. It typically beats seventy times a minute and three billion times in a typical human lifetime. It’s working really really hard to pump blood…but what supplies blood to the heart? Well, it’s the heart the heart supplies blood to itself. So in a sense the heart is self-sustaining.
What life advice do you give your patients with heart conditions?
It’s difficult. The American Heart Association still does not list emotional stress as a key modifiable risk factor for heart disease. The key risk factors are still high cholesterol, high blood pressure, high blood sugar, diabetes. Why is that? Well, in part it’s because it’s much easier to give someone a pill to lower their blood sugar, lower blood pressure, blood cholesterol, than it is to lower their emotional stress. But our lives are incredibly stressful, so it’s really key that we understand the connection between our emotional lives and the biological heart. So what do you do about it?
Well, it differs from person to person.I find that twenty minutes of aerobic exercise is incredible stress reducer for me my life. But my wife is really a yoga aficionado. She does it daily, but I personally don’t get the same reaction when I do yoga. People are different. It’s just important that everyone understands how important stress is and how detrimental it can be on our heart health and knows to do the things that ameliorate it: whether that’s exercise, yoga, meditation, spending time with friends. Connection and community are really important in our lives and we don’t pay enough attention to that. So, you know, what I would to tell patients who want to live long healthy lives with healthy heart: obviously don’t smoke, exercise and eat right. But then there’s another aspect: pay attention to your relationships and the people you have in your life. Are they supportive? Do they make you feel good? How do you respond to stress? How do you transcend distress? These things are also a matter of life and death.
Thanks for your time doctor.