About a year and a half ago I was fortunate enough to weasel my way into a human dissection class. Technically I wasn’t supposed to be allowed into the class as I didn’t have the proper pre-requisites fulfilled. I did, however, have a New York State’s professional license. Being an L.M.T was my golden ticket into an anatomical playground. I called him Joe, my cadaver, he was in his early 70s when he died and had a number of co-morbidities. Primarily he suffered from Congestive Heart Failure. This disease process presents in a number of ways but one of the most remarkable to those of us in the lab was the chronic back up of blood due to the decreased pumping ability of his heart. In short, his organs were enormous, in fact three times the size of someone who does not suffer CHF. Most of our hearts are around the size of our fists. His was the size of Andre the Giant’s fist, maybe bigger. His liver was so blood rich and heavy I had to use both hands and a good ole fashioned heave ho to remove it from his body. His spleen was the size of my two fists side by side. Normally it’s this tiny little nugget tucked into a pocket behind your stomach. His bulged. It protruded into his stomach and carved out a permanent alcove. His gallbladder was so full of green bile it turned the surrounding tissue of his liver green. The doctor who instructed me and had been leading cadaver labs for over 20 years had never seen anything like Joe and his enlarged organs. We all had to take a section of the body to do a more detailed dissection and present the function and form to the class. I got the major organs I just wrote about including his lungs which were small and black from years as a smoker and being pushed aside by his other blood engorged organs. When it came to his heart (which appeared to have literally exploded on the operating table as most of the right atrium was missing and the remnants shredded) I remember constantly thinking about how here is a case where having a big heart is not a good thing really at all. I hear people remark constantly about how someone has a big heart and isn’t that a lovely thing indeed. ”She has such a big heart, she feels things deeply, yes, but look how much she gives.” It’s considered a compliment to have a big heart. Unless you’re Joe and it is most likely what killed him.
So when I removed his heart from the peritoneal cavity, I noted its weight and size. I’ve seen human hearts before, it’s funny to me how much they do and do not look like the classic heart shape we have all come to know. Dissecting this organ I got a real understanding of what the big deal is about the heart. Not only does it supply the body with blood but it has its own circulatory system. It works both as a muscle and also has en entire electrical system. Cool right? Electricity. In your body. This is why we respond to defibrillation. We jolt the heart, stop it and it resets. Like unplugging your modem but better. It makes a sound that is accepted among the science and medical community. Lub dub, lub dub, lub dub. To put it simply, the lub is the atrial valves closing when the blood goes into the ventricles and the dub is the aortic valve closing when the blood exits the heart to go to the lungs for oxygenation. Patrick Swayze described it in “Dirty Dancing” as “ga-gong, ga-gong.” That part of the movie always embarrassed me.
Now, Joe’s heart had been through a lot of surgery. I counted 4 bypasses. When I cut open the atria and ventricles I found collected blood pooled at the bottom. When I stuck my finger in the inferior vena cava I removed a clot the size of my thumb. The walls on the left ventricle and atrium were four times as thick as the right. While thicker walls on the left side by two times is common in all of us, in those with CHF it was something I had to see to comprehend the difference. One of my favorite structures of the heart are the chordae tendinae. Heart strings. They pull the flaps closed on the valves that separate the chambers of the heart. But we have them and they look like strings. I literally pulled on Joe’s heart-strings. I wondered how many times he had felt that when he was alive. I wondered who came up with that phrase. Was it an anatomist? Did they know we have heart-strings? I looked it up, an unremarkable finding to say the least. Point being, here is this incredible anatomical structure that has to work in order for us to be able to, well, do anything. It has been given even more importance by being what most humans believe to be the center of our emotional lives. We don’t really ever talk about the hippocampus, the amygdala or the entire limbic system of the brain that we actually know is in charge of our emotional lives. We tally it all up to the heart. And while I know where my emotions come from I am continually baffled that when I am sad from a loss of love, my heart actually aches. I feel it in my chest. Not in my brain. Sometimes in my gut. After studying Joe’s heart, after seeing how it can keep us alive and be what kills us, after falling in love and choosing to fall out of love, reading countless stories about getting the girl, watching numerous plays about the main character finding love, after listening to countless songs about heartache and love and everything in between that first kiss and the final goodbye here’s the best I have come up with:
I have studied the heart. I understand its mechanism. I can read a rhythm strip and tell you what is happening electrically. I have taken one out of a human body, cut it open, identified all of it’s anatomy, stuck my fingers in all the wholes and pulled on the chordae tendineae (heart strings). I can tell you how it perfuses blood to itself and the rest of the body. I can trace a drop of blood all the way through its entire structure. I understand its disease processes and dysfunction. But for the life of me I cannot tell you I understand how a heart determines feelings or emotions and why it makes the choices it does.
Here’s some pictures. I like a visual.
