the heart

Me: I think I have a heart defect.
Friend: Why?
Me: I have to think about it. I just know it's an odd heart.

*

We've been learning about the heart. We've read about it from the point that two cells make one embryo, to how it functions in a baby, to how it morphs into an adult. We've seen our professor twist foam tubes to help us visualize (couldn't tell one end from another). We've watched animations on our computer on how the heart folds, closes, develops. We've detached the lungs from the heart in our donors, and held the heart in our hands--not fully, still clinging onto the body. We haven't seen the individual chambers yet, but we can peer at the vessels cut open on either side.

The heart, like everything when you really think about it, is complicated and simple. It is important and complex. It's a system, and of course another system could have worked, but it's this one that we have. It's an amazing one, but a million things can go wrong. In the end it's a fragile thing; it gets confused and malformed and tired out. It is so beautiful.

The fetal heart can't depend on lungs for oxygen. So it comes up with all these mechanisms to deal with it. It might make you wonder why the fetus doesn't just have functional lungs. But you don't instinctually think that. Instinctually you think that of course, it has to grow. Its starts one way and it learns and ends up in another way. It doesn't happen right away. I think it's funny, though, that the mechanisms the heart has to cope with not being fully developed yet, are just as complex as the development the heart is waiting for.

Sometimes the adult heart suffers because one of these fetal heart qualities persists, never goes away. In the fetal heart blood can travel between the right and left atria. In the adult heart, this portal closes. It should close.

In one of our case studies, a patient had a thrombus (clot) in his vein that traveled to his brain and caused a stroke. In a normal person, this clot would have traveled through his heart to his lungs and might not have caused much of a problem. But this patient still had the portal between his atria. So the clot has two paths: a normal one through one atrium to the lung and an abnormal one, through one atrium to the next atrium and to the body, to the brain. The clot in this patient took the latter path. An online animation showed the clot on its course, and I found myself mourning it aloud. Oh no. Oh, that's sad.

This is called a "paradoxical" clot, because it starts out in one system (pulmonary, that of the lungs), but it ends in another (systemic, that of the body). That's the price of staying undeveloped, of staying open, of leaving another path, one that's not right and not healthy. Your system hurts itself, makes a mistake, misjudges.

But you can't say it's unnatural, this so-called defect--it's natural, it's how you were made. And so what if you didn't make the decision to have it that way, to keep a remnant of your innocent, brand-new self? And so what if you still have the choice of two paths, when inevitably you are going to have to go down both and one will hurt?

I love the heart. It's so strong and vulnerable. It can adjust to some alterations, but it's particular. It needs certain things, and it needs them to give them away, all the while sustaining itself. I love the heart. But I don't think I will study it in isolation. Someone else should prevent strokes and the like, but me, I don't think I can look after odd hearts. I wouldn't want to fix them.