Heart

What does it really mean to have heart? For centuries, this question has occupied philosophers, poets, and physicians alike. In Heart: A History, cardiologist and author Sandeep Jauhar invites you on a sweeping, intimate journey through the biological, emotional, and cultural life of our most charged organ. He argues that we have spent too long viewing the heart solely as a machine—a pump to be repaired and optimized—when it also serves as a mirror for our emotions, relationships, and spiritual life. Understanding the heart’s scientific evolution, he insists, is inseparable from understanding our own emotional and cultural development.

Framed around his family’s generational history of heart disease—both of his grandfathers and later his mother succumbed to cardiac conditions—Jauhar blends memoir, history, and medical science. He reveals how the heart’s cultural power shaped medical taboos and propelled some of humanity’s most daring innovations. His narrative spans the earliest anatomical investigations of the Renaissance to modern-day transplants, defibrillators, and heart-lung machines. Yet, as the author’s own CT scan uncovers early coronary artery disease, it becomes clear that these scientific marvels cannot disentangle the heart from its metaphorical depths.

The Heart’s Dual Identity

From the ancient Egyptians, who preserved the heart as the seat of the soul, to Shakespearean lovers dying of heartbreak, the symbolic weight of the heart has always persisted. Jauhar shows that only in the past few centuries did medicine wrench the heart free from myth to reimagine it as a biological device. The transformation was both liberating and alienating—enabling lifesaving interventions while stripping away the sense of awe that once accompanied matters of love, courage, and grief. As Jauhar argues, the tension between machine and metaphor defines how we live and die today.

Medicine’s Triumph and Limit—From Galen to Modern Cardiology

The book unfolds chronologically through three parts: Metaphor, Machine, and Mystery. In the early chapters, we encounter early anatomists like Galen and William Harvey, whose discovery of the circulation of blood marked science’s first true understanding of the heart’s mechanics. Later, as surgery invaded the body’s sacred core, figures like Werner Forssmann, who famously threaded a catheter into his own heart, and Daniel Hale Williams, who performed one of the first open-heart surgeries, revolutionized cardiology.

Each breakthrough emerges from an act of audacity. Jauhar recounts the 1950s creation of the heart-lung machine by John Gibbon and the subsequent open-heart procedures by Walt Lillehei, who connected patients to living donors through cross-circulation. Such stories illuminate how the heart’s mystique forced medicine to confront moral, technical, and symbolic boundaries. The heart’s transition from untouchable sacred organ to technological frontier mirrors our civilization’s trajectory—from reverence to control.

Emotion, Stress, and the Social Heart

Jauhar—himself a heart-failure specialist—extends this exploration into the present by showing that medicine’s mechanical paradigm has blindsided us to the psychological and social factors shaping cardiac disease. Chronic stress, loneliness, and socioeconomic inequality exert as much strain on the heart as cholesterol or hypertension. Drawing on landmark epidemiological studies like the Framingham Heart Study and the Whitehall Study, he demonstrates how our emotional lives literally harden arteries and alter physiology. In this light, the metaphorical heart—symbol of empathy and connection—becomes a biological truth.

From Loss to Reconnection

Ultimately, Jauhar’s exploration is both professional and personal. As his mother declines and dies from heart disease, his reflections transform from scientific curiosity into moral reckoning. What he concludes is as spiritual as it is clinical: to heal our hearts, we must heal our ways of living. The heart’s mechanics have yielded to human hands—but its meaning, he writes, must be reclaimed by human communities, relationships, and compassion.

“To treat our hearts,” Jauhar concludes, “we must repair our societies and minds.” The heart, as both organ and metaphor, remains the central reminder that science and emotion, body and soul, are never far apart. In this fusion of memoir and history, he offers a new way to live—with heart in every sense of the word.

Jauhar begins his journey by tracing how humanity has long viewed the heart as the seat of emotion and character. He recalls how, as a boy, he couldn’t bring himself to vivisect a frog, prompting his mother to say his “heart is too small” for such work. The remark becomes the seed for his lifelong reflection on what the heart symbolizes—a paradoxical mix of strength and tenderness. His first anatomy class in medical school deepens the question: as he dissects his Indian cadaver, he feels both awe and sadness, sensing a story of love, labor, and loss lingering in the flesh. Even as the organ is revealed as muscle and tissue, it refuses to surrender its poetic power.

Ancient and Cultural Symbolism

Across millennia, we have placed our emotions in our chest. The ancient Egyptians weighed the heart of the dead against a feather to judge a soul’s purity. The Greeks made it the dwelling place of courage (thymos), while medieval mystics like Heinrich Seuse engraved the name of Jesus onto their chests to prove devotion. These traditions show how the heart once stood at the intersection of the divine and the human. Even today, Valentine hearts and phrases like “take heart” or “heartbroken” prove that metaphorical inheritance still beats within our culture.

The Physiology of Feeling

Modern science, Jauhar argues, has confirmed what poets intuitively knew: our emotions literally shape the heart’s function. The phenomenon of takotsubo cardiomyopathy—popularly known as “broken heart syndrome”—occurs when intense grief or stress weakens the heart muscle, ballooning it into the shape of a Japanese octopus trap. The sufferer may feel crushing chest pain, not metaphor but physiology. In one striking case, Jauhar describes a woman who developed heart failure shortly after her husband’s funeral—an anatomy of loss made visible through echocardiogram.

He connects this to studies showing spikes in cardiac deaths after natural disasters—the 1995 Kobe earthquake and the 2011 Vermont floods among them—when collective trauma literally breaks communal hearts. It’s a modern echo of what anthropologist Walter Cannon once called “voodoo death,” the fatal power of belief and fear. Whether aboriginals struck down by curses or modern workers paralyzed by stress hormones, the cause is the same: the autonomic nervous system unleashing its storm.

The Emotional Anatomy

The heart’s two halves mirror its dual purpose. The sympathetic nervous system drives fight-or-flight responses—adrenaline pounding, vessels constricting—while the parasympathetic system slows and soothes. In moderation, they maintain balance; under chronic stress, they collide. Jauhar reminds us that healing the heart means taming not only cholesterol but also anxiety, anger, and loneliness. Ancient metaphors were right: courage and compassion are cardiovascular virtues.

Over centuries, medicine transformed the heart from sacred vessel to mechanical pump. Jauhar narrates this shift through historical scenes—cadaver dissections in Renaissance Italy and experiments in Victorian London—that slowly displaced the soul with science. William Harvey’s 1628 discovery of circulation marked the revolution, proving that blood travels in a closed loop propelled by the heart’s muscular contractions. Yet, Harvey himself saw divine poetry in the process: the heart, he wrote, was the sun of the microcosm, a celestial engine.

Anatomy and the Birth of Modern Physiology

From Leonardo da Vinci’s glass models of the aortic valve to Harvey’s meticulous experiments on animals and humans, the heart became an object of measurement rather than worship. Its chambers, valves, and vessels formed a blueprint of reliability—each beat a triumph of design. But in reducing the organ to mechanism, medicine risked losing sight of its meaning. Jauhar’s scene in the anatomy lab—his cadaver’s heart rigid in death—embodies that scientific paradox: the more precisely we dissect the heart, the further we drift from its mystery.

Confronting the Taboo of Touching the Heart

For nearly two millennia, physicians dared not touch the heart of a living being. Aristotle and Galen believed injury to it meant instant death. Jauhar’s historical sketches of 19th-century pioneers—Daniel Hale Williams in Chicago suturing a pericardium in 1893, Ludwig Rehn in Germany sewing a stab wound directly in the ventricle—mark the dawn of cardiac surgery. Their audacity shattered a cultural taboo older than medicine itself. From divine sanctuary, the heart became something that could be “repaired.”

From Machine to Meaning

The notion of the heart as complex plumbing and wiring dominates cardiology today—stents, grafts, pacemakers. But Jauhar insists that even these mechanical triumphs fail to capture the organ’s deeper truth: it is not only a system but a story. Every patient’s heartbeat carries memory, emotion, and history, bridging the ancient metaphors with modern medicine.

The book’s middle chapters, especially “Clutch,” “Dynamo,” and “Pump,” read like a medical thriller. Jauhar recounts how a series of fearless innovators transformed the impossible into routine. Daniel Hale Williams, an African American surgeon, performed one of the earliest open-heart operations in 1893. C. Walton Lillehei, in the 1950s, connected a sick child’s circulation to his father’s body to create the first successful open-heart repair—literally a family lifeline. Each story, narrated with suspense, captures science as an act of moral courage.

The Heart-Lung Machine and the Age of Surgical Heroism

John Gibbon’s twenty-year quest to build a heart-lung machine embodied this courage. Working with his wife Mary and stray cats, he devised a contraption that oxygenated blood outside the body, allowing surgeons to operate on a still heart. Bourne from failure and loss—he conceived the idea after watching a woman die of a pulmonary embolism—the machine redefined life support. “Among the boldest achievements of man’s mind,” as one contemporary called it, it turned cardiac surgery into modern art.

The Risks Behind the Victories

These successes came at great cost. Children like Gregory Glidden, the first cross-circulation patient, died within days. Surgeons were accused of hubris or even murder. Yet without those losses, no techniques could have advanced. Jauhar draws a parallel to his own anxieties as a young cardiology fellow performing midnight echocardiograms and facing unpredictable emergencies. Fear, he admits, is the necessary twin of progress.

From the Operating Table to the Human Condition

By humanizing these pioneers, Jauhar restores the soul to the era of the machine. Each surgical innovation—sutures, valves, pumps—served not only biology but also our longing to defy mortality. The lesson is universal: boldness in medicine demands empathy as much as ingenuity.

If earlier generations learned to sew and bypass the heart, the mid-twentieth century discovered how to electrify it. In “Wires” and “Generator,” Jauhar explores the age of pacemakers and defibrillators—devices born from equal parts genius and obsession. Werner Forssmann’s self-catheterization in 1929 paved the path for modern interventional cardiology; Michel Mirowski’s implantable defibrillator in the 1980s gave humanity the power to shock life back into a faltering organ. The heart was no longer beyond human control—it could be restarted at will.

Electricity as Salvation and Suffering

Yet the electricity saving lives also inflicted new torments. Jauhar’s patient Lorraine Flood exemplifies the modern paradox: her defibrillator rescues her from sudden death but subjects her to painful, unpredictable shocks that leave her traumatized. She becomes afraid to shower, drive, even live freely. Medicine’s triumph creates psychological bondage. The “donkey kick,” as patients describe the shock, reminds Jauhar that every cure can carry its own affliction.

The Hidden Toll of Technology

Flood’s story parallels that of post‑9/11 New Yorkers whose arrhythmias spike amid collective trauma. Psychological wounds, Jauhar argues, reverberate through cardiac rhythm like aftershocks. Even machines designed to prevent death can perpetuate fear. He juxtaposes this reality with Mirowski’s haunting backstory: a Holocaust survivor who invented the defibrillator after watching his mentor die from arrhythmia. In both the lab and the clinic, grief sparks innovation.

The electric heart, Jauhar concludes, reveals a deeper paradox—that control over death demands a reckoning with life’s fragility. We can resuscitate rhythm, but restoring peace requires community and care.

Science’s most profound discovery, Jauhar argues, is that the heart’s fate is shaped not just by biology but by society. The Framingham Heart Study, launched in 1948 in Massachusetts, revealed the concept of “risk factors”—high blood pressure, cholesterol, smoking. But it also had blind spots. Its participants were overwhelmingly white and middle-class, leaving vast populations—South Asians, African Americans, the poor—out of view. What the study called ‘risk’ was only part of a larger story: social stress and inequality.

Stress as a Biological Force

Through narratives of President Roosevelt’s unchecked hypertension, Japanese immigrants whose heart-disease risk tripled after moving to America, and overworked London civil servants, Jauhar synthesizes decades of research showing that chronic stress literally reshapes arteries. Sir Michael Marmot’s Whitehall studies found that mortality rose with every step down the occupational ladder—not from malnutrition, but from loss of control and dignity. The ‘Type A’ personality, once blamed for heart attacks, has given way to subtler insights: hopelessness and social isolation may be deadlier than ambition.

Cultural and Genetic Clues

For Jauhar, this data hits home. His Indian heritage places him in the world’s highest-risk group for heart disease. Even vegetarians in India develop blocked arteries early—a mystery partly explained by genetic predisposition, partly by rising urban stress. He highlights new research like the MASALA study (Mediators of Atherosclerosis in South Asians Living in America), which explores how migration and cultural dislocation amplify physiological strain. The heart, it turns out, remembers displacement.

Chronic anxiety, he explains, triggers continual sympathetic arousal—elevating adrenaline, blood pressure, and vessel inflammation. Over time, hormones meant to save us from acute threats erode our arteries. Healing requires not just medicine but social reform: safer neighborhoods, supportive families, meaningful work. The lesson echoes Peter Sterling’s theory of allostasis—humans need environments where vigilance can rest.

Jauhar’s memoir crescendos in grief. His mother’s death from a nighttime heart attack embodies the culmination of everything he has studied: emotional upheaval, biological vulnerability, the unbridgeable limits of medicine. As her Parkinson’s advances, he becomes both son and doctor—administering medications, arranging caregivers, wrestling with guilt. When she dies, he confronts what no medical training can prepare one for: the unbearable ordinariness of loss.

The Mother’s Heart

He links her likely cause of death—an arrhythmia during REM sleep—to John MacWilliam’s early 20th‑century research showing that nightmares can trigger lethal surges of adrenaline. In his hands, science turns elegy: data becomes remembrance. The cremation of her ashes on Long Island Bay parallels ancient Indian rituals on the Ganges, completing a spiritual circle between East and West, modern medicine and eternal mourning. “If our family was a body,” he writes, “my mother was its heart.”

Mortality and Meaning

Her passing transforms Jauhar’s philosophy. Death, once the enemy of medicine, becomes its teacher. The heart’s final silence, he reflects, is not failure but release; the same organ that sustains love also grants mercy. In this revelation, the doctor reconciles his scientific and emotional selves—the twin ventricles of his own identity.

In the final chapters, Jauhar turns from history to hope. Diagnosed with early coronary plaque himself, he begins a personal experiment. Through meditation, yoga, and mindfulness, he attempts to soften what years of professional pressure and inherited fear have hardened. His conversation with a yoga-practicing friend, Anand, crystallizes the lesson: ‘Your mind is not your owner.’ The physician learns—slowly—that the heart’s healing requires stillness as much as science.

From Ornish to Modern Prevention

He visits a Dean Ornish lifestyle medicine center, where patients reverse plaque through vegetarian diets, daily walking, yoga, and social connection. The regimen’s success, controversial yet promising, reinforces a point Jauhar has seen in decades of research: emotional support and community consistency predict cardiovascular survival as much as medication does. “Connection is medicine,” he concludes—echoing modern findings on loneliness as a health epidemic.

Beyond the Limits of Technology

After fifty years of innovations—angioplasty, stents, implants—cardiology may be approaching diminishing returns. The next breakthroughs, he argues, must be social and psychological: reshaping cities for walking, reweaving community bonds, and teaching people to manage stress proactively. Quoting neuroscientist Peter Sterling, he urges a shift from repair to prevention, from vigilance to satisfaction. “Reduce the need for vigilance,” Sterling writes, “and restore small satisfactions.”

A Reintegrated Understanding of the Heart

By the book’s conclusion—his daughter Pia resting playfully on his chest—Jauhar’s heart, once anxious, beats in harmony with life. “Are you happy?” she asks; his answer defines the new cardiology he imagines, one that unites emotion, biology, and humanity. The mechanical era has brought miracles, but the next revolution, he insists, must be one of empathy.