Dr. Shahar Madjar

On an autumn Sunday, just after he had his morning coffee, 57 year old Adam Bloom, became aware of his own heartbeat. It wasn’t the faster heart rate he remembered from his younger self–after a three mile run, or when he fell in love at first sight.

It wasn’t the slower, relaxed heartbeat he sometimes noticed after a class of deep-breathing meditation at the YMCA. It was an ominous rhythm–unpredictable and irregular. A heartbeat so chaotic, he would tell himself later, that for a long time, he lost his faith in a world order: no nights, mornings, afternoons; no summer, fall, winter, spring; no breakfast, lunch, dinner; no church bells tolling. Instead of order, disorder! And the sense of danger, and the fear of impending death.

In an essay he wrote in a biology class he took many years earlier, in high school, Adam, a man who would years later become a mechanical engineer, wrote: “my heart is no more than a simple pump.”

He calculated that at a normal heart rate, along a normal life span (78.6 years), a heart would have beat 2,891,851,200 times! “A durable, long-lasting pump,” he wrote, “but a mere pump nevertheless.” His teacher advised him to revise his essay.

In the revised version of his essay, Adam wrote: “To many the heart is a mystery: some romantic souls see it as the seat of human emotions (perhaps because their heart races at the sight of a loved one); others consider it as a mere mechanical pump.

The truth lies in between these two views: the heart is a sophisticated pump which adapts to the needs of the body by adjusting its rate and contractility. That’s it.”

Adam then added: “Even the mystery of the origin of the heartbeat is no more. In 1906, Martin Flack, a medical student who worked under the supervision of Arthur Keith, solved the “mystery“. Arthur and his wife were bicycling through the beautiful cherry orchards near their cottage in Kent, England. Upon their return, Martin announced with great excitement that as he was studying the heart of a mole under the microscope, he discovered a wonderful structure–a group of cells in the atrium (the upper chamber) of the heart. This group of cells, Flack and Keith believed, the sinu-atrial node, was the long sought-after site of origin of the heartbeat–the pacemaker. From the sinu-atrial node, the electrical current propagates, in an orderly wave, into the muscle cells in the entire heart. And this, in turn, results in a coordinated contraction.” In Adam’s mind, it all became as clear as the sky on a cloudless day: the heart is a pump controlled by its own electrical system. It holds no secrets.

Years later, in the emergency department, Dr. Gold told Adam, “Your heart is misbehaving. It is beating faster than it should, and its rhythm is irregular. We call it atrial fibrillation.

“The normal rhythm generated in your sinus node is overwhelmed by rapid, irregular electrical discharges that originate elsewhere–in the tissues around the sinus node. As a result, your atrium, the upper chamber of your heart, quivers. Instead of coordinated contraction, instead of regular rhythm,” the doctor said, “we are dealing with irregular rhythm, and uncoordinated contraction.

Dr. Gold explained the treatment options: “we will start with medications to control the heart rate and restore its normal rhythm. If these measures fail, we will perform cardio-version using electrical shock. It is as if we turned off your heart for a moment, and pressed the re-start button.”

That didn’t appeal to Adam, but when Dr Gold described the many symptoms and complications that would ensue should he decide to forgo treatment–shortness of breath, light-headedness, loss of consciousness, swelling of the legs, and even, God forbid, a stroke–Adam understood the severity of his situation.

How could I truly understand the mechanism of the heart, any heart, my heart? This question was natural to Adam for he was, after all, an engineer. He answered such questions with self-assured certainty: in order to design a perfect skyscraper, he would observe the collapse of poorly-designed buildings; to fully understand flight, he would watch airplanes nose-dive into the ground. After his own heart had lost its normal rhythm, Adam found comfort in the realization that his heart failure was the key to understanding the wondrous design his heart was.

After several attempts, Adam’s heart returned to a normal rhythm. He gained new insight into the wonders of his heart, and the universe around it.

I told you that the sinu-atrial node is the heart’s pacemaker. But what governs the sinu-atrial node? If the pacemaker is a watch, who is the watchmaker? The answer has to do with jumping spiders, migrating butterflies, and the oneness of the universe. I shall return.

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.