Haider Warraich: State of the Heart
Selected Excerpts
“Wait—what—I have heart failure?” he asked abruptly. Startled, he looked to his wife, who started crying. “He has heart failure? No one told us he has heart failure! What is heart failure?” she wailed.
“The heart, that muscular organ beating in your chest as you read, sending pulsations throughout your body, is perhaps the part of the body most associated with life at both ends of human existence. Hearing a heartbeat has become a rite of passage for anyone who becomes pregnant… On the other end of existence, when someone falls to the ground unconscious, the reflex of anyone with an ounce of knowledge about the human body will be to reach for their wrist and feel for a pulse. If there is a pulse, there is life. If there is no pulse, there is no life.”
Discussion Questions
Warraich discusses the significance of the heart beat at the beginning and end of life. Do you see a clear distinction between the metaphorical meaning of the heart and its biological meaning, or are the two intertwined?
Warraich’s patient’s wife wails, “What is heart failure?” The wife of the first recipient of a permanent artificial heart reportedly asked, “Will he still be able to love me?” How does the metaphorical meaning of the heart shape communication around cardiac disease?
Even in our modern era of evidence-based medicine, the longstanding metaphorical significance of the heart as the seat of emotion, passion, and love is here to stay. How might our understandings of the heart as metaphor and machine complement each other, or are they at odds?
Reflections from #MedHumChat
“…it’s so important to speak in clear terms with patients and while heart failure may not be perfect term, many patients can go years with heart failure having never had a doctor tell them what they have. Our job though must include explaining what that means though.” —@haiderwarraich
“The biological and metaphorical hearts most definitely intersect. When the heart stops, body death is instantaneous. This carries over into the metaphorical domain. In Snow White, for ex, the queen wants the girl’s heart cut out to ensure she is dead.” —@sjauhar
“I remember first learning about Takotsubo cardiomyopathy, or broken heart syndrome & it really solidified this connection for me. Of how emotions & our physiology are intertwined & how even ‘broken’ is recoverable.” —@Sarahjabertooth
“Wow what powerful quotations! I’ve always felt HF was such a harsh phrase when talking to pts. I guess I would say to the wife that perhaps the heart is only the conduit, but the love itself is housed elsewhere (soul or consciousness or essence of being).” —@zacharygjacobs
About this #MedHumChat
State of the Heart: Exploring the History, Science, and Future of Cardiac Disease was joined with “How Your Emotions Change the Shape of Your Heart,” a TED Talk by Sandeep Jauhar and “[i carry your heart with me(i carry it in],” a poem by e.e. cummings for a #MedHumChat discussion November 20, 2019 exploring The Heart: Metaphor and Machine.
This chat was co-sponsored by Circulation: Cardiovascular Quality and Outcomes (@CircOutcomes), an American Heart Association journal.
We were honored to be joined by special guests Haider Warraich and Sandeep Jauhar. Sandeep Jauhar, MD (@sjauhar) is a cardiologist, NY Times columnist, and author of Heart: A History.
The pieces for this chat, along with the discussions questions, were selected by Ritu Thamman.
About the Author
Haider Warraich, MD (@haiderwarraich) is the Associate Director of Heart Failure at the Boston Veterans Affairs Hospital, Associate Physician at Brigham and Women's Hospital and Instructor at Harvard Medical School as well as the author of State of the Heart.