03 February 2015

The Man Who Touched His Own Heart: True Tales of Science, Surgery, and Mystery by Rob Dunn

Summary from Goodreads:
The secret history of our most vital organ--the human heart
"The Man Who Touched His Own Heart" tells the raucous, gory, mesmerizing story of the heart, from the first "explorers" who dug up cadavers and plumbed their hearts' chambers, through the first heart surgeries-which had to be completed in three minutes before death arrived-to heart transplants and the latest medical efforts to prolong our hearts' lives, almost defying nature in the process.
Thought of as the seat of our soul, then as a mysteriously animated object, the heart is still more a mystery than it is understood. Why do most animals only get one billion beats? (And how did modern humans get to over two billion-effectively letting us live out two lives?) Why are sufferers of gingivitis more likely to have heart attacks? Why do we often undergo expensive procedures when cheaper ones are just as effective? What do Da Vinci, Mary Shelley, and contemporary Egyptian archaeologists have in common? And what does it really feel like to touch your own heart, or to have someone else's beating inside your chest?
Rob Dunn's fascinating history of our hearts brings us deep inside the science, history, and stories of the four chambers we depend on most.

I love the history of medicine.  Get me a copy of Oliver Sacks, or a biography of cancer (The Emperor of All Maladies), or a discussion of medical ethics (When the Wind Catches You and You Fall Down or The Immortal Life of Henrietta Lacks) and I'm all in.  So I was really intrigued by the title of this book.

Well, it wasn't exactly what I thought.  I was hoping for medical case studies from history - what The Man Who Touched His Own Heart is really about is the history of human concepts of the heart as an organ and the history of cardiac medicine and surgery.  Sooo...OK, I'm still in, at least for most of it.

I like the idea and concept of this book very much.  Dunn, who is a professor of ecology and evolution, starts back at the very beginnings of Western medicine, when practitioners just began to speculate about the function of the heart and what that organ represented in our religions and cultures.  Galen, Avicenna, da Vinci, and Vesalius all appear as humans began to dissect corpses to learn the correct human anatomy of the heart (only mammals and birds have four-chambered hearts, so examining, say, a frog doesn't get you very far).  Once Harvey posited the motion of the blood and the microscope was invented discovery accelerated - the first known open-heart surgery, the first heart-catheterization, the attempts to build heart-lung bypass machines to allow more extensive cardiac surgery, and - in a major part of the book - the attempts to determine the correct origins and treatment for that scourge of the modern age, arteriosclerosis (or so we think).

Now, this book is for a lay audience - which isn't even remotely my bailiwick given the epidemiology degree - and I think it works quite well most of the time.  However, a few of the arguments felt a bit convoluted.  For example, he discussed a 2012 meta-analysis (that link might not get you access to the article if you're not academically affiliated - the citation is Stergiopulous and Brown, Initial Coronary Stent Implantation With Medical Therapy vs Medical Therapy Alone for Stable Coronary Artery Disease: Meta-analysis of Randomized Controlled Trials, Arch Intern Med. 2012;172(4):312-319 - also, that citation wasn't actually noted in the text; just a note about how randomization works....gonna give a bit of editorial side-eye here) looking at medication+angio/stent for atherosclerosis vs medication alone then jumped back about 30 years by referencing two studies in the 80s/90s that contradicted the meta-analysis's findings because statins weren't available then...huh? I do research and those paragraphs didn't flow well. I also felt like bits were missing from the story of cardiac medicine such as the development of heart valve replacements or repair, the extension of the heart-lung machine to ECMO (extracorporeal membranous oxygenation - it allows the lungs to rest and heal while the heart pumps, which could have been briefly introduced/explained), and the development of extremely complex operations to save children born with severe congenital diseases like hypoplastic left heart syndrome.  The sections near the end of the book on comparative anatomy and evolution are very good, as they should be given Dunn's background

One thing that I think would have been very helpful, considering the intended audience, was an actual anatomical description - with pictures - of the normal working anatomy of the heart at the beginning of the book, then a picture of the condition or injury Dunn is describing in the relevant chapter. In example, there's a point at which Dunn describes, in writing, the congenital malformation Tetralogy of Fallot (a consistent appearance of four cardiac anomalies - stenosis of the pulmonary artery, ventricular septal defect, biventricular connection of the aortic valve, and hypertrophy of the left ventricle), but not completely.  I had to stop and look it up, even though I know what the condition entails.  For a reader not versed in medicine or anatomy, I'm sure a section like that is very confusing.  So perhaps a few more illustrations for the paperback edition? (If they were added after the digital advances were released you can ignore the comment - I haven't had a chance to see a finished copy, yet.)

(Caveat for the entire book: if you are an animal lover, this book may not be for you. The history of medical discovery is paved with the use of laboratory animals for research, often in non-ethical and very lethal ways, none more so than the treatment of cardiac ailments.)

Dear FTC: I was given access to a digital advance copy by the publisher.

1 comment:

  1. This sounds really interesting, but I'm not sure if I can deal with the animal stuff. Might be worth it though!

    Have you read Atul Gawande? He's one of my favourite medical essayists, although I'm definitely a layperson. :)