The Citadel Within
The Citadel Within
Book review by Jude Joseph Lovell
Someone very special to me was recently hospitalized after exhibiting symptoms consistent with congestive heart failure. We learned later that there had been no “cardiac event” after all—the heart in question was responding to attacks of anxiety and depression. Only about a week later, I saw an article about a new book that offered a fresh look at the connections between the physiological and the emotional in this most unique and fundamental of human organs.
It wasn’t just the recent scare that drew me to Sandeep Jauhar’s Heart: A History, however. Like many of us, I too have numerous reasons to pay attention to, well, matters of the heart. My late father endured a long battle with Parkinson’s disease, but he also had survived two heart attacks. The Parkinson’s caused him to fall and break his hip in late 2014, but it was the weakness of his heart that prevented him from recovering after surgery.
My maternal grandfather suffered from terrible heart ailments. My dad’s mother died of heart failure. But maybe the most significant for me personally is what happened to my father’s father, who collapsed and died instantaneously from a massive heart attack in 1961. He was only 58.
Jauhar, a cardiologist, fellow Silver Sager and memoirist, begins his relatively brief but impassioned narrative with an account of his own paternal grandfather’s death following a snake bite. The author describes this as “the most consequential event of my life,” even though it preceded him by fifteen years. Thus, he grew up with a “fear of the heart as the executioner of men.” Many of us no doubt feel the same way.
But fear is wasteful, and one of the services this book provides is to help the reader bypass that fear and instead appreciate this amazing organ. Jauhar points to simple facts that may have escaped readers’ attention. The heart, for example, is the only organ that moves. It has a deep metaphorical significance to all of humanity, across borders and cultures. And it alone has a symbiotic relationship with our emotions. No one says a “have a brain” when appealing for assistance, just as no one “loses kidney” when the chips are down.
Jauhar next undertakes a brief but fascinating review of the major innovations in cardiac medicine, from 
the late nineteenth century to the present. From the first successful heart surgery in 1897, to the painstaking development of a heart-lung machine, to the ingenious inventions of balloon angioplasty, defibrillators, and the pacemaker—each is succinctly examined, along with the colorful figures behind them.
What I appreciated even more was Jauhar the writer’s artistic instincts. It is clear from both the tone and structure of this history that his interest transcends the clinical. He divides the book into three sections, entitled “Metaphor,” “Machine,” and “Mystery,” which helps to reinforce his unique view of what has been a clear vocation as well as a kind of specter hanging over him.
Jauhar neatly blends medical material with fascinating historical anecdotes. Readers may not be aware of how profoundly President Franklin D. Roosevelt’s problematic cardiac health affected the trajectory of heart medicine throughout the world. And who would know that the metallic stents doctors routinely insert today into arteries to keep them open are commonly coated with a natural antibiotic found in soil mold from Easter Island?
All along, the doctor places emphasis on the “psychosocial factors” that play an important role in heart health, remembering his own history as well as his professional experience—including an unimaginable stint working as a first responder in New York after September 11, 2001. This unique mix of perspectives drives him at times to challenge the direction of his own field.
“We have overused stents and pacemakers,” Jauhar writes. “We have moved away from the emotional heart.” Near the end of the book, Jauhar makes a compelling argument that modern cardiology may have reached the outer limits of what it can achieve in our era and that emphasis must shift towards awareness, lifestyle changes, and stress management.
My only disappointment with this important book is what felt like a missed opportunity in the third segment, “Mystery.” I had hopes it would bear the greatest impact of Jauhar’s careful reflection. Instead it focuses primarily on personal accounts of his mother’s death and his work at Ground Zero in New York. These events direct his inquiries towards matters of the soul and spirit, but while the stories are moving and their authenticity indisputable, they feel hesitant—as though the writer is not comfortable with what they taught him.
Nonetheless, Jauhar’s elegant narrative is still a thoughtful analysis of a subject affecting everyone on this overburdened planet.
Art credit by: “Heart Attack” by Lenka Havelková (Czech Republic) https://www.deviantart.com/larosedepetitprince
