The Open Heart Club

by Gabriel Brownstein

  Long before such ideas were common, Steno saw that hearts were made of butcher’s meat, that people reproduce in the same way chickens do, and that the ground we stand on is not fixed but changing. However, he’s most striking not for his discoveries but for his later abandonment of them. Though his observations led in a straight line toward Charles Darwin, Steno gave it all up. Just as his career was hitting its peak, he quit the study of nature, converted to Catholicism, and became a priest, a bishop, and finally a saint. He shut his eyes to all he had understood and intuited.

  In his worship, Steno was as radical as he had been in his anatomy. When summoned to the Vatican, he walked barefoot from Pisa to Rome, and his bleeding feet horrified the pope. As a bishop in Germany, he gave his cathedral over to the poor, letting them sleep there, and he so enraged the town burghers that they threatened to cut off his ears and nose and drive him out of town. After Steno’s death, Gottfried von Liebniz, the greatest mathematician on the continent, ran all over Europe seeking the promised dissertation that Steno had said that he was writing. Liebniz never found any of Steno’s final papers.

  I first stumbled on Steno because of historical coincidence—he was the first to describe my heart defect. But as I read about him, I found something more: a story that weirdly echoes the ones told to me by Ali Zaidi and Bridgette Ratliff. What do we mean by healthy? How do we deal with the problem of mortality? To me, Steno’s life reads like a parable of knowing and not knowing, of perception and denial. He looked deep into the nature of hearts and time and material being—maybe deeper into the existential void than anyone in his century—and at a certain point he snapped and turned his eyes toward heaven. Steno is my hero and my opposite. I’ve never in my life been as brave or committed or observant as he. I’ve always wanted to be normal, and I’ve never been able to look directly at my heart.

  Steno was born in Copenhagen on January 1, 1638, according to the Julian calendar, January 7, according to the Gregorian. He was called Niels Stensen in Danish, but he signed his name Nicolas Stenon in French and Niccolo Stenone in Italian. In scholarly Latin, he called himself Nicolaus Stenonius. His last name was shortened when his papers were read at the Royal Society in London after his death, and so that’s how he’s known in English: Nicolaus Steno.

  His mother was a widow, his father a widower, both on their second marriages. Denmark was in decline, in a world of medieval violence, pestilence, and famine. His father was goldsmith to the king but to make a decent living had to sell wine out of his cellar, and the family lived upstairs from his father’s workshop. The street outside was fetid with rats and sewage. The family attended a church without a roof. It had been blown off in a storm and never repaired.

  At three years old, Niels became mysteriously crippled—“morbis satis difficiles,” as he wrote. He could not run. He could not play. “When I was very small,” he wrote, “I took little pleasure in talking with other children. Because for three whole years, from three to six I was ill, I became accustomed to the company of older persons and formed the habit of listening to adults talking about religious matters rather than playing with my contemporaries.”

  His disease lifted in 1644. That same year, his father died. His mother married her third husband, Peter Lesle, another goldsmith. Lesle died the next year. She married a third goldsmith when Niels was twelve. The boy worked with all these fathers. He polished lenses, fixed the gears of watches, changed the colors of metals, and examined the properties of mercury, all obsessions of seventeenth-century physics. His fingers became extraordinarily nimble.

  In 1654, the plague hit Copenhagen and wiped out roughly 9,000 people in a town of 28,000. The students in Steno’s school were enlisted to cart away the bodies. About half of them died. Steno’s Lutheran education was heavy on the classics and religion. He was taught Latin in the early years, Greek in the fourth and fifth grades.

  Entry into Copenhagen University involved a ceremony in which the applicant dressed in blackface, wearing a peaked hood, a hump back, horns on his head, and a giant nose. He was attacked by a trustee wielding sticks, pliers, and a knife. After the beating, the boy appeared in ordinary clothes and begged for admission. A dean poured wine over the accepted student’s head and put salt on his tongue.

  At Copenhagen University, the dominant cosmological plan was the one devised by Tycho Brahe, the school’s most famous alumnus and the last of the great naked-eye astronomers. Tycho had coined the word “nova”—he had seen one explode in the sky. He wore a gold nose because he had lost his own in a duel, and rumor had it that he was later murdered by Johannes Kepler, who wanted to steal his notes and library. Tycho’s geoheliocentric astronomy was a compromise between Copernicus’s and Ptolemy’s, proposing that the sun revolved around the earth and the other planets revolved around the sun.

  At school, Steno kept a journal, which he called Chaos. In it, Steno rejected medicine as he saw it practiced around him. “I would fear that someone might define medicine,” he wrote, “as: The art of standing with furrowed brow in front of the patient, uttering inanities.” He read Paracelsus, the sixteenth-century mystic who burned the books of classical physicians and believed in chemistry, that the body’s health lay in a proper balance of sulfur, salt, and mercury. He also studied the works of Althanesius Kirchner, the most popular intellectual of the day, who had mapped Atlantis, who claimed to be able to read hieroglyphs, and who had himself lowered into Vesuvius to see its roiling insides.

  After reading Francis Bacon, Steno became devoted to experiment. “From now on,” he wrote, “I shall spend my time, not on musings but solely in investigation, experience and recording of natural objects.” He studied water as it turned into ice—proving that it changed not in weight but in structure. Steno used mathematical rules to study the permeability of skin and muscle membranes: “This should be investigated more carefully and systematically according to Descartes’ method, or by considering directly what enters the pores of the blood, what its particles are, how they move, what is expelled from there and how.” He scolded himself for his laziness: “Almost the whole day my disturbed mind, being preoccupied with various reflections, could do nothing else than skim lightly over everything, then immediately to leave the causes of everything aside, but I pray, thee, o God, take this plague from me and grant me the power to free my soul from all distraction, to work on one thing alone and to make myself familiar with the tables of medicine alone.” For him, the study of nature was the study of God: “One sins against the majesty of God by being unwilling to look into nature’s own works.”

  The winter of 1660 was brutal. Sweden invaded Denmark, and the troops burned the suburbs around Copenhagen. The seas around the city froze solid, and the invading army laid siege. The citizens starved. Steno was enlisted in the city’s defense. Skinny, small, and studious, he manned the battlements, and in his journal he kept notes on snowflake formation, setting out principles of crystallography. No one knows how he did it, but with his journal in hand and carrying letters of recommendation from his professors, Steno snuck out across the frozen sea, through the besieging troops, down into Germany (also war-torn) and from there to Amsterdam. He was twenty-two years old. From a walled, isolated town of 20,000 half-starved and sickly people, he came to the center of the modern world.

  Amsterdam was ten times the size of Copenhagen, clean, peaceful, and prosperous; the shipbuilding, banking, and whaling capital of the Dutch Republic; the seat of the world’s most powerful mercantile empire. The city was cosmopolitan, with refugees from all of Europe’s religious wars: Jews from Spain, Quakers from England, Baptists, Walloons, and French Huguenots. Hundreds of printer-publishers produced tens of thousands of titles, more books than the rest of Europe combined. Steno presented his letters of recommendation to Gerald de Blaes, known as Blasius, professor extraordinary at the Athenaeum of Amsterdam. Blasius accepted him and allowed him to work in his laboratory, but he didn’t think much of the homely young Dane. The contempt was mutual. Steno wat
ched Blasius lecture on chemistry and dismissed the master’s work as vulgar and messy.

  After he saw Blasius perform a five-day dissection on the head and neck of a convict, Steno bought the head and neck of a sheep at a butcher’s stall and brought it back to Blasius’s workshop. He investigated the sheep’s neck and mouth. He introduced a probe, examining “the course of the arteries and the veins.” Delicately, he poked the membranes. His probe slipped. “I felt that the point of my knife, no longer confined between the membranes, more freely moved in a wide cavity, and as I pushed the iron further, I even heard it clink against the teeth.”

  Steno showed his discovery to Blasius. Blasius did not believe that Steno had found anything novel. Maybe he had made the hole with his knife, Blasius suggested. Steno demonstrated that was not the case. Then, Blasius continued, Steno must be confused. This was not a new salivary duct, but one already discovered, probably—he said—Wharton’s duct. No. Steno knew where Wharton’s duct lay. He showed it to Blasius in the mouth of the sheep. The duct that Steno had found was in a different spot. Maybe it was a freak, Blasius suggested. Again, no. The duct occurs in all sheep, in most mammals, and in every human being.

  “I seem to have discovered a little salivary duct,” he wrote in a letter home. Steno’s former professor, Thomas Bartholin, wrote back expansively: “The learned men of our country join me in not finding enough words to praise… the success you have attained. All rejoice that their fellow citizen, and I trust my disciple, is making such strides in the study of glandular systems. Proceed, my dear friend. Proceed with great steps toward immortal glory.”

  The duct would be named the ductus stenonius, also called Steno’s duct and Stensen’s duct. Blasius became enraged and accused Steno of plagiarism. He, Blasius, should get credit for the duct that had been discovered in his lab and not that “wretched boy” from Denmark. Steno had to leave Amsterdam. He headed for the University of Leiden, the leading center of anatomical study in Europe. Blasius sent letters ahead of Steno’s arrival, trying to destroy the young man’s reputation, but to no avail. Steno devoted the next two years to the study of the glands, discovering seven new ones in a single ox head and writing on the production of saliva, tears, and breast milk. As he built his own reputation, Steno raged at Blasius, pointing out how little Blasius knew about glands and how obvious it was in his writings that Blasius couldn’t distinguish between the different ducts of the mouth.

  The public fight between the two anatomists, as well as his discoveries about the glands, made Steno a prominent man. He began lecturing, performing anatomy publicly. The anatomy theater in Leiden, built on the model of Vesalius’s famous one in Padua, held two hundred people, the audience packed tightly in concentric, rising rings around the central table in which the anatomist worked on the corpse. Relics were on display in the hall, including the penis of a whale and a skeleton rider on a skeleton horse. Public dissections were held in the winter months so the cold could keep the corpse from rotting and keep down the stink. Steno performed on January 1, 1661, anatomizing a male corpse. On January 5 to 7, he vivisected a dog, examining the animal’s lymphatic, pulmonary, and vascular systems. On January 14, he vivisected a pregnant dog and its unborn puppies. On February 7, he anatomized the body of a man named Janicke Jansen, recently dead of syphilis.

  The students were rowdy. The university gave them a tax-free annual allowance of 194 liters of wine and 1,500 liters of beer. In taverns, they liked to play a game where they threw clubs at a cat hanging in a cage from the ceiling. When the cage broke, they all gathered around and beat the cat to death. Another popular game was “Head in a Lap.” One student would put his head in a girl’s lap, and he would try to guess which other girl was spanking him. Most of these women worked in the fabric mills around the university, and as one English traveler reported, “The women are said not much to regard chastity whilst unmarried.” Steno stood apart from all this. His Jesuit biographer, Raffaelo Cioni, draws him as celibate: “He was of fine appearance, gentle of disposition, and one whose modesty was evident. An object of interest to the young women of Holland, he was no more beguiled by them than he had been by the girls of Copenhagen.”

  All his life, Steno never had a romantic attachment to a woman. In Leiden, his circle of friends were all men, most of them unmarried, all of them scientifically, aesthetically, and philosophically inclined. In the summer of 1661, after the anatomy season was over, he and his new friends took a tour of northern Europe. They took walks and boat rides, visited musicians, writers, and chemists. They looked at old castles and churches, toured gardens and marketplaces. They spent a lot of their time at libraries and feasts.

  The penalty in Holland for sodomy was execution by strangulation, burning, and then drowning. But in the 1660s, there was a thriving gay male culture both in Amsterdam and in Leiden, with secret meeting places and secret codes. The men called each other nicht, or “niece.” They met in private houses, in parks, and in particular taverns, like one in Amsterdam called The Serpent. Steno, a solitary child in Copenhagen, a monkish student in the university, and a visiting scholar in Amsterdam, seems to have discovered a home for himself in Leiden, intellectually, socially, and perhaps romantically as well.

  15.

  I WAS FIDGETY ON the train, going over the questions I had for the doctor, rehearsing my anxieties, drinking coffee, and unable to read. Around noon, I ate a Hebrew National frank on a gluey bun that had been stuck in the snack car’s microwave. I looked out the window at the wide marshy Hudson, and as we traveled north, I was on the wrong side to see the Atlantic and the buoys and marinas of Rhode Island.

  I got off at Back Bay Station with a couple of hours to kill. It was April. I had no luggage, just a backpack. I strolled from Copley Plaza to the Fenway Gardens and stopped at the Museum of Fine Arts. I don’t have any particular memories of what I saw or thought while I walked those streets or which paintings I looked at in the museum. I remember the warm weather and a kind of lightheaded sense of the surreal. I always like walking alone and anonymous in a city, a city whose monuments don’t hold any memories for me, but this time I felt like I was undercover, pretending to be somebody I wasn’t. I was sweaty inside my healthy-person disguise. The lobster shell of my denial hadn’t cracked, but it trapped me.

  The pediatric cardiology waiting room at Boston Children’s is a cheerful place, a big open space with lots of bright colors and sunlight, soft couches and toys on the floor. While Columbia Presbyterian has the busy polyglot feel of Washington Heights, Boston Children’s feels clean and dignified like Harvard. Most of the patients were babies and toddlers. There were mothers everywhere and the occasional dad—a guy my age with a mustache, a job, a marriage, and a child in trouble. Tables were stacked with copies of parenting magazines and books for kids. Highlights for Children and Clifford the Big Red Dog. A woman beside me asked what I was doing there (Was she suspicious? Do child molesters hang out in the pediatric cardiology waiting room?), and when I told her I was there to see Dr. Freed, her eyes brightened. What was my kid’s defect? Hers had been born with tetralogy of Fallot. There was the baby, bundled in a bright car seat, sleeping. I had to explain it was me—that I had been born with tetralogy. Her eyes welled up, and I saw how she saw me, tall and looking healthy, a sign of what her own child might grow up to be. She asked how I was doing, and I told her I was doing great—teaching at a college, feeling strong, and repaired completely.

  After the nurses weighed and measured me, Dr. Freed came out and introduced himself. He was tall and slightly stooped, bald with a walrus mustache around an O-shaped mouth. We shook hands. He had cleared some time for me, he said, since I’d come in from out of town. He walked me to his office. Late afternoon sun fell through the windows across his big wooden desk.

  “Did you enjoy your trip to the Museum of Fine Arts?” he asked.

  I was startled. How did he know I had gone to the museum? A dreamlike thought came to me, the kind of thought a small child might inven
t about the magical powers of a teacher or a parent. Dr. Freed was that kind of cardiologist, I decided: the kind who kept track of his patients on the days they visited him, who knew where they traveled and what they did, the kind who knew everything. My wonder must have read on my face. He chuckled and pointed to the MFA pin on my lapel, the one they gave me at the museum after I paid admission. I took off the pin and put it in my pocket.

  I was expecting a battery of tests in Boston, but Dr. Freed said there was no need. He had the results from Columbia. In his office he asked about my work, my teaching, and my writing. He felt my neck with his cool and gentle hands and warmed his stethoscope before he touched it to my back. He felt my hands and my feet and ankles. He watched my chest rise and fall as I breathed. We talked about diet and exercise.

  In very broad terms, Dr. Freed described the problem I was facing. He drew diagrams on a piece of paper, explaining the basics of my heart as no one had ever done for me before. As a result of surgery, I didn’t have a pulmonary valve, he explained, crossing out one part of the heart. The blood leaking backward had enlarged my right ventricle. He drew arrows in magic marker and plumped out one side of the box marked “RV.” For the first time, I could visualize my condition.