The Man Who Touched His Own Heart

by Rob Dunn

  With the details of the high-resolution images, the simulation produced a working heart out of nothing but the high-resolution skeleton of a real heart and a few rules for the behavior of the muscle fibers. The model contains no master instructions, just directions for the behaviors of the individual fibers, but that is enough, much as the simple behaviors of individual ants can yield the sophistication of the colony. What is more, the approach is sufficiently flexible that, with high-resolution images from dog and rabbit hearts, the team has also been able to simulate the beats of the hearts of those animals. Just as in real hearts, each heartbeat is slightly different from its predecessor, a function of the specific sequence in the contractions of millions of cells. And each unique heartbeat of these simulated hearts is an indication that the scholars have come to understand the most important basics of how the arrangement of heart muscles and their signaling yields a beating heart. What was also unintentionally indicated, though, was the humility of scientists, engineers, physicists, and physicians. The computers that produced (and produce) these virtual, bloodless, unexcited hearts are so large, they require eight separate rooms filled with ten thousand processors. Here, then, is the real miracle, evidence of both our limited understanding and the heart’s greatness. Those who attempt to create or improve artificial hearts must contend with the physical moral offered up by the supercomputer heart—namely, that the real heart is so complex that the best model of it we can make takes rooms and rooms, and even then, the model is far humbler than the real organ.

  Vázquez and the team of more than thirty scholars with whom he works hope one day to stimulate not just an “average” heart but also particular hearts, yours or mine, so that the problems in individual hearts might be better understood and treated. Vázquez plans to add in a model of the flow of blood, maybe even the dynamics of the heart’s responsiveness, though not quite yet.

  Decades before Vázquez began building his computer heart, physician and essayist Lewis Thomas, describing the attempts to produce artificial hearts, wrote, “Not knowing the why of heart disease, we provided a makeshift device.” But if Vázquez and his colleagues are able to simulate individual hearts, healthy ones and sick ones, they might one day also be able to use these makeshift digital devices to understand some of the electrical failures of hearts, some of the whys. They might even be able to model particular problems, such as my mother’s arrhythmia, to understand where and how to treat the muscle fibers. At least in theory, they could model the clogging of the coronary arteries and the consequences. But for that, they would need to understand the blood, and even then, this approach would answer only one kind of why, the why of details and mechanisms. The other more difficult why is why these problems occur in the first place, why and when. A partial answer has been waiting for years, far from the supercomputers and surgical theaters, inside the body of an Egyptian queen.

  9

  Lighter than a Feather

  If thou examinist a man for illness in his cardia, and he has pains in his arms, in his breasts and on one side of his cardia… it is death threatening him.

  —EBERS PAPYRUS

  I first saw her in a photo. In the image, she looks forward. She is beautiful beyond reason. Her arms and chest are dressed in a honeycomb. She is holding two hard-to-distinguish objects, and her thin, dark neck rises proudly to her smooth face. The long braids of a wig cover her ears. She does not quite smile, but nearly. This is how she is remembered, in this single image, at age forty-five.1 Then, of course, there is her body, which has come to change our understanding of the story of our hearts.

  Born approximately thirty-five hundred years ago, she was the eldest daughter of Queen Nefertari and Ramesses II. She lived in the Valley of the Queens. She traveled with her royal parents as they were feted throughout Egypt, being feted herself in the process. At the dedication of the Abu Simbel rock temples in southern Egypt, she was honored with her own statue. She would have been carried around and tended to. Her diet would not have been a typical Egyptian diet, rich in vegetables and deficient in meat; it would have been a privileged one. She lived a good life. She may have eaten bread, olive oil, goat meat, pig meat, and honey, and she may have drunk beer.2 Repeat. Add some delicious grapes. It went on like this, and then her mother, Nefertari, died. Her father remarried, and then the second wife died. Then her father died; when he did, Meryet-Amun became queen. She was a young queen for a very short period, and then she disappeared. This was, for a long time, all that was known of her fate.

  Whatever happened at the end of her reign, when Meryet-Amun herself eventually died, we can assume her regal family spared no expense in readying and preserving her for what would come next. Specialists were called in. They cut open her small body beginning at her breastbone and lifted her organs out. All were tended to individually before being placed in ceramic jars, which would sit alongside her in case they might later be of use. Her heart alone was replaced in her body, which was now just a vessel, her posthumous boat. She was then wrapped up and sealed in a coffin on which her likeness was painted, and this was sealed inside another coffin, which in turn was sealed inside a giant sarcophagus. The sarcophagus was brought into her tomb. Inside her sarcophagus, her heart, buried beneath flesh and linen, continued to hide a secret, a sort of buried treasure that has recently been uncovered.

  Her resurrection began in Egypt in 1940. Herbert Winlock, an explorer from the Metropolitan Museum of Art, was searching the Egyptian sands for statues of Queen Hatshepsut, the woman who had ruled Egypt as a king from 1479 to 1458 BC. Winlock was not alone. He was surrounded by a great army of men out on the sandy plains of Thebes. Each wielded a shovel or other instrument, all looking at the piles of sand for a hint of what might lie beneath.

  Little was known at the time about their quarry, Hatshepsut, because her successor, a bitter son, all but obliterated the evidence of her reign, hacking apart each of the many statues of her likenesses, one by one.3 Winlock wanted to find statues that might have been missed, though he knew as well as anyone that sometimes what you find is altogether different from what you were looking for.

  Winlock’s men worked an entire season without success. They found ruins and bodies, of course—Egypt is full of both—but nothing of great significance. Then, one of the assistants saw something in the drifting sand,4 up on the hills around the site where they had been working: pieces of shale stones where none seemed to belong. The shale might have been nothing at all. But, at least to Winlock’s prepared and perhaps overly hopeful eyes, it looked like something. Could it be a pile of rocks tossed up where a tunnel had been dug, a tunnel into a tomb? He hoped. Winlock had been out in the desert for a long time, and any hint of discovery was enough to excite him. His heart pounded; it leaped at his throat.5 He gathered his team and quickly they began to dig. They were trying to be careful, but from a distance, they looked like a pack of eager dogs, all searching for the same bone. Below them was the Valley of the Kings, and just beyond, the agricultural land along the Nile, rising like a green mirage. They dug and dug and then dug some more. They dug for a whole day and then forty-eight more, without any sign of discovery, all on Winlock’s gut sense that somewhere beneath them was something more. Then, on February 23, the sand began to give way.

  The foreman, Reis Gilan, reported to Winlock that the men had found a tunnel! It was rounded, shaped in the way that every tunnel—be it a mineshaft or an artery—seems to be shaped. The tunnel continued on to a brick wall. The wall looked as though it had been built hastily out of makeshift bricks. It was left unfinished and ready to be reopened. The men wanted to break the wall; they were dying to see the other side. It would be so easy! Like Winlock, they wanted to find treasure, whether for the excitement of discovery or because they had their own ideas about what they would do with it when it was found.

  Winlock told the men to wait. If there really was an important discovery behind the wall, he didn’t want everyone to know yet. He sent everyone home and guarded the hole. So
me resolution, the men hoped, might come the next day (little did they know that the full revelation would take more than eighty years).

  Several days later, on February 28, Winlock and a much smaller crew returned to the brick wall. They began to push carefully through. They hoped that, on the other side, they would find treasures—statues, gold, art, perhaps even a royal tomb (though over the weeks, Winlock’s confidence had waned). Instead, they found garbage. There were scraps of things, bits of pots, baskets, and who knew what else. It was ancient garbage; in Winlock’s words, “a rather disreputable rubbish hole.” But the garbage was not all that had been left. There was a body, abandoned next to a small coffin. This body would turn out to be a small story, not what they were after. Farther in, they found a well, and beyond that, they could make out, by the light of their primitive flashlights, more of the tunnel. It continued, it seemed, on the other side and maybe, just maybe, there was a hint of a chamber, an atriumlike opening. Winlock went back out and told the men to go home. He stationed a guard at the site that, after so long in the desert without success, was beginning to seem, possibly, auspicious.

  In the next days, Winlock had the men gather some planks, but before they could bring them into the tunnel, everything that had already been found had to be photographed and cataloged. Archaeology is a study in tedious anticlimax. Most days, it can be downright awful, the antithesis of what archaeologists new to the field hope it will be. Then, if you are lucky or prepared or both, there are the days when you get to jump over the well and see what is on the other side. Winlock knew that day was coming, but he was also beginning to sense that what he and his men had found was significant enough that he would be judged not just by his peers, but also by history; it would pay to wait.

  Slowly, photos were taken; drawings were made. Every piece of garbage was labeled. It was not until the morning of March 11, a full two weeks after the tunnel had been found and nearly eight weeks after the men had started digging, that the well could be crossed. Finally, the wood planks that had been cut to be just the right size so as to fit down the narrow tunnel and around a corner and then over the well were taken in. It was not going to be easy. The men put one plank down and then extended the other. The planks not only fit, they seemed to settle into ancient grooves that must have been used thousands of years before to span the same gulf. Between the two planks, they set up a little platform over which Winlock could scurry. Winlock moved across and hesitantly started down the tunnel. As he did, his heart lightened, buoyed by possibility. His body was, in his words, “tingling with curiosity.”

  Beyond the well, the tunnel led into a large room where Winlock and his men could stand. In the room there were two enormous coffins, and inside the innermost coffin, a body. The body was wrapped in clean bandages, which were labeled, written on with detail and care. Here was a discovery. Here, also, was a series of mysteries, as time would prove.

  Winlock was concerned with the mysteries of the woman’s identity and the story of her life, and those would be partly resolved. Before Winlock left the coffin to the museum, he had gathered a few observations about the previous life of the body inside. Her chamber and coffins had been prepared with great care and expense, as had the small piece of cloth recovered from the well bearing her name; it was, she was, Queen Meryet-Amun.6 Here was a real queen, the queen who had disappeared. She would have moved among the masses with special treatment, ushered on through her fortunate life until she died, whereupon she was ushered through her death. At least, that is, until Winlock got hold of her and then abandoned her in the back room of a museum.

  The biggest mystery has turned out to be why and how she died and disappeared. She was not young for her time, and yet she died of something—some specific cause. Winlock couldn’t tell, nor did he particularly care. He moved on to other mysteries in his own field of study, and the body of this queen was, in essence, abandoned. It was taken unceremoniously to the Cairo museum, where for ninety years it would simply wait. Her body had already waited since 1580 BC; what were a few more years?

  The clues to Queen Meryet-Amun’s death would eventually be found in her body, but her sarcophagus also offered a clue. There, Winlock found the normal elaborate scribbling one expects on Egyptian things: the picture-words of hieroglyphs and then literal pictures. One of the latter showed a heart being weighed on a balance against a feather.

  When an Egyptian king died and went to the underworld, it was believed, his heart was put on a scale to see whether it weighed less than a single bird plume.7 A light heart allowed passage into the afterlife, where a king could eat and copulate to his heart’s content. The actions of a life were, it was said, scribbled on the heart, such that its weight was a fair measure of the king’s actions. The idea that the measure of a man was written on his heart would reemerge in Christianity, in which it came to be believed that the heart contained a written record of sins and vice. The Egyptians were first, though, at least when it came to literally measuring the heart to judge a person’s life. With time, this judgment was extended beyond the king to courtiers, the nobility, and even the priesthood.

  In the hieroglyphs, a god was said to do the weighing, but the balance was watched over by a baboon that played the role of referee for admission to the afterlife, keeping his eyes on the fairness of the judgment. If the heart was light, the deceased could travel to the afterlife. Most Egyptian research on the body was related to ensuring a good afterlife rather than a long life. The daily life was the preparation; the afterlife was the real deal. Unless, of course, the heart was heavy, in which case both it and the chance for rebirth were eaten by the devouring beast Ammit, a Chimera with the head and jaws of a crocodile, the body of a lion, and the hindquarters and tail of a hippopotamus. It is tempting in retrospect to think of Ammit as a heart attack, the consequences of a heavy heart.8

  It is not known whether any hearts were actually weighed or, if they were, to what sort of feather they were compared. It would have been in everyone’s best interests to choose a heavy one, perhaps a lead plume. Many sarcophagi show images of the weighing of hearts, but among the most often discussed of such images is one found on Queen Meryet-Amun’s sarcophagus. It is particularly elegant and clear. In it, the side of the balance holding the queen’s heart appears slightly higher than the side holding the feather, but only slightly. The Egyptians, in other words, recorded the queen as having died with a heart just light enough to avoid Ammit’s jaws. But Dr. Gregory Thomas at the University of California, Irvine, and his colleagues were about to prove that this was wishful thinking.

  In 2008, Gregory Thomas visited Egypt for a cardiology meeting and, while there, toured the Egyptian National Museum of Antiquities in Cairo with his Egyptian colleague Adel Allam, a cardiologist who specialized in imaging hearts. In the museum, the two happened upon a mummy, that of King Menephtah (son of Ramesses II, born in about 1200 BC), which was labeled curiously. The text inside the glass case noted that Menephtah suffered from atherosclerosis. Atherosclerosis was, as Thomas, Allam, and all of their colleagues learned in medical school, a modern disease.9 Something was clearly wrong with the label, or at least that was the first conclusion to which the two men came.

  Thomas and Allam both work daily with the modern reality of atherosclerosis. They face a plague. In 2010, seventeen million people died, around the world, of cardiovascular diseases—more people than now live in New York City—and most of those deaths were ultimately the consequences of atherosclerosis. The number of such deaths is predicted to increase. In countries that already have effective public health, this increase will come from population growth and lifestyle trends. In other countries, such as Egypt, the increase may include other causes. As nations become developed, they are saved from the contagions and diseases of infancy and youth, and cardiovascular disease kills in their place. It is in this light that cardiovascular disease caused by atherosclerosis seems like a modern problem, one associated with Western life and diet. This is what we have been taught
. This is what most doctors believe. Yet the truth is more complicated.

  By the time Thomas and Allam saw the mummy in the National Museum, it was already known that heart disease is typically preceded by the formation of plaques in arteries. Those plaques are caused by inflammation that arises when cholesterol and certain immune-system cells (macrophages) begin to build up below the endothelial lining of large arteries. The word cholesterol is derived from the Greek khole, for “bile,” and sterol, for “hard” or “stiff.”10 It is waxy and fatlike in appearance, but it is not a fat. It is a complex form of alcohol—a sterol—with the molecular form C27H46OH. Like all alcohols, its construction requires nothing but carbon, hydrogen, and oxygen. Cholesterol is necessary in your body. Without it, things go tragically wrong. But things can go tragically wrong with it too. Under certain conditions, the body reacts negatively to the cholesterol in the blood. Instead of simply being moved from one part of the body to another, the cholesterol is attacked by the immune system’s bullies, macrophages and inflammatory cells. While we tend to think of plaques as fatty—yellow with cholesterol and other lipids—most of their mass is composed of the cells produced by our own immune cells. If our immune systems did not attack the cholesterol in the first place, the plaques would never form.