The Source of All Things

by Reinhard Friedl

  That was what I was hoping too, but to be on the safe side I asked the coordination center for the nearest hospital with a gynecology department. It was thirty kilometers away.

  * * *

  It was an early May evening, mild for this coastal region. Lots of people were having barbecues and the Saturday night was electrified with anticipation of the upcoming Champions League final. With flashing lights we approached the patient, speeding through a concrete jungle. We turned at a garden allotment area covered in barbecue smoke, another concrete jungle, then we parked next to the ambulance that had arrived a few minutes earlier. Our arrival had not gone unnoticed: at three windows faces were visible, hair rollers around one, toplessness below another. On the ground floor there was a delicious smell of freshly cooked garlic, one floor up of coffee; an apartment door was open on the second floor—we were in the right place, as the name beside the doorbell told me. In a small bedroom, two paramedics were already looking after the patient, a blonde woman in her mid-twenties, her face red, her bangs damp on her forehead. Why is she covered up to her neck in a duvet? I wondered. She smiled at me, I smiled back. A paramedic was kneeling on the right side of the bed, taking her blood pressure. On the left, an oxygen saturation monitor was attached to her finger. My driver was preparing the ECG. An intravenous drip had been put in place already, and the glucose test was showing normal results. Everyone was busy, which in turn was making them feel okay. Don’t just stand around. Help. Work through the medical to-do list. Yet the three men in their steel-capped boots, equipped for a crash on the highway, seemed out of place in this small bedroom with its photo wallpaper (did such a thing really still exist?). And where was the tummy that held my second patient? The mother-to-be hid her body from sight, the duvet up to her chin. She felt good, judging from the fact she was beaming. But it was best to ask.

  “How are you feeling?” I inquired.

  The smile became wider still. “Good.”

  “Are you having contractions?”

  “Yes.”

  “How often?”

  “Every few minutes.”

  “Then we still have time to drive you to the clinic,” I said with relief.

  “I don’t think so,” she replied, suddenly tense, and pulled back the duvet. I could not believe what I saw. The baby’s head was at the pelvic floor. I could already see a bit of fluffy hair. The mother was so relaxed I had not expected the birth to be so far advanced. I had to take a deep breath.

  “I’ll quickly wash my hands,” I heard myself say. I had to think for a second. A premature birth in the thirty-fourth week. I had operated on the hearts of a few premature babies, some of them weighing less than 500 grams. But a birth was something entirely different. Besides, we weren’t in a birthing suite full of neonatologists and pediatric nurses, but many miles away from a hospital.

  On my way to the small, windowless, and rather stuffy bathroom, it occurred to me that we lacked someone to boil towels. That’s what they used to do in the old Westerns I had watched at my grandma’s. That was the only thing that came to mind in that moment. Apart from the birth of my own children, this was the first birth I would attend as a doctor. But this was also a matter of life and death, and I was familiar with those. This little human being was about to barge into the world about six weeks too early, and I did not want to think about the horrible complications that might ensue. When I returned to the bedroom, the patient announced: “It’s starting again.”

  A paramedic gave me gloves. I put them on and stepped closer with outstretched hands, to protect the mother’s perineum and to be able to slowly “unwind” the child, should that become necessary. Then she made a sound like suppressed sneezing three or four times. I got another surprise. The child shot out like a cannonball—straight into my hands.

  * * *

  My heart nearly stopped. The child was blue and limp. As quiet as a mouse. What now? You can work as an emergency doctor for twenty years without ever experiencing a birth. In my case, I had extra qualifications in the resuscitation of children. But in that moment I was numb. Helplessly I held a tiny newborn human being in my hands. At least my doctor’s reflexes worked. I heard myself ask for a suction drain to suck away the mucus from the baby’s mouth. During my medical course I had worked in a gynecology department in Bangkok for a few weeks, where it was like a production line for children, around the clock, thirty beds in a maternity ward, separated by curtains. Such thoughts raced through my head at lightning speed—while I was highly alarmed as the little one was not showing any signs of breathing; the baby urgently needed oxygen. A paramedic gave me the suction catheter. My shock-frozen brain thawed. The little one had to breathe. If the baby would not breathe, its heart would soon stand still. Was it beating at all? My hands remembered my own newborn children. I turned the baby over, noticed for the first time that it was a boy, and then—there was no sound on earth more beautiful—he began to scream. He screamed powerfully and, it seemed to me, with a lot of outrage. I could understand that—there you were just seconds ago, suspecting nothing evil, in a nicely darkened environment, with chilled-out heartbeat music, floating in pleasantly warm amniotic fluid. Then you are pressed through a tight tube, deprived of oxygen, and eventually plopped out into a bright, cold, and hard new world. He screamed his pain for the world to hear, and this primal scream saved his life. All life is suffering, Buddhists say. In this case, though, pain had led to life.

  “Jakob,” the mother said.

  “Ja,” I replied. Yes.

  “Ja-kob,” she said again.

  “Yes. Jakob.” Lovely name. The Ja/Yes at the start. And what a start it had been. Little Jakob was screaming like a furious animal now. His whole body was screaming, and his heart supported him. I no longer needed the suction drain. Jakob’s lungs were working better and better, which had direct consequences for his heart. As the pressure in his thorax suddenly changed, his heart, too, adjusted from its state before birth to what was required now. The right side of the heart was pumping blood into the lungs. In Mom’s tummy the lungs had been bypassed as oxygen was supplied by the mother through the umbilical cord. The new blood paths from heart to lung are opened with the first breaths, and all bypasses closed—a fundamental change for the cardiovascular system. The new chapter in Jakob’s life had started with a big “Yes” to life. He was now five minutes old. But his heart had been beating for six and a half months. And his life had started nearly eight months ago.

  The birth of the heart

  At Jakob’s procreation, his father’s semen dissolved into his mother’s egg. From this moment, every human being is genetically a unique individual who has never before existed and never will again. The inseminated egg cell divides itself into so-called stem cells, and after twenty-two days the little heart beats for the first time. This big bang of life needs a special ingredient, discovered only a few years ago. Researchers at the University of Montreal found that something magical happens with undifferentiated embryonic stem cells when they are sprinkled with the “love hormone” oxytocin: they join, transmute into heart muscle cells, and begin to beat in sync.1 The love hormone is thus the essence of the first heartbeat. Isn’t that fascinating? I will examine this hormone and its effect on the heart further in the sections below titled “The all-purpose glue of love” and “Heart breakers.”

  No one would dissect children’s hearts to conduct such research; as is often the case in medicine, the results come from animal experiments. But the same magic happens for human beings: the love hormone that gets the heart to beat is created by its own stem cells, by the expression of certain genes—and it also comes from the mother.2

  * * *

  When was your first time? Maybe on an ice-cold February night? On a mild May evening? When did your heart first beat? No one took a photograph of this important moment; it happened secretly, quietly, hidden deep within your mother’s womb. It was the beginning of your life. The first twitch of your first heart muscles transported a little b
lood that became the stream of your life. Seven weeks after procreation, the heart is already functional. Blood supply and organ development during the next eight months depend on the heart. It is an infinitely soft first boom. “A sound that comes from silence.” That is what the heart is called in an ancient language, Sanskrit: Anahata.

  * * *

  When is a human being a human being? That is a big debate in stem cell research. As soon as the egg cell has been inseminated, the human begins to grow, a process for which its cells have to divide and proliferate. At this stage, a cell can still become anything: an eye or a toe or the heart or the tongue. Hence the name stem cell—as all other cells will stem from them. They carry within them our complete genetic information, and researchers hope that this fountain of youth will allow them to repair and even grow organs and body parts. But should that be allowed? To create human beings artificially and use stem cells from the growing embryos as a spare-parts store? Or would that be murder? Are they humans, yet, at that early stage? Philosophers, theologians, and scientists debate who is best suited to answer these questions.3 However, the brain alone cannot determine such questions. Ask your heart; it knows the answer.

  * * *

  I put my stethoscope on Jakob’s heart, closed my eyes, and concentrated on entering this subtle world of noises. The sound of Jakob’s heart was clean. That’s what doctors call it when they don’t hear anything suspicious. No whizz, rumble, or machine sound. This heart was beating fast and determinedly. Clean heart sound, I would later note in my emergency doctor’s report.

  Jakob’s first heartbeat was not the beginning of his life, but it was certainly an important moment for him and even more so for his parents. When will his heart beat for the last time? That will mark the end of his earthly life. Or will they pronounce him dead one day and take out his heart while it is still beating? Will his heart thus continue to beat, even when he is dead (brain-dead)? This topic, too, is hotly debated at present. According to many experts, death is defined as brain death.4 Life, then, does not necessarily span between the first heartbeat and the last, as you may have thought until now. But when exactly does it begin and cease? Maybe Eternal Life 2.0 exists, and we only change our shape?

  * * *

  Unimpressed by all these questions, the little heart grows quickly. Seven weeks after procreation its development is finished. From about the eighty-fourth day, sonography can monitor its well-being with ultrasound waves. The moments when I saw each of my children’s beating hearts for the first time are forever etched in my memory. It was love at first sight. In this black-and-gray ultrasound shadow play, most parents can only distinguish the heartbeat anyway. Nature protects the child so well that it is not easily accessible even for our most modern medical methods. We have only a small number of parameters to assess its development. Heartbeat and heart prosperity are among the most important.

  * * *

  With the increasing development of heart and nervous system, from about the sixth month, the baby’s communication with its environment is established. It starts to kick and push. Its heart rate increases when it does so, and slows down again when it rests. However, the fetal heart rate not only changes through its own behavior, but also with the psychological and physiological state of its mother. The baby’s heart adjusts to the mother’s day–night rhythm. The baby’s heart frequency and number of movements will decrease when the mother is not well and, for example, she does not have enough oxygen in her blood. If Mom is stressed or afraid, the little heart will beat faster. Lack of oxygen, sleep hormones, and stress hormones are passed on through the umbilical cord, and within a few minutes the baby will react to them too. And every drop of alcohol, even a single one, can cause damage, as the latest studies show.

  Due to this synchronization of the average heart rate, which can last up to twenty-four hours, one can say that the hearts of mother and child are intimately connected.5

  However, the fact that a veritable conversation can take place via their hearts is a new scientific discovery.

  The language of the heart

  Mother and child are different people; each of them has their own inner beat and their own “heart voice:” the heart rate variability. As already described, at closer inspection the heart rate is not constant, but changes from millisecond to millisecond and from heartbeat to heartbeat. These constant changes are chaotic and can’t be predicted, at least not by our apparatuses and mathematical models. Mother and child, like all people, tick differently—or so we thought until recently. But they can also synchronize themselves down to the finest time scale. Toward the end of the pregnancy, from the thirty-sixth week, there are phases during which the two independent hearts follow each other from millisecond to millisecond in perfect synchronicity. They beat as one. That is infinitely more subtle and exact than the approximate alignment of the average heart rate that was known so far. In one study, during the six five-minute periods that were examined, thirty episodes of synchronization occurred, with an average length of fifteen seconds.6 That is extremely surprising, as mother and child are completely independent. They don’t have the speedy connection that is the nervous system, and neither is the child directly connected to the mother’s circulation. Substances are exchanged only through the umbilical cord, but this path would be far too slow for such a fast synchronization. I was downright electrified when I read that. How can hearts put themselves in sync when they are not directly connected? Physicists and health professionals of Boston’s famous Harvard University, too, thought about this phenomenon.7 Could it be based on the principle first described by Dutch naturalist Christiaan Huygens in 1656? If you mount two pendulum clocks next to each other on a beam, they will tick in sync after a while. Back then, Huygens assumed that the two pendulums synchronized themselves via tiny imperceptible motions in the beam.8 However, mother and child are not pendulum clocks, but rather tick irregularly, erratically, and each have their own beat. So imagine two “clocks” that tell their own time from second to second but nevertheless become attuned to each other.

  In biology, a synchronization of independently oscillating systems has occasionally been observed elsewhere. For example, the synchronous chirping of crickets, the synchronous discharges of nerve cells in our brain (as when they comprehend language), or the simultaneous glowing of fireflies.9 The sinus node, in the area of the right atrium, is a tiny node in our heart, so small not even a heart surgeon can see or feel it. All excitation of the heart originates from it, and it consists of millions of cells. Every single cell is a small oscillator, and before a heart gets to do even one ba-boom, all of the cells have to discharge together and synchronously.10 But still, which secret mechanism leads to the perfect synchronicity of two hearts, those of mother and child? Imagine this: we do not know!

  Possibly the ears play a role in this. The child can at this stage in its development already hear motherly heart tones and the whooshing knocks of her pulse wave. This could well be the missing weak impulse that drives the child’s heart to beat in sync with the mother’s. If one views the development of a human being as a continuous process, divided into a time before birth and a time after, the synchronization of the heartbeats of fetus and mother may indeed be seen as the baby’s prenatal communication with its environment.11 We already send our first messages as unborn babies in the womb. The language we use is the language of our hearts—for me, this is communication between two humans in its most fundamental, earliest, purest form. It is not two brains exchanging information, but two hearts.

  The synchronous glowing of fireflies, the chirping of crickets, and the simultaneous firing of our brain cells—it is always about communication and connection, there are messages encoded here. It is assumed that a mother’s special awareness of her child is founded in the synchronization of their hearts. Scientists found confirmation of age-old knowledge in their experiments: mothers know when the unborn child is well, how it is faring, and if it feels poorly right now. This special awareness may arise fro
m the communication via the heartbeat.

  * * *

  Another answer is to assume the mother’s heart is the pacesetter. Or perhaps the baby’s heart. Or both become attuned to each other in a very precise and synchronous choreography. The mother cannot hear the baby’s heart, but maybe her heart can notice it—with seismological refinement—via signal paths not yet known to us. In systems that are in resonance with their environment, small vibrations may intensify to a single large amplitude—which may be so powerful that it makes bridges collapse, or small waves become gigantic ones. Would many hearts be capable of something like this?… And how was Jakob’s heart?

  * * *

  He had become still. So still I was suddenly no longer sure he was okay. I examined him carefully. Then he started to move and grabbed my little finger as if to say hello. And he screamed again. But less strongly than before—it now sounded like whimpering. Maybe something deep inside him knew that the separation from his mother was life-threatening. He needed protection, warmth, and food rather than a cold stethoscope on his chest. But he was not alone. His mother was here, impatiently waiting for the end of my examination. When would she be able to take her son into her arms?

  “Jakob, now you can go to your mom,” I said and handed the newborn to his beaming mother.