The Source of All Things

by Reinhard Friedl

  * * *

  To relocate death from the heart to the brain is a scientist’s heartless brainchild. And I believe that people all over the world sense this. Shouldn’t the decision be whether I would gladly donate my organs when my brain has stopped working and won’t ever work again? I will willingly give my organs, my cornea, and other parts to someone who needs them and who will gain more quality of life with my help. However, I am not doing so as a dead person, but as a living one. It is my last good deed in life, not my first good deed in death. My time has come. This would be a clear, life-affirming decision. For this reason, I have an organ donor card. I decided this in full consciousness, and after my organs are removed I want to die “conscious” of my decision. But what consciousness will that be if my heart is beating but my brain is switched off? According to the German Organ Transplantation Foundation, general anesthetic is not necessary, as it would work predominantly in the brain—which is no longer working in this case, so no pain can be felt.11 Moreover, the person has been pronounced dead before the transplantation, even though their heart was still beating. For this to remain the case, the whole spectrum of the therapies of intensive care medicine is exhausted to keep the corpse alive—including the neurotransmitters dopamine and noradrenaline, which also affect the heart. I don’t know about you, but when I read something like this I deem it downright bizarre. If indeed I ever become an organ donor, I want general anesthetic during the extraction.

  * * *

  As we have seen, there are children who are born without a cerebrum and who survive and are conscious, in a simple way. In the past, such children were used as organ donors—in the same way that premature babies were operated on without sufficient anesthetic, on the assumption that they did not have any consciousness and they were not real human beings.12 That is beastly cruelty and shows what people are capable of if they are led by reason alone, relying only on facts that can be objectivized and measured. As a surgeon, I consider helping people be free of pain one of the greatest achievements of medicine.

  * * *

  Who benefits from equating brain death with the death of the whole person? Some priests, doctors, and politicians seem to think they can convince people to donate their organs if they make the well-defined brain death plausible to them. I believe the opposite is the case. It would be more appropriate to call brain death “cerebral arrest” or “brain failure.” In this case one should be able to give away one’s organs and then die. In any case, different countries have different ideas about when exactly brain death occurs and what exactly has to be observed in order to confirm it.13 This is comparable to the question of when life starts. If death equals brain death, does life start with the “brain birth”—and when would that be? Only when the brain has fully developed, or when it is just beginning to grow? With the first brain cells from the twenty-fifth day after procreation, or shortly before birth in the thirty-sixth week of pregnancy?

  * * *

  Modern medicine does not know the whole truth about the beginning of life, nor about its end. Different views are debated, controversially, by science, religion, and philosophy. However, if the transition and process of dying are finished and death has occurred irreversibly, doctors are able to determine it exactly and easily. Livor mortis develops, as well as rigor mortis and, in an advanced stage, decay. Those are the sure signs of death that every doctor today has to be guided by. That has not always been the case, and many people in former times were plagued by the fear of being buried alive by mistake, only appearing to be dead. That may have happened with a deep unconsciousness or a poisoning, when the pulse would have been so weak it couldn’t be felt. The mistrust in medicine’s competence regarding such existential questions has always been great. Time and time again, people who had been thought dead have awoken from their sleep, a blackout, a coma. The idea of being buried alive continues to be unbearable to many people today. In his book Mein Leben mit den Toten (My Life with the Dead), Alfred Riepertinger tells of a shocking method to overcome that fear, which even today is still carried out in Vienna, a city with morbid charm: the heart stab.14 The dead heart is stabbed in order to give people who in life are afraid of apparent death the ultimate certainty they have asked for in their wills. There is a special heart-stab knife for this action—which is not deemed murder. The knife is about twenty centimeters long and sharp on both sides, as it has a double edge. Based on my experience with various knife wounds to the heart and those which missed the mark, I would claim that even the “heart stab” is not 100 percent reliable. Anyway, even Arthur Schnitzler (1862–1931), who was not only an eminent Austrian author of plays and stories but also held a medical degree, made use of this service. On the other hand, authors have vivid imaginations, and close to his death Schnitzler may have been more poet than doctor.

  THE HEART IN THE EYES

  When I arrived at my parents’ house, I was extremely relieved to find my father conscious; he even had the strength to welcome me warmly. My mother and my siblings, who lived close by, had looked after him lovingly. I wanted to support them and simply be there with them. For the moments when I wasn’t needed, I had brought along some work, including a scientific article from the journal Nature Neuroscience which had fascinated me when I read it the first time. Signals from the heart had been detected in the brain during a complex experiment.1 Of course I had a keen interest in this and hoped to get an understanding of the experimental set-up; to do so, I would have to familiarize myself further with a field usually foreign to me, namely neuroscience.

  After a few days with not a lot of peace and lots of family commitments, I had still not unpacked the article. My father was a little better, and it even looked as if he would be able to celebrate his eightieth birthday in a few weeks’ time. I decided to take advantage of being close to the Brenner Pass and take a trip to Italy in the second week of my holidays. I visited Genoa, Portofino, and of course Florence, where I had a long wait as one of many thousands of visitors to be admitted to the Academia. And there it stood, the best-known sculpture in art history—Michelangelo’s David. It was much taller than I had imagined, even though I knew that David measured slightly over five meters. Of course it impressed me, but I found Michelangelo’s many half-finished sculptures even more interesting. From them one could learn how he had worked and how mere stone had been turned into shape. They reminded me of the wonderful paper cut-outs by British artist Rob Ryan, who carved the following words out of paper to form the title (and cover) of his book: “I thought about it in my head and I felt it in my heart but I made it with my hands.”2 It seemed to me that in my search for the whole heart I would retrace this sentence back to front.

  I would have liked to stay longer in the Academia, but the rush of visitors was so relentless that I was pushed past the masterworks as if on a conveyor belt, and suddenly I stood at the exit. There were Davids galore on offer in countless souvenir shops. Without so much as glancing at them, I elbowed my way through the crowd, stopped, and turned back to see a replica of David’s head. No, I had not been mistaken. He had heart-shaped pupils! And this was despite the sculpture being a tremendously naturalistic depiction, with perfect shape and perfect proportions! Why had Michelangelo’s genius deviated from this approach toward the center of seeing, the pupils?

  We see better with the heart

  That evening, I became lost in the article from Nature Neuroscience, and it seemed to me as if a further piece, or stone, in my heart’s puzzle was falling into place—not the one that David had hurled between Goliath’s eyes, even though it had something to do with my sudden understanding. Little David, facing the giant, needed a lion’s heart and could not afford to tremble when faced with such powerful superiority. Courage and love make one fearless, and the heart incorporates both qualities with its synthesis of adrenaline and oxytocin. But that alone is not enough. The young shepherd also needed a sharp eye in order to hit the giant—who was many times his size—with the utmost precision. His throw had to hit
home, he had only one chance. And he succeeded, also because one’s vision becomes sharper with a brain that listens to the heart—this was evident from the article that I had carried with me for so long. Now was the perfect moment to grasp it, with brain and heart.

  * * *

  The brain reacts to signals that come from the heart, and these signals influence our perception and our decisions. With every heartbeat, the heart’s sensors pass on information to the brain and the neocortex.3 When the brain responds, so-called heartbeat-evoked potentials (HEPs) become detectable. These are measurable changes of certain brainwaves in response to the messages from the heart. To measure them is very involved and requires extremely sensitive technology.

  In an experiment, subjects were shown a weak visual stimulus—gray-and-white patterns with such little contrast that they are right at the threshold of optical perceptibility and thus often are not consciously perceived. When such a stimulus was presented to subjects in a phase when the brain was reacting to the heartbeat, the probability that they could consciously see the image was significantly higher. Before the stimulus was presented, neither the multifaceted physiological body data nor the brain’s general excitability could predict the correct visual recognition. When they saw the stimulus, the subjects had to press a button. The study’s authors concluded that the heart’s signals to the brain immediately influence our decisions and our behavior.

  Additionally, the heart’s signals transport information to the brain that influences our physiological ability to see. If a stimulus is recognized, this process in the brain in turn influences the heart: after the decision it becomes slower and seems to relax.

  This experiment betrays an enchanting, simple elegance. The stimulus was neutral, a pattern in shades of gray and white with little contrast. Emotions or certain expectations did not recognizably influence the brain’s reaction to the heartbeat. The brain’s responses were spontaneous, sometimes occurring and sometimes not. We do not know when or why the brain reacts to a heartbeat and when it doesn’t. We can only speculate. This is also true for the message that Michelangelo carved into stone. Maybe it was an experiment, and the pupils in David’s eyes, five meters up, could be seen only by those who were connected with their heart? That would be entirely possible, as current studies have come to the conclusion that we perceive ourselves more intensely and feel more compassion for others in situations where our brain clearly reacts to our heartbeat.4 The amplitude, or strength, of heartbeat-evoked potentials is reduced when certain heart diseases and types of depression occur. That could mean that we are more susceptible to negative emotions such as feeling depressed, but also to heart disease, when our brain ignores the signals that are the voice of the heart.5

  * * *

  Such was probably the fate of neuroscience for a long time, as the brainwaves that have their origin in the heart are very fine and subtle. For decades it was believed that they were interference, as with a badly tuned radio. Today we know that it was not that the radio had been badly tuned; rather, our listening devices and measuring instruments were not sensitive enough. Extremely sensitive tomographs now show that the incomprehensible noise is in fact the sound of intricately structured body signals to which our brain responds and which influence our perception and decisions. In a scientific guest commentary on the study mentioned above, experts arrive at this insight: “Given how seriously the brain appears to be taking the heartbeat, perhaps we as experimenters need to do so as well.”6 Michelangelo took this to heart 500 years ago.

  * * *

  An interference entered my consciousness. It was my cell phone. When I saw the number, I had a premonition. Thoughts about my father had been with me on this trip; sometimes it had seemed to me as if he was standing beside me.

  “I will speak at the funeral,” I promised my mother. When I ended the call I knew that I would not give an ordinary eulogy. I wanted to speak with the voice of the heart, with the look of David in my eyes. My father had been a bricklayer. What would he have said about this sculpture? He had never been interested in “things like that,” but had not badmouthed them either and never put obstacles in my path, but rather had supported my development through the stones he laid and the houses he built. I had only grasped his savoir vivre late in life. And I demonstrated this three days later when I gave the whole eulogy in the wild Swabian dialect of our native area. “Michelangelo would have depicted him with a heart in the palms of his bricklayer’s hands. To build houses for other people was his way of expressing love.” My father did not respond that time; maybe he was already busy again in the afterlife, as his philosophy of life was “Work hard, work hard, build a little house.”

  A warrior’s heart

  Once I was back at my Baltic Sea home, I pulled a ten-kilogram tome on Michelangelo from the shelf. A friend had given it to me after my habilitation. The art world was ignoring this peculiarity of the pupils; I only found a few words about the hearts in David’s eyes.

  Instead, I discovered in the heavy tome a discussion among scholars about the question of whether Michelangelo had depicted his David before or after the fight.7 I think both aspects are visible, and that is the artist’s genius. He formed the white marble in a balanced state of exertion and relaxation, getting close to the nature of the heart. The sculpture depicts a physically present, focused David. He was only able to win this uneven fight in the state of a warrior who had gathered himself beforehand. In the moment of the fight he was connected with his heart, and his brain was open to the heart’s signals—which gave him the strength and sharpness of vision to hurl the stone with all his might between the giant’s eyes. This is where the “third eye” resides—an energetic center that represents visionary clarity and intuition, according to many spiritual traditions. In a certain way you kill a person if you extinguish these qualities. A person without knowledge, perception, and intuition is dead inside. But perhaps David’s fight was over, and the giant was at his feet. David’s gaze has nothing presumptuous about it, and he does not boast; it is the gaze of someone who has done what he had to do in a straightforward manner. In the gaze of the man with the warrior heart there is compassion for the defeated and also the victor’s gratitude toward those who helped him.

  The collective heart

  David was an underdog. But he had something that made him invincible. Not only his warrior heart, but also the hearts of those on his side who believed in him. He could be sure of the support of his people, the tribe of Israel. Hearts can synchronize themselves across vast distances and in dangerous situations. This was demonstrated a few years ago by people who literally walk through fire.

  * * *

  Every year on June 23, two tons of oak wood are set alight in an amphitheater in San Pedro Manrique, a small village of 600 people. Three thousand visitors from near and far eagerly await the fire ritual, which begins at midnight. When the bed of glowing coal is ready, the procession of firewalkers from the market square to the amphitheater begins. They are all inhabitants of the village, between nineteen and forty-six years of age. The crowd and their friends and relatives accompany them and cheer them on. Then they dance around the embers for a few minutes and walk barefoot across the seven meters of fire carpet, which is 677°C hot. Most of them also carry a person who is dear to them on their backs. In a spectacular study, the heart rates of twelve fire walkers (eleven men, one woman), one of their loved ones in the stands, and other spectators (who had no personal connection to the fire walkers) were measured. Nonlinear mathematical analysis uncovered that during the ritual a baffling alignment and synchronization occurred between the dramatic-looking heart rate curves of the fire walkers and their loved ones. These curves are not at all linear, but like a rollercoaster of emotions. Every pair has their own highs and lows. In contrast, the heart rate of the spectators with no connection to the walkers remained indifferent.8

  Gradually—and still largely unknown publicly—scientists are beginning to understand that hearts are able in multiple w
ays to connect synchronously with each other. But how exactly do they do that in an amphitheater with several thousand spectators, and across quite a distance? After all, the heartbeat is not audible, the participants do not touch, and they are involved in different activities. The authors of the study conclude that it would have to be a certain type of information that is exchanged between hearts, one we cannot measure.

  In the frenetic collective excitement of a ritual, in the formation of a sense of togetherness, a palpable, physiologically measurable connection of hearts can occur; this affects the hearts of those actively involved as well as of those looking on. The supportive power of collective rituals is a phenomenon in all known human cultures. It fosters community coherence and encourages its members to stand up for one another.9 We cannot deliberately influence our heartbeat, but—however it may work—hearts seem to sense when they are needed: they connect and go into resonance, similar to what certain nerve cells in the brain (the so-called mirror neurons) do in such situations. Compassion and support, then, are not only matters of the head but also concerns of the heart. The many scientific studies on the synchronization of hearts allow us to conclude that the amplitude of many hearts may add up and become a collective heart; then we are like one heart.

  LOVING

  After my visit to Michelangelo and my father’s death, I initially had trouble returning to the operating room. I would have liked to spend more time with what was dear to my heart, more time than the clinic’s everyday routine would allow me. On the other hand, I was looking forward to the familiar environment of my daily work. So one morning I entered the nurses’ room, which is always buzzing with intense discussions. I did not hear what my colleagues were talking about, but when I entered they fell quiet.