Reasons of the Heart

I.

In the beginning it cuts through the dark: a swath of Milky Way rolled out through the void, a snake on its belly in the grass, a root needling through black dirt.

Before a heart becomes a heart it begins as a tube, narrow, pulsing with little flutters. The tube is made up of cardiomyocytes, heart cells, that expand and contract even isolated in a Petri dish—they know what to do without being told. The cardiac tube ripples, squeezing fluid through the fetus, its rhythm so faint only an internal probe can discern it, but it is there, like a whisper of fog breathing across the water.

The embryonic heart pumps even when it doesn’t really accomplish anything because the mother’s heart is doing all the real work. We learn to live by joining in before we’re ready. I become me by letting my flesh work itself out.

We learn to live by joining in before we’re ready.

But how do the very fibers of my being know what to do without me telling them? The philosopher Pascal said that the heart has reasons which reason does not know. What does the heart know? What moves it from the beginning before it has become itself? Chance? Fate? Love?

When I heard my son’s heartbeat on the doppler, a wind rushing over my anticipation, I knew his existence was a gift, the first sliver of a sunrise that might yet roll back behind the horizon. But I also felt myself pulled toward the day we would meet. No matter what happened in the weeks to come, I would be his father. The cosmos and the earth had conspired to make it so. Chance, Fate, and Love are not always so easy to distinguish.

II.

On the twenty-third day, there is a great turning. The tube folds upon itself so that what was on the top is now on the bottom and the bottom is now on the top. This is the way of things. Don’t get too comfortable.

The bottom of the fold swells, like a ripening peach, while inside the tube sheaths of flesh thicken out of nothing, creating chambers, right and left, upper and lower. At the same time, other places ripen, go thin, disappear, while new membranes grow over the openings from either side like apertures, swinging doors that open only one way.

Ninety-nine times out of a hundred all goes according to plan, the turning, the thickening, the thinning, this microscopic fugue of flesh working itself out, so that when this becoming of a person has been gestating for six weeks, everything is in place, and the structures simply have to grow. Or so it is written.

Embryonic hearts expand in proportion to the blood they receive as the liquid flows through the chambers. The heart is nourished by its own work. As the red blood cells squeeze through the organ, they bring oxygen and nutrients to the muscles which swell and thicken, become strong enough to propel the fluid through a network of capillaries woven together like lovers’ fingers through a smooth grey brain and frothy alveoli.

But once every hundred hearts, it goes wrong. The tube twists upon itself so that the great arteries are reversed, the sheaths of flesh don’t quite reach across the tiny chasm, leaving holes that cause a murmur between each thud. Once in ten thousand hearts, some membrane grows too thick so that there are walls where there should be gates and the blood does not bring oxygen where it is needed and that part of the heart becomes shriveled and weak, the cardiomyocytes pulsing to no effect. It’s hard, knowing when to open and when to close, when to give and when to receive.

It’s hard, knowing when to open and when to close, when to give and when to receive.

One of these defects is called tricuspid atresia. The valve flowing into the right ventricle thickens as a barrier instead of a passage and so the ventricle does not grow. The child has half a heart. “I’m sorry but your baby’s heart is abnormal,” the doctor said to us, “We don’t know why.” Was this Fate or Chance?

III.

Not so long ago, many of the one-out-of-a-hundred simply turned blue and died, suffocating on the very air they could not pump through their limbs. Nature did not choose them.

But Dr. Helen Taussig, Dr. Alfred Blalock, and Mr. Vivien Thomas, Dr. Blalock’s surgical assistant, found a way to alter the circulation through defective hearts. Mr. Thomas, barred from becoming a doctor because he was Black, perfected the procedure on dozens of dogs before Dr. Blalock performed it for the first time on a child, who lived. Later, others like Dr. Francis Fontan, would invent operations that make it possible for a heart to function with a single ventricle.

Even sick hearts, even half-hearts, want to pump blood to their bodies. Sometimes we just need a little help. We need to give Fate a little nudge, tell Chance to knock it off. We’re trying to do what we were made to do, become ourselves, thank you very much.

IV.

My son is almost three years old now. Sometimes he climbs to the top of the couch and jumps all the way to the floor and when I tell him that he needs to be more careful, he goes back up and does the same thing, giggling. He does not mind the pale scar running down his sternum or the pockmarks on his torso from which the chest tubes drained. His lips and fingernails turn blue in the cold but when I hold him against me under my coat they go pink again and I know that fresh red blood, bursting with breath, is pulsing through little branches crisscrossing all his flesh. Soon he’ll have his Fontan procedure, his third and, God willing, final operation.

As the embryonic heart grows, its chambers begin to thump in rhythm, the gentle flutter of the atria and the corresponding thud of each ventricle that will one day race with desire or languish on a warm Sunday afternoon. It was Leonardo Da Vinci who discovered, by attention to the heart muscle’s striations, that each thud comes not from a simple squeeze, but a twisting motion. With every beat, our hearts wring themselves out. This is what it means to live: to be torqued upon yourself like a wet rag until every last drop is pressed out of you but also somehow into you in exactly the same moment.

With every beat, our hearts wring themselves out.

I remember the day of my son’s first surgery, the day that seeped into the night, when I could feel my own heart twisting in terror, while his lay still, held like a hazelnut in the surgeon’s palm while the bypass machine pushed the blood through his veins in a constant motion without rhythm. When I see him now, I cannot help but be amazed that he is here, that any of us are here, that when we might just as easily disappear into nothing, a million quiet turnings keep us going, mirroring the wheeling heavens above and the Love that set them in motion.

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