“You gotta have heart...” 

There are instances where people have the intelligence and ability to do a job, but are, most cataclysmically, the wrong people for the job. They are, for one reason or another, emotionally unprepared.

They give psych tests for police applicants, and one of the disqualifying personality types is the fundamentalist. It makes sense. You don’t want to come around a corner to find a cop, red-faced, lips laced with spittle, screaming, "You have SINNED! Against GOD!" while waving his gun wildly at a terrified motorist who is sobbing that she didn’t SEE that it was a red, no-parking zone. Fundamentalists tend to take their perceived duties a little TOO seriously, and aren’t real good on perceiving graduations between right and wrong.

Similarly, you probably don’t want to hire a security guard who is convinced that ghosts and vampires stalk the night. You’ll always have to worry just a little bit that one morning, you’ll come in and find him sitting in his office, looking perfectly calm, but with blood stains on his uniform and a strange little smile on his face, and he might turn to you and say, in perfectly conversational tones, "I had a good night last night, boss. I killed six vampires." First thing you do is go out and see what those "vampires" might have been.

It isn’t a function of intelligence, or maturity. I sometimes think of fundamentalism, which imposes a prefabricated "truth" over life, the universe, and Douglas Adams, filtering all perceptions and mandating an often inappropriate set of responses, as an exogenic form of psychosis, whereas plain old madness is endogenic, or from within. It’s not a point of view that scores me much in the way of brownie points among the local bible beaters, but the fact is that fundamentalism, while most frequently expressed in religious terms, is a personality disorder that interacts with religion disastrously.

Fundamentalists are often intelligent, socially pleasant, and capable. But there are areas where they are horribly wrong for the circumstances.

There was a truly excellent article by Sheryl Gay Stolberg that appeared in the 10/8/02 edition of the New York Times (http://www.nytimes.com/2002/10/08/health/anatomy/08HEAR.html) entitled "On Medicine's Frontier: The Last Journey of James Quinn".

James Quinn was a patient, diagnosed as terminal with irreparable heart disease, and not considered a candidate for a transplant. Thus he became one of seven terminal patients to date to have an artificial heart, the AbioCor, implanted. The device, perhaps the most promising artificial heart made to date, had brought about at least temporary improvement in all of the patients. However, six of the seven are dead, and the one survivor, Tom Christerson, is regarded as something of an anomaly.

According to Stolberg, Quinn, a 52 year old Vietnam vet, was diagnosed as terminal in the fall of 2000, in the late stages of cardiac failure aggravated by untreatable high blood pressure. Because of other factors, he wasn’t a candidate for a regular transplant – not that transplant patients have much luck securing a healthy organ in time.

So the physician, Dr. Louis E. Samuels, approached Quinn and told him of this program with the AbioCor artificial hearts. Quinn was intrigued, hopeful at the thought of a new lease on life, or at least a extension with some hope of a little quality time, and willing to contribute to medical research at the same time. So far, so good.

But the Quinns had one question that should have sent warning signals to the physicians that perhaps he wasn’t going to be the ideal subject. Stolberg reports that he told her, "I asked my wife, `Am I going to feel the same things that I feel now? Am I going to feel that I love you with all my heart?'"

A lot of Christian fundamentalists take seriously that Biblical description of the soul as residing in the heart. They thus believe that the heart, rather than the brain, is the source of all human emotions and desires and volitions. Medically utter nonsense, to be sure, but they believe it.

So right off the bat, you had a patient who was basically asking if he would still be a human being after the operation, which should give any physician pause.

Stolberg’s article explores the coercive aspects of anyone who is a terminal state being offered an extension of that life, possibly with some quality, in return for being a guinea pig. The ethics and psychomedical aspects are, to be sure, questionable.

If you take a person who listens to his heartbeat and considers it proof of god’s presence in his life and the affirmation of his humanity and his immortality, then perhaps it isn’t a good idea to ask him if he would like to live a few extra months, only without that heart.

One of the more troubling aspects of the AbioCor is that it doesn’t beat. It just sort of hums. A person with one doesn’t have a pulse, as such. That nearly imperceptible thudding in the inner ears is gone. The faint sense of pulsation is gone.

For anyone, that would have to be a unsettling experience. At some level, your unconscious would have to be endlessly screaming, "your heart’s not beating! You’re dead!"

If I was in a position where I was near death from cardiac failure, and was offered the AbioCor, I would have to think about that long and hard. As best I could under the circumstances.

And I think the heart is just a muscle, no more a seat of my soul or intellect than my gluteus maximus. At least the latter IS a seat.

In Quinn’s case, there’s nothing in Stolberg’s article to suggest that he decided he was no longer human, or bound for hell because he no longer had a soul, or any such silliness. And Quinn seemed to be a intelligent man, and fundamentalists do have a way of ignoring conviction in favor of annoying reality from time to time. Quinn probably realized that he felt pretty much the same way he always did, and was still religious and still loved his wife and family, and did all the things that people with regular hearts did.

But, just as the lack of a pulse would always be in the back of our thoughts, an unsettling silence, for Quinn, the lack of a "Heart" had to be an equally unsettling silence. In addition to the unease a lack of pulse would cause.

Maybe artificial hearts won’t be the way to go. Maybe we’ll learn how to make stem cells march in formation, and be able to just grow a new, natural heart for someone like Quinn, from his own DNA. A natural heart, as much a part of you as the one you were born with, without rejection problems or clotting problems. But that’s a while off. For now, given the shortage of donor organs, artificial hearts look to be our best bet.

Nor am I suggesting that fundamentalist Christians shouldn’t be allowed to get artificial hearts. (I’ll get mail accusing me of such anyway, of course).

Stolberg made it clear enough in her article that medical ethics boards needed to be examining the psychological and emotional problems involved in the unhappy conjunction of patient desperation and the false promise of experimental treatments.

I think that closer attention to the patient’s emotional and spiritual standards needs to be applied. While the problems involved can sometimes be obvious: an orthodox Jew, for example, would never accept a pigs’ heart as a transplant, even briefly; other issues, such as Quinn’s, are less apparent, but can play as big a role.

Quinn had poor quality of life and died miserably. He got nine extra months, but questioned its value, even considered suing the doctors. It wasn’t what the new heart did that didn’t occult his chances for a good recovery; it’s what it didn’t do. It didn’t beat, and it didn’t remind him that he was one of god’s children.

When he died, at his wife’s request, the remains of his old heart was taken out of its jar, stuck back in his chest, and he was buried with it.