Cold Reality Of An Artificial Heart.docx

Cold reality of an artificial heart Originally published August 19, 2007 at 12:00 am Updated August 19, 2007 at 2:07 am Peter Houghton, part man, part machine, could be called a model cyborg. But there are nagging problems in the recesses of his soul.

Share story By Joel Garreau Peter Houghton is grateful for his artificial heart. It has saved his life. He’s just a little wistful about emotions. He wishes he could feel them like he used to. Houghton is the first permanent lifetime recipient of a Jarvik 2000 left ventricular-assist device. Seven years ago, it took over for the heart he was born with. Since then, he has walked long distances, traveled internationally and kept a daunting work schedule.

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At the same time, he reports, he’s become more “coldhearted” and “less sympathetic in some ways.” He doesn’t feel like he can connect with those close to him. He wishes he could bond with his twin grandsons, for example. “They’re 8, and I don’t want to be bothered to have a reasonable relationship with them and I don’t know why,” he says. He can only feel enough to regret that he doesn’t feel enough. Once a rugby player Life took a turn

Houghton, 68, has become a man after his own heart. It is a large part of his identity. His e-mail name is Heartpump1. When first encountered at a 2006 Oxford University conference called “Tomorrow’s People,” he comes across like the rugby player he once was, sturdy and broad-chested. But in 2000, due to severe heart failure at 61, Houghton was staring at death. He knew death well. Trained as a psychotherapist, he had become a palliative-care counselor in London and Birmingham, looking after the dying. He had helped 122 people into the beyond. He’d made his peace with death. That’s one reason the heart scientists saw Houghton as a prime candidate for the first European clinical trial of their new technology. He came to after the June 20, 2000, operation with a titanium turbine about the size of a C battery embedded in his dysfunctional left ventricle, the heart’s main pumping chamber. It has only one moving part: the impeller that moves his blood. If you listen to him with a stethoscope, you don’t hear the usual loud tha-thump-thump pulse. What you hear is a whir. “Like a washing machine,” he says, in one of numerous telephone interviews. He also woke up with a titanium jack coming out of his head. Getting power to a turbine in your chest is a life-or-death situation. Barney Clark, of Des Moines, Wash., the first artificial-heart recipient in 1982, was tethered to machinery the size of a clothes dryer. The question was whether you could make all that so portable that people could have “quality of life.” Houghton’s batteries are compact enough that he carries them in a small camera bag. But if you want to get that power to the heart, you need to stretch the wire to a plug on your body that leads from the inside to the outside. The skull is a simple, safe site, though it has its price. Someone once tried to steal his camera bag, and Houghton had to think fast and correctly to reconnect himself. The new heart was a marvel. Soon Houghton was back on his feet and was traveling the world, giving speeches, writing books, becoming chairman of the Artificial Heart Fund and engaging in a 91-mile charity walk. Those who enthusiastically embrace bionic enhancement hailed Houghton — part man, part machine — as the model cyborg. There were just these few nagging problems in the recesses of his soul. “My emotions have changed. Somehow I can’t help that,” he says. “Being a Jungian psychologist, I would describe myself as less intuitive. More of a thinking, more rational, less intuitive person.”

No one really knows why Houghton has this trouble — whether it is the machinery, or the drugs, or depression, or advancing age, or the lingering effects of major surgery, or a lack of hormones secreted by the heart, or even that human brains have always been optimized by having their oxygen delivered in pulse-driven spurts, not constant pressure. Houghton naturally reaches for psychological explanations. “The procedure lands you in a position that no one has ever pioneered: what it does to a person as a person.” He says he can see that those close to him “can do without you. So you protect yourself against that knowledge. You’re not very central to their lives anymore. This means you’re much more cautious about how you use your emotions. You try not to invoke them. You become coldhearted. The thought doesn’t agree with me, the fact that it happens. But I don’t know what to do about it.” Clinical depression Views on faith altered Houghton has also developed “a careless attitude toward money. You don’t care if you’ve overspent your credit cards or not. If you don’t have any time left, you might as well enjoy it. It doesn’t go away. You just sort of control it. ‘What the hell,’ you think, ‘if I want something, I’ll have it.’ “ It’s taken him some time to plan more than a day or two into the future. Seven years into this, he says that, with effort, he can now think all the way out to six months. “The pump brought about some religious crises,” he reports, causing him to think about his devout Catholicism: “questioning the afterlife. Who knows? These are only priests. They’re not very good at being challenged on the subject.” Houghton wrote up his thoughts in a book, “The World Within Me.” Five years after the operation he went through a period of clinical depression. “Several times I thought, better off if I wasn’t here. Let everyone get on with their lives. I felt I’d like to put an end to it. But choosing the methods puts me off. Feel cowardly about killing yourself.” He saw a psychiatrist. “He wasn’t too worried,” Houghton says. “It’s a perfectly rational response to a difficult set of circumstances. … He challenged me — ‘Are you sure you mean it?’ I did mean it, but not sufficient to overcome my fear of the actual process.” He was prescribed antidepressants for 18 months, and was weaned off them six months ago. There are few data on the psychology and cognition of cyborgs like Houghton, although “a lot has been reported, anecdotal,” according to Timothy Baldwin, the biomedical engineer primarily involved with circulatory-support devices at the National Heart, Lung, and Blood Institute.

In the U.S., there were only 40 implants of permanent ventricular-assist devices in the last reporting year. Most are used to keep people alive until a human heart can be found for transplant. (Houghton’s original condition ruled out a transplant.) No one has had one for as long as Houghton: His cardiologist reports his six other implant patients have died. Robert Jarvik, the legendary inventor of the first permanent total artificial heart, strongly doubts Houghton’s issues can be laid on the Jarvik 2000 pump. “It’s hard to measure being a human. One thing we do know is that good restoration of blood flow restores health, a good experience of life.” Implant recipients “are normal again, restoring physical conditions. How they go on with their lives is what they do, not what doctors do.” He does, however, say he doesn’t recommend Jarvik 2000s for heart-attack patients. Being an apparently healthy person one day and the next day waking up as a cyborg would, he acknowledges, present psychological problems. Mind vs. body “Pump head” effect Medicine has long treated body and mind as a dichotomy. The first human surgery successfully using a machine to imitate the pumplike function of the heart and lungs came in 1953. Subsequently, cardiologists long gossiped about a side effect they irreverently dubbed “pump head,” a decline in psychological and cognitive capacity associated with the procedure. It wasn’t until decades later, however, that this effect on what it means to be human started being taken seriously in scientific journals. A groundbreaking New England Journal of Medicine report was published in 2001. Chemotherapy for cancer dates to the 1940s, but a psychological and cognitive deficit known as “chemofog” only recently has been getting serious attention. “Science guys are not attuned to this. People slough it off,” notes Arthur Caplan, head of the department of medical ethics at the University of Pennsylvania. Their attitude is ” ‘You might be more distant? More cold? What do I care?’ People who evaluate the devices spin to positive measures, not subjective ones.” Adrian Banning, Houghton’s cardiologist at the renowned John Radcliffe Hospital in Oxford, said, “Psychology is tough. Why is it not explored in any great depth? Because I’m a cardiologist, not a psychologist, I guess.” Much of the original artificial-heart work was driven by the technological optimism born of the space program. Some of the current work is driven by the idea that brains and bodies are separate entities.

But in light of Houghton and other victims of psychological and cognitive trauma after intervention in their bodies, some scientists fear we are tampering not with a bodily machine but with the human spirit. “We’ve got to understand the organs and systems coming into our lives. We haven’t paid a lot of attention to the psychological or emotional aspects of thinking of ourselves as bodies,” says Caplan. “People interested in eternal life through body regeneration or organ substitutions” consider humans to be “a brain on top of a complicated bag of water,” he says. “Ship that brain elsewhere, and it would still be you. Not true, exactly. Not that we couldn’t adjust or adapt. But in some subtle ways, our sense of self — who we are — is shaped by our carcasses. Shaped by the containers we drag around.” Interventions Effect on emotions Heart interventions are numerous. These include quadruple-bypass surgery, coronary-stent insertion, coronary balloon angioplasty and the implantation of a cardioverter defibrillator. Vice President Dick Cheney underwent these four procedures in 1988, 2000, March 2001 and June 2001, respectively. His defibrillator was replaced last month. Cheney’s longtime friends have suggested they have detected changes in his personality. Brent Scowcroft, the former national-security adviser to George H.W. Bush, told The New Yorker: “I consider Cheney a good friend; I’ve known him for 30 years. But Dick Cheney I don’t know anymore.” Scowcroft, who made no reference to heart interventions, was unavailable for comment for this story. Confronted with Scowcroft’s observation on “Face the Nation” in 2006, Cheney said, “To suggest I’ve changed, or my fundamental views of the world have evolved over that time, basically, I don’t think that’s valid.” Heart surgeon Timothy Gardner, former co-chairman of a National Heart, Lung, and Blood Institute panel on neurocognitive changes after cardiac surgery, says the study of emotional or cognitive shifts brought on by technological implants is “of course, not nuts.” Houghton is working on a book, “Cyborg Life,” based on his professional interviews with more than two dozen people who have faced death and now live with technological interventions, from heart machines to chemotherapy. Whatever the future brings, Houghton says, being snatched from the brink of death and transformed into a symbol for cyborg life while experiencing serious psychological transformations “has been quite an experience.” “A roller coaster.

“Better than being dead, I think. “Three days out of five.” Joel Garreau