Let us contemplate, you and I, the bloody electric muscle. Let us consider it from every angle. Let us remove it from its bony cage, its gristly case, and hold it to the merciless light, and turn it glinting this way and that, and look at it as if we have never seen it before, because we never have seen it before, not like this. Let us think carefully about the throb of its relentless tissue. Let us ponder it as the wet engine from which comes all the music we know. Let us contemplate the thousand ways it fails and the few ways it does not fail. Let us gawk at the brooding genius of its architecture. Let us consider it as the most crucial and amazing house, with its four rooms and meticulous plumbing and protein walls and chambered music. Let us dream of blood and pulse and ebb and flow. Let us consider tide and beat and throb and hum. Let us unweave the web of artery and vein, the fluttering jetties of the valves, the coursing of ions from cell to cell, the sodium that is your soul, the potassium that is your personality, the calcium that is your character.
Consider the astounding journey your blood embarks upon as it enters the pumping station of your heart. In a healthy heart, a heart that works as it has been designed to work over many millions of years by its creative and curious and tireless and nameless holy wild silent engineer, blood that has been plucked and shucked of its oxygen by the body straggles back into the right atrium, the capacious gleaming lobby of the heart.
This tired blood, dusty veteran of an immense and exhausting journey, shuffles forward to and through a small circular door in the wall, a door with three symmetrical flaps: the tricuspid valve.
This circular door opens into another big room, the right ventricle, but at the very instant this ventricle is filled to capacity with tired blood the entire ventricle contracts!, slamming in on itself, and our tired heroes are sent flying through the pulmonary valve and thence into the pulmonary artery, which immediately branches, carrying the blood to the right and left lungs, and there, in the joyous airy countries of the blood vessels of the lungs, your blood is given fresh clean joyous oxygen!, gobs and slathers of it!, o sweet and delicious air!, as much as those heroic blood cells can hoist aboard their tiny cellular ships, and now they resume their endless journey, heading into the marshlands and swamps of the lungs, the capillary beds, which open into the small streams and creeks called venules, which are tributaries of the pulmonary veins, of which there are four, the four magic pulmonary rivers carrying your necessary elixir back to the looming holy castle of the heart, which they will enter this time through the left ventricle, whose job is to disperse and assign the blood to the rest of the body, to send it on its quest and voyage and journey to the vast and mysterious wilderness that is You, and to tell that tale, of the journeys of your blood cells through the universe of You, would take a billion books, each alike, each utterly different.
But so much can go wrong. So much does go wrong. So many ways to go wrong. Aneurysm, angina, arrythmia, blockages and obstructions, ischemia and infection, pericarditis and pressure problems, strokes and syndromes, vascular and valvular failure. The ways that hearts falter and fail are endless. They clog and stutter. They sigh and stop. They skip a beat. They lose the beat. Or they beat so fast and madly that they endure electrical frenzies. One electrical frenzy is called circus movement: the electrical impulse leaves the rhythmic world of contraction-and-rest and enters a state of essentially continuous beat. A heart in circus movement may beat five hundred times a minute for as long as ninety seconds before it stops altogether and the person wrapped around that heart dies.
Consider those ninety seconds. A minute and a half. The fastest and last minute and a half of that one life. A minute and a half tipped forward into relentless irretrievable headlong final free fall. The heart sprinting toward oblivion, unable to rest, revving into chaos; achieving, for the last ninety seconds of its working life, a state of such intense beat that it comes as close to beatlessness as it ever could while beating: until it ceases to beat.
Or think of the heart as a music machine—not a far-fetched idea, for the heart runs on electric impulse and does so in a steady 4/4 rhythm. A musician friend of mine maintains that the 4/4 rhythm, standard in popular music, feels right, feels normal, because it is the pace of our hearts, the interior music we hear all day and all night. We are soaked in the song of the heart every hour of every year every life long.
Fill my heart with song, sings Frank Sinatra, and is your heart filled with pain?, sings Elvis Presley, and my heart will go on, sings Celine Dion, and open your heart, sings Elton John, and open your heart, sings Lenny Kravitz, and he had a heart of glass, sings Blondie, and I’ve been a miner for a heart of gold, sings Neil Young, and don’t be blind heart of mine, rasps Bob Dylan, and why does my heart feel so bad, moans Moby, and put a little love in your heart, sings Annie Lennox, and everybody’s got a hungry heart, roars Bruce Springsteen, and my heart still beats, sings Beyoncé, and Lord with glowing heart I’d praise Thee, sang Francis Scott Key, and stop draggin’ my heart around, snarls Tom Petty, and I got them broken heart blues, moans Sonny Boy Williamson, and I canna live without the inarticulate speech of the heart, sings the genius Van Morrison, and this is the last chance for hearts of stone, sings Southside Johnny Lyon, and unchain my heart, sings Joe Cocker, and what would rock and pop and blues and gospel and jazz and soul and rap do without this most necessary musical organ? Would there even be such a thing as music if there were no hearts to break and fill and unchain and hijack?
It weighs eleven ounces. It feeds a vascular system that comprises sixty thousand miles of veins and arteries and capillaries. It beats a hundred thousand times a day. It shoves two thousand gallons of blood through the body every day. It begins when a fetus is three weeks old and a cluster of cells begins to pulse with the cadence of that particular person, a music and rhythm and pace that will endure a whole lifetime. No one knows why the cluster of cells begins to pulse at that time or with that beat. These cells undergo what is called spontaneous depolarization. Channels inside these cells begin to leak sodium and the wash of sodium sparks the trading of potassium and calcium back and forth which inspires an electrical current which, augmented, is the beat of your heart. These cells are infectious, as it were: if you put them alongside any other type of cell in the body, they make the other cells beat to their beat.
The heart is the first organ to form. It is smaller than a comma when it begins, and ends up bigger than a fist. Every cell in it is capable of pulsing. No one knows how that could be. The pulse begins when a baby is about twenty days old. No one knows why it happens then. The pulse then continues, on average, for about two billion pulses, and no one knows why that many, or that few. Why not one billion per creature? Why not twenty billion? Mayflies to mastodons, beetles to bison, prophets to poets, infants to infanticides, all are issued the same number of pulses to do with what they will. Tell me, asks the great quiet American poet Mary Oliver, what is it you plan to do with your one wild and precious life?
Consider the engineering of the heart. It begins life as a primitive hollow tube of tissue which bends and loops and twists and turns and envelops and overlaps and intricately creates itself as a heart, the wings and tendrils of tissue advancing and retreating, holes and spaces appearing, walls and valves constructing themselves according to a mysterious and extraordinary command and design, all this infinitesimal heartchitecture bathed in the one fluid in the ancient universe that can sustain the new wet machine: rich fresh blood from the mother, which she sends through the placenta to her developing child in oxygenated bursts to the new brain, the new heart, the rest of the new body.
Here are some magic numbers: all mothers at all times past and present to all children developing under their hearts send 62 percent of placental blood to the new brains, 29 percent to the new body, and 9 percent to the new heart. Hitler and Ho, Gandhi and Gautama, Mohammed and Maimonides, Mao and Moses, the Madonna and her mother, the Madonna and her Child: when they were fingers of flesh floating in their mothers, new ideas clinging to uterine walls, they received blood from their mothers in exactly the same doses.
In America these days one woman dies every minute of every day from a failed heart. More women die of failed hearts than men. Failed hearts kill more women and men than the next seven causes of death combined. The highest rate of death by failed heart is in Utah. The lowest rate is in Mississippi. More than four hundred babies are born every day with flawed hearts. One percent of all babies born all over the world are born with flawed hearts. Twenty percent of all babies born with flawed hearts will die before their first birthday.
Our body fluids contain about one percent salt, nowadays—very likely the exact salinity of whatever ancient sea we managed to crawl out of, a sea we could leave because we had learned, first of all, to contain it; and that sea is contained and remembered most crucially now in the heart, where salt sloshes back and forth between cells, forming the first thrum of the heartbeat, first hint of the absolute and necessary note from which comes the salt song of You.