‘Have you ever longed for someone so much, so deeply that you thought you would die? That your heart would just stop beating?’
– Tracey Emin, Strangeland
This is going to sound somewhat ridiculous but when it comes to meeting new patients and making new diagnoses, I have favourite diseases. I’m probably supposed to say that the best part of being a doctor is helping people, but in reality I’m much more selfish than that. For me, it’s all about getting the right answer to the puzzle that each patient represents. I have to find the right diagnosis or isolate the right cause. Once I’ve worked this bit out, deciding on treatment and further management becomes much easier! And, oh my gosh, it’s hugely satisfying when that answer isn’t obvious and takes a bit of deduction. I’d clearly much rather my patients weren’t sick at all but then they wouldn’t be patients and wouldn’t need my help, so my next best offer is the correct or most likely diagnosis so progress can be made.
I was reminded of this during my night shifts last week because I admitted a patient who has possibly my favourite ‘I’m so smart’ diagnosis, but it’s not one that I enjoy making because it makes me really sad. They had Takotsubo cardiomyopathy, a disease of the heart that is also known as Broken Heart Syndrome.
Patients with this disease look exactly like they’re having a heart attack. They have awful chest pain, they are breathless and sweaty, and all the initial tests appear to confirm that they are indeed having a heart attack. Urgent treatment is started, which in severe cases will mean an emergency procedure to clear the blockage in the artery that is causing all the trouble. But when this angiogram is performed, everything is normal. There is no blockage, no heart attack in the conventional sense of the word. And, over the next few days to weeks, the changes in the ECG return to normal and, usually, the heart is left completely unscathed.
In patients with Takotsubo cardiomyopathy, which language geeks might be interested to know is named after Japanese octopus traps that look like the shape the heart forms during the peak of the disease, it isn’t a blocked artery that has caused the pain. It is the result of emotional stress. It is caused by bereavement or grief or any number of intense, painful emotional experiences that release a flood of stress hormones that cause actual damage to the heart. It is genuinely and literally heartbreaking.
I find this both upsetting and also strangely affirming. I suspect it’s because of the work that I do that I often view the mind and the body as completely separate entities and forget how intrinsically linked they are. I have spent so long learning about how and why my body does what it does that I have a tendency to look at its functions quite clinically. I know that the fluttery feeling in my stomach when I am excited or nervous is just adrenaline. I know that I sometimes feel dizzy after extraordinarily good sex because of a huge vasovagal response that is trying to slow down my racing body but gets a bit carried away. I know how hormones and neurotransmitters can and will affect my mood. I know how my body affects my emotions, but I forget that this can also work the other way around, that my thoughts and emotions can affect my body.
I think there’s something kind of wonderful about the fact that it is possible to feel so strongly that it can physically change me. This knowledge gives the scientific side of me proof to cling onto, physical evidence that what I feel is real. It’s not just my brain playing tricks on me or hope running away from reality. And it simultaneously warms my romantic heart, knowing that emotions really are that powerful a force. That what I feel is changing me and it’s not just a silly fantasy of my heart.
And I think I need this reassurance even more with emotions that could hurt me. I need this proof that they are real. I tend to dismiss them, or justify them away and try to persuade myself that I feel so shit because I’ve not been sleeping or because I’ve not been eating or because of any number of excuses. I don’t like to admit that I feel so awful because of something so intangible, because I can’t fix that. I can’t heal a non-existent hurt, so part of me is thankful that an intense emotional pain such as this could be converted to a material, somatic pain and then be allowed to heal.
Considering how controversial he has now become, I am a bit loathe to quote him but there was a Richard Dawkins book on my curriculum at med school that quite matches my current thought process on this subject. He once wrote about whether beauty can exist in science, asking as an example if a rainbow is any less beautiful once it is understood that it is formed from sunlight refracting through the tiny prisms of the raindrops and is not magic. I believe it is as beautiful, and possibly more so because I now know why.
I hope it’s now the same for my understanding of emotions – they are deeply rooted in my body, created by its functioning and also modifying its actions to better express the sensation, and all the more powerful because of this union. Is the rush of warmth and happiness that I feel when I see him less exciting because I know it has a scientific and evolutionary basis? Are the electric shocks that lift my skin into goosebumps when he touches me less spine tingling because I know about cutaneous nerves and reflex reactions? And is the tearing, wrenching pain of my patient’s heartbreak any less real than a knife in their gut, just because there’s no physical wound?
I didn’t think so…