By Joel Garreau
Washington Post Staff Writer
Saturday, August 11, 2007
Peter Houghton is grateful for his artificial heart. After all, 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, it has unquestionably improved his physical well-being. He has walked long distances, traveled internationally and kept a daunting work schedule.
At the same time, he reports, he's become more "coldhearted" -- "less sympathetic in some ways." He just 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.
Could the poets have been right all these millennia? Could emotions be matters of the heart?
My heart is fixed, O God, my heart is fixed: I will sing and give praise.
-- Psalms 57:7
Peter 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 the spring of 2000, at the age of 61, due to severe heart failure, Houghton was staring at death.
He was okay with that. He knew death well. Trained as a psychotherapist, he had become a palliative care counselor in London and Birmingham, looking after the dying. "The things they need to do, can do, the stages it will take, things like that," he explains. He had helped 122 people into the beyond. He'd made his peace with death.
In fact, that's one of the reasons 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 helpfully, 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-and-death situation. Barney Clark, 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. Recently, "a woman in the supermarket came up and asked 'What's that thing in your head,' and brought her two children," he says. "It's not really depressing. Just something that happens a couple of times a month."
The real price of his tin heart, he says, was the shift in his spirit.
The heart has its reasons which reason knows nothing of.
-- Blaise Pascal
The new heart was a marvel. Soon Houghton was not only back on his feet, he was traveling the world, giving speeches, writing books, becoming chairman of the Artificial Heart Fund and engaging in a 91-mile charity walk. This all caused those who enthusiastically embrace bionic enhancement to hail 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. Less sure if I can do things by inspiration."
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 for hundreds of thousands of years, human brains have been optimized by having their oxygen delivered in pulse-driven spurts, not constant pressure.
Given his training, however, 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. You're an invented person trying to cope with it, trying to deal with the emotional context of it."
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 any more. 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."
His grandsons "are gorgeous little boys, but when you come down to it, they're not going to remember you very much. So automatically you sort of think, there isn't anything I can do about this. Not going to get too hurt about it. You give them hugs and the usual things. You just don't feel -- they're not part of my life, you know what I mean?"
There are other issues.
Houghton says he's 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.
Also, "the pump brought about some religious crises," he reports. It caused 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 about his suicidal thoughts. "He wasn't too worried," Houghton says. "It's a perfectly rational response to a difficult set of circumstances. Wasn't surprised by it. Advised me to try and think about what I was doing. He didn't try to put me off. 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 United States, 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. In fact, Houghton's cardiologist reports his six other implant patients are no longer in the running. They all have died.
Robert K. 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 jogging along one day and the next day waking up as a cyborg would, he acknowledges, present psychological problems.
Nobody has ever measured, even poets, how much a heart can hold.
-- Zelda Sayre Fitzgerald
Medicine has long treated body and mind as a dichotomy, giving especially short shrift to the human spirit, which is so difficult to quantify.
The first human surgery successfully using a machine to imitate the pump-like function of the heart and lungs came in 1953. Subsequently, cardiologists in their locker rooms 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 back to the 1940s. However, a psychological and cognitive deficit known as "chemofog" only recently has been getting serious attention as something other than the anecdotes of anxious breast cancer patients.
"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." They think " 'I'm a cardiologist. I save lives. He's still here seven years later but feels disconnected? Sort of mumbo-jumbo-y,' " Caplan says.x
"Psychology is tough. Why is it not explored in any great depth?" asks Adrian Banning, Houghton's cardiologist at the renowned John Radcliffe Hospital in Oxford. "Because I'm a cardiologist, not a psychologist, I guess."
Everybody's at war with different things. . . . I'm at war with my own heart sometimes.
-- Tupac Shakur
The number of human bionic parts in existence or in the pipeline is accelerating. These include the cochlear implant that for decades has allowed the profoundly deaf to hear, the artificial eye that pipes computer camera signals into electrodes implanted in the retina, the artificial hippocampus (the part of the brain responsible for storing new memories) being developed at the University of Southern California, the artificial tongue being developed at the Luebeck Medical University in Germany, artificial lungs, artificial livers, epileptic seizure predictors and preventers, artificial arms and hands controlled by the nervous system, and the celebrated Acticon Neosphincter -- the artificial anus.
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 our brains and bodies are separate entities. But now, in light of Houghton and other victims of psychological and cognitive trauma after intervention in their bodies, some scientists fear that 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 Arthur 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.
"People who have their heads frozen to live forever, like Ted Williams -- my view is that if you get your head stuck back on something" that isn't your body, "your identity will be shredded. It isn't you anymore. It could lead to despair and depression, rather than gratitude that you can live forever. If you find yourself embodied in a different way, your perceptions and awareness of the world would be changed."
Heart interventions are numerous. These include quadruple-bypass surgery, coronary stent insertion, coronary balloon angioplasty and the implantation of a cardioverter defibrillator. Vice President Cheney underwent these four procedures in 1988, 2000, March 2001 and June 2001, respectively. His defibrillator was replaced last month.
Without necessarily referring to his heart procedures, longtime friends of the vice president have suggested that they have detected changes in his personality over this time. Brent Scowcroft, the former national security adviser to George H. W. Bush, told the New Yorker, "The real anomaly in the administration is Cheney. I consider Cheney a good friend -- I've known him for 30 years. But Dick Cheney I don't know anymore." However, Scowcroft made no reference to heart interventions. He was unavailable for comment late last week.
Cheney denies that there has been any change in his psychology, saying that if anything happened to affect his thinking recently, it was the events of 9/11. "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," he said in 2006 when Bob Schieffer on "Face the Nation" confronted him with Scowcroft's observation.
Timothy J. Gardner, the heart surgeon who is president-elect of the American Heart Association and former co-chair of a National Heart, Lung, and Blood Institute panel on neurocognitive changes following cardiac surgery, says that in his view, the study of emotional or cognitive shifts brought on by technological implants is "of course, not nuts."
As a man thinks in his heart, so is he.
-- Proverbs 23:7
Houghton is working on a book called "Cyborg Life." It is based on his professional interviews with more than two dozen people who have faced death and now live with dramatic technological interventions -- from heart machines to chemotherapy.
Houghton's co-author is James J. Hughes, who teaches health policy at Trinity College in Hartford, Conn. He is also the author of "Citizen Cyborg" and is executive director of the Institute for Ethics and Emerging Technologies.
"He's a trooper," Hughes says of Houghton. "Inspiring guy. My kids really dug him."
Houghton's collected narratives, Hughes says, show "the difference between the happy picture -- 'glad to be alive' -- and the long-term sequela of having foreign objects in your body -- those can be a big contrast. A lot of people don't have financial resources. It sucks to be sick and hurting. I don't think we should be sugarcoating the enormous sacrifices these people have been making and will be making into the future. They get benefits out of it, but some find they regret those choices."
The direction of research "takes us from these crude and not entirely satisfactory devices to nanotechnology," Hughes says. Nanotechnology is the creation of man-made objects that are exceedingly small -- down to the level of individual atoms and molecules. Its advocates hope to see millions of robots smaller than a blood cell coursing through our veins in the foreseeable future. These "nanobots" would, among other things, serve as watchdogs, pouncing on things that go wrong -- like the formation of cancer cells.
"Insofar as having a foreign object inside your body changes your sense of identity, Peter is more of the mind that it does," says Hughes. He, however, is an optimist.
"We have adapted to glasses, or pins in your legs if they get broken. Things get normalized. You no longer see yourself as odd or outside the norm. This will happen to all of these interventions."
Whatever the future brings, Houghton says that being snatched from the brink of death and transformed into a poster child 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."