Radical Evolution: The Promise and Peril of Enhancing Our Minds, Our Bodies -- and

What It Means to Be Human

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.

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By
Joel Garreau
Peter Houghton is grateful for his artificial heart. It has saved his life.

Hes 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, hes become more coldhearted and less
sympathetic in some ways.

He doesnt feel like he can connect with those close to him. He wishes he
could bond with his twin grandsons, for example. Theyre 8, and I dont
want to be bothered to have a reasonable relationship with them and I
dont know why, he says.

He can only feel enough to regret that he doesnt 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

Tomorrows 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. Hed made his peace
with death.
Thats 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 hearts main pumping chamber. It has only one moving part: the
impeller that moves his blood.

If you listen to him with a stethoscope, you dont 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.

Houghtons 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 cant 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. Youre not very central to their
lives anymore. This means youre much more cautious about how you use
your emotions. You try not to invoke them. You become coldhearted. The
thought doesnt agree with me, the fact that it happens. But I dont know
what to do about it.

Clinical depression

Views on faith altered

Houghton has also developed a careless attitude toward money. You

dont care if youve overspent your credit cards or not. If you dont have
any time left, you might as well enjoy it. It doesnt go away. You just sort
of control it. What the hell, you think, if I want something, Ill have it.

Its 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. Theyre 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 wasnt here. Let
everyone get on with their lives. I felt Id like to put an end to it. But
choosing the methods puts me off. Feel cowardly about killing yourself.

He saw a psychiatrist. He wasnt too worried, Houghton says. Its 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. (Houghtons 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 Houghtons issues can be laid on the
Jarvik 2000 pump.
Its 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 doesnt 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 wasnt 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, Houghtons cardiologist at the renowned John Radcliffe
Hospital in Oxford, said, Psychology is tough. Why is it not explored in
any great depth? Because Im 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.

Weve got to understand the organs and systems coming into our lives.
We havent 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 couldnt 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.

Cheneys 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; Ive known him for 30 years. But Dick Cheney I dont know
anymore. Scowcroft, who made no reference to heart interventions, was
unavailable for comment for this story.

Confronted with Scowcrofts observation on Face the Nation in 2006,

Cheney said, To suggest Ive changed, or my fundamental views of the
world have evolved over that time, basically, I dont think thats 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
http://www.seattletimes.com/seattle-news/health/cold-reality-of-an-artificial-heart/