Heart. Johannes Hinrich von Borstel

       Afterword

       Acknowledgements

       Introduction

      Everyone has a general idea of what a heart attack is: it’s pretty bad news, health-wise. It causes chest pain and shortness of breath. Not infrequently, it can cause our heart, whose job it is to keep pumping blood through our arteries, to give up the ghost completely. Not good news at all. Our heart is, after all, the muscle that ensures even the most far-flung corners of our body, from the tops of our heads to the tips of our little toes, are kept constantly supplied with nutrients and, more importantly, oxygen-rich blood. This is, clearly, vital for our survival.

      If someone were to interrupt the flow of blood from your heart to your brain even for just a few seconds, your body would react as if you had been hit over the head with a blunt instrument: you would lose consciousness, and whether your brain would be much more than jello or pudding afterwards is doubtful at best. This is because our brain doesn’t handle oxygen deprivation very well at all. So, our heart beats — sometimes faster, sometimes slower, sometimes even seeming to stand still for a brief instant — an average of 100,000 times a day. Each time it contracts, it moves about 85 millilitres (2.8 fluid oz.) of blood, which makes approximately 8500 litres (over 2245 gallons) per day. We would need a tanker truck to transport that amount of liquid around with us. It’s an impressive performance!

      A heart attack was the reason I never got to meet my Grandpa Hinrich. He died more than a decade before I was born, after collapsing with pains in the chest and shortness of breath. Looking at the big black-and-white picture of him on my grandmother’s living-room wall, I always used to wonder what it would have been like to meet him. Ironically, he looked so robust in photos! I could never understand how such a small thing could bring down such a fine figure of a man.

      And so, from an early age, I began to devour all the textbooks and illustrated volumes I could lay my hands on that contained any information on the heart and how it can fail. My parents rewarded my interest by giving me more reading material, and I gradually began to develop a real fascination for all the processes that go on inside the human body. That was when I decided I wanted to work with nature and medicine when I grew up. I was determined to become a scientific researcher or perhaps a doctor (Plan B: street musician). And I wasn’t content with just reading: I also collected everything from mouse skeletons to tortoise shells — anything that could help me gain a better understanding of the body.

      When I was 15, I decided to make good use of the school holidays, put my books to one side, and apply for work experience at a veterinary clinic. Nervously, I dialled their number. I heard the phone ringing at the other end of the line. Four rings, five rings. With each second, I became increasingly anxious. Seven rings. Just as I had convinced myself that no one was going to answer, someone did pick up the phone. A woman’s voice spoke in a business-like monotone.

      ‘He-hello … ?’ I stammered. ‘Is this the veterinary clinic?’

      ‘Yes. How can I help you?’

      I mustered all my confidence and replied: ‘My name is Johannes von Borstel. I’m looking for some work experience during the holidays and …’

      The voice interrupted me, ‘What year are you in at school?’

      ‘I’ve just turned 15 and I’m in Year Nine.’

      There was a heavy sigh at the other end of the line. ‘Let me tell you straight out, there’s not much chance of you doing work experience here. Sometimes, if we have an emergency situation, we might have to cut a dog right open without so much as a by your leave. You’re too young to be watching that kind of thing.’

      Too young? Surely not. Too squeamish? Possibly. That was precisely what I had to find out. It was the very thing I wanted to experience firsthand, to gain an insight into what happens beneath the skin, and to see with my own eyes all the goings on inside us mammals. How could I come by such an opportunity? I had no choice but to take the bull by the horns: I sent out more applications, including one to the emergency unit of my local hospital.

      Two days later, the letter I had been eagerly awaiting arrived. A positive answer! And — I could hardly believe my luck — in the emergency department! At the time, I had no idea of the significance that piece of paper would have for my life. It was nothing less than my entrance ticket to a future more exciting than anything I had yet experienced.

      The night before the first day of my work experience, I couldn’t sleep. My head was buzzing with thoughts. Images of frantic emergency procedures, demigods in white coats fearlessly defeating every kind of disease, gaping wounds gushing with blood, and me in the midst of it all. I was wracked with nerves. What kind of medical cases would turn up the next day? What would I be expected to do? What would happen if I made a mistake? Might I make such a serious blunder that someone could actually die? And would it be my fault? I had no idea of the procedures on an emergency ward. My only preparation was a first-aid course I’d done.

      ‘JOHANNES!!! FOR GOD’S SAKE! GET IN HERE NOW! HOW COULD YOU BE SO CARELESS?!’ The voice boomed across the entire emergency ward.

      Oh no, I thought. I’ve really messed up. And on my first day, too. Following the direction of the voice, I hurried across the ward and into the room I figured the ominous words had emanated from, to be confronted with a tragic scene. A doctor and an assistant stood before me, snorting with rage and glaring at me accusingly. Succumbing to the unstoppable force of gravity, drops of liquid were dripping onto the floor, where they formed a very conspicuous puddle.

      ‘YOU’VE REALLY MESSED THIS UP! THERE’S NOTHING MORE WE CAN DO. THAT’S IT NOW!’

      I nodded, guilt-stricken, and looked away in shame. I had overreached myself. Then came the staccato orders from the doctor: ‘Clean up this mess. The boss will be here any minute. We can’t let him see this. He won’t like it at all!’ The assistant nodded in agreement and left the room. I pulled on some gloves, grabbed a roll of paper towel, and tore off a few sheets to soak up the accident. When the roll was finished and there was still no end to the deluge in sight, I threw in a towel for good measure.

      I was just about to throw the rather pungent bundle in the bin when the senior consultant suddenly loomed up before me. ‘Johannes? Have you put some coffee on?’ He grinned, eyeing the dripping bundle in my hands.

      ‘In 15 minutes …’ I stammered. ‘I’ll need to put a fresh pot on.’

      The first mistake of my medical career: incorrectly filling the coffee machine, transforming it into a coffee-spouting gargoyle. Disastrous! It was the only coffee machine on the entire ward.

      Well, that’s a great start, I thought. What can I say to the people in the staff room to turn this situation around?

      ‘Well, you’ll just have to take your breaks without a cup of coffee,’ I piped up, smiling hopefully at the assembled company. ‘It could be worse, and it’s healthier for you, too.’ After all, this was a hospital. They should agree with my reasoning.

      So, what did I learn on my first day? The simplest way to turn even the friendliest of hospital departments into a baying mob is to deprive them of their coffee fix. And acting like a pompous know-it-all compounded my mistake. No wonder, then, that I instantly rose from the position of intern to that of Public Enemy No. 1. To make amends, I baked them a marble cake.

      The fact that I never actually had a serious mishap with a patient during my work experience was mainly down to the gradual, well-prepared way I was introduced to the jobs I was allowed to take on. As it turned out, I was not expected right away to treat gaping wounds, stem blood-spurting arteries, or deal with any other serious medical emergencies. Before I was allowed to join in with any such activities, I had to complete a very intensive program of learning and, most importantly, watching.

      Shadowing the senior consultant on his rounds, learning bandaging techniques, practising