“God contracts and expands.” (2:245)

The heart is a fairly small muscle that beats 100,000 times a day and produces roughly 115,000 Joules of energy, enough to boil a cup of water for some tea. Like a flowing river, deoxygenated blood travels from the right side of our body to the right side of our heart via valves and chambers until passing through our lungs, where each breath we take facilitates the oxygenation of every individual blood cell with 4 molecules of oxygen. The now oxygenated blood, continues to progress, never stopping, now through the left side of the heart, again passing through valves and chambers, eventually being pushed out to the rest of our body with the help of the left ventricle. The left ventricle is the thickest, largest, strongest, and most muscular part of the heart because it has the responsibility of pumping oxygenated blood through the aortic valve and aorta to the rest of our body. If this continual circulation is ever interrupted, it can lead to catastrophic outcomes.

There are several ways this flow can be interrupted, many of which happen before birth and require immediate surgery after delivery. Congenital heart defects (CHD) are some of the most common types of birth defects, but as medical care and treatment have advanced many of the babies that suffer from them usually end up living long and healthy lives. Treatment isn’t required while babies are in their mother’s womb, because the circulation of the heart is different before the baby takes its first breaths, and there is normally a mixing of oxygenated and deoxygenated blood. CHD can be mild, like a hole in the heart between two chambers that allows the mixing of oxygenated and deoxygenated blood. Ventricular septal defects and atrial septal defects (holes in the heart) are some of the most common forms of CHD. Sometimes these defects can be resolved on their own or may not be realized until much later in life, or they may require a “patch” repair if they are larger. VSDs and ASDs are associated with Down’s Syndrome, and maternal risk factors including diabetes, obesity, and smoking. Patent foramen ovale (a hole in the heart that fails to close) is found in up to 30% of the general population. It usually requires no treatment and isn’t discovered unless complications like a stroke occur later in life by having a blood clot form, requiring the blood to then travel through the hole, and then be shot up through the aorta into the brain. All babies are born with patent (open) ductus arteriosus – the ductus arteriosus is a fetal blood vessel that allows flow from the right heart to the aorta, necessary when the baby is in their mother’s womb, but incompatible for life after the baby is born. Within the first few days of life, this blood vessel should close and eventually transform into a ligament that helps tether the pulmonary artery and aorta to each other. If closure fails and the ductus arteriosus remains patent, a continuous machine-like murmur can be heard with a stethoscope, and treatment with indomethacin is started. Untreated, a PDA would result in cyanosis (blue/gray skin) and Eisenmenger Syndrome due to decreased oxygen delivery [1].

The heart’s responsibility is not only to provide oxygenated blood to the rest of the body but to also somehow feed itself. The heart’s muscles exhaust 11.6% of the body’s total oxygen consumption in order to maintain its own contractile activity, coming in 3rd after the liver (20.4%) and the brain (18.4%). During contraction or systole, the heart pumps at 120 mm Hg to provide blood through the aorta and arteries. During relaxation, or diastole, the heart expands and allows for blood to fill into its chambers and also flow through the coronary arteries. These coronary arteries are the arteries that will feed the heart itself. Thus, in order to feed itself the heart must relax and therefore allow its coronary arteries to expand and provide blood to itself. When the heart is contracting and providing blood to the rest of the organs it is too constricted to provide blood to itself. Since these branches are located within grooves of the heart, when the heart is systole the arteries are too constricted for blood flow due to increased tension. This is especially true regarding the arteries supplying the left ventricle since it is larger and more muscular – remember this is where the aorta will branch off, providing oxygenated blood to the rest of our body.

This balance between contraction and expansion may remind some readers of the concepts of Qabd (contraction) and Bast (expansion) in Sufism or Tzimtzum in Jewish mysticism, and how one truly feeds the other thus allowing for growth through this cycle of contraction and relaxation. Tzimtzum is used to explain the process of creation, a contraction of infinity happening to give birth to a finite universe [2]. The Sufi tradition is a personal journey described as “contraction and openness are mysterious ‘bargains’ that have been made without the will or intention of the traveler. The first one blocks his or her way; the second one gives him or her wings to fly to new heights [3].” What is perhaps most interesting is that our physical heart performs this contraction and expansion perfectly so long as we take care of it, whereas our spiritual heart can have lapses in this critical exercise. Maybe, if we understand how to take care of our physical heart, we will also find the answer to keeping our spiritual heart healthy. Prophet Muhammad, peace be upon him, emphasizes this connection as follows: “Verily, in the body is a piece of flesh which, if sound, the entire body is sound, and if corrupt, the entire body is corrupt. Truly, it is the heart.”

Some ways to take care of our physical hearts include incorporating more physical activity into our daily lives, eating less and healthy, and controlling our stress. Perhaps our spiritual health would also benefit from these and similar activities, including regular acts of worship, fasting, controlling our temper, and being kind to others. When we don’t take care of our physical heart, it begins to fail since oxygen ceases to be delivered to our heart and the electrical currents can no longer travel effectively, thus resulting in a heart attack.

Coronary artery disease is the leading cause of death worldwide, and especially in developed countries. The deadliest heart attack occurs if there is a blockage of the left anterior descending coronary artery, which is why it is tragically termed the “widow maker.” Beginning from adolescence, arteries begin to accumulate fatty streaks and progress to an atherosclerotic plaque. This plaque can lead to several disastrous complications such as follows:

• a narrowing or complete obstruction of an artery, impairing blood flow and leaving the heart thirsty for oxygen
• a stroke due to a blood clot caused by decreased movement, breaking off and flowing to the brain
• a weakening of the vessel wall leading to an aneurysm, the vessel bursting

For some patients, a heart attack becomes a wakeup call in order to make the many necessary lifestyle changes that are necessary in order to live a long and healthy life. However, 20% of patients will experience a second heart attack. As the heart gets weaker and weaker it can eventually develop cardiorenal syndrome, a complication that results from the heart being unable to pump effectively resulting in it getting backed up in the heart and the right side of the body. This increase in volume in the body is further exacerbated by the kidneys, which continue to retain fluids and thus cause the body to become overloaded. This leads to edema, or swelling, in the legs that can eventually progress to the lungs and cause congestive heart failure. As the kidneys try to ameliorate the fact that the heart is not pumping effectively, they ultimately worsen the situation leading to end-stage renal disease and stage D heart failure.

Of course, as with almost all medical conditions, these fatal results can be prevented much earlier with lifestyle changes, even before introducing medical intervention with prescription drugs or other procedures. These lifestyle modifications include moderate aerobic exercise at least 3 times a week, a diet rich in vegetables and low in fats, sugars, and carbohydrates, smoking and alcohol cessation, and weight reduction (which would come as a result of these modifications). It is also important for patients that are already dealing with hypertension, diabetes, and hyperlipidemia should keep them well-managed and controlled.

Maybe similarly, some simple lifestyle changes, such as putting aside a few minutes every day to reflect, can be the secret to keeping our spiritual heart healthy. Our heart must remain healthy to keep the rest of our body healthy. Considering the close relationship between our physical and spiritual heart, our spiritual heart must be kept healthy to keep the rest of our spiritual body healthy. Spiritually healthy individuals will further reinforce the health of our community, for Prophet Muhammad, peace be upon him, says, “The believers in their mutual kindness, compassion and sympathy are just like one body. When one of the limbs suffers, the whole body responds to it with wakefulness and fever.”

“As the whole of existence is in His grasp and at His free disposal, it is He Who directs and disposes of all things, from the heavens to the human heart… When God wills, He contracts a heart so tightly for what only He can provide that only He can satisfy it. By contrast, He expands and exhilarates it to such an extent that it needs nothing. Contraction is caused by God’s Majesty; openness is caused by His Grace. (Fethullah Gülen, Emerald Hills of the Heart).”

References

• https://www.heart.org/en/health-topics/congenital-heart-defects
• https://www.britannica.com/biography/Isaac-ben-Solomon-Luria#ref163236
• http://fgulen.com/en/fethullah-gulens-works/key-concepts-in-the-practice-of-sufism-1/qabd-and-bast-contraction-and-openness

It was a blustery February morning, and just a few days before my 40^th birthday, when my cell phone rang. I thought perhaps it was someone offering me early well wishes. But it was my mom, calling with news that would forever alter the course of my life.

“Hi, Mom,” I said as I sat down. “How are you?”
“Not good,” she whispered like a frightened child sharing a dark secret. “You know I’ve been feeling really down lately.”

“Yeah,” I said softly, matching her breathy tone.

She was talking so quietly that I cupped my hand over my left ear so I could hear her.
“I just swallowed a bunch of sleeping pills,” she blurted out.

My eyes widened as I sprung to my feet, nearly tripping over my toddler.

“A bunch? Like, how many?” I asked.

“I dunno,” she replied. “A lot.”

I raced to the kitchen, my hands trembling as I fumbled to dial 911 from the landline while trying to keep Mom talking to me on my cell.

A few moments later, I told her that the paramedics were on their way. She mumbled something incoherent. I could already feel her drifting away.

“Can you hear me?”

Numbing silence filled the line. Desperate to keep her awake, I continued talking, my voice growing louder each time I spoke.

“Are you still with me? Mom? Mom!”

Sensing the intensity to my tone, my 8-year-old son asked what was wrong. I wanted to comfort him, but I had to keep focused on Mom. Meanwhile, my toddler, who had only just realized his grandmother was on the phone, threw his goldfish crackers to the floor and pleaded to speak with her. He reached for the receiver with his tiny, cheddar-stained hands and shrieked, “I talk to Ga-ma!”

“Not now,” I said gently.

Both my boys burst into tears as my mind raced with worry. I paced the floor and repeatedly asked, “Are you still there, Mom? Keep talking to me.”

But I only heard a hint of monosyllabic mumbles, then a thud.

I stopped for a moment and stood beside the sliding glass door, shifting my weight from my right leg to my left as I stared out at the falling snow. I kept my eyes fixed on a specific tree branch in an effort to still my mind even as my restless stomach churned.

The wind whipped wildly, which made the snowflakes look as if they were engaged in a vicious game of tug-of-war. Blowing in umpteen different directions, the blustery scene depicted my current state of mind: frenzied, scattered, unsettled. My anxious eyes darted back and forth between the ticking clock, my wailing kids, and the straining pine trees in the backyard.

Finally, I heard the paramedics in the background and for the first time in forever, I took a breath.

I shot off a text message to my brother.

“Call me,” I wrote. “Mom just tried to kill herself.”

Even as I hit “send” with my quivering thumb, the moment seemed surreal. Did this really just happen? How? Why?

As I drove to Missouri, I tried to imagine what was running through my mom’s desperate mind as she ingested an entire bottle of sleeping pills. I envisioned her in her soft flannel pajamas, sitting on the cold tile bathroom floor, swallowing one handful of pills after another. My eyes squeezed shut and a lump formed in the back of my throat. I knew clinical depression was scary, but I’d never seen it up-close-and-personal.

When I stepped inside the hospital room, Mom’s eyes revealed a mixture of sorrow, regret, guilt, and fear. I sat next to her on her bed. She clasped my hand in hers, gripping it tightly.

“I’m sorry,” Mom said softly, staring at the floor.

It’s okay,” I replied.

The truth was that it wasn’t okay. Not even a little bit. But what else could I say?

I stayed with her for several days, trying to soothe her by offering hugs and encouraging her by offering advice.

“Go to group therapy. Go to individual therapy. Do anything and everything to help you feel better,” I suggested. “Snarf up every resource possible.”

But instead of concentrating on getting better, she seemed more concerned with how her behavior would be perceived.

“What will people say if they find out what I did?” Mom asked, her eyes brimming with tears.

After she was released from the hospital, I went back home to Indiana. The following month, I was cautiously optimistic when Mom invited me, my husband, and our sons to visit her for her birthday and stay through Easter weekend. I took it as a good sign that she wanted to reconnect with her grandsons, so we packed our bags and drove west.

Though it was great to spend time with Mom, she was anxious and unsettled, worried that the kids might make a mess in her house. This was a far cry from the woman who in the past would often jump into the lake to entertain her grandsons. She spoke slowly and methodically yet still stumbled on her words. She seemed uncomfortable in her own skin. She wouldn’t even sit down to eat meals. Instead she stood by the sink, nervously nibbling at her food like a rodent.

One morning when the house was quiet, Mom approached me and said meekly, “Christy. I have to tell you something.”

“What is it?”

I didn’t want to rush her or force her, but I was desperate to hear what she had to say.

“I haven’t been completely honest with you,” she said, squeezing my hands as if to relay some sort of message to me through code.

“Honest about what?”

She opened her mouth, but no words came out. I pressed her a bit more.

“You can tell me, Mom. Whatever it is, I’ll help you. What are you not being honest about?”

“We’d better get ready,” she said tersely, releasing my hands. “The boys want to go to the zoo today.”

Just like that, the moment was gone.

At the zoo, the kids had fun seeing the animals and riding the train, but I couldn’t get past the vacant stare in Mom’s eyes. It was like she was looking past everybody—like she wasn’t all there. Anytime I tried to engage with her, I’d get the same response: “I’m tired.”

That evening after tucking the boys into bed, I asked Mom if she wanted to talk. She looked at me with a pained expression, like she was gripping a hot plate without a pot holder.

“Well, I…um, I,” she muttered.

I don’t know if she couldn’t speak or wouldn’t speak or what was going on. But her mind definitely seemed muddled. I knew something was gnawing at Mom, but I didn’t know how to pull it out of her.

When I laid down to bed that night, tears welled up in my eyes as I confided to my husband, “I think Mom may still be suicidal.”

I hated to admit it out loud, and yet, I could sense a definite heaviness to her spirit.

“Why do you say that?” Eric asked.

“I can’t put my finger on it, but she’s definitely not herself. She’s apologized profusely for trying to kill herself, but earlier today she told me that she’s not been completely honest with me, and when I asked her what about, she clammed up. Have you noticed how empty her eyes look?”

“What do we do? Your dad won’t listen. He’s adamant that she’s getting better.”

“But clearly she’s not. I wish I could get her to confide in me, but I feel like us being here is stressing her out more,” I said. “If the boys’ energy is causing her anxiety to spike, maybe we should take off and let her and Dad have a quiet holiday weekend.”

“Okay,” Eric agreed.

The next morning, I found Mom in the kitchen. She wasn’t eating, cooking, or doing dishes. She was simply standing in her housecoat staring into space. Until she caught a glimpse of my oldest son. Then her eyes moved to him and she watched him intently, like she was memorizing his every move. She did the same when my younger son entered the room. When I sat down, she acknowledged me with a weak, forced smile like she was using every last bit of energy to keep from crying.

I approached her and said softly, “Mom, we’ve decided to leave early.”

“When?”

“Here in a few minutes,” I said. “Eric’s packing the car.”

Confusion, sadness, and relief simultaneously spread across her face.

“Why today?” she asked.

“I can tell you’re struggling, Mom, and I know the boys have a lot of energy. I want you to be able to rest so I think it’s best if we get out of your hair.”

Her lips began to quiver, her brows furrowed, and she said with palpable remorse, “I’m sorry, Christy. I’m so sorry.”

It was a phrase she had repeated numerous times over the past three days so I didn’t think much of it. I replied in the same way I had all weekend—by telling her, “It’s okay.”

We hugged and I told her I loved her.

“Things will get better,” I whispered into her ear. “I promise.”

Those were the last words I ever spoke to my mother.

Six weeks later, my phone rang again. When I answered, I heard my dad’s voice, low and scratchy, say my name, followed by a long pause.

“She did it again,” he said quietly.

My gut clenched as all the color drained from my face.

“What?” I asked.

“She was doing better. She seemed stronger….” he said, his voice cracking.

My entire body began to tremble.

“It’s far worse this time,” he continued. “She swallowed hundreds of pills of all different kinds.”
My knees buckled.

“No-no-no-no,” I repeated.

How could this be happening again?

“I’ll jump in the car,” I told my dad as tears sprang to my burning eyes. “I can leave right now and be there by midnight.”

“Even if you left now, I don’t think you’d make it in time to say goodbye.”

Wait. What? Goodbye? Oh, Jesus!

My breath caught in my throat as my heart splintered.

When I got news in the middle of the night that Mom had died from the overdose, my world faded to grey.

Why? Why? Why? Why?

A thousand other questions bombarded my brain, but this was the predominant one. I could not, for the life of me, make sense of the fact that my sweet, loving, kind, compassionate mom would choose to take her own life. It defied logic and left me feeling helpless, hopeless, and hollow. How was I supposed to go on? How was I to let go of the guilt that gnawed at me round the clock? How was I to ever smile again? None of it seemed possible.

“Everything’s possible with God,” well-meaning people told me. But their platitudes and looks of pity only pissed me off. They didn’t know what it felt like to be leveled by grief. Though friends encouraged me to find peace through prayer, I did the opposite and gave God the silent treatment. What did I have to say to Him, anyway? I was angry that He had not only taken away my mom but that He had allowed her to exit the earth in such a terrible, tragic way. Having been a Christian all my life, I’ll admit it felt strange to cut Christ from my life, but I didn’t know what else to do. Many days, I found myself curled in the fetal position, sobbing and gasping for air.

Over the next six months, everything was a chore—driving, cooking, reading, even sleeping. Then one night I fell into a deep slumber and was met by a vivid dream that seemed to carry with it a distinct message.
I was at home when suddenly bright blue skies began to darken as a slight breeze tickled the shutters. Instantaneously, the sky transformed into a greenish-black hue. A small hiss followed a rumble, then a booming crash. The ground shook with a sinister force. Giant tree limbs snapped. Heavy shutters broke. Tin mailboxes crumpled. Wooden dog houses cracked. As the wind continued to howl, dirt, debris, and trash swirled through the air like frenzied snowflakes. Fence sections and lawn ornaments crashed through windows and dented car doors.

The scene was chaotic and scary. I glanced out the window, helpless and weak. Then, just as quickly as it built, the storm died out, and the world grew eerily still. I stepped outside to assess the damage and my jaw dropped at the sight of the devastation. Our beautiful house—a house I had always perceived to be strong and indestructible—was now a shell of its former self.

As I walked the perimeter of the house, I saw that it was uprooted from its foundation. It became evident that we wouldn’t have access to power or water anytime soon. It was going to take a lot of time and effort to rebuild this foundation—to start fresh. As a result, we would not be living comfortably for quite some time.

There was a silver lining, however. Despite such extensive damage, we determined that we could stay in the house, which provided a degree of comfort.

I stood in stunned silence, beholding the wreckage that surrounded me. I couldn’t believe the massive devastation that had leveled my life in the blink of an eye. But…I had survived.

For the first time since Mom’s suicide, I woke up with a sense of peace. I knew I would still face challenges and cry countless tears. But I had survived the worst, and though my foundation was shaky, I was still standing. And I could feel God standing beside me.

In the weeks and months ahead, I began surrounding myself with others who needed love and support, and, together, we journeyed through our pain: we shared tears, smiles, and embraces, and we held one another up, day in and day out. I learned that being in a community is perhaps the most important piece of life’s puzzle when it comes to maintaining a healthy existence. I also found that even in the deepest, darkest pit of despair, one can find a sliver of light, a glimmer of hope, a hint of peace. And that is what propels us forward, enabling us to breathe in, breathe out, and carry on.

Over time, the pressures that accumulate from our commitments and responsibilities can affect our mental health. Through prolonged periods of stress, cortisol and adrenaline poison our body, which can lead to anxiety disorders. To maintain our emotional and mental health, we must consider the state of our spirituality and be mindful of the metaphysical aura which is in continuous interaction with our physical body.

Our cardiovascular system meticulously delivers oxygen and nutrients to body tissues and in turn removes carbon dioxide and waste products. The average rate of contraction is 75 beats per minute, meaning that a human heart contracts 108,000 times a day, more than 39 million times in one year, and nearly 3 billion times during a 75-year lifespan. However, this magnificent center of our being is not only related to our physical, but also our spiritual, well-being. The blood that our heart pumps contains more than just oxygen and nutrients for the body. It acts as both a radiator of goodness from the spirit (ruh) and evil from our carnality (nafs). The Arabic language has eight different translations for the word “soul,” with each of them accounting for a different element of the soul, including the heart, reinforcing the link between the physical and metaphysical.

Basic cardiovascular physiology denotes that deoxygenated blood returns to the right ventricle, which pumps it into the pulmonary trunk and then to the lungs, where carbon dioxide is released and oxygen is absorbed. Oxygenated blood then travels back to the left side of the heart into the left atrium, then into the left ventricle from where it is pumped into the aorta and subsequently the arterial circulation.

Based on this circulatory system, one may speculate about an interaction between our heart and soul. The right ventricle, where our deoxygenated or “dirty blood” returns, might be the location point of our evil-commanding carnal soul or nafs-al ammara. In contrast, the left ventricle, which pumps clean, oxygenated blood, might be the locus of the presence of our spirit (ruh). Thus, one can think of the heart as a tool of the soul, and the soul as a mirror of the heart [1]. If the mirror is kept clean, one can see. If it is dirty, then we are blinded. In this way, the state of the heart affects the soul; the two are in a directly proportional relationship.

Long before the advancement of modern psychology, emotional and mental well-being were highlighted in the Qur’an. The verse “And We have already created man and know what his soul whispers to him, and We are closer to him than his jugular vein,” (50:16) is a perfect example of the spiritual psychology that is immanent throughout the Qur’an. Not only does it demonstrate the proximity of God to His servants at times of inner turmoil, but it also sheds light on the notion of delusion, or whisperings of the heart (waswasa), and that He is aware and understanding of moods of doubt.

Prophet Muhammad (pbuh) also refers to the relationship between the heart and soul: “Truly in the body there is a morsel of flesh which, if it be sound, all the body is sound and which, if it be diseased, all of it is diseased. Truly it is the heart” (Bukhari). This hadith refers to the close relationship between the bodily organs and the subtle psychic organs of the human soul; the spiritual heart is the center of human consciousness and is interrelated to the bodily, physical heart.

Our conscience, or mind, must acknowledge and make sense of all the thoughts, feelings, and sensations that arise. Muslim scholars describe possible sources for inner voices to be God, the angels, the devil, and the physiological body [2, 3]. With the appropriate depth of perception, self-regulation and spiritual expertise, one can distinguish between them. While waswasa has a negative connotation and usually refers to the whisperings from the devil and our nafs, we can also receive sources of inspiration from other metaphysical beings such as angels [4]. The mind’s ability to see the world through patterns and metaphors are the workings of the heart, and a gift from God to help us see the meaningful connections in life and to learn by reflecting upon experience. In this way, mindfulness provides an innovative approach to treat mental health issues. By having awareness and a clear comprehension, one can pay attention with patience and care to what happens and try to resolve it accordingly.

It is an understatement to say that we have an incredibly complex and dynamic aura, where the interaction of the metaphysical and physical matter that make up the human body are continually interacting. We’re constantly receiving input from other existing beings around us. There are mechanisms of action we can adopt to make a protective shield against these forces, some of which can have a negative impact on our soul.

The most obvious constituent of this shield is being immaculate in performing prescribed worships. These “must-do’s” are a reference point for us. If we slack off in our worship, our protective shield against waswasa is inevitably weakened. The ablutions we take throughout the day, even before we sleep, are another protective mechanism, while in the remembrance of God (dhikr), our hearts will “find tranquility and satisfaction” (13:28). However, even saints have lamented over periods of “dark nights” when the believer is tested by God who, for a short period, withholds from the devotee all delight in prayer and worship. Sufis describe this state of the soul as qabd, literally meaning being grasped by hand. This causes distress and makes one suffer from spiritual blockage. On the other hand, the soul can also reach a state of bast, or openness, expansion, development, or relief, when one is freed from spiritual blockage and develops inwardly. Thus, “God contracts and expands” (2:245) and believers must make both of these states fruitful by being thankful during openness and seeing contraction as an effective remedy for the sickness of the soul.

Trying to solve psychological problems solely with spiritual therapies is a mistake. Mainstream, pharmacological therapy can be necessary, just like in physiological disease. We rarely hesitate to see a doctor when we have an allergic reaction or the flu, but a psychological disease is assumed to be resolved through worship. While prayer is an incredibly powerful metaphysical tool that eases and lessens mental health problems, it might not be enough to completely cure a person of their condition. Psychological problems can be considered a cancer of the soul and should be treated with the appropriate therapy – that is, professionally. While prayer will undoubtedly have an anesthetic effect on the patient, going to see a psychologist would be the active prayer. Only then can you leave the outcome to God, after having done your part of fulfilling both verbal and active prayer.

As Imam al-Ghazali said, “Knowing the definition of these diseases, their causes and their cures, and remedies to fix them, is personally obligatory on every Muslim” (Al-Majmua). Thus, we are obliged to not only realize what is going on in our hearts and our conscious minds, but also to cure ourselves from any of the diseases that may have a negative impact on our mental or physical health.

Notes

1. Aysel, M.; Yavas I.; Akdag, M. 2016. Ruh ve Psikolojisi. (unpublished draft).
2. Nursi, Bediuzzaman Said. 1926, The Words, the Second Station of the Twenty-First Word.
3. Gülen, Fethullah. 2008. Varligin Metafizik Boyutu, Istanbul, 2008, pp. 322-336.
4. Aysel, M. 2018. “The Dynamic Vesvese Model,” Association for Psychological and Spiritual Sciences. (unpublished draft).

Being an academic is not an easy thing. In many countries, it seems you are always between a rock and a hard place when you are in academia. Politics permeate the academic halls, where positions might be assigned or created for political allies. Besides this, as a faculty member your superiors have unrealistic expectations of you, such as excruciating teaching loads and a tough oral exam with professors in your field in order to gain some tenure. In recent years, Turkey has unfortunately been one of the worst cases where all these challenges have become unbearable. Arguably the biggest problem of Turkish academics has been the lack of freedom to become critical intellectual voices in public spheres. Academics’ speeches, actions, and political views have traditionally been monitored and tracked by the Higher Education Council or government appointed University Presidents. After the July 15, 2016 coup however, some academicians’ problems became more of a struggle to stay alive. Why were thousands of academics and tens of thousands of teachers fired and arrested for “taking a part in” a military coup attempt on July 15 in Turkey? I can’t find any rational answers.

The current difficult lives of academics are connected to the societal and historical understanding of authority in Turkey. After the coup d’état in 1980, Turkish society witnessed an era where the state and the government were taken as sacred concepts. A lingering tradition since the ancient Turkish states has been that people would rather avoid advocating for truth and morals when they feared doing so would come back and bite them through the cold force of an authoritarian state. Psychological and even physical lynches could and have happened since the power owners and patriarchs are always positioned to be the identifiers of “transgressors” and dictators of the “consequences.” Few people advocated for human rights. For instance, when a group of academics signed an ‘academics for peace’ declaration in January 2016, over 60 Turkish academicians were fired or punished for “spreading Kurdish terrorist propaganda and undermining the country’s national security.” There was no big public uproar, since anyone objecting to it would be demonized as “terrorist supporters.”

Speaking your mind, expressing your opposition, and writing freely have never been easy for thinkers and academics in autocratic regimes. Unfortunately, Turkey has become one such regime in which critical academics are among those facing collective hatred and punishment for their beliefs and views.

These same arguments were recently used as a social lynch for another group: followers of Fethullah Gülen, a Turkish cleric who lives in Pennsylvania. For the last five years since one the biggest corruption scandals involving cabinet members and President Erdogan’s son broke, each investigation has been shut down by Erdoğan with the accusation towards Gülen followers, aka the Hizmet movement, that they were plotting a coup attempt against the government. What followed was the complete overhauling of the police force and police education institutions with the suspicion that many Gülen followers had “infiltrated” their ranks. After the coup attempt on July 15, 2016, which Erdoğan described as “a gift from God,” he also shut down the military and purged half of all high ranking officers, along with thousands of lower ranking members of military, many of whom are still in jail now. 15 major universities were shut down, along with more than 3,000 other schools and hospitals. In the government sector, from health to judiciary, from education to academia, more than 150,000 lost their jobs and 80,000 were arrested upon accusations of being a member of a so called “terrorist organization” with such “evidence” as using free apps like WhatsApp or Bylock, or having Gülen’s books at home or having an account at a once successful bank: Bank Asya. Many reports of abuse and torture in jails emerged since then, and about 40,000 previously convicted inmates were set free to open up space for Gülen’s followers.[1]

Erdoğan’s regime easily demonizes others who are in the opposition by putting them into the “Gülenist” melting pot. For example, atheist religious history professor Candan Badem was first detained, then released, then fired from his job for belonging to the “FETO” organization, a dysphemism produced by the government for Gülen’s followers. The people in Turkey are silent about the genocidal actions of the government because the government has the power to silence even the journalists. Hysteria is in its peak as my own family tells me I cannot send them money from U.S., call them from U.S., or invite them to U.S., which are all received with suspicion by the government that you may be affiliated with the Gülen movement (Gülen has been a US resident for almost two decades). While there are serious claims that Erdoğan himself might have had a part in the coup to consolidate his power, no one including judges, prosecutors, (who are themselves jailed), or the media (Erdoğan shut down all opposition media and arrested over a hundred journalists) can investigate these claims fully. The judiciary system is also on complete lockdown: it made the news when a judge was arrested during his very own court hearing. On another account, as a judge couple were being arrested, their two children, one of them a toddler, were locked in the house from outside and left home alone until their grandparents arrived from a faraway city late at night and found them hungry and desperate. Of the other kids whose parents were arrested some were taken into state custody in unknown locations and not released to their relatives even though they requested them. A female journalist, Ayşenur Parıldak, reported being sexually harassed and tortured while in custody and being confined to a cell. A left-wing journalist, Aslı Erdoğan, was withheld from taking any medicine or being provided a cardigan despite her multiple serious health issues and cold prison cells. She and other left-wing prisoners got the same accusation. After her release, she is now in exile in Germany, awaiting the outcome of her court case in absentia.[2]

Universities were already struggling with favoritism and unfair practices in Turkey. After the so called coup attempt, all university presidents were called into a national meeting organized by the Director of Higher Education Council (HEC) in Turkey, who threatened them that he would take necessary actions against those who “act slowly” in purging Gülen related academics.[3] This was the start of the public statement and demonstration contest among universities where University Faculty Senates hastily wrote statements shunning the group and calling them FETO (abbreviated for “Fethullah Terrorist Organization”) as directed by pro-Erdoğan media, and walked in groups in the streets protesting FETO, while there was no real evidence, official prosecution, or trial. This public hysteria resulted in thousands of fellow academics being fired without any evidence or due process based simply on the lists of profiling done by Erdoğan’s regime officials. Worse, many unions were asking when these positions would be reposted so “other” citizens could apply. Obviously, again, no one was questioning the ethics of this situation, but rather trying to think of ways to benefit from it, whether by trying to replace them with their own kin, or reporting on others to get them fired. Their attitude was, “If you are not going to bite me, long live the rattlesnake, and bite others as you wish!” As an academic who proudly thinks academics can carry an identity to become the bearers of hard truths, this is especially scary to me; not only did academics in Turkey remain silent about social injustices, but some unscrupulous people helped perpetuate this silence by demonizing a group of colleagues. Of course those people proved their worthiness of being strong allies to the current hierarchical system of university presidents, who follow orders from the Director of HEC, who in turn is reporting to the government. It is obvious that this system cannot produce the next generation of critical thinkers and intellectuals.

Why do I care about this personally? Along with some of my friends, my brother, who is an academic, is currently in jail for an unknown accusation after the coup attempt. His wife, who was an entry level secretary within a small municipality, was the first one to be detained. Police stormed into their house 2 days after he and his wife learned they were fired from their jobs. Since the government increased the detainment period to 30 days we were under a big trauma after they took her, not knowing her whereabouts since no one was allowed to make any contact with her, including any attorneys. Was she being raped or tortured? Was she being beaten severely to get some kind of confession out? What is currently happening is similar to what happened in World War II or the Bosnian War where an entire system to protect basic human rights collapsed along with the judiciary system and sense of justice. Can you imagine the feelings of a helpless husband, mother, or father? Worse, can you imagine them having a 2-year old toddler screaming non-stop after witnessing the shock of his mother violently being taken from her family? Three days had passed when she was in front of the judge and the prosecutor for “being a member of a terrorist organization.” Seeing how fragile her health was, the prosecutor asked for her release. She was united with her son at last. However, those judges and prosecutors were shortly fired for not being ruthless enough to hunt all Gülen followers. We don’t know where she and her son is, since she left her town to avoid the trauma of being separated from her toddler, fearing they may call for her arrest again.

A few days after they released her, my brother was taken into custody. He was a shining star in his work, attending each and every conference in his area of expertise, publishing both Turkish and English articles. Philosophy was his passion. They released him after a few days of detainment and courts. Later, when the prosecutors were changed, they sent out another warrant for his arrest. He immediately turned himself in knowing he had nothing to hide. They seized his computer, all of his digital files, and his phone, and they were never returned. All of his academic work was gone. In the first five days of his arrest, his wife snuggled with his coat, refused to eat anything, and just lay in bed. Their toddler still is under a huge shock, and asks for his dad and does not understand why they had to leave his toys, clothes, and everything else he knew to be home.

Besides being permanently fired from their jobs with no social security, health benefits, and retirement without any due process, these academics are no longer able to be hired by any other company or institution due to official and unofficial orders from the government dehumanizing them. Their children who have terminal diseases got their Medicaid cancelled and denied any services at hospitals. They were left to become homeless, helpless, and hungry. “They will beg us to kill them,” Minister of Economy Nihat Zeybekçi said,[4] while a municipal director of AKP, the ruling party, said: “Let them eat tree roots.”[5]

The collective hatred towards and punishment of all opposition for their beliefs is reminiscent of Jewish genocide under Hitler’s regime. This incredible violation of human rights destroyed Turkish academia, freedom of speech, writing, and research, and caused social fractions and hatred among universities. To all governments and to the international community of academics: We must support the rights of these scholars and not let another genocide happen in Europe in the 21^st century.

[1] www.turkeypurge.com

[2] https://pen.org/advocacy-case/asli-erdogan/

[3] https://tr.sputniknews.com/turkiye/201607191023938783-yok-baskani-universite-feto/

[4] https://www.birgun.net/haber-detay/bakan-zeybekci-gebertin-bizi-diye-yalvaracaklar-122392.html

[5] http://www.hurriyet.com.tr/gundem/ak-parti-il-baskanindan-fetoculere-agac-koku-yesinler-40242531

The day my husband died, my work for a newspaper had taken me out of the office to do interviews and take pictures. I hurried back to my computer because I wanted to finish early. The man I had loved for three decades had not been well for several years. He had attempted suicide several times before, and I had always been there to stop him, but today – on a most magnificent Tuesday, the kind of day only an Alabama sky can provide – I was worried. The weekend had given us new problems, and new problems usually brought with them reactions that could range from unusual behavior to a complete loss of hope.

I telephoned him as I drove from one interview to the next. We talked briefly about ordinary things and about my new idea: that he should try out a new program I had found. He had been diagnosed with bipolar depression in 2004, a behavioral disorder that decreases a person’s ability to handle stress. The toll this took on him in a few years far exceeded the ravages of major depression he had dealt with alone for a lifetime.

Those years had taken a toll on me, too. But I had no idea what lay just ahead. Suicide is not just a personal disaster. It happens to everyone in a family and devastates whatever life came before, changing forever those who are left behind.

After writing my column for the week, I left work early. I felt desperate to get home. On the way, I called him again. The day before had been his fifty-eighth birthday. Our plans had changed a couple of times recently, but the weekend had been eerily quiet. On Sunday afternoon, we sat on the deck in the sunshine. I grew tired watching him go through boxes of papers and discard this or that. At the time I thought he was just organizing. I left him to go inside and take a nap. When I returned he had finished, and the day ended with the sweetness I had known for so long: the satisfying closeness of just being with him.

But by this Tuesday, around four o’clock, the calls between our cell phones kept dropping – or perhaps he kept hanging up. I told him I was on the way home. As I did, I passed a grocery store and thought I should stop for a birthday cake. Yesterday had not gone well, and today I had a chance to do something special for him, but I was exhausted and felt driven to be with him. Something was wrong. I was sure of it. I didn’t stop, a fact I regret.

His voice, when we spoke again, was too calm. He told me he had broken into the gun safe, the one I bought after he had his first psychotic break. I realized later he could have done that at any time. My false sense of security had been nothing more than a thin veil.

“I’m not mad.” Inside, I panicked. What would I do now that I only had my voice with which to save his life? “Where are you?”

Carefully, as if speaking to a child, he told me. I asked him to put the pistol down and cross the road to our neighbor’s house. When the connection broke, I dialed 911, reported the situation, and heard the words that would change the course of my thinking.

“Don’t go in,” the operator said. “Sometimes they wait until they see you before they do it. Park on the side of the road where he can’t see you.”

That was something I had not thought of before. It terrified me. Woodenly, I obeyed. Now I had entered an alternate reality, shock creeping over me like a blanket. I stopped the car as close to the house as I could without being seen.

Eventually, a young deputy arrived, took my house key, and went inside, finding my husband’s body. He came back to my car, where I waited. Through the window, which was rolled down, he extended his hand, and I latched onto two of his fingers with my own. His expression was so pained that I couldn’t bear to make him tell me what he had found.  

“I know,” I told him, and he explained that the scene would first have to be treated like a homicide. I nodded and stayed where I was as he drove back to the house.

It took more time for neighbors to arrive and the call to go out to our church friends who gathered around the car and waited with me. I made calls to his family and to our children in three different states. I was deep in shock.

From there, the nightmare of the past few years changed into the hellish existence of a grief I had never known before. I was familiar with death. My mother had died. So had my father and my brother-in-law. Even in childhood, in my life as a preacher’s kid it was not uncommon for me to attend every funeral and visit every grieving household. I played the beautiful organ in our church sanctuary at the funeral of one of my best friends’ father when I was only nine or ten years old. I had read and written about death, but this was different.

Sometimes suicide comes without warning, but for several years before my husband’s suicide, his uncontrollable, rapid cycling moods and bizarre episodes left us both drained. He was at the mercy of his illness, and as I tried to help him and to get help for him in every way I could, I was at the mercy of his illness as well.

Physically, I had already used almost all of my strength. I had no reserves. My body was anemic; my mind was in a state of constant crisis. Even the moments between emergencies became crises because those were the waiting and worrying times. I never knew what would be coming next, but I knew it would be horrible.

Suddenly, as I sat in my car on the side of the road, he was gone, and I entered the aftermath of suicide. Since that day, I’ve worked alongside thousands of other survivors of suicide loss to try and understand what happened; and to mourn, heal, and rebuild. To help myself, I had to help others who were struggling through similar situations.

I discovered that grieving and hope can become entangled with regret and guilt and so many other emotions. During this confusing time, hope is a concept that is difficult to hold onto. Hold onto it we must, however, even if we have to borrow strength from each other.

Suicide changes us, but together, we can turn mourning into joy. For me, healing became a three-step process. I first found that co-support fortifies survivors so that obstacles like secondary wounding do not halt progress toward a successful return to life. Then, there is the essential but difficult step that enables survivors to let go of their past lives and turn toward new ones. No one wants to go on without a dear loved one, but a healthy recovery from grief depends on finding the strength to let go. Without this interim step, a survivor may not realize there are other ways to carry forward the memory of the lost one, other kinds of relationships that can be built with the departed. Lastly, there is an internal drive that emerges in most survivors that motivates them to go beyond just surviving to making meaning out of loss. This can manifest first as an instinctive need to do something. This guiding force inspires survivors to find or to create ways to carry a message forward, to turn their own personal tragedies into victories by helping others. They may write books, found organizations, set up foundations, or contribute in other ways. Many of these are artistic or creative in nature and come straight from the heart.

Suicide touches all kinds of people from every background and belief system. It can create a barrier between those closest to the person who died and those around them. Historically, suicide has been viewed by many societies as a social taboo, but the underserved stigma, shame, and shunning that surround suicide is being dispelled by the efforts of loved ones who are banding together to share both pain and healing. One such group – the Alliance of Hope for suicide loss survivors (www.allianceofhope.com) – is attempting to change the culture surrounding suicide worldwide. With the guiding slogan “Kindness Matters,” members share the simple but powerful knowledge that one can not only survive the loss of a loved one or friend to suicide but also can go beyond just surviving to rebuild happy, productive lives.

“You are not alone.”

“This was not your fault.”

“Healing is possible.”

“There are specific things you can do to build a new life that honors the one you lost.”

When I reach out in this way to comfort a mom or dad, a partner or child who is in more pain than they ever knew existed, it is because of the many times I saw my husband’s gentleness, his respect for all living things, his brilliant mind at work. His life is not defined by how he died. Neither is mine. He made such an impact on my life and on the lives of anyone who knew him that even his illness – even suicide – could not change the good he did in the world.

I can only hand survivors a little hope, but in that moment, hope is enough.

The human cerebrum is divided into two hemispheres, the right and left. These sides are not identical to one another in structure or function. The right hemisphere is in charge of coordinating functions related to the left side of the body, and the left part of the brain controls the right side of the body. To date, science hasn’t been able to explain the reason for this split.

There are other differences between the hemispheres, including functions like speech and motor skills. For example, in 90% of people, speech and hand skills are centered in the left hemisphere. However, skills such as drawing, architecture, or sense of perspective – skills that are spatial and dimensional – are dominated by the right hemisphere. While the two hemispheres are employed for various tasks, they communicate with each other. For this to happen, a structure called the corpus callosum, which contains only axons as nerve extensions, is placed between the two hemispheres and enables the transfer of information. For instance, if a needle sticks your left hand, this is perceived by the right hemisphere. In patients where the corpus callosum is missing or disconnected, when an image of a red apple is shown with the left eye closed and again with the right eye shut, the patient will report having seen no apple.

The lack of a corpus callosum is rarely encountered as a birth defect (corpus callosum agenesis). In this instance, there is rarely a deficiency when it comes to movements and sensory receptions. Activities such as speaking, standing, balancing, walking and running are almost similar to normal levels.

In the case of epilepsy, an abnormal electric current is observed in the cerebrum. The corpus callosum can be cut by surgery, disconnecting the two hemispheres in order to prevent the dispersal and transfer of abnormal electricity to the other hemisphere of the brain.

These days, this surgery is not implemented unless necessary. Obviously, performing this surgery means communication between the two hemispheres is interrupted; the tasks that are assigned to the right brain remain only in the right and the ones assigned to the left brain stay in the left. This can complicate basic motor skills. For instance, if a person wants to write or throw a ball with two hands, this task is first planned in the left hemisphere, then it is transferred to the motor-skill regions found in both hemispheres via the corpus callosum. These skills are developed via both sides of the brain and our hands, and usually one hand is better in these skills than the other. Because the left brain is usually dominant, most people are right handed.

Schizophrenia is a permanent psychiatric disease that affects a person’s emotions, thoughts, and behaviors. It means being split-minded, or the separation of the mind (in Greek, schizo means split, or divided, and phrenos means mind). In schizophrenia, the coordination between the hemispheres is disrupted and the two hemispheres intervene simultaneously to solve the same problem. Briefly, it may not cause a problem if a specific task requires only one hemisphere to be in charge; however, complications arise when both hemispheres try to solve the same job. In schizophrenic patients, it has been reported that a problem exists in the corpus callosum; therefore, communications are hindered between them. This results in a disruption.

At this point, some questions may arise. Why is our body controlled by two brain regions that have different jobs? Why do these two hemispheres communicate? What would happen if our brain was not built in two parts?

It’s hard to give answers to these questions. Sometimes, we end up with nothing to say but, “if God creates in this way, then it must be in the most beautiful form.” There is nothing useless, extra and unnecessary in the human body. But the following can be hypothesized regarding the two sided functioning of the brain: cerebral hemorrhages always occur in only one side of the brain. Speech is lost if the left side is injured, and spatial and geometrical skills are lost when the right side is injured. Therefore, maybe while a function is lost on one side, the functions of the other side are conserved.

Though the different hemispheres of the brain are in charge of different functions, they successfully fulfill their duty to activate our bodily functions through constant communication. Despite continuing clinical studies, the full extent of the brain’s power remains mysterious. Its incredible design, which allows the body to function so perfectly, is a sign of humanity’s remarkable architecture.

Heart Failure

The heart is basically a pump that provides the force needed to circulate blood and its contents to the body. It consists of four chambers: left ventricle, left atrium, right ventricle, and right atrium. The right ventricle and atrium collect the blood from the whole body and pump it to the lungs for removal of carbon dioxide and replenishment of oxygen. On the other hand, the left ventricle and atrium are responsible for collecting the blood from the lungs and pumping it to the body through the aorta (main artery). Non-stop blood circulation requires life-long and unfailing heart muscle power. Common symptoms of heart failure include waking up at the middle of night with shortness of breath and decreased ability to walk a few steps upstairs. Heart failure could arise due to any condition that decreases efficiency of the myocardium (heart muscle – Figure 1) through myocardial infarctions (death of muscles due to lack of oxygen, also known as heart attack) or overloading, such as hypertension, that requires increased contraction force. Loss of function in the ventricles (lower chamber of the heart) may require the use of ventricular assist devices (VAD).

Ventricular assist devices

A VAD is a mechanical pump that is implanted into the chest of patients to support the heart function through bridging the blood flow from the lower chamber to the aorta (Figure 2).^2,3 A VAD is usually useful during or after cardiac surgeries until recovery of the heart or while waiting for a heart transplant. VADs could also be used long term if the patient is not eligible for a heart transplant due to other complications. A VAD has several components, including a tube carrying blood out of the heart into a pump, a pump with another tube carrying blood to the aorta, and a power supply connecting to a control unit that monitors the VAD`s functionality.

There are different designs of VADs such as HeartMate, HeartWare, DuraHeart, and so on. Some VADs pump like the heart does, using a pumping action, and others use continuous blood flow. Intriguingly, VADs with continuous flow lead to a loss of normal pulse, but this has been found to decrease complications and increase survival. Two types of VADs include left ventricular assist device (LVAD) or right VAD (RVAD). LVADs are the most commonly used ones due to higher incidence of left ventricular function loss. If both LVAD and RVADs are used together, they are called a biventricular assist device (BVAC). VADs nowadays could be used not only for people with end stage heart failure, but also earlier stages of heart failure, including children. A VAD takes ninety percent of the pumping function of the heart. When using a VAD, your heart will still beat and have a rhythm. If none of these works for a patient, this requires the use of a mechanical or artificial heart, also known as total artificial heart (TAH).

Total artificial hearts

An artificial heart is a mechanical device that substitutes for the failing heart.^4,5,6 They are commonly used during heart transplantations to bridge the blood flow temporarily or to replace the heart permanently during a shortage of transplantable hearts. Early studies with artificial heart trials go back to the 1940s. Since then, various groups worldwide have invested in development of artificial heart prototypes and performed animal and human trials. Total artificial heart prototypes include, but are not limited to, SynCardia, ABIOMed (AbioCor), and Carpentier (CARMAT).6

SynCardia is developed from the Jarvik-7. It was first implanted in 1982. Dr. Robert Jarvik originally designed the Jarvik-7 (Figure 3). Barney Clark underwent the first artificial heart implantation at the University of Utah and survived for 112 days. This was followed by other implants. The longest survival with the Jarvik-7 is 620 days. However, the device is more commonly used on patients as a bridge during heart transplants. It has two pumps that resemble the two ventricles of the heart and is pneumatically (air) powered. The pump of SynCardia is covered with polyurethane. A pneumatic driver used in the US is a non-portable console, and requires patients to stay in the hospital. However, a portable version has been developed in Europe that could be carried a backpack while a patient waits for a donor heart.

The ABIOMed (AbioCor) is a completely self-contained, total artificial heart, which avoids the need for an external console or having wires or tubes piercing the skin to power the device. It uses a wireless energy transfer system, also known as a transcutaneous energy transmission system. This decreases the risk of developing infections due to implants.

CARMAT, on the other hand, is designed by Alain F. Carpentier.⁷ It is a fully implantable artificial heart with embedded biomaterials that make the device more biocompatible. In addition, the CARMAT includes valves made from cow heart tissue and has internal pressure sensors. This allows a person to adjust the flow rate in response to increased demand, such as during exercise. This feature distinguishes the CARMAT from other artificial hearts that provides a constant flow rate.

Biological artificial hearts

Synthetic replacement of organs is one of the long-sought dreams of modern medicine. To this end, there are efforts to develop biological artificial hearts in the laboratory. One recent study took the approach of producing a decellurized (empty from cells) scaffold of a mouse heart and recellurized it with human cardiac cells, and showed that lab-grown human heart tissue can beat on its own (about 40-50 beats per minute) in as short as a few weeks (Figure 4).⁸ They took the advantage of induced pluripotent cell (iPS cells) technology to produce multi-potential cardiovascular progenitor (MCP) cells, which could give rise to all three types of cardiac cells found in the heart. This area of research is still in its infancy but in the future, at least, it may provide tools to generate patches of heart tissue to replace damaged parts of the hearts. Given the success of a mouse heart cellurized with human cardiac cells, it’s possible that scientists will also try to decellurize the heart of a monkey or another animal and then cellurize it with human cardiac cells to produce a beating human heart in the laboratory as an alternative source to a full heart transplant.

Another approach to a biological artificial heart is to genetically modify animals in a way that their hearts will be compatible with a human body. Genetic engineering is a rapidly evolving field that one day could provide such tools for scientist to grow necessary organs in monkeys, dogs, or maybe even horses. Genetic modification may overcome tissue rejection issues when they are transplanted into a human body. For instance, one study tested the possibility of a heart transplant from genetically modified pigs into monkeys and showed the applicability of heart transplants between different species.^9,10

Until the development of biological artificial hearts, ventricular assist devices and mechanical artificial hearts seem to the best options. However, artificial heart implants have had various complications, including infections, pneumonia, high fevers, and multiple organ failures with variable survival rates based on the type of device and materials used. Another issue is the necessity of artificial heart to meet requirements of the body in terms of heart flow rate. For instance, the required flow rate of someone walking or exercising is different than someone at rest. In addition, the possibility of mechanical or computerized systems to fail may be a source of distress in patients implanted with artificial hearts or assist devices. This reminds us of that as long as we take care of our heart’s health, we won’t have worry whether its battery could fail – and what a mercy that is.

It is stunning that even with so much need and effort we are still not able to develop something that completely replaces all the functions of a heart. This clearly points that the heart is a marvelous gift granted to us. We are counting on every beat of the heart for our survival, and we should give thanks, with every beat, for what an incredible gift we’ve been given.

References

1. Bui, A. L., Horwich, T. B. & Fonarow, G. C. Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8, 30-41 (2010).

2. What Is a Ventricular Assist Device? NHLBI, NIH. Retrieved from www.nhlbi.nih.gov/health/health-topics/topics/vad/ on 1/2/14.

3. Ventricular assist devices (VADs) Definition – Tests and Procedures – Mayo Clinic. Retrieved from www.mayoclinic.org/tests-procedures/ventricular-assist-devices/basics/definition/PRC-20020578 on 1/2/14.

4. Artificial Hearts. Retrived from www.umasswiki.com/wiki/Artificial_Hearts on 1/2/14.

5. Artificial heart. Retrieved from en.wikipedia.org/wiki/Artificial_heart on 1/2/14.

6. Heart Assist Devices. Texas Heart Institute. Retrieved from http://texasheart.org/Research/Devices/index.cfm on 1/12/14

7. Carmat artificial heart patient in good condition: hospital. Retrieved from www.reuters.com/article/2013/12/30/us-carmat-patient-idUSBRE9BS07O20131230 on 1/2/14.

8. Lu, Tung-Ying, Bo Lin, Jong Kim, Mara Sullivan, Kimimasa Tobita, Guy Salama, and Lei Yang. “Repopulation of decellularized mouse heart with human induced pluripotent stem cell-derived cardiovascular progenitor cells.” Nature communications 4 (2013).

9. Heart of genetically modified pig ‘successfully transplanted into monkey’, South Korea scientists claim. Retrieved from http://www.dailymail.co.uk/news/article-2164964/South-Korea-scientists-successfully-transplant-heart-genetically-modified-pig-monkey.html on 12/1/14

10. Pig to human transplants. Retrieved from http://www.theguardian.com/world/2002/jan/03/qanda.simonjeffery on 12/1/14

How could this piece of information solve my problems? This little sentence cannot really answer all of life’s possible dilemmas, can it?

I am walking home on the unusually dark street. I am only used to seeing it in the brightness of day, when the flowers are in stark contrast to the shortly trimmed grass and the voices of other kids fill the air with their sweet, bell-like melody. It has been a long, long day at my best friend’s house. We have played hide and seek for hours, we have painted suns with her new water colors. But it is late now and my big brown eyes are almost closing. As always, I do not want to admit that I am tired. It seems shameful and boring. Only old people get tired! To the bouncy, curious 6 year-old that I am, sleep is the ultimate waste of time, especially when constant adventure is waiting around every corner.

It would have probably seemed frightening to see the neighborhood so empty, so suspiciously silent if I had to walk home by myself. My excessively wild imagination would have made me shudder at the thought of all the horrific monsters, dragons, witches and ghosts whispering and quietly planning their evil moves in the darkness. But I am not alone. A strong, tall man is walking next to me, holding my little hand. Dad. He is there to guide me through the summer evening. His presence makes the place seem warm and inviting. The dim lights coming out of the windows of the houses around me appear to soften the atmosphere, making the moment almost dream-like.

I suddenly remember a very important question I wanted to ask him. I have been wondering about it all afternoon but the logic of it seemed to be beyond me. It is undoubtedly an adult matter. I turn up to gaze at his friendly round face and ask with urgency:

“Dad, which side is better, the left or the right? I can’t decide which one is my favorite.”
He smiles from under his black moustache and wisely answers, his green eyes sparkling:
“The left of course. It’s where your heart is.”

Adults have it so easy. They simply have all the answers. Of course the left side is the best one! I nod, completely agreeing and feeling overwhelmed with my father’s undeniable expertise at life. I am also a bit disappointed that I did not reach the conclusion myself. I wish I was like him.
…

From that day on, I had no doubts. Every time I had to choose between turning left or right at an unfamiliar cross roads, I chose left. Every time my best friend wanted me to choose in which of her two clenched fists she had hidden a candy, I chose the left one. I never doubted my dad’s conclusion for a second. Choices, choices… who said they were so difficult?

My father died shortly after that walk. Nobody warned me that my source of endless adult wisdom would abandon me and my beautiful mother so abruptly. I did not manage to ask him even one hundredth of my questions. I could not ask him why boys were so annoying at kindergarten or why my first grade teacher had such an enormous belly. I knew he would have had the explanation. He would have dispersed the fog of my confusion in an instant.

Later, my questions changed but I still wished my dad were there to help me with the riddles. Why were boys even more annoying as I got older? How could I heal my broken heart? The more I grew, the harder the questions became. Why did he have to leave so early? Would he be proud of me? Was I making the right choices? Did I choose the right university? What would he think of my boyfriend? I had the feeling he might not have had all the answers. I was starting to realize that nobody does. But I wanted to ask him all the same.

I had so many questions but so few memories. The more time passed, the less I remembered. I remembered he was so fun, that he would play with me and a balloon in the living room until it was time to go to bed (and even a little longer when my mom wasn’t watching). He liked to fish; it was his passion. He had many friends, and our apartment was always full of smiling, warm people.

With time, however, I started forgetting these memories. I forgot the important details – I no longer remembered his smell, his voice. The most difficult was that I did not have any recollection of his words to me. I craved to know his opinion, to have his advice, to feel him guiding me once again. But the only real memory I had of his wisdom was the short little answer to my silly childish question. The left side was better because my heart was there.

How could this piece of information solve my problems? This little sentence couldn’t really answer all of life’s possible dilemmas, could it? It couldn’t tell me how my father first knew he was in love with my mom. I will never know that. It could’t tell me if he would approve of me studying abroad. Had I wasted my time with my dad on a meaningless, pathetic little discussion …

Forgetful creatures we humans are. If we live abroad long enough we could forget our own language, they say. I’ve also heard that, once vested with too much power, some people forget where they came from. This is a dangerous kind of amnesia. It can, of course, be a good thing – they say forgetting helps you heal faster, helps you deal with loss and pain. This, they say, is the good kind of forgetfulness. In my case, loss and pain did not disappear with time. Only memories.

This stupid human nature tricked me – I suffered the worst kind of amnesia – I was forgetting my father. It felt like I was being unfairly robbed of the little I had left from him. As a teenager, I tried to rebel against this stupid memory loss. I wanted to simply turn off all my thoughts about him, I excluded him from all conversations; I would not say the word ‘dad’ – I just skipped it. But it didn’t help. Late at night, I kept looking at pictures of him from our summer vacations together, hoping a memory would jump at me and help me get to know him better. But it never did.

The only real memory I had left was the silly conversation in the evening street. It was perhaps quite illogical of me but with time, I grew to believe that my precious recollection could, in fact, guide me through life. I chose to make the best of what I had left. My only memory of my father’s words became my life motto. ‘Follow your heart.’ It might sound cliche but I sure did not take it from the movies. It’s true that he never really said that to me. But I believe he meant it. I believe that if he could sit with the already grown-up me tonight for a cup of hot chocolate by the fire, he would tell me exactly that: to follow my heart. His moustache would be gray or even white, but his sparkly green eyes would be the same. He would tell me to follow my heart. After all, he was a wise man, how could he not agree?

This motto helped me finally answer my endless questions. It wasn’t my father doing all the work for me. I had to solve the puzzle myself. I simply followed my heart. I followed my heart when I chose to study law – I wanted to fight for justice. I followed my heart when I chose to go abroad – I wanted to help my inspiring mother have a better life. My heart took me places that were not easy. I had to learn to survive on my own among strangers and build my life from scratch. It was scary and it made me doubt my heart. My human nature had a tendency to betray, and this made me fear, and fear made me weak. But my heart never disappointed me. I stuck with it and it brought me to magical kingdoms filled with love, compassion and friendship. I will follow it again and again, and I will not hesitate. I have learned to trust it, because it knows best. And I know my father would approve. After all, he is also in my heart. He is still holding my hand, guiding me through the darkness with a smile under his moustache. And he would be proud of me.

I don’t really need to know all the answers. Nobody ever does. Some people know too much and yet they are not happy. Plus, where is the thrill of knowing everything? Where is the adventure? I am blessed to have what I have: my family, my friends, my love and my precious memory to show me the way. Supposing I have inherited my father’s wisdom (and I like to think that I did), I should be alright. Don’t worry about me.

“It’s very hard to grow a tree,” he said. “Just like it’s very hard to grow a person.”

“Well” my brother said, “if you and mom could grow me, I can grow a tree.” He was eleven at the time.

By the end of the summer, only one of his sprouts was still alive. He’d forgotten what kind of tree it was – in his enthusiasm, he hadn’t time for labels. On a Sunday in early September, after church, my family went out to our backyard with hand shovels and a rake. On our hands and knees, we took turns digging in the soft, wet earth. It was a warm day, and the late-season sun spilled like gold filigree through the leaves of our large oak tree. My brother and father, rich earth worked into the fissures of their hands, tenderly planted the sapling. I could tell, by my father’s face, that he didn’t give the tree a chance. But my brother believed completely, and when the planting was finished to his satisfaction, he stood and said a prayer, a brief benediction and blessing for our house.

He spent that autumn tending to the sapling. He would water it daily, and measure its progress with a ruler. Against all odds, it continued to grow.

So, too, did my brother. As the years passed, and the tree grew thicker, my brother grew taller. He fell in love, had his heart broken, lost his way. By the time he left home, seven years later, the tree had grown into a healthy, albeit small, tree. It had claimed its unceremonious space in our backyard. But it hadn’t borne fruit, and we had mostly forgotten to notice that the tree was there. We still had no idea what kind of tree it was.

“A defective tree,” my father said one night, bitterly. “A tree incapable of growing fruit.” My brother had been gone a year then, and we heard word of him sparingly – a postcard from Louisiana, or a phone call from a hotel in Oklahoma. I left home the next year. I took my first trip to Paris, where I fell in love with the city, and a woman, my future wife. Another year passed, and my brother and I did not speak.

When I received word that my brother had died in a car crash in Texas, I was living in the south of Spain with my wife. She was pregnant by then, a small sapling growing inside her, and when I hung up the phone on my father, the first thing I thought of was what my brother had said all those years before: There’s a whole tree in this little seed. I looked at her and thought: There’s a whole person in this little seed. Then, naturally, I cried.

It was late June. We arrived in Philadelphia just in time for the funeral. It was a small affair at a church outside the city, on a small plot of land overlooking a creek. The grave had already been dug, the fresh earth piled high beside it. I remembered my brother’s small hands, their crevices grooved with dirt. Afterwards we returned to our house. It had grown quiet in the years since my brother and I had left, and my parents would soon sell it.

That night at dusk, my father took me out to the backyard. “I have something to show you,” he said. We walked barefoot through the grass, the cicadas murmuring in the dense, sultry summer air. When we got to my brother’s tree, I noticed something moist and wet beneath my foot. I knelt down. It was a plum. There were plums all over the ground, and more on the tree.

“It’s the first year it blossomed,” my father said. “I couldn’t believe it.”

We roamed through the gloaming, prospecting the luscious, purple globes from the low branches, biting into the soft flesh, the juices spilling down our chins. They tasted good. As I ate, I picked out the seeds, put a few of them in my pocket. They came with me on the plane back to Spain. I planted them in cups all over our house, much to my wife’s amusement. I watered them diligently, checked them daily for growth. When we planted one of the seedlings at the end of the summer, my wife’s stomach was already large, and while I worked in the earth, she sat on our porch and watched. “It will never grow,” she called out to me. “Seedlings never grow.”

As I write this, our son is playing in our backyard, his small, growing body shaded by the small, growing branches of a plum sapling.

By examining the heart of a crocodile, researchers have discovered how it is that an air-breathing land animal can manage to glide through murky waters for several hours without the need to surface.

There is that one scene in documentaries that we often come across on television: Crocodiles gliding gracefully inside the water, waiting for hours for the perfect time to pounce and snatch their prey from their necks and into the water. But how do these animals manage to stay underwater for almost two hours without surfacing for air even though they, just like human beings and other land animals, live on pulmonary respiration and are in need of the free oxygen in the air?

A member of the reptiles class, crocodiles do not have gill nor can they have skin respiration since their skin is covered with a thick and airtight keratin armor. Just as every living organism are provided with a suitable anatomic and physiological character for their survival, crocodiles are also granted with a system that facilitates their long stay in the water.

Crocodiles are bestowed with a special heart anatomy different to other reptiles like lizards, tortoises, and snakes. The hearts of other reptiles are designed to contain three sections including two atriums and one ventricle. The right atrium, which collects the returned oxygen-deprived (deoxygenated) blood and the left atrium which collects the oxygen-rich (oxygenated) blood retrieved from pulmonary arteries of the lung, transports the blood to one common ventricle. Because there is only one ventricle to receive and combine oxygenated and deoxygenated blood, a mixture of less oxygenated blood is pumped to their body. Depending on outside temperature, the body temperature of a reptile increases or decreases. Their metabolism slows down, almost to a halt, while their body temperature decreases when outside temperature drops near or beyond freezing conditions. Hibernation begins as a result. Frogs and reptiles stop hibernating as soon as their body temperature increases depending on the outside temperature when the weather gets warm. These organisms are called cold blooded animals (with variable body temperatures) because of this feature.

The heart of a crocodile is different to other reptiles in that it has four chambers just like birds and mammals. Blood is sent to the lungs for gas exchange from the right, and from the left ventricle it is pumped to the body. Thus the two types of blood do not mix in the heart. However, what is interesting is that blood is mixed as soon as it leaves the heart via a valve (foramen of panizza) placed in between the right and left aorta.

What could be the purpose of blood, which does not normally mix in the heart, mixing through the medium of a hole? Does this opening in between two aortas indicate a flaw? It is understood after some research that this hole in fact is not a flaw or an anomaly; on the contrary, it is a necessity for a metabolism suited perfectly to the lifestyle of the crocodile.

Warm blooded vertebrates like birds and mammals with a four chamber heart have faster metabolic speeds and higher blood pressures. For these organisms can only supply the energy they consume during their daily activities via such a fast metabolism and a high level of oxygen provided with oxygenated blood.

If the metabolism of a crocodile was fast like mammals all throughout the year, it would have to continuously be nourished and use oxygen. Furthermore, because crocodiles do not have much predators, they could have also lead to the extinctions of some species by overpopulating if they featured a faster metabolism. The low ratio of heart-body mass in crocodiles (0.15%) compared to mammals and birds (0.40%-0.50%) cause the movements of crocodiles to be relatively slower. The Almighty, who creates everything with his wisdom, lowers the blood oxygen ratio and the metabolic speed of crocodiles by creating a valve that combines the two aortas. Thus eliminating the possibility of crocodile overpopulation.

Crocodiles have two aortic arches whereas mammals only have a left, and birds have one right aortic arch. The left aortic arch, despite some contact with the returned blood via foramen of panizza, delivers the oxygenated blood towards intestines, stomach, spleen and the liver after receiving it from the left ventricle of the heart. This is because the digestive system of a crocodile requires oxygen-rich blood. Deoxygenated blood while exiting the right ventricle goes towards the pulmonary arteries of the lung for exchange and mixes with oxygenated blood coming from the right aorta, feeding other organs that are instrumental for its slow metabolism.

Under the water, separated oxygen-rich and oxygen-poor blood mixes when exiting the heart and switches route, thus making oxygenated blood vessels start to carry oxygen poor blood. So what is the reason behind this switch in the direction of the bloodstream under the water? See at this point, the extraordinary features of the crocodile blood circulation system kick in. The two anatomical features belonging only to only crocodile hearts is what enables them to stay under water without breathing. Because of little or no lung use under the water, a big portion of the blood stream is diverted away from lungs; therefore oxygen poor blood is pumped back to the body. As one feature of the two, foramen of panizza restricts (does not close) upon signals coming from nostril sensors under the water but expands and remains open on land. The two aortic arches connects with each other via foramen of panizza as soon as they leave the heart but merge completely in the lower parts of the body away from the heart (anastomosis).

The second feature stems from a serrated valve. Refilling of pumped blood is stopped via a passive, thin leaf-shaped valve which is located at the tip of the pulmonary artery exiting the right ventricle. Thus, one-way direction of blood flow in the heart is maintained. These valves, which carry nodules made of connective tissue, constrict during the dive and blood flow to the lungs is reduced greatly. Therefore blood rejoins the systemic circulation from the right aortic arch.

The blood circulation of crocodiles is similar to birds, mammals, and humans while they are active on land. Oxygen-deprived blood is sent to lungs for gas exchange. The only difference is the turning of the right aorta to the left and the left aorta to the right. Oxygen rich blood not only flows through the left aorta but also through the right aorta via foramen of the panizza as well causing distribution via two channels into the body. However, the foramen of the panizza being open is not sufficient for these two channels to be used. At the same time, the pressure of the blood within the left ventricle needs to be higher as well. This way, high pressure oxygenated blood flows into the right aorta through the opening of the panizza, applying pressure to the valve at the tip of the right aorta to close it in order to prevent the mixing of the oxygen-poor blood into this route. As a result, oxygenated blood gets distributed quickly by each aortic arch without mixing with the used blood. Thus, oxygen-poor and oxygen-rich blood follows the following route on land

* Deoxygenated blood: Body – superior and inferior pulmonary veins – right atrium – right ventricle – lung pulmonary artery – lungs.

* Oxygenated blood: Lung pulmonary vein – left atrium – left ventricle – right aorta and left aorta via panizza valve (both aortas are active) and body.

The opening of the panizza narrows with the help of signals coming from the nostrils when crocodiles submerge. At the same time serrated valves at the tip of pulmonary artery that transports the blood to the lungs also constrict. While this serrated valve is at work, a majority of the blood returning from the body is not sent to the lungs because they are not functioning at the time. This serrated valve also increases the pressure of the right ventricle. This pressure, along with elevated resistance in pulmonary circulation and lowered pressure of systemic circulation, leads to the opening of normal valves at the tip of the left aorta. In the end, the left aorta which normally carries oxygenated blood on land starts carrying oxygen deprived blood, and there is a route switch.

The most beneficial part of this switch is to re-route the deprived blood back to the body via a different route, that is, the left aorta. This by-passes the lungs and prevents time loss. Despite the fact that blood of the left aorta mixes with the oxygenated blood of the right aorta to some degree via the panizza valve, the main function of this opening while submerged is to supply blood flow to the arteries feeding the heart and brain through the transfer of some poor blood from the left aorta into the right aorta; this way vital organs are not left without blood.

Blood returning from the body is not sent to the lungs for gas exchange when crocodiles are under the water. However, existing oxygen in the blood can be delivered to the tissues quickly by a route switch. The amount of bicarbonate ions that is important in the transport of CO2 in the blood increases when oxygen pressure in the tissues drop. Anaerobic respiration of tissues increases. This leads to an increase in lactic acid levels and reduces pH. Eventually, it facilitates the release of oxygen carried by hemoglobin. In the end, oxygen that is bonded with hemoglobin is used more efficiently. In the meantime, the body temperature of a crocodile submerged under water decreases and slows down its metabolism, reducing the need for oxygen. Oxygen stored in the blood can be sufficient up to two hours under the water. However when these reserves are consumed, crocodiles have to resurface to breathe even though it may cost a prey to escape.

Crocodiles can live on land and in the water and adapt to their environments with ease and efficiency thanks to the ponderous working of their mechanisms under water, the change in blood circulation, slow blood flow, reduced body temperature and metabolic speed bestowed upon them. Just like humans in sleep, crocodiles can remain submerged for long periods (4-6 minutes in usual dives; up to 2 hours when pressed) with this perfect system granted to them. Crocodiles use these mechanisms not only when under water, but also while resting or for periods after heavy feeding.