How Much the Heart Can Hold

Essay by Nancy Smith

How Much the Heart Can Hold

The Art of Dario Robleto and the Science of Heart Transplants

The artist Dario Robleto has a sculpture called Lunge for Love as If It Were Air, which consists of two small, black feathers floating in a glass jar, positioned upside down, conjuring the image of a pair of shadowy lungs. The feathers were created with stretched audiotapes of two deceased lovers’ recordings of each other’s heartbeats. I was drawn to this object because of its beautiful form, and upon learning about the underlying material, the piece became even more captivating. A recording of a heartbeat already generates a deep sense of wonder in me — to even capture this mysterious beating organ feels like a kind of magic — but to then reconfigure the tape into an unexpected pair of feathers gives the heart a whole new dimension of awe. I encountered this piece in The Heart’s Knowledge: Science and Empathy in the Art of Dario Robleto, a book about a range of his works, including those that were part of an exhibit at The Block Museum of Art at Northwestern University in 2023. Jennifer L. Roberts, in writing about this piece in the exhibition’s catalog, says, “The span and stretch of their love is sealed in the jar like a black moth. Or like the cold filament of an inverted light bulb. Or perhaps like a dark firefly, a speck of rapture once perceived.” While looking at this piece and Robleto’s intriguing collection of heart-inspired work, such as sculptures and prints of early waveform recordings of the heart, I was reminded of the first human-to-human heart transplant, which took place in Cape Town’s Groote Schuur Hospital in 1967.

Dario Robleto, Love, Before There Was Love, 2018. Earliest waveform recordings of blood flowing through the heart during an emotional state (1870), rendered and 3D printed in brass-plated stainless steel, and brushed steel and glass vitrine. Image courtesy of the Mary and Leigh Block Museum of Art, Northwestern University.

I had a brief stay at Groote Schuur in 2003 when I was sick from what was eventually diagnosed as dengue fever. I remember sitting in a dimly lit waiting room, drooping from a fever and a light delirium, my muscles on fire. Dengue fever is sometimes referred to as break-bone fever because it is so painful. I tried to move as little as possible as I eyed the other patients, wondering what they had — were their insides shattering like mine? I was taken to an exam room, where I sat alone and waited for a doctor to see me. I have no particular connection to the first heart transplant, other than my profound curiosity and those lonely moments in the exam room when I imagined what it must have been like for the heart’s recipient, Louis Washkansky. If I hadn’t been so sick at the time, I think the sense of wonder would have been more heightened than it was, but still, I remember sitting on the exam table, my legs dangling, aware that this was an especially historical place.

Washkansky was a 53-year-old grocer who had suffered multiple heart attacks and ultimately developed congestive heart failure. He had ended up in Groote Schuur after numerous surgeries and months of decreasing heart capacity until his heart had only about one-third of its capacity to circulate blood through his body. On a sunny morning in early December, as Washkansky slowly declined in the hospital, 25-year-old Denise Darvall was out in the city, shopping with her family, when a car hit her as well as her mother. Although her mother died instantly, Denise was taken to the hospital with a severe head fracture. It was soon determined that she had no brain function, but her heart was still viable. The surgeon, Christiaan Barnard, carefully discussed the options with Denise’s father and soon secured her heart for the transplant. The very concept of an organ transplant was not readily accepted and, in the early days, was often criticized for being unethical, especially as the concept of brain death was not widely adopted until the 1970s. Which is to say, someone can be effectively dead but still have a beating heart. Indeed, this was an issue with Denise Darvall, and there was significant debate about how to actually declare her death.

Remarkably, Ann Washkansky, Louis’s wife, had driven by the scene of the accident that morning, unaware that her husband’s new heart would be recovered, some hours later, from that gruesome scene. Ann had been conflicted by the fact that to receive a heart transplant someone else had to die and as she came to understand details about Denise, the donor’s heart took on a sense of identity. “Knowing about that girl, and her life and her family, made it all so inhuman, somehow. My husband’s heart had an identity. It wasn’t just a piece of flesh anymore,” she said. The Heart of Cape Town Museum, in detailing the story of this first transplant, refers to the heart as “the symbol of the essence of life,” and it is especially within the context of a transplant that the organ seems to take on these dual characteristics — form and essence.

Making something visible is the first step in knowing it, and knowing the heart meant we could record it, change it, and, ultimately, operate on it. Even heart cells in a petri dish do one thing: beat.

Above: Dario Robleto, The Boundary of Life is Quietly Crossed (still), 2019. Two-channel 4K video, color, 5.1 surround sound installation. Image courtesy of the Mary and Leigh Block Museum of Art, Northwestern University.

Dario Robleto, Unknown and Solitary Seas (Dreams and Emotions of the 19th Century), detail, 2018. Earliest waveform recordings of blood flowing from the heart and in the brain during sleep, dreaming, and various emotional states (1874–96), rendered and 3D printed in brass-plated stainless steel; lacquered maple, 22k gold leaf. Image courtesy of the Mary and Leigh Block Museum of Art, Northwestern University.

The sphygmograph, invented by Karl von Vierordt in 1954, and further developed by Etienne Jules Marey in 1863.

Robleto has several other sculptures that put recorded heart rhythms into physical form. Unknown and Solitary Seas represents the earliest waveform recordings of inhalation and blood flowing through the heart and brain during various emotional experiences. Recorded during 1874–96, these sound waves were solidified in brass-plated stainless steel. The pieces are presented as a series of golden waves, creating an elegant snapshot of centuries-old pulse waves. Other early recordings, wavy oscillations in Sparrows Sing to an Indifferent Sea, capture the heart’s reaction to different experiences: riding a bike, being scolded, and listening to music, among others. Roberts writes, “All of Robleto’s recording sculptures have a quality of waiting about them — waiting for someone or something to recognize that there is something to detect about them, that they still harbor messages to decipher. Waiting to tell them that they are not alone.” This strikes me as analogous to falling in love. There is a sense that your beloved holds secrets for you to uncover while you are quietly waiting to be understood through each increasingly intimate interaction. This piece makes me wonder why hearts are the physical place where we situate love. The heart is a common metaphorical catchall for emotion — though there are many arguments to be made that love happens all over the body, from the brain to the fingertips. So, why this organ in particular? How did the heart become the place that signifies our emotional center?

Some of the earliest Western poetry, written by Sappho for her female companions in the seventh century, identifies the heart as a place of passion. She writes, “And then Love shook my heart / like the wind on the mountain / troubling the oak trees.” Likewise, philosophers Plato and Aristotle situated the deepest human emotions in the heart. Plato says, “Every heart sings a song, incomplete, until another heart whispers back. Those who wish to sing always find a song. At the touch of a lover, everyone becomes a poet.” Venus, the goddess of love, is said to have coupled humans by setting their hearts on fire. This mythical history has ingrained in Western culture a sense that there is something special about the heart, and within it, something meaningful to be unearthed in our fellow humans.

The heart and its connection to the human condition are central to much of Robleto’s artwork. In Radical Fiber: Threads Connecting Art and Science, he has written about the organ: “For most of history, across time and cultures, the heart wasn’t simply a metaphor. It was considered the literal vessel of the soul, this conduit between the immaterial and material domains. Our great poets and philosophers and priests have all weighed deep questions about identity and emotional authenticity, fate and faith, around the heart.” This tendency to hold the heart above other organs doesn’t only happen in philosophy or poetry; hearts have always been special in the world of science and medicine too. Part of what makes Robleto’s work so interesting is that it exists at the complicated intersection of art and science, often bringing poetic observations to scientific discovery.

Another piece in The Heart’s Knowledge exhibit, First Pulse, 1854, captures the first time a human heartbeat was recorded. Karl von Vierordt, a German doctor, created a sphygmograph, a device that wraps around a person’s wrist, captures their pulse, and records it. The recording is not entirely unlike a contemporary blood pressure reading or an EKG, if not exactly as precise. The sphygmograph used a soot-covered piece of paper under a tiny rod of metal that reacted to the pulse and created a set of curvy lines on paper, representing the arterial movement. This device, like many medical breakthroughs, made the invisible visible. The unknown, inside world of our bodies, was now represented on the outside. Making something visible is the first step in knowing it, and knowing the heart meant we could record it, change it, and, ultimately, operate on it. Even heart cells in a petri dish do one thing: beat.

When I lived in Cape Town, my house was only a short walk from the Main Road, where Denise Darvel’s accident occurred. I didn’t know it at the time, but reflecting now, I am struck by the way paths cross: Denise and the drunk driver who killed her, Ann as she drove past the scene, and some decades later, me, as I walked to a nearby cafe. And then, there are the many cars and pedestrians who have crossed over that same street since. What kinds of histories do we unknowingly pass every day? The routine moments and the remarkable lives, mostly unknown, under our feet. The first heart transplant, and those physical human connections, contain within it that sense of mystery, of magic — the same feeling I get from Robleto’s artwork.

My most vivid memory of Groote Schuur Hospital wasn’t the nurses or doctors, the other sick folks around me, or even the exam itself — all of which feel hazy in my mind. For some reason, I have a clear image of a long hallway I walked down after I exited the exam room. Feeling tired and confused, I’d taken a wrong turn back to the lobby and found myself in a deserted hallway, a dark corridor with a window at the end, and a lone wheelchair stationed at the far end of the hall facing the window, as if a ghost might have been sitting in it watching the clouds float by, carefree in the blue sky.

The wheelchair was an older variety, turn-of-the-century, wooden, with a tall back. It felt like something that could have existed at the time of the heart transplant. Perhaps the very wheelchair that Louis Washkansky might have been transported around the hospital after his surgery. He survived the transplant but died 18 days later from pneumonia. Denise’s father lamented her death for a second time.

Why does this quiet memory remain so clear in my mind? I was only in that hallway for a few moments. Nothing eventful happened. It was silent and there wasn’t a single person there. I think now it might have been because I was afraid I would die alone in a country that wasn’t mine and that hallway would have been my last memory. I didn’t experience anything so severe as a heart transplant, but there is something about being in a hospital with an uncertain set of painful symptoms that can make you imagine the worst. I stood for a moment, and then turned and found my way back to the main waiting room where I picked up some medication, went home with a friend, and, surprisingly, recovered a few days later.

The duality of the heart, as both an emotional and biological entity, is clear in the case of broken heart syndrome, which occurs after someone suffers severe emotional distress or intense loss, such as the death of a loved one. The technical name for this, Takotsubo Cardiomyopathy, comes from Japan, where it was first described in the early 1990s. A person’s heart develops a weakness in the left ventricle, which causes the rest of the heart to work harder. As the shape of the left ventricle becomes enlarged, it takes on a bulging form similar to the small, round container called a takotsubo, which is used to catch octopuses in Japan. The physical symptoms seem to be a reaction to emotional trauma; the heart materializes what it feels. Elizabeth Gilbert suggests that having a broken heart is a good thing. “It means we have tried for something,” she writes. However, anyone who has suffered a broken heart might find this perspective to be of little comfort, as the residue of loss remains with us long after our companion has departed.

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In the case of a transplant, it is sometimes thought that an organ recipient takes on the emotions, memories, or personal qualities of their organ donor. This is not just a superstition or myth. The kinds of changes that have been reported include shifts in preference, such as for certain foods, alteration in emotions or temperament, modifications of identity, and intriguingly, memories from the donor. Many of these memories are of the actual moment of death and seem to be more common in recipients who received a heart from someone who experienced a violent death. For example, one transplant recipient had a repeated visualization of a blinding light and an intense sense of fear. His heart donor was a police officer, killed by a gunshot wound to the face. The changes, though anecdotal, are quite commonly reported. One woman was able to recall the name of her donor, despite never having been told his name. Another woman said that she even feels love differently, and after the transplant, she became a less emotional person. A straight man, after receiving a heart from a lesbian woman, became a significantly better lover, saying that he simply had a better understanding of the female body. This was verified by his wife.

Above: Dario Robleto, First Pulse, 1854 from the portfolio The First Time, The Heart (A Portrait of Life 1854–1913), 2017. Photolithograph with transparent base ink on hand-flamed and sooted paper, brushed with lithotine and lifted from soot, fused with shellac and denatured alcohol. Mary and Leigh Block Museum of Art, Northwestern University, gift of Northwestern Engineering. Image copyright Dario Robleto.

A Lady, A Map of the Open Country of Woman’s Heart, Exhibiting its Internal Communications, and the Facilities and Dangers to Travellers Therein, c. 1830.Lithography of D.W. Kellog & Co.

F.T. Lewis and M. E. Abbott, Model of the Heart of a Human Embryo 4.6 mm long x 108, 1915.

Pieter van Gunst, Anatomical Study of the Blood Vessels and Circulation, 1685. Engraving after an image by Dutch painter and art theorist Gerard de Lairesse.

Johannes Gossner, The Heart of Man Who After His Conversion Has Fallen Again Into Former Sins, And Is Now Entirely in the Power of Satan, 1851.

What kinds of histories do we unknowingly pass every day? The routine moments and the remarkable lives, mostly unknown, under our feet.

Recent research has shown that there are four types of memories that live in cells: epigenetic memory, DNA memory, RNA memory, and protein memory. Scientists are still unearthing the various ways these kinds of memory function — in our hearts and the rest of our bodies — but the connection between the heart and the brain is so strong that doctors have coined terms like “heart memory” and “heart feelings.” This was something Ann Washkansky seemed to intuitively know, as she, at one point, wondered if Louis would acquire any of Denise’s personality traits. He may not have lived with her heart long enough for us to know if he experienced any changes related to her identity, but there is every reason to believe that he could have.

Despite the recipient taking on personal qualities from the donor, a primary issue with transplants is organ rejection. The body instinctively tries to reject a transplanted organ because it is a foreign object. Transplant recipients have to take immunosuppressive drugs for the rest of their lives, which ironically, makes them more susceptible to other diseases, like cancer, which are often stopped by early immune responses. It is strange that to understand another person’s memories through their heart, we have to suppress another embodied reaction — our own capacity to fight off intruders that can cause us real harm. It raises questions, too, about the people who love a heart transplant recipient. Do they have to relearn their relationship, adjusting to these new personality traits?

Perhaps this is somewhat true, even without a transplant. What do we shut down in order to understand another person? What part of ourselves do we let go of to be with, and to better know someone else? What happens as we change and become new people over and over again in the course of a relationship? What part of us is lost when we lose someone we love? The heart generates 50–60 times more electrical power than the brain, and 5,000 times more electromagnetic power. I wonder if this is why, when we’re in love, our hearts flutter and spark, race and drop.

Another potential tactic to avoid organ rejection can be found in the ghost heart, something I first learned about from Robleto’s writing on the subject. Initially, the concept behind a ghost heart, which is being developed in Dr. Doris Taylor’s lab at the Texas Heart Institute, was to take a damaged human heart and wash it clean, literally, removing all the cells, and reducing it down to its shell, or what is called an extracellular matrix protein. The result is an uncanny and hauntingly ghost-like heart, entirely white, almost translucent, every damaged cell stripped away. If a person’s faulty heart could be removed, cleaned, infused with the person’s own stem cells to rebuild the muscle, and reinserted back into the body, it is thought this might prevent the rejection issue altogether because you are effectively getting your own heart back. However, it’s not quite that simple. Despite the remarkable capacity of stem cells to regenerate healthy cells, it is difficult to get a damaged human heart to work again, and scientists have yet to perfect the ghost procedure in humans (and are currently experimenting with pig hearts), though the possibility itself is fascinating. Why is the ghost heart so intriguing? It is visually arresting — and like Robleto’s artwork, generates a new vision of the heart and what it can be — but there is also something seductive in the way it offers a sense of newness, of starting over, as if we could simply wash away the damage we’ve done to our bodies and begin again.

Robleto’s sculptural piece, Love, Before There Was Love, captures a waveform recording of blood flowing through the heart before and during an emotional experience. Two waveforms, captured in brass-plated stainless steel, stand side by side, solidly grey and decidedly different. The first wave has a softer form, a calm, steady rhythm, while the second wave has sharper, deeper angles, suggesting a more intense heartbeat. Recorded in 1870, this early recording forever froze a heart’s physical reaction to emotional feelings. Some of the other emotions captured in Robleto’s work — through photolithography created with invisible ink and hand-flamed and hand-sooted paper, evoking the original sphygmography recordings — illustrate human experience at various times, both mundane and extraordinary: 8 Months Pregnant, 1870; Umbilical Cord, First Gasp, Cutting of the Cord, 1886; Riding a Bike, 1906; Name Softly Called While Sleeping, 1877; Emotion of Fear from Shouting the Word Snakes 1896; Sadness from Listening to a Sung Melody, 1896; and, my personal favorite, Smelling Lavender, 1896. The original recordings rendered everyday emotional connections as scientific data, and Robleto both retains the science and simultaneously re-renders them into art, centering the emotional capacity of the heart. The works included in The Heart’s Knowledge ultimately collapse the boundary between what is known and what is felt, a boundary that was always tenuous.

Zelda Fitzgerald writes, “Nobody has ever measured, even poets, how much a heart can hold.” In looking at Robleto’s work, I get a sense of how much the heart can hold, though it’s not a physical capacity or a number of beats, but rather an indescribable, infinite range of feelings. If the heart has memories, what else does it have that we have not yet uncovered? If emotions shift when we receive a new heart, what hidden traits are we carrying around in our own hearts? Art and science are both exploring these kinds of questions, and despite the many advances in medicine, the heart remains mysterious, not because we don’t know how it works, but because we don’t know what it can truly do. 💜

SEE ALSO: The Heart’s Knowledge: Science and Empathy in the Art of Dario Robleto, edited by Michael Metzger, Mary and Leigh Block Museum of Art, 2023 • Radical Fiber: Threads Connecting Art and Science, edited by Rebecca McNamara, The Tang Teaching Museum and Art Gallery at Skidmore College & DelMonico Books, 2023.

Nancy Smith is a writer and artist in Brooklyn. She is currently working on a climate fiction novel and a collection of essays. Her work has been published in McSweeney’s, The Rumpus, Santa Fe Writers Project, Your Impossible Voice, and elsewhere. She received her MFA in Creative Writing from the University of San Francisco. somequietfuture.com