How to mend a broken heart

0:00This message comes from U.S. Bank. Simplify how you do business with Business Essentials, a powerful combination of no monthly maintenance fee checking and card payment processing. Deposit products are offered by U.S. Bank National Association. Member FDIC. This is the TED Radio Hour. Each week, groundbreaking TED Talks. Our job now is to dream big. Delivered at TED conferences. To bring about the future we want to see. Around the world. To understand who we are. From those talks, we bring you speakers and ideas that will surprise you. You just don't know what you're going to find. Challenge you.

0:38We truly have to ask ourselves, like, why is it noteworthy? And even change you. I literally feel like I'm a different person. Yes. Do you feel that way? Ideas worth spreading. From TED and NPR. I'm Manoush Zomorodi, and today we are starting the show with a case of heartbreak. A patient of mine was admitted to the hospital, and weeks prior, her husband had died. And a couple of weeks after the funeral, she took a look at his picture, and all these emotions came back, flooded back. the sadness, the grief over their life together. This is cardiologist Sandeep Jahar. She developed chest pain. And she got short of breath.

1:32And by the time she was in the hospital, she had distended neck veins, water in her lungs. She was visibly panting. All signs of congestive heart failure.

1:46so we suspected that she had actually had a heart attack that she had blockages in the arteries that feed her heart but when we checked with a angiogram her coronary arteries were pristine it wasn't a hint of blockage anywhere but her heart had weakened to less than half its normal function and it had a very unusual shape and what we found was that it was the syndrome Takotsubo cardiomyopathy or the broken heart syndrome what is that so Takotsubo is a special pot that's used in Japan to trap octopuses. And it has a sort of wide base and a very narrow neck. And that's exactly the way her heart looked on the ultrasound that we did.

2:54The base was constricted. The apex of the heart had ballooned out into this distinctive shape. Whoa, that is crazy. So her heart was like swollen and and this is what heartbreak can look like literally yeah so emotions and the responses that they engender can have a direct effect on the heart and the heart can acutely weaken in response to heartbreak or grief such as after the death of a loved one or the end of a romantic relationship.

3:39So we told her that very likely this would improve, you know, once her emotional state had returned to normal, and that's exactly what happened. You know, once the grief had subsided and she came back to a sort of baseline state, we repeated the ultrasound and her heart had returned to normal. so you know it's just a fascinating um syndrome we too often think of the emotional aspects of the heart as purely metaphorical or symbolic but emotions can have a direct disruptive effect on the heart and um there really is such a thing as as as heartbreak The average human heart beats nearly 3 billion times over the course of a life.

4:34But when stress, fear, or sadness weigh on us, the heart can suffer, sometimes even break. There are, however, ways we can mend it. And so today on the show, stories and ideas about soothing heartache. From the connection between our emotions and our health, to protecting our romantic relationships, and facing our anxiety about the future, we'll explore ways we can nurture our most vital organ. Sandeep Jahar's fixation on the heart stems back to his family history, and a story about his grandfather from 1953, before Sandeep was even born. It was a summer day in July. My grandfather was working in a tiny shop in Kanpur, which was a rural community in North India, and he was bitten by a snake.

5:39now snake bite is fairly common in india and uh when my grandfather came home for lunch he was feeling fine but some neighbors brought in the snake that they claimed had bitten my grandfather and it was a shiny black cobra and my grandfather took one look at it and he slumped to the floor and died. At the hospital, a doctor pronounced him dead on arrival and said that it wasn't a snake bite that killed my grandfather, but it was a heart attack, probably induced by the sudden sort of tremendous fright of looking at the snake that had bitten him and the fear that he was not going to be able to survive the snake bite.

6:40So it's not just grief or romantic heartache that can affect our hearts. It can be any really extreme emotion. Right. Was this a story that you heard a lot when you were growing up? Yeah. That event was profoundly tragic in our family. And I sort of grew up with this fear that something would happen to my own father. And that fear translated into sort of an obsession. I remember I would lie in bed and sort of monitor the thudding of my heart in my chest. I would look up at the ceiling fan that was rotating and try to synchronize the rotations of the blades with my heartbeat. and I sort of became obsessed with this sort of dichotomous nature of the heart that it was constantly moving and yet so vulnerable and in the process made us vulnerable.

7:46In other words, there was such a thing as sudden death and the fact is that sudden death almost always occurs because of the cessation of the heartbeat. Here's Sandeep Jahar on the TED stage. Heart syndromes, including sudden death, have long been reported in individuals experiencing intense emotional disturbance or turmoil in their metaphorical hearts. In 1942, the Harvard physiologist Walter Cannon published a paper called Voodoo Death, in which he described cases of death from fright in people who believed they had been cursed, such as by a witch doctor or as a consequence of eating taboo fruit.

8:33In many cases, the victim, all hope lost, dropped dead on the spot. What these cases had in common was the victim's absolute belief that there was external force that could cause their demise and against which they were powerless to fight. This perceived lack of control, Cannon postulated, resulted in an unmitigated physiological response in which blood vessels constricted to such a degree that blood volume acutely dropped, blood pressure plummeted, the heart acutely weakened, and massive organ damage resulted from a lack of transported oxygen. Today, death by grief has been seen in spouses, and in siblings.

9:21Broken hearts are literally and figuratively deadly. You know, Sandeep, I think we hear a lot these days about how stress is bad for us, it's bad for our health. But do you feel like people just don't take that seriously enough or they don't understand the stakes of how much stress and emotions are connected to our physical well-being? Yeah. Now, you know, the American Heart Association for the longest time did not list psychosocial stress as a key modifiable risk factor for heart disease. Now, why is that? I think the reason is that it's so much easier to lower blood pressure than it is to lower emotional stress.

10:14You can take a pill to lower your cholesterol or your blood pressure, but psychosocial stress is just an entirely different beast. And, you know, it's interesting that I went through a three-year training program in cardiology, and not once did we talk about the effect of stress or the emotions on the heart. And so how do we – what do we do, Sandeep? How do we get to this middle place where we feel – I mean is it – you open a magazine and you'll be told to meditate basically. But I think what you're talking about is both on an individual way managing our own stress and also a systemic way that we need to care for ourselves differently.

11:04So there are a lot of ways to go about it. But I think the first step is to recognize that there's a problem. Do you know how long a typical American doctor allows a patient to speak before interrupting them? About 16 seconds. I was one of those doctors. But nowadays, I'll walk in and I'll let the patient talk. And increasingly, I see that if I let the patient really describe what's bothering them, you can get deeper. You can get to the sort of root cause of things. I've just recently actually learned about a patient who was having heart failure symptoms and you know all sorts of physical trouble and it turned out that he had a tremendously disrupted relationship with his two daughters and that grief over that disrupted relationship just came out in the office visit.

12:14He was weeping. So we actually reached out to the daughters, you know, and talked to them about what was going on at his request. And, you know, the improvement in that relationship with his daughters had tremendous effects on his physical health. So I would say that this is a very fertile area. And, you know, I think we would do well to act in ways, change our lifestyles, to pay respect to the intense effects of emotions on this organ that we need to survive. That's cardiologist Sandeep Jahar. He's the author of the book Heart, A History. You can see his full talk at TED.com. On the show today, heartache.

13:13I'm Mnuchin Zamarodi, and you're listening to the TED Radio Hour from NPR.

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14:56Call, click Grainger.com, or just stop by. Hey there, listener. Did you know that NPR's app is better than ever? With live radio, digital stories, podcasts, and new videos, you can get everything in one place on the NPR app. It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. And on the show today, heartache. Okay, let's sit down. So one of our producers, James, Test, test. and his partner, Joanne. Test, test. How does that sound? It looks good. Well, they just got married last year. And so we gave them an assignment. So are you ready? Yeah, let's do it. We asked them to peer into the future and talk about what issues, relationship issues, they think might come up.

15:50I mean, we're about to move to a really expensive part of the country. Money, child care, careers, buying a home, the big issues that can cause a lot of heartache for couples. Yeah, I mean, I don't know when we'll be able to afford to buy a house there. I mean, we want to have kids soon, and daycare is also really expensive. My mom was a stay-at-home mom, so it's going to be tough. We're moving close to your family, but my family lives all over the place. Yeah, and one of us might have to give up our career to be a parent full time. It's a lot. Yeah, it's a lot. So we weren't just being callous by pushing James and Joanne to have this difficult conversation.

16:37We asked them to do this because our next guest says discussions like these are crucial to preventing heartache later on. I think it's fair to say that most people live marriages without thinking about divorce. This is Harvard Law professor Jeannie Suk Gerson. She teaches family law. In fact, at the height of your love for somebody, when you're really looking forward to the life that you're going to build with this person, that is the best time to start thinking about these relationships in a way that is divorce conscious. Jeannie continues from the TED stage. The reason that I think this is so important is that I think everyone should be having some of these very painful conversations that divorced people experience.

17:27These are painful conversations about what we contributed, what we owe, what we are willing to give, and what we give up. Those conversations should be happening in a good marriage, not after it is broken. Because when you wait until it's broken, it's too late. But if you have them early on, they can actually help build a better marriage. In your TED Talk, Jeannie, you actually break things down into three examples, three principles that you think couples need to consider. That's right. First, marriage is an exchange of sacrifice, and that that sacrifice has to be thought of as a fair exchange.

18:19The second one is the idea that there's no such thing as free child care. And the third is what is starting out as each person's property probably is going to become part of the general property of the marriage. The first one, sacrifice should be a fair exchange. Take the example of Lisa and Andy. Lisa decides to go to medical school early in the marriage, and Andy works to support them. And Andy works night shifts in order to do that, and he also gives up a great job in another city. He does this out of love, but of course he also understands that Lisa's degree will benefit them both in the end.

19:03But after a few years, Andy becomes neglected and resentful and he starts drinking heavily. And Lisa looks at her life and she looks at Andy and she thinks, this is not the bargain I wanted to make. A couple of years go by, she graduates from medical school and she files for a divorce. That is rough, Jeannie. Yes. When you look at that situation, which I think is extremely common, you think to yourself, did this couple, did these two people ask themselves and each other what they were exchanging and how fair that exchange was? What was each giving up? What was each giving to the other? What was each going to owe the other person?

19:53And these, of course, this language of owing and giving and exchange is, for many people, anathema to a romantic connection. But that is, I think, a delusion to think that a marriage can be devoid of those things. And in fact, that is what a marriage ultimately is when you strip it down. It is an exchange. You know, it's making me think of people I know and what they say, like, well, we just have to get through these next few tough years. And then like as though utopia will arrive once the degree does. Exactly. And maybe, you know, if you get through those tough years, of course, many marriages go through tough years, and then they have a better period.

20:39That's wonderful. But if those tough years end up harming the connection and the intimacy, which sometimes it can, that's when they're going to be forced to talk about these questions about exchange and who owes what and who gave what and who sacrificed what. And that is when And Lisa is going to realize she is owing Andy financial support. And then, of course, Andy might get financial support from Lisa. But is he going to truly feel compensated for the things he gave up? So if Lisa and Andy had followed Jeannie Gerson's rules, what would they have thought about? What conversation would they have had prior to or early on in their marriage?

21:26Well, if they had thought about this, it's possible that Lisa would have looked at the situation that I mapped out and would have thought, well, maybe it's not a good idea for Andy to give up his job that he likes. And it's better to take on loans now than to have Andy give up his career. That is a possibility. Or she might have thought, let me see if I could get a part-time job in order to defray the costs so that Andy is not entirely responsible. It's more fair, you're saying. That's the part. Yes, we're both going to have to sacrifice, but we're going to have to sacrifice equally. That's right.

22:06And to understand what the sacrifices are, which also breeds less resentment. Ah, resentment. Yeah, resentment is like the big killer. Resentment is the big marriage killer. So let's take another couple, Emily and Deb. They live in a big city. They have two children. They both work. Emily gets a job in a small town, and they decide to move there together. And Deb quits her job to look after the children full time. Deb leaves behind an extended family, her friends, and a job that she really liked. And in that small town, Deb starts to feel isolated and lonely. And 10 years later, Deb has an affair, and things fall apart.

23:01Now, the marriage mediator who would have come in before they moved and before Deb quit her job might have asked them, what do your choices about child care do to the obligations you have to each other? How do they affect your relationship? because you have to remember that there is no such thing as free child care. So, Deb and Emily, what specifically should they have talked about when planning to start a family? They might have thought about how much Deb relied on the network of family, friends, and work colleagues in terms of her general happiness and how that is precisely the kind of social context in which full-time parenthood actually works well.

23:54Maybe Emily, the one who got the job in the small town that everyone moved there for, she might have thought to herself, on the one hand, I love this new job offer. It's so exciting. On the other hand, I have to factor in what the cost is for my partner. And if Deb incurs this cost, what will be owed to her? What will I owe to her? So let's go back to Lisa and Andy. Lisa had an inheritance from her grandmother before the marriage. And when they got married, they bought a home. And Lisa put that inheritance toward a down payment on that home. And then Andy, of course, worked to make the mortgage payments.

24:35and all of their premarital and marital property became joint. So in a split, what's going to happen? They're going to have to sell the house and split the proceeds or one of them can buy the other out. So this marriage mediator, if they had talked to them before all of this happened, that person would have asked, what do you want to keep separate? And what do you want to keep together? And how does that choice actually support the security of the marriage? Because you have to remember that what's yours probably will become ours unless you actually are mindful and take steps to do otherwise. I can see Lisa thinking like, this is incredibly unfair.

25:24That's right. That might seem incredibly unfair. And in Andy's mind, if a different role were to pertain, he would think, hey, I made all that money and we were able to make mortgage payments. So that it would seem unfair to him if somehow now the inheritance that went into the down payment got separated out and given to Lisa. So there is a lot of potential for strife, for resentment, and for a feeling of being aggrieved. You're sort of saying you should decide with your partner before you even get close to being in a position where the law might decide for you. That is exactly what I'm saying.

26:08Jeannie, I feel I would not be doing my journalistic duty if I didn't point out that not only are you a family law expert, but that you are also divorced. I am. I am divorced. And I got divorced less than 10 years ago. And then I got remarried. In my TED Talk, one of the lines that I quote is something that someone once told me, which is, you should always marry your second husband first. and the important thing that I draw is not that you can only meet the man of your dreams or the woman of your dreams the second time but rather that the mindfulness about what a marriage is the sacrifices that are exchanged all of those principles become more more easy to think about once one has been through a divorce and I would really like to have people not have to go through a divorce to learn those things.

27:08Jeannie Sook Gerson is a mediator and family law professor at Harvard. You can watch her full talk at TED.com. And as far as James and Joanne, they're on board with Jeannie's ideas. So do you think after all this divorce talk, you are still like excited to be married? Yeah, I think so. I think we can stick it out. Okay.

27:40On the show today, stories about heartache and how we live with it. I did not expect to be in pediatrics. I never thought that I was someone who was playful enough to be in pediatrics. But I found that I was better at it than I realized. And there was something about the innocence, the tenacity, and also the vulnerability of children that I just really wanted to be a part of. And also having the opportunity to support their parents and care for them. It just fit. This is Weiwen Sato. She's a pediatric nurse in the intensive care unit, which means she's helping the littlest patients at the toughest moments.

28:33Sometimes it feels like for a moment I am watching another person's story as I would on TV. But then I quickly realize I'm in the room with them. and in whatever time I have with them, whether it's this one shift or if I come back in future shifts as their nurse with them, that for this time, I am primarily watching their heartbreak and their story and their grief, but I am also a part of it. Wei Wen has to be there for her patients and their parents. But the heartache can feel overwhelming for her, too. There was a patient we had where the patient had drowned and was not going to pull through.

29:36And the parent was at the bedside and was just utterly devastated by the prognosis and had just collapsed to the floor when this parent realized this was not going to get better. And I felt my own sadness well up, and I allowed some tears to begin to flow, but I knew that this was primarily about the parent's grief, and it wasn't about mine, that my focus had to be on the parent and supporting them. For a pediatric critical care nurse, tragedies are part of the job. But there are joyful moments, too, when children recover. And all those ups and downs they began to wear on Wei Wen. Here she is on the TED stage.

30:32Like many of my colleagues, I went into nursing because I wanted to be a therapeutic presence for others. I envisioned the profession to be one where I lived on the highs, feeling like I was always doing something meaningful and helpful for others. I thought that the highs alone would be enough to help me cope with the intense stress and heartache that come from taking care of so many sick and sometimes dying patients. But as I rode the roller coaster of suffering with my patients and their families, I quickly understood that I was going to need something more than the intermittent feel-good moments to sustain me through the lows.

31:17There would be shifts where we thought we were on the road to recovery and the patient suddenly doesn't do well. They suddenly crash. And all of our expectations for things to go well go the other way. and it made me realize there's a lot here that I can't fix and I didn't think this is what I signed up for and there was certainly a point where I didn't know what to do with that. Did you ever try to talk yourself out of it? Did you ever say to yourself, well, look, it's a job. This is the way it is. Just do your best and go home at the end of the day. Yeah, absolutely. I think there's often this sense that I clock out at the end of my shift and you know what, I just need to leave what happened behind and shift gears, go home to my family, enjoy my family.

32:16I did everything that I could. But I began to realize there wasn't an easy separation and there wasn't just a way to clock out and shut it down. And this isn't just true for me. Nurses everywhere are battling this challenge. In our times of weakness, vulnerability, and helplessness, we need nurses who have found a way to preserve meaning and commitment to their work. While many external factors contributing to burnout have been studied, I have been asking what we nurses are to do with the internal issue of grief. Not in terms of caring for others in their grief, but working through our own grief on a deeper level as we are affected by the suffering of our patients and their families.