Heart Failure

I’ve always been interested in the life sciences in general, and human physiology specifically, and I’ve been thinking a lot lately about hearts in particular.  The human heart is incredibly powerful and actually quite capable of overcoming many adverse conditions, to some degree or another.  On the other hand, while most of our major organs have ways of storing necessary nutrients, or of reducing activity and maintaining function when necessary nutrients are not available, the heart does not.  Our kidneys, for example, have such a marvelous functional reserve that we can lose 75-90% of kidney function before developing any symptoms at all.  But the heart has no reserve.  Our hearts need a constant, ongoing supply of oxygen and glucose, and when either supply is interrupted, a heart begins to die very rapidly.

I’ve thought about that as I’ve considered how often we speak of the heart as the metaphorical center of ourselves, especially spiritually.  As we exercise and consume healthy foods with the necessary nutrients, our heart grows stronger, more efficient, more consistent.  The risks of damage to our heart decrease, and along with them, the risks of any interruption to that supply of air and sugar that is so vital to our heart function decrease.

I think our spiritual well-being is very much like that.  We need a constant supply of spiritual nourishment, which comes in the form of prayer, scripture study, Sacrament meeting attendance, and keeping the commandments, to keep our spirit alive and healthy--to feel the love of the Lord and to hear the promptings of his spirit, to know what is right.  We need exercise, in the form of participating in and renewing covenants, by partaking of the Sacrament and going and returning to the temple, to have the capacity for spiritual exertion.

The Lord often refers to spiritual decline as a “hardness of heart”.  One of the primary problems that develops in the human heart that prevents healthy functioning is a gradual hardening of the valves and vessels within the heart that make it work.  That isn’t something that happens suddenly.  Too many cheeseburgers and bags of chocolate over too many years of moving too little leads to a little loss of function at a time.  At first, we may not even really notice: hiking isn’t very fun any more, because getting up the hill is hard enough and draining enough, that we fail to enjoy the view.  So we do it a little less often.  And then other, simpler, tasks get a little harder, so we stop doing them so much.  And before long, even basic tasks become challenging and we start to see that we’re in trouble, but the road back to health just seems so daunting that we doubt we can do it.  

That’s how spiritual hard-heartedness happens, too.  We stop doing the little things, we allow the spiritual nutrients to stop flowing: we’re too busy to read ours scriptures, we stop listening when we pray, or maybe stop praying altogether, we skip Church once in awhile.  The gunk builds up and the vessels get hard and our spirit starts to die to the things of eternal life. Pretty soon, spiritual exercise isn’t just a little uncomfortable, it feels impossible. But its not.  We understand that, with our physical bodies, what took years to do will not be undone in a week, but sometimes we expect spiritual damage to be undone nearly instantly after we try to change our ways.  Because of the tremendous power and grace of the Lord, spiritual healing can often happen more quickly than physical healing, but it still takes work and it still takes time.  

Sometimes heart patients will deny their problems, because they feel like they have made a mess of themselves and are ashamed.  Doctors want them to face the problems not to embarrass them, however, but because they know that they can’t help someone get better until the patient is willing to identify the problem and allow the doctor to lay out a treatment plan, that the patient will commit to follow.  All of the Bishops and Stake presidents I have known have felt the same way about the individuals within their stewardship.  Though it can be hard to believe when we are in a hard-hearted state, a call to repentance is an act of love, whether it comes directly from the Lord through inspiration and prompting, or through one of his appointed servants.  Inspired leaders reach out not to condemn or shame, but to echo Alma’s plea: “If ye have experienced a change of heart and if ye have felt to sing the song of redeeming love, I would ask, can ye feel so now?” (5:26)

Many of the adversities we face in this life, however, are not self-inflicted.  Sometimes it is not our own sin that hurts our hearts, but the decisions of others, over which we have no control.  To withstand the spiritual challenges presented by such adversity, we need to be spiritually fit.  One of the interesting ways that the human heart prepares for adverse conditions is in the development of collateral circulation:  the heart has several major arteries that supply the heart muscle itself with the necessary blood for continued function.  But as we engage in consistent cardiovascular exercise, our heart forges new, smaller vessels that will keep blood flowing should one of those larger arteries become obstructed.  Obstruction of one of those vessels is one of the most common causes of a heart attack, and the presence of those extra passageways can be the difference between full recovery and permanent damage, between living and dying.

No one glides through life unchallenged or unhurt, so when adversity strikes, especially those trials which seem completely undeserved and unfair, whether we are able to use those trials to grow spiritually or are defeated by the spiritual hill, will depend largely on the spiritual exercise we have done to prepare our hearts for exertion and challenge.  Faithfully adhering to and exercising our covenants will decrease the probability that unexpected heartache will severely damage our faith.  If we have been participating in the Sacrament in a meaningful way, if we have been attending the temple and living up to the covenants we made therein, if we have been consistently serving in the Lord’s name, we will have enough avenues to sustain spiritual life in times when we are squeezed and, hopefully, refined.

But here is where the applicability of the metaphor begins to wane.  In a mortal heart where there is an unexpected, severe stress, if a clot lodges in an artery and no collateral vascularization is present, that individual is most likely going to die, quickly.  No second chances.  

But the Lord is an eternal being, and a patient one.  If there is one thing the scriptures teach us, it is that the Lord does not give up on his children quickly.  One of my favorite scriptural phrases is found repeatedly in the ninth chapter of Isaiah (and quoted in the 19th chapter of 2 Nephi), “his hand is stretched out still”.  The prophet outlines the the many follies and abuses of the people--in other words, the things they must give up or change in order to come to the Lord again--and then reminds them “for all this, his anger is not turned away, but his hand is stretched out still”.

No matter what we may have done, no matter how far we may have slipped, no matter how much we have allowed our hearts to harden, the Lord wants us to turn to him.  He wants us to know peace, to have joy, to take his hand.  But he will not force us to do so.  It is absolutely essential to the fulfillment of our Father’s plan that we be able to choose for ourselves what we will do, and who we will be.  Our Father and our Savior know better than anyone that that inevitably means that we will fail.  That’s OK.  It hurts, its embarrassing, and if you’re prideful like I am, it can occasionally be infuriating, but we are only left to struggle alone if we choose to do so.  Sometimes, in medicine, what finally brings a heart patient to a doctor (or an ER) is attempting to do something that is necessary and realizing, usually very painfully, that they can’t do it--that they are physically incapable of doing something for themselves.  So it is with us, that often what causes us to turn to the Lord is not a habit of humility, but the facing of a trial that we realize we are not capable of bearing alone.  Charles Spurgeon once wrote, “I have learned to kiss the wave that slams me into the Rock of Ages.”  I hope to someday be humble enough that I will remain close to the Lord at all times, but in the meantime, I am learning to be more grateful for the challenges and deficiencies that remind me often how much I need his presence and his grace.

Sometimes we struggle to explain the Atonement, but I suspect that, because it is so awesome in its depth and breadth, we try to make it more complicated than it is.  Elder Holland recently said, “Brotherly hands and determined arms reached into the abyss of death to save us from our fallings and our failings, our sorrows and our sins.”  I believe it really is as simple, and as complicated, as that.  

A few months ago in primary, I gave each of the kids a paper heart, and asked them to put their own name on it.  Then we did various things to the paper hearts to symbolize different things in life that we do, or that others do to us, that can cause hurt to our hearts: we stomped on our hearts, and they held up pretty well;  we crumpled them up, and though they were a little thinner and pretty crinkly, we were able to smooth them back out pretty well, all intact;  then, we imagined some of the worst things we could think of happening, and we ripped the hearts in half.  I asked the kids to try to put them back together.  Most of them gave up immediately; a few of the more determined, independent personalities tried adamantly to weave the tiny little wisps of construction paper tears together, but eventually they conceded defeat as well.  Put a pin in that thought, I’ll come back to it in a moment.

Part of what prompted the thoughts that led to this talk were the talks given by Elder Renlund, a newly sustained apostle, and President Nelson, the newly sustained president of the quorum of the 12 apostles, at the last General Conference.  Though their talks ultimately went in very different directions, each began by telling a story about one of their most devastating moments as a doctor, facing a particularly hard patient loss.  Both men are superb heart transplant surgeons--Elder Nelson was a pioneering leader in the fields of both heart valve surgery and heart transplant surgery.  The combination of intelligence, knowledge, work ethic, physical skill, and sheer nerve required for a successful heart surgeon is rather unique, and I find it intriguing that the Lord has called two men from that field to serve in the leading Council of His church.  It is mind-bogglingly incredible to me that human beings, faced with the challenge of hearts that have exhausted all other options and cannot be fixed, have figured out how to keep someone alive temporarily while removing their heart, and then placing an entirely different, healthy heart in their chest, hooking up vessels like their rewiring a car, and then sew that person back up and they go on living their life.  That is so completely astounding as to be almost unbelievable.  

But what actually struck me about these stories, was that part of what made those moments so difficult for these doctors was that they had already dealt with so much loss.  As an incredible an accomplishment as human heart transplant is, the bodies into which they are placing those hearts are still mortal bodies.  The gifted individuals who perform the surgeries are only mortal, and the bodies that the “new” hearts are taken from are similarly mortal.  So many things can, and very often do, go wrong.  The extraordinary promise of a new heart and a longer, better life, can rapidly collapse, often into complete and utter loss.

Here, too, the metaphor, thankfully, fails.  In Ezekiel, the Lord declares, “A new heart also will I give you. . .and I will take away the stony heart out of your flesh, and I will give you an heart of flesh.”  Back to our Primary lesson:  I told the kids the hearts could be put back together, and then I brought out the big heart.  A heart about twice the size of the others that had the Savior’s name on it.  I took the two pieces of my little broken heart and glued them together onto the Savior’s heart.  I explained to the kids that the Savior can heal our hearts, but only if we give them wholly to him, to make our hearts one with his--and if we try to pull away from his heart, ours will break all over again.  

Mortal heart transplants, as phenomenal as they are, face a high failure rate, because all the parts involved are mortal.  The Savior promises a new heart, but it isn’t a fallen mortal one that will, whether it’s immediately or in few years down the road, eventually fail us;  he offers his heart.  The new heart he gives us is his eternal, unblemished, unfailing, unwavering heart.  What manner of men ought ye to be? Even as he is.  Be ye therefore perfect, even as our Father in Heaven in perfect.  He can give those high commands, because he willingly and selflessly provides what we need to achieve them.

One thing we can count on, that is true for every human being, is that our hearts will fail us. Because we are earthly beings subject to the fall, that is true spiritually as well--at some point or another, and for most of us many times over, our hearts fail us.  Later in his life, many years after reminding his brethren of the “song of redeeming love”, Alma prayed, “Yea, I know I am nothing, as to my strength I am weak.  Therefore I will not boast of myself, but I will boast of my God, for in his strength I can do all things.”  When we feel spiritually weak, when we feel emotionally beaten up, when we feel like we’re sitting at the bottom of a huge mountain and think, “I just can’t do this”, we have to remember that we don’t have to climb it alone, that the Lord will strengthen our hearts.  When Peter had enough faith in the Lord to step out of a boat in a stormy sea, he walked on water.  And when it got scary and overwhelming and his heart began to fail him and his feet consequently began to sink, the Lord reached down and pulled him above the waves.  He didn’t let Peter drown--he won’t let you either.

But just as getting up and walking a few more steps than you did yesterday will begin to strengthen your mortal heart muscle, taking a few more steps in faith than you did yesterday will begin to strengthen your spiritual heart.  We each have to start where we are and take one step at a time forward.  It will take time.  It will be hard work.  But the cost of discipleship, as high as it can be, is significantly lower than the many costs of a hard heart.

And when the storms come, as they inevitably will, and the waves crash and the wind howls, we must hold on tightly to what we already know and trust that the Lord is there in our trouble.  When we feel overwhelmed, and it seems too much to bear, we can remind our frightened and strained hearts that there is someone to turn to who knows the pains we face and the apprehension we feel.  As Elder Holland said, “When life is hard, remember we are not the first to ask, ‘Is there no other way?’”  The Savior pressed on, through pain and blood and exhaustion beyond comprehension or compare, so that he could heal and uplift and seal our hearts for something better.  

We all face heartbreaks, and sometimes there is no earthly solution.  Sometimes, we make decisions, or the consequences we bear of other people’s decisions, force us to let go of what we thought our eternity would look like.  But the Lord has promised us over and over that no good thing will ultimately be withheld from those who faithfully make and keep covenants with him, even if we cannot see, from this side of the veil, how those blessings will be fulfilled.  President Monson recently said, “At times. . .we feel surrounded by the pain of broken hearts, the disappointment of shattered dreams, and the despair of vanished hopes. . .We feel abandoned, heartbroken, alone.  If you find yourself in such a situation, I plead with you to turn to our Heavenly Father in faith.  He will lift you and guide you.  He will not always take your afflictions from you, but He will comfort and lead you with love through whatever storms you face.”

As we struggle, sometimes succeeding and sometimes falling flat, each step forward is a little easier to make if we trust that we have a Father who loves us and is watching over us, and a Brother who willingly unburdens our hearts of the weight of our sins and failures.  I love that the scriptures teach us of the faithful devotion of obedient and powerful prophets, without glossing over their flaws and missteps.  At the beginning of the Book of Mormon, we see Lehi, trying to manage unruly sons, sacrificing his comfortable home and position to obey the Lord’s commandment to flee Jerusalem.  But we also see him doubt, and hear him grumble.  We see some of the moments that his heart fails him.  Lehi does the only thing any of us ever needs to do, what we must do: he repents, and he takes another step forward.  And little by little, he becomes the man who, in his parting testimony to his sons, declares with confidence and humility, “The Lord hath redeemed my soul from hell; I have beheld his glory, and I am encircled about eternally in the arms of his love.”