The Scientist and the Little Hearts
How to be Wrong with Skill and Grace
By: Patrick S. Cross, LMT, CPN, CET
“Failure is not fatal, but failure to change can be.”
-John Wooden
“There’s still so much we just don’t know, but this machine is showing us things we’ve never been able to look at before.” Dr. Mark Jeong tells me with a look of excitement as he lovingly, and very gently, pats his bulky machine like proud parent.
A few minutes earlier I am settling into a chair reaching for my notepad and a pen in Dr. Jeong’s humble office in the cardiology research department at the Anschutz medical facility in Aurora, Colorado.
“So can you tell me a little bit about the research your team is doing here?” I ask as I scribble my pen on the paper making sure it’s working.
“Yeah, but it’s kind of complicated to talk about,” Dr. Jeong explains, “Probably better to show you.” His face lit up as though he’s just had a fantastic idea. “Want to see my machines?”
“Yeah,” I blurt out, “Is that ok?”
“Sure!” Dr. Jeong beams, “Just don’t touch anything.”
As we walk the long hallway from his office to his lab I’m struck by the seriousness, and simultaneous childlike wonder he and his colleagues seem to emit. They all beam a bright smile and wave as we walk passed their offices and laboratory rooms, then a split second later their heads are down with the pursed lips and pressed eyebrows of people who are laser focused on discovering the deep, hidden secrets of the human body.
We reach the end of the hallway and come to a thick security door barring us from the laboratory on the other side. Without skipping a beat Dr. Jeong hops up on one leg, hip bumps a device on the wall, and the red light on the door flashes green with an audible click from the locks. Dr. Jeong swings the door open and motions for me to walk in.
“That’s the main cryo freezer,” He tells me as he points to a giant metal refrigerator on the way through his lab, “that’s a big deal. That’s how we keep the samples safe.”
“Samples of what?” I ask, imagining toads and cats and other things we used to dissect in science class.
Dr. Jeong stops walking, his smile fades and he takes a big breath. “Those are our hearts.”
“Your hearts?” I repeat back, making sure I heard correctly.
I guess it did make sense. This is a cardiology research lab. I guess I just hadn’t imagined a giant freezer full of hearts.
“Yeah,” He confirmed, looking almost a bit sorry. “It’s tough sometimes to work with these samples. We’re extremely grateful for the knowledge we’re acquiring, but every time I put a sample on a slide I know there’s a kid who didn’t make it.”
“That’s a sobering thought,” I said, thinking of the families who have each suffered a terrible loss that each one of those samples represent.
“Yeah,” Dr. Jeong adds, “We just hope that what we learn here can lead us to better treatments and more lives saved.”
With that he walked over to one of his machines and smiled softly. “These guys show us what is happening in all of those hearts at a level we could never see before. They tell us so much more about what’s actually going on in there. It’s really incredible.”
“Where did those machines come from?” I ask, admiring the bulky, but elegant contraptions in front of me.
“I built them.” He admits, with a shrug of his shoulders. “My mentor, Dr. Coraddo Poggesi, has two that he built in Italy. There’s one in Seattle too. Those ones, and these ones are the only five in the world. Italy is where I learned to build them. Hell of a process though. The first one took years because we ran into so many problems.”
“What kinds of problems?” I asked.
“Well, for starters I figured building one of these in Italy would be the same as building one here. Not the case.”
“What’s different about Italy?” I asked, “Altitude?”
“Well, yes,” He chuckled, “but that didn’t really make much of a difference.”
“The big problem was electricity.” He continued, “They use direct current over there, we use alternating current in the states.”
“Oh,” I raised my eyebrows, hoping he might explain further without me having to admit I had no idea why that would make a difference.
“Direct current is quieter.” He explained, and then elaborated as though realizing I still didn’t get it. “These machines read tiny changes in electrical current, pressure, and tensions. I mean really tiny. Some minor surge in the electricity anywhere in the building that would otherwise be undetectable can show up as big noise on this thing. So when the machine is translating what it sees into what I can see, a small surge like that can screw up the readout. Took me forever to figure that out.”
“So how did you get around it?” I asked.
“First we took it off the grid by using car batteries.” He grinned, “That sort of solved the problem, but was really inefficient. Then we tried other kinds of batteries. It was still not great. So eventually I had to get an electrical engineer to come in here and help me rewire the whole damn system.”
“So they work well now?” I marveled, getting as close a look at the machine as I could without touching it.
“This one,” He smiled, patting the one I had my nose two centimeters away from, “yeah this one works pretty well, but this one is amazing.”
He pointed to the one across the room.
“That’s the second one I built.” He beams, “I could still improve it, but that’s my baby. Here I’ll show you how it works.”
He walked me over to the machine and flicked on a monitor. The first thing that popped up on the screen looked like it was written in a different language that I’d never seen before. Then he fiddled with the controls and I saw an image pop up. I’ve seen the image before, but only in concept drawings. It’s a single muscle fiber, so tiny that the head of a fine point sewing needle would look like the empire state building next to it.
Then he pressed another button on the machine and a glass vile descended from a dispenser and began flushing clear liquid over the tissue sample on the slide.
I watch the muscle fiber twitch on the display.
He pressed the button again, the fluid stopped, and the heart fiber relaxed.
I stared wide-eyed as Dr. Jeong smiled.
“We can view all the way down to single sarcomeres and watch what they’re doing in real time.” He said, “That’s how were getting answers to questions we could never even think to ask before.”
Even with my comparatively basic background in anatomy and physiology I thought of at least a dozen questions I was giddy about the possibility of getting real answers to with this machine. I took a deep breath to calm myself, and asked him the one question I’m here to ask.
“Is there anything you’ve discovered that went against what you thought you knew about how the heart works?”
That is to say, in essence, is there anything Dr. Jeong has discovered that accepted science was wrong about.
“Well, yeah.” Dr. Jeong smiled again. “All sorts of stuff. You have to understand that science is not definitive, and it’s not law. Sure there are laws of physics and so on. There are constants we can count on. Like I said before, there is still so much we just don’t know yet, and what we do know changes constantly with new information and new ways of looking at what is already going on. Nature has figured all this stuff out. We’re the children here trying to understand what nature is doing, and we get it wrong constantly.”
“So what was the last big thing you discovered we were wrong about?” I asked, trying to digest what he had just said while staying focused on my notes.
“Well, right now we’re trying to understand HEFPEF.” He answered, as I scribbled wildly on my notepad.
“Wait, what?” I asked, stopping my pen and looking up confused.
“H.E.F.P.E.F.” He repeated, a little bit slower. “Heart failure with preserved injection fraction. HEFPEF for short.”
I stared blankly.
“That’s when the control proteins have trouble relaxing properly.” He explains.
I slowly nod.
“It’s when the heart doesn’t relax very well, and fails.” He goes on, with a smile.
“What we’ve discovered is that the hearts of adults act completely the opposite from children’s hearts.” He said, “The way they contract and relax is almost opposite at the cellular level. At least in regards to heart failure.”
“So what does that all mean?” I asked, trying to piece together the implications.
“Basically,” He explained, “the medical community has been under the impression that children’s hearts are simply smaller versions of adult’s hearts. And that makes sense to think that way right?”
“Sure,” I said, “That makes perfect sense.”
“Well,” He continued, “what makes sense, and what is actually the case, are very often not the same thing. Little people’s hearts are not just little versions of big people hearts, no matter how much sense that makes to think they are. When we first saw the evidence of that we didn’t believe it. We actually thought the tech had brought us the wrong slides. And when the tech ensured us that we had the correct slides, but brought us new ones just for good measure, we saw the same thing and still didn’t believe it. We told the tech he’d screwed up again. We totally let him have it.”
“But the slides were the right ones?” I asked, trying to imagine Dr. Jeong, with his incredibly calm, and sunny disposition, yelling at his tech.
“Oh yeah, he was right all along.” Dr. Jeong chuckled, “We of course apologized to him later, but he was not very happy with the whole situation.”
“So what does that mean for medicine?” I asked.
“It means that we are starting to understand why some heart medications that work great for adults don’t work at all for kids. Sometimes it’s the things we didn’t expect that lead us to the most interesting insights.” Dr. Jeong said, swiveling his chair back towards his machine.
“So essentially the scientific community was wrong about children’s hearts just being small versions of big people hearts, and your work is leading to better medicine that could help save more lives.” I reasoned, trying to keep up with what he was telling me.
“Not just my work.” He pointed out quickly. “There’s a lot of great people figuring this stuff out.”
As he said that he stopped, sat back in his chair, and took a deep breath.
“I’m going to tell you what I tell my post doc students.” He said, “It’s not about being wrong. Our eyes can only see what our brains can comprehend. When we see things, we build expectations. When we have expectations, we start to see things that promote our expectations. That’s where it gets tricky. To find out what is really going on we need to be honest with ourselves about what we expect to see, and then if we see something that is not in line with our expectations we need to open our minds to different possibilities. That’s how we can make real progress where we might have been falling short in the past.”
“So it’s not so much about right or wrong?” I said, trying to organize what he’d just told me in my own mind. “It’s more about just being able to shift our expectations of what we think is true.”
“Being wrong comes with a sense of shame.” He said, “but, especially in science, things are going to turn out to be different than what we expected so often, that we would be ashamed constantly if we saw it as being wrong. We would never want to admit it when the results of a trial or experiment don’t match up with what we expected to see.”
“On top of that,” He added, getting excited. “A lot of the time what we didn’t expect is way more interesting than what we did expect! Looking at a failed experiment and trying to decipher what it means makes us smarter.”
“How’s that?” I asked, amused at his sudden burst of excitement.
“Look at it this way,” He said, “If the results don’t make sense we can come at it from a different angle, and we may end up having a completely unexpected breakthrough. That’s the essence of the scientific process.”
“What about scientists who aren’t willing to admit they’re wrong?” I asked, curious if he worked with any such people.
“Oh you mean like on T.V. or in courtrooms or political arenas?” He said, with one eyebrow raised.
“Yeah,” I said, “like the ones who deny climate change or that too much sugar causes obesity.”
“Those are not scientists,” He said matter-of-factly, “Those are spokes people.”
“You ever have to work with anyone like that?” I asked.
“No.” He said bluntly. “We don’t really have any of those around here.”
Then he added, “I’ve run into some pretty big egos. That’s for sure. But no one who is unable to look at the evidence and shift their views. No one that close minded.”
The lesson
Being wrong is not a failure of personhood. It doesn’t make us incompetent or bad people. Being wrong is nothing more than a failure in perception. What we expected to be true simply wasn’t. Or what we expected to be false turned out to be true. It does not mean we are lesser humans for it, even though it can feel that way initially (especially if we were self righteously stubborn or vocal about how right we were leading up to being wrong).
Viewing our failures in perception honestly and with an open mind makes us smarter. The first step to being able to do that is to view our failures in perception as simply something different than what we expected. The next step is to come at it from a different angle. This means asking ourselves how we can think with a different mind.
If we can do that we may just have an unexpected breakthrough.