I am seated in the response vehicle on our way to an emergency case. My thoughts are drifting to the body systems – it’s a habit that I developed during my training; run through the systems (of mostly anything) and see how everything connects. A stray thought pops up: how does my knowledge of anatomy link with my knowledge of change?
We are on our way to a cardiac case and my contemplation turns to the heart. By reframing change as a living process, I wondered at the complexity that this reframe brings forth. Central to the idea is the heart, the organ that moves blood around but also the philosophical centre of feeling. By looking through a scientific lens with philosophical tinting the heart is pivotal to actual life and feelings like love and hate.
The call was cancelled and we stop for coffee. I experience a massive urge to sketch the heart and to write down my thoughts. The pencil in my bag, I discovered, was broken and I did not have a sharpener with me. I hurried over to a small shop (you can almost find anything in these places) and asked for a pencil and sharper. A search began and a box of pencils and a SpongeBob sharpener was produced – wonderful!
First I drew the heart as I know it. I think of it in this view and can add detail as required (no more detail required for this piece). It is a dissected view showing the four chambers, four valves and major blood vessels.
I notice that I have a silly smile on my face because I am willingly leaving out some details like tendons and smaller vessels. It bothers me somewhat. The imperfection of what I am drawing is noticed deep inside me and I smile again: this is not an exam! I transfer a photo that I took from the sketch in my notebook to my computer and add some colour and items to help better explain, briefly, how the heart works.
The heart has four chambers: two atria and two ventricles.
Deoxygenated blood (blood low in oxygen) flows from the organs (where cells used the oxygen) into the right atrium, then into the right ventricle that pumps it out through a blood vessel that conveys it to the lungs. The lungs will oxygenate the blood again.
Oxygen-rich blood flows from the lungs into the left atrium, to the left ventricle that pumps it out through the aorta to the organs (where it makes contact with cells). The organs will consume the oxygen and the process starts again. The next picture shows the entire process.
Now for the important question: How does change connect to the heart?
I can immediately think of some ways in which it connects:
- Although connected to the urge of sketching something, the first connection is Heron & Reason’s ways of knowing (Experiential, Presentational, Propositional and Practical knowing). The focus here is on the presentational, the drawing of sketches to assist my thoughts and theorising .
- From a complex responsive process (CRP) perspective: the oxygenating and de-oxygenating represents enabling and constraining which are process inherent to relating 
- The contact areas remind me of the full contact with each other as humans in conversation. Full contact here refers to “Contact occurs at the boundary of self and other” and “Contact is the experience from which meaning is extracted”. Contact is also the time where change (and meaningful exchange) takes place. 
- What also occurs to me is that the heart’s actions are mechanical (albeit automatic). The heart does not pull blood into it and only pushes either blood ready for oxygenation towards the lungs or oxygenated blood to the organs. The mechanics are therefore aimed to sustain, protect and preserve life. This applies to an ‘active’ role in change. “Doing” is not a bad thing.
- I also find the oxygenated-deoxygenated blood representative of the spectrum where there cannot be happiness without sadness, there cannot be agency without communion etc. [4; 5]
I will obviously spend time with these thoughts in order to unpack it further. For now though, the heart is at the middle of change.
What are your thoughts on this?
 Heron, J., & Reason, P. (2008). Extending epistemology within a co-operative inquiry. In P. Reason, & H. Bradbury (Eds.), The sage handbook of action research: Participative inquiry and practice (2nd ed., pp. 366-380). London: Sage.
 Stacey, R. (2005). Values, spirituality and organizations: A complex responsive processes perspectives. In D. Griffin, & R. D. Stacey (Eds.), Complexity and the experience of leading organizations (pp. 93-123). London: Routledge.
 Nevis, E. C. (1987). Organizational consulting: A gestalt approach. Santa Cruz, CA: Gestalt Press.
 Gergen, K. J. (2009). Social construction: Revolution in the making. An invitation to social construction (pp. 1-30). London: Sage.Watzlawick, P., Weakland, J., & Fisch, R. (2011). Change: Principles of problem formation and problem resolution (Rev ed.). New York, NY: W. W. Norton.
 various works by Thich Nhat Hanh
By Niel Stander