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Archive for Saturday, February 21, 2009

Pen and stethoscope: Physician Abraham Verghese turned to writing to heal himself and others

February 21, 2009

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Abraham Verghese, an infectious disease specialist, says doctors would benefit from understanding that to every patient, illness is a story. His most recent book is the novel “Cutting for Stone.”

Abraham Verghese, an infectious disease specialist, says doctors would benefit from understanding that to every patient, illness is a story. His most recent book is the novel “Cutting for Stone.”

— Nearly two decades ago, when Abraham Verghese put his career as a physician on hold to try his hand at fiction, he knew he wanted to write an “epic medical novel.”

Beyond that, things were a little vague.

Verghese, an internist specializing in infectious disease who’s now on the faculty at Stanford’s medical school, spent the late 1980s in Johnson City, Tenn., ministering to the first wave of AIDS patients to surface there. Needing a break from his immersion in the then-untreatable disease, he cashed in his 401(k) plan and headed for the Iowa Writers’ Workshop.

He arrived in 1990, carrying his briefcase to his first workshop meeting, then sat quietly as his work-boots-and-jeans-wearing peers tossed around the names of unfamiliar writers. Barth! Babel! Cheever! Verghese headed for the library, where he would check out armfuls of books “just to find out what the hell they were talking about.”

What he did know was that his time in Iowa was something he couldn’t afford to waste.

“I was taking care of people my age who were dying,” he says. “The constant feeling, hearing from them, was that life is transient and can end very quickly, so don’t postpone your dreams.”

Nineteen years later, Verghese’s dream of writing has carried him to a packed auditorium at Vanderbilt University’s medical school. Maybe 300 doctors and students — some carrying worn copies of “My Own Country,” the 1994 nonfiction book about his Johnson City experience — have assembled on a frigid January morning for grand rounds. These weekly sessions, in which medical eminences address urgent professional questions, are normally devoted to “arguing about some disease,” as department of medicine Chairman Eric Neilson puts it.

Not today.

Verghese’s topic is “The Pen and the Stethoscope: What Writing Can Teach Us About Medicine.” Over the next hour, he merges insights from his twinned careers.

He says harried doctors must understand that to every patient, illness is a story. He turns the death of the great writer-physician Anton Chekhov into a parable of humane medical care. He shows how the concept of the epiphany applies to both fiction and medical diagnosis.

He doesn’t mention “Cutting for Stone,” the hefty, old-fashioned novel he’s finally written. But in the question period, someone asks for “a sentence-or-two teaser.”

“It’s very much a medical epic,” Verghese says. “It begins with a nun, Sister Mary Joseph Praise, giving birth to twins in an operating room in a mission hospital in Africa. And the father is there, a British surgeon, but he does not know exactly how he could be the father.”

He smiles.

“I won’t tell you more. I hope you’ll read it,” he says, to prolonged laughter and applause.

Remarkabale life

Despite the remarkable life he has lived, nothing in it approaches the intensity of the climax he invented for the fictional brothers Marion and Shiva Stone. Yet he is, like Marion, a physician of Indian parentage, raised in Ethiopia, who ended up in the United States. Obviously, Verghese poured his personal and professional soul into “Cutting for Stone.”

“It’s all there. I left nothing out,” he says with a rueful laugh.

Behind the lectern, Verghese appears poised. Actually, he is nervous. “The very fact that I’m up there speaking at Vanderbilt is an anomaly,” he says later. “Most foreign physicians are invisible around here.”

He has felt like an outsider his whole life. At 53, he knows that won’t change.

Verghese’s parents were Christians from India’s Kerala state who left home to teach in the schools that Ethiopia’s emperor, Haile Selassie, was building. This made their three sons expatriates from birth. Then, when Verghese was around 9, his parents entered a quarrelsome phase and he sensed — wrongly, it turned out — that their marriage was imploding. Imagining himself somehow responsible, he developed what he has called “a precocious anxiety that could only be obliterated by constant activity.”

He obsessed over tennis.

He filled tiny notebooks with observations on people around him, fancying himself a spy.

He also read voraciously — which introduced him to what he calls the “romantic, exciting, slightly mysterious” world of medicine.

Verghese started medical school in Ethiopia but left amid political chaos there. In 1973 he joined his parents in New Jersey, where he was a hospital orderly.

Continuing his medical training in the United States would have meant starting from scratch and Verghese wasn’t considering that possibility. But one day he ran across a copy of “Harrison’s Principles of Internal Medicine” and was overwhelmed by nostalgia. “I had learned that book inside out,” he says, “and I just had this great sense that I could not let all that go.”

He went to medical school in Madras, India. He married. He returned for a residency in Johnson City and, after a fellowship in Boston, headed back to Tennessee just as AIDS was making itself known there.

The irony was tremendous. He had chosen his specialty in part because he was caught up in “the conceit of cure,” the sense that doctors can fix anything. Now his patients faced a deadly plague for which no cure was known.

Out of despair, he started leaving “the medical-industrial complexes I worked in” to visit patients at home. The results amazed him. His presence seemed to help them come to terms with their illness.

“I began to realize what it was the horse-and-buggy doctors of a century ago had to offer,” he says. “They had no penicillin. They had no drugs. They were not dispensing cures — but they were dispensing healing.”

When Verghese got to the writers’ workshop in 1990, AIDS stories poured out of him. No one in Iowa was writing quite like this. “In the workshop, you saw a lot of dating stories,” says Verghese’s classmate Tom Grimes.

“My writing was primitive and crude in a way, but it was shocking, it had stuff in it,” Verghese says.

Narrative medicine

Literary agent Mary Evans sold his story “Lilacs” to the New Yorker, which published the story in October 1991. Suddenly, he wasn’t just a doctor anymore.

His nonfiction book “My Own Country” evoked the emotionally fraught, often heroic lives and deaths of his Johnson City patients, and it told a broader story as well: how an “urban” disease colonized rural communities. A finalist for the National Book Critics Circle Award, it became a Showtime movie and an essential text about the AIDS epidemic.

“Medicine is very much about narratives,” Horwitz says. “It is about a patient’s story and how you come to understand it.”

By embedding this concept in his own work, Verghese can help shape the story of medicine itself. Or at least he can try, as he’s doing right now in Nashville.

On the screen behind him is a photograph of the Russian writer Chekhov. Verghese wants to tell the story of how he died — and how his physician behaved.

Knowing that tuberculosis would soon kill him, Chekhov felt an urge to travel. His wife took him to a spa in Germany, where a crisis ensued. The spa physician decided to send for an oxygen pillow.

“What’s the use, doctor?” Chekhov is reported to have said. “Before that arrives, I will be a corpse.”

The doctor changed his mind and ordered champagne.

Chekhov emptied a glass, lay down quietly and died.

“I’ve done some very unusual things at the bedside,” Verghese tells his listeners. “But I don’t think I ever would have thought of ordering a bottle of champagne.”

He sounds like a doctor who thinks he’s been somehow remiss — and like a writer who wishes he’d conjured that ending himself.

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