Dr. Abraham Verghese was drawn to medicine through fiction, through the idea that medicine, like fiction, was a “mysterious, noble, romantic and highly desirable quest” for knowledge, a way to deeply understand suffering and the human condition.
This idea came to Verghese from his reading of Somerset Maugham’s Of Human Bondage. His instructors at the Madras Medical College in India reinforced the connection, teaching that each patient tells a story. When a person is sick she will give her doctor pieces of information about how she feels; a bit like reciting one paragraph of a novel. The doctor’s job is to understand the whole story—what happened before or around this paragraph. And so the doctor, like the writer, must listen, observe, and bring the details of a story, a life, together.
After medical school in India, Verghese traveled to the United States for a residency, spending three years in Johnson City, Tennessee. It was there that he witnessed the first signs of AIDS, and the physical, emotional, and societal impact the disease’s spread had on his community. In 1991, he earned his M.F.A. at the Iowa Writers Workshop and also published “Lilacs,” a story about AIDS, in The New Yorker. This led to his first book, My Own Country: A Doctor’s Story (1994), about arrival of the AIDS epidemic in rural Tennessee. A few years later, working in Texas, he met David, an intern who became the subject of his second book, The Tennis Partner: A Story of Friendship and Loss (1998), which is about addiction and suicide.
But fiction always was his first love, and his inaugural novel, Cutting for Stone (2009), brings together storytelling, medicine, and a search for understanding. Verghese writes of two generations of doctors in Ethiopia and America, two very different settings for the practice of medicine. “In Africa,” he says, “nothing separates doctor and patient, no layers of paperwork, technology or specialists. In that setting, I wanted to put very human, fallible characters. … To take it to America was to contrast this world with Western medicine, with the power and beauty and science, but also its failings.” The book is also, in his words, “about the danger of losing yourself in the profession and not keeping a handle on your personal life or, as Yeats said, balancing ‘perfection of the life, with perfection of the work.’”
Since 2007, Verghese has served as senior associate chairman and professor of the theory and practice of medicine in the Department of Medicine at Stanford University, while he continues to write. At Stanford, he encourages medical students to practice a keen development of the senses—both from practice and from reading. “The humanities are vital in helping students maintain empathy with their patients,” he says. “I use Tolstoy’s The Death of Ivan Ilych to teach about end-of-life, and Bastard Out of Carolina to help students really understand child abuse. A textbook rarely gives them the kind of truth of understanding achieved in the best fiction.” On the flip side, it might also be said that being a doctor has made Verghese a better writer.
Excerpt from Cutting for Stone (2009)
Life is full of signs. The trick is to know how to read them. Ghosh called this heuristics, a method for solving a problem for which no formula exists.
Red sky in the morning, sailors take warning.
Pus somewhere and Pus nowhere means Pus in the belly.
Low platelets in a woman is lupus until proven otherwise.
Beware of a man with a glass eye and a big liver…
Across the outpatient department, Ghosh would spot a breathless young woman, her cheeks flushed, contradicting her general pallor. He’d suspect narrowing of the mitral valve of the heart, though he’d be hard-pressed to explain exactly why. It would make him listen carefully for the soft, rumbling murmur of mitral stenosis, a devilish murmur which, as he said, “you’ll only hear if you know it’s there,” and then it was only audible with the bell of the stethoscope lightly applied over the apex of the heart after exercise.
I’d developed my own heuristics, my mix of reason, intuition, facial appearance, and scent. These were things not in any book. The army soldier who’d tried to steal the motorcycle had an odor at the moment of his demise, and so, too, had Rosina, and the two odors were identical—they spoke of sudden death.
But I didn’t trust my nose when I should have, when it picked up signals from Ghosh that put my nerves on edge. I wrote it off as being a function of his new job as a professor, a side effect of his new suits and new environment. When I was around him it was easy to be reassured. He’d always been upbeat, a happy soul. But now he was even more jovial. He’d found his best self. For a man who prided himself on “the three Ls: Loving, Learning, and Legacy,” he’d excelled in all three.
On the anniversary of Hema and Ghosh’s marriage, I woke myself at 4:00 a.m. to study. Two hours later, I walked over from Ghosh’s old bungalow to the main house…Hema was still sleeping. The hallway bathroom door stood open, steam coming out. Ghosh stood in front of the washbasin, a towel around his waist, leaning heavily on the sink. It was early for him. I wondered why he was using this bathroom. So as not to wake Hema? I could hear his labored breathing before I saw him and, certainly, before he saw me. The effort of bathing had winded him. In his reflection in the mirror, I saw his unguarded self. I saw terrible fatigue; I saw sadness and apprehension. Then he saw me. By the time he’d turned around, the mask of joviality which had fallen in the sink had been slapped back on, not a seam showing.
“What’s wrong?” I asked. I felt my stomach flutter. The scent was there.
Cutting for Stone (2009)
The Tennis Partner: A Story of Friendship and Loss (1998)
My Own Country: A Doctor’s Story (1994)
“Health Care’s Next Crisis,” Daily Beast, March 24, 2009
“Why Isn’t Obama White,” San Francisco Chronicle, October 2008
“AIDS at 25,” New York Times, June 2006
“Close Encounter,” New York Times, September 2005
“On Death and Dying,” Wall Street Journal, August 2004