Author and medical practitioner Abraham Verghese talks to Meenakshi Kumar about his twin careers and how his work as doctor closely related to his writing
Abraham Verghese is one of the few medical practitioners in the western world who believes in the importance of bedside medicine. This belief, he says, stems from his training in India as a medical student. Trained in infectious disease, Verghese now spends most of his time in internal medicine at Stanford University’s School of Medicine. At the same time, he is a successful author of books such as My Own Country, The Tennis Partner and Cutting for Stone. Presently, he is working on his next, Maromon Convention, which is based in Kerala, the birthplace of his parents. In an interview with Meenakshi Kumar, he talks about his twin careers and the importance of bedside medicine.
You successfully combine two careers – one as a medical doctor and the other as a writer. How are you able to balance the two?
For the longest time I used to say that it really was just one career, namely medicine. And that my passion for medicine is what led me to writing and the writing came out of the passion for medicine. But it probably feels disingenuous for me to keep saying that at this stage. The truth is that I work at both things separately and almost interchangeably; on any given day, each has its own requirements for keeping up. (I am reminded of William Carlos Williams, the great American poet and a paediatrician, who would often scribble some ideas on scraps of paper in between housecalls.) It makes me a much slower writer than most -- Joyce Carol Oates has probably written two books while I do this interview! I am very fortunate at Stanford to have some protected time for my writing. The University and my boss see my creative writing as sort of a research equivalent. Whereas other people disappear to their labs to work, I disappear to a secret office where I write. But there are long stretches where I am busy clinically and cannot get to my writing. Trying to do both forces me to be very efficient with my time and to say no to many things.
My Own Country, The Tennis Partner and Cutting for Stone are heavily autobiographical. How tough is it to pen down your own experiences and emotions for others to read? As a writer, is it some kind of a cathartic process for you?
The first two books were memoirs and, therefore, needed to be autobiographical. I actually found it quite difficult to write those memoirs, because I assumed the story was largely not about me, even though they were true stories — I was just the observer. My Own Country was about AIDS in rural Tennessee and The Tennis Partner about the phenomenon of doctors and drug addiction. But in both cases it appeared that I became more of a character in the story, in the sense that my reaction to what I was seeing was germane to the story. My editors kept coaxing revelations out of me, pointing out that the reader would feel shortchanged if I slammed the door every time the narrative lens swung in my direction. So, I wound up revealing a lot, but I feel good about it: the reader who has done me the honor of picking up the book deserves to know those things.
Cutting for Stone was different. It is obviously a work of fiction: I am not a twin, my parents are not physicians, etcetera. However, I did draw upon the geography and political history that I knew intimately, and many of the sentiments are clearly mine. That said, I suspect that many novels, especially when the novelist has a philosophy of some sort to expound, will inevitably be autobiographical.
How did you decide to write The Tennis Partner, arguably a much more difficult book as it deals with your difficult friendship with a tennis pro who is trying to break out of drug abuse, and your coping with a failed marriage. To write about your own frustrations, vulnerabilities and idiosyncracies so frankly could not have been an easy thing.
That was really a tricky book to write. But I did want to give voice to a subject that people don’t usually write about, namely heterosexual male friendship. You see, women write so eloquently about their deepest friendships; gay men right beautifully about their friends ... But heterosexual men tend to couch their friendships in sporting metaphors such as “my tennis partner” and “my golfing buddy”. Particularly in India in college and medical school, I had very close male friendships. I considered them not just incidental to my life but deeply important to my well being, my sense of self. So, the book I hoped would give testament to those friendships. Your deepest friendships are very much like good health in that you might only realise what you have when you have lost it.
Cutting for Stone, your first novel, is a sweeping saga spread over five decades of life in Ethiopia and America. What was the inspiration behind it? Why did you want to write this book?
I always wanted to write a big novel. I love the idea of creating a world that the reader enters and loses all track of time and lives in the story for several generations and finishes the book ... and looks around and it’s only Tuesday. I love the idea of “fiction as the great lie that tells the truth about how the world lives” -- something that Dorothy Allison said. I love the idea of fiction as a truth telling device, as a means of pursuing a kind of scientific inquiry. I also wanted to write a novel that captures the romance of medicine, both the study of it and the practice of it. I came to medicine because of books like that. I am thinking of The Citadel by A.J. Cronin, Arrowsmith by Sinclair Lewis and Of Human Bondage by Somerset Maugham (even though the medical element in Maugham’s book was quite minor). It was my hope to write a book that would bring a generation of young folks back to the notion of medicine as a calling, as a romantic pursuit, a form of service that is deeply meaningful.
You are one of those rare doctors in today’s world who strongly advocates the old-fashioned one-on-one physical examination. What has been your experience so far with patients regarding this? Also, how open are patients to this old-school method of examination?
Patients actually immediately appreciate and understand the need for this sort of exam. Although you may call it “old-fashioned” I actually think it’s essential, especially in enabling you to order further tests judiciously. I can’t tell you how many examples I see of patients who get unnecessary radiation exposure and other expensive medical misadventures that could’ve been avoided if someone had simply listened to them and examined them carefully. But quite apart from the ability of the bedside exam to pluck the “low hanging fruit” — the obvious diagnoses -- it also is a ritual of great importance. If you think about it, you are seeing someone who is a stranger to you who nevertheless tells you things they would not necessarily tell their spouse or priest. And then incredibly they disrobe and allow touch, which in any other context is assault. And all of this takes place while the physician is wearing a ceremonial white gown and the patient is wearing an exam robe. And it is happening in a room with furniture and instruments on the wall that are unlike any room in your house or mine. In other words, it has all the trappings of a ritual ceremony. And patients are disappointed if after all that you simply do a half-assed prod of the belly or stick your stethoscope on top of their clothes. By contrast, if you do the exam with some skill (and I’m thinking of my professor at Madras Medical College, Prof. K.V. Thiruvengadam, who could do such a quick and skilled exam) patients are not only appreciative, but they are in awe. And symbolically, the exam serves to locate their problem on their body, not on some image in a computer or a cath lab. The exam validates their personhood. Rituals, whether it is a wedding or a funeral, are about transformation and the transformation in doing this particular ritual well is a cementing of the patient physician relationship, a bonding. William Osler, a famous physician and educator, said many years ago that patients judge us by the “manner and skill with which we do the least manoeuver on them” and not by the diplomas on our wall or the certificates of hospital training.
Does this belief in ‘bedside medicine’ stem from your medical training in India, particularly Chennai? In India still, lot of doctors conduct a one-on-one physical examination.
I think my skills at the bedside are very much a product of training in India as a medical student. I had two huge influences: Professor K.V. Thiruvengadam and the late Professor N. Rangabashyam who taught surgery. I feel guilty at times to think that my reputation in America in medicine largely rests on something that every student is drilled on in India and knows so well. That skill has died in America, in large part due to the fact that there is not a high-stakes clinical exam with real patients — a viva -- at the end of training. I have no doubt that if in America we created a high-stakes exam, American students would quickly have the same skills as their British, Canadian or Indian counterparts. Though even in India I am told that the haste to use technology and the abundance of technology (I see more CT scanners on every corner than tea shops!) suggests that the same phenomenon of skipping the physical exam might be happening here.
What are you most passionate about – medicine or writing? Has writing always been a part of your life and what made you decide to pursue it along with a demanding career in medicine?
I think it’s fair to say that I am most passionate about medicine. The writing is an extension of that. It came fairly late in my medical career. I don’t see my writing surviving without the fuel and energy and great privilege that comes from being with people at the most vulnerable moments in their lives. I hope no one forces me to choose between one or the other, but it would not be much of a choice.
Who have been your literary inspirations?
The list would be too long to give you here and also I worry that it might offend a few people. For starters, Dickens, Maugham, Marquez, John Irving, Michael Ondaatje, Robertson Davies, , R.K. Narayan and so many others. I am reading as much regional Indian literature in translation as I can get my hands on. Such treasures there that I can only access if there are English translations.
Do you see yourself writing a book which has nothing to do with your past or the medical profession?
Hmm. In as much as medicine has everything to do with life-and-death I would suspect it would be impossible not to involve medicine in some way when writing a novel.
When not writing or busy with patients, what keeps you occupied?
Life keeps me occupied, learning about it. And learning to be in the moment -- this moment. I have three sons who each in their own way delight me and make me quite proud. The youngest is still in school so when he’s with me I spend quite a bit of my time with him. I’m also involved in some intriguing research on the role of ritual in medicine and on metaphor in medicine, work that crosses disciplines. At Stanford, I am enjoying being on the same campus as colleagues in anthropology, ethnography and social sciences. So, I’m able to attend all kinds of lectures and learn all the things I missed for want of a good liberal education. I’m afraid I specialised in science much too early, at the pre-university level! My older brother George (who graduated from IIT Madras and is a professor at MIT now in Boston) and I both joke that in our retirement, we would love to become PhD students and leisurely study philosophy or English literature, for the pure pleasure of learning.
Abraham Verghese will be in India in early January to take part in The Hindu Lit For Life in Chennai
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Keywords: Abraham Verghese, medical student, science fiction, truth-telling device, The Hindu Lit For Life, Stanford University’s School of Medicine, My Own Country, Hindu LFL 2014, Hindu lit fest, chennai lit fest, literary festival