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‘The things I will remember most’

(Courtesy of Abraham Verghese)

Tucked away in a corner of Stanford’s School of Medicine, Dr. Abraham Verghese works most days of the week. His office consists of the conventional staples: a computer, stacks of papers and files, framed certificates of academic degrees and a coat stand in the corner where multiple white coats — all with his name and title embroidered across the chest — hang. His bookcases are filled not only with classic medical references, but also his own works, a testament to his tremendous success as a physician-writer.

Verghese has written pieces for a wide variety of publications, including The New Yorker, the New York Times and the Wall Street Journal. He is a professor for the theory and practice of medicine, internal medicine residency program director and senior associate chair for the Department of Internal Medicine. But two days of the week, Verghese retreats to a separate office — a secret location with someone else’s name on the door and without a landline — to write.

But even with the appearance that he leads two distinct professional lives, Verghese identifies himself completely as a primary care doctor.

“I don’t really see [writing and medicine] as two different professions,” Verghese said. “You listen to the patient’s story or history — and what is a history but a story? — and you learn to match stories with your repertoire of stories. When you do the physical, you’re looking at the body as though it’s a text, and you’re trying to read the words of the text.”

Verghese’s work as a writer certainly sets him apart from many other physicians. With a master of fine arts degree in fiction from the Iowa Writers Workshop, Verghese’s writing spans from memoirs to editorials to novels. His most recent published work, “Cutting for Stone,” has been on the New York Times bestsellers list for 88 weeks in a row.

“It’s like a dream sometimes when I think about that,” he said.

With Verghese’s interests in the ritual of the physical exam and establishing a trusting relationship between patients and their physicians, the School of Medicine recruited him as a tenured professor in 2007. According to Verghese, despite Stanford’s patient-centered curriculum, many medical students become disillusioned when they get to the hospital ward.

“Typically, they have a great ability to imagine the suffering of patients, a wonderful humanity,” he said. “The period of training can greatly endanger that humanity…unless you’re careful, the patient becomes almost lost sight of in the hurry to learn about the disease.”

Verghese noted a shift in medical care away from the patient toward a priority of efficiency and greater dependency on technology, and he argued that a dysfunctional healthcare system was the culprit.

“If you put in a needle or do something to a person, you get reimbursed,” Verghese said. “If you spend 45 minutes with a geriatric patient, which is how much time they need, you will lose money and you’ll go out of practice because you can’t pay the overhead.”

According to Verghese, in the current health-care system, physicians order many often-unnecessary tests in the emergency room for billing purposes rather than seeing patients first and then ordering relevant tests. He envisions a future process that is less expensive and technology-dependent and more individually based.

It’s easy to see why patients immediately feel at ease when talking to Verghese, who is warm, serene and personable.

“Incredibly, they tell you things they’d never tell their rabbi, or preacher, or temple priest,” Verghese said. “They disrobe and allow touch, which in any other context would be assault. Then they listen to your suggestions and advice. In being able to influence them in a positive direction, you really need to understand who you are and how you appear to other people.”

Verghese became a physician by unconventional means. Born in Ethiopia to Indian parents, he grew up in a well-educated household, with both parents as teachers. He was in the middle of his medical training when civil war broke out, leading him to leave Ethiopia for the United States.

Verghese worked as a nighttime orderly in a New Jersey hospital until he decided to return to medical school and finish his training in India. He completed his residency in Johnson City, Tenn., right at the time when the town was experiencing a deluge of people with HIV/AIDS returning home, in most cases, to die. He wrote his first memoir, “My Own Country,” about these experiences, which he identifies as the turning point for him becoming a writer.

“[A scientific paper] couldn’t encompass the tragic nature of this voyage, or the grief of the families, or my own grief at seeing this happen again and again,” Verghese said. “[Good writing] allows you to fully live the experience and to be in the shoes of the people experiencing it.”

These cases in Tennessee were Verghese’s most trying and continue to inspire him to this day.

“It was the most poignant period of my life,” Verghese said. “I often think of so many of those men — I see their faces so clearly — and they were the bravest souls that I ever met. And they died before any of this therapy was around.”

Verghese’s patients in Tennessee also had a profound impact on his concept of masculinity.

“Most of them were gay, and I was not homophobic, I was ‘homoignorant,’” Verghese said. “To be around a gay man is to understand that…so much of being a man is also about learning to be a good friend to a woman, to be respectful to women.”

For future doctors, Verghese highlighted the importance of a liberal arts education.

“You’re going to get the biology as you go on,” he said. “Why humans weep when they hear Bach, or why slavery ended when a book like ‘Uncle Tom’s Cabin’ was written, or why fiction moves people to change their lives…you need to get all those things in order to be a good physician, because you’re dealing not with robots; you’re dealing with emotive beings.”

Despite his lauded accomplishments on paper, Verghese sees the meaningful bonds he forms with his patients as his greatest achievement.

“My relationships are the things I will probably remember most on my deathbed, not the piece of work I accomplished,” Verghese said. “[Medicine] seemed like this grand adventure of working with people, and, you know, I never stopped seeing it that way.”

 

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