The Good Doctor
With a third book set to arrive in stores next year, Abraham Verghese has established himself as one of the most gifted writers ever to make Texas his home. Then again, writing is just a hobby compared with his somewhat more ambitious day job: Changing modern medicine as we know it.
“FIRST IMPRESSIONS CAN point to the most important diagnoses,” said Abraham Verghese, leading the way through a warren of drab hospital corridors in San Antonio this summer. We were hustling toward an appointment with medical students of the University of Texas Health Science Center, and the 49-year-old doctor was explaining his belief that American medicine has become too enamored of its lavish technology. An Indian born in Ethiopia, Verghese was trained in the British tradition, which relies heavily on bedside diagnoses, and he still approaches curing and healing like a detective. “When I’m in a crowded elevator, I feel like I’m not paying attention unless I recognize at least three symptoms in the people around me,” he said. “And if there’s nobody else in the elevator, then I need to be studying the mirror, looking at myself.” We had just emerged from an elevator, and his remark had an unsettling effect on me. I felt scrutinized at a glance, and I was momentarily jolted into an acknowledgment of that ever-lurking shadow—sickness and dying—that we try to whistle past in the alleyways of life.
Verghese has an athletic build and bearing, thinning dark hair, and a rich brown complexion. A woman friend of mine recently exclaimed, “I saw Abraham make a speech, and he made me want to take my clothes off.” The setting of her fantasy did not seem to be a medical examining room. A naturalized U.S. citizen and a specialist in infectious diseases, Verghese exudes a soft-spoken charisma. He is a pioneer in the treatment of rural patients infected with the HIV virus, who came into the profession in the eighties, a time when American doctors felt all but invincible; only cancer was truly feared, and its cure was considered just a matter of time. But the dread plague of our era shattered the illusion that research physicians, laboratories, and pharmaceutical companies had all the answers, and Verghese remains a careful doubter in search of telling clues.
HIS APPROACH TO MEDICINE is also shaped by his other passion: Verghese is one of the most gifted writers ever to live and work in Texas. At nights, after he’s had dinner with his wife and their seven-year-old son has gone to bed, he regathers his energy and focus and slips into his other cloak. He’s already written two highly acclaimed memoirs, My Own Country (1994) and The Tennis Partner (1998), both of which achieved a delicate balance of tragedy and transcendence, themes that run through his personal life and his philosophy of medical practice. And sometime this spring he hopes to finish his much-anticipated first novel, Cutting for Stone. The new book draws on the remarkable odyssey that finally made Texas his own country, but the title goes back to medieval times, when traveling monks hacked and sliced on people without disinfectants or anesthesia to remove their kidney—and gallstones. Most patients died of infection as these forebears of modern medicine moved on, plying their crude trade.
For all the plaudits he’s earned as a writer, Verghese is still foremost a doctor, and a highly sought-after one. Two years ago, after entertaining an offer from Yale, he went to the medical school in San Antonio to take on yet another challenge: to found its Center for Medical Humanities and Ethics. For more than two decades, medical students have been pondering ethical quandaries such as disconnecting a respirator and allowing an unknowing patient to die; Verghese and his colleagues have designed a four-year curriculum that requires a literary approach to ethics coursework and case studies. “Students come to medicine with a great capacity to imagine the suffering of others,” he says. “Then, as they enter their clinical years, they’re taught to take the patient’s unique story of illness and translate it into the formal language of a chart. The student may hear a patient say, ‘The pain started at four in the morning and immediately reminded me of my father, because he died of cancer and it began with a similar pain.’ But what the student records in the chart is not the voice of the patient but the voice of medicine, a formal language that sounds like this: ‘This forty-seven-year-old white female developed the acute onset of left flank pain eight hours prior to admission.’ This language is essential for diagnosis, but the danger is great that students may depersonalize their patients and begin to think of them as simply ‘the diabetic foot in bed two,’ ‘the myocardial infarction in bed three,’ or ‘the chronic renal failure in bed five.’” To critics who scoff that making overworked apprentice physicians read Kurt Vonnegut fiction and watch Frankenstein movies is a waste of resources and time, Verghese points to a course syllabus that addresses the alarming incidence of depression and addiction among physicians; the anger of doctors and the motives of whistle-blowers; and the concerns of a deaf couple who employ in vitro fertilization and genetic diagnosis to ensure that their baby will also be born deaf and grow up in the culture they know. Right or wrong? Or does that language even apply? “Through the humanities,” says Verghese, “we can keep the students’ imagination of the suffering of others alive.” So he insists that his students pay attention to stories, the ones right in front of them—the ones he’s been writing about all his life.
DOUBTING THOMAS IS THE APOSTLE WHO SAW CHRIST after the Resurrection but had to touch the wounds from the nails and spear before he could believe it was him. Tradition holds that Thomas went on to preach in Parthia, an ancient country in what is now Iran, and that he died a martyr in Macedonia. But a church in Malabar, a coastal region in southwest India, contains a tomb where his bones are alleged to lie. It is in Kerala, a state with a significant Christian population whose legends boast the mission and ministry of Thomas. Centuries of occupation by the Portuguese doubtless influenced the choice of faith by the people of Kerala, but however it came about, Kerala is the only part of India where boys are commonly given names like Abraham.
Verghese’s parents were physics teachers who did not meet until after they had left Kerala and immigrated to Ethiopia. In the forties, after Emperor Haile Selassie had spent World War II trying to rid his country of the Italian fascist invaders of Benito Mussolini and of the British liberators who came afterward, he committed himself to modernizing Ethiopia. A diminutive and stylish man, Selassie was enormously impressed on a trip abroad by schoolteachers in Kerala, so he recruited them en masse, which is how two Indians named George and Miriam came to meet in Africa and have a boy named Abraham in 1955.
Haile Selassie was an accessible emperor, roving the eucalyptus-lined streets of Addis Ababa in a fleet of glass-topped Rolls-Royces, pressing his palms together and bowing to Indian women who caught a glimpse of him. Jacqueline Kennedy, whom he entertained in an imperial mansion modeled on Buckingham Palace, befriended him during a trip abroad as America’s first lady. One of Verghese’s strongest early memories is of his parents taking him and his brothers to the public hanging of three men who had attempted a coup. Verghese was six. The dead men swayed from a scaffold above “a dancing horde,” he would later write, which leaped “into the air in unison, chanting and ululating.” The men had been executed in their beribboned uniforms, and their shoes had been stolen. “But where are their shoes?” he asked his parents. His far-flung Indian family included several doctors, and he spent a fascinating year of premed study in India, but Verghese grew up thinking he would always live in Ethiopia. He was accepted into a medical program there in the early seventies, but he soon found himself a student without a school in a country in chaos. A colonel named Mengistu Haile Mariam, whom Verghese describes as the Stalin of Africa, would turn a mass revolt into a leftist military dictatorship; in 1974 the emperor with all those special-ordered Rolls-Royces was arrested and hauled off in the backseat of a Volkswagen Beetle, to die imprisoned and senile. The medical school was shut down by the authorities; in an apartment, Verghese and other students “smoked too much and drank too much and played endless games of Monopoly.” Every dawn presented the sight of corpses in the street. Verghese’s parents fled to the United States, but he procrastinated. One night in the tense weeks before the revolt, he was in a bar and had dallied past the eleven o’clock curfew. The owner locked her customers inside, because curfew violators were routinely shot. Again there came a moment of stark focus on feet.
