What book, no make that, what novel, could possibly make a young person decide to become a physician? As much as I love fiction, I’d never considered it an incentive for anyone’s career choice. Not at least until Dr. Abraham Verghese convinced me that the tools in a writer’s toolbox – conflict, character and metaphor – are also essential to a practice of medicine that involves not only curing but healing.
Verghese was the featured speaker at this year’s Literature + Medicine conference at Texas Health Presbyterian Hospital Dallas. Half the members of my book group were there – Verghese fans since we read his 2012 New York Times bestselling novel, Cutting For Stone. And although I’ve become a fan of this seemingly unlikely conference on the confluence of medicine and literature, this was the first time I remember a featured speaker talking about the importance, the essential importance of fiction to the practice of medicine.
“I will begin with a story,” Verghese told the audience packing the Fogelson Forum Auditorium at Presbyterian Hospital. . “Story is so fundamental to medicine. When we meet a patient, we take a history, and the word story is embedded in history.”
And so he told a story about one of history’s most famous physician-writers, Anton Chekhov. Ill with tuberculosis, which was incurable in his time, Chekhov and his wife decided to visit a spa in Germany’s Black Forest. A medical crisis occurred during the visit, and the spa’s doctor, who would have been more likely to treat cases of indigestion, Verghese told us gently, suddenly found himself responsible for the care of another physician. And not just any physician, but the most famous one of his time.
Chekhov assured the doctor that he realized he was dying, and that any palliative efforts would be futile. But they were in a spa, after all. So, perhaps doing what he knew best how to do, the doctor ordered a bottle of champagne. “How long it’s been since I had champagne,” Chekhov said. And raising his glass, he drank it slowly, turned on his side, and died.
Beyond the charming anecdote lies one of Verghese’s great concerns: the difference between curing and healing. Chekhov could not be cured. He could be – and was – healed.
Verghese experienced this difference for himself, becoming a physician in the era of HIV, of being “caught up in the conceit of a cure and we had no way of dealing with a disease for which there was no cure.”
When one of his patients was too ill to come in for an appointment, Verghese made the radical decision “for my own closure” to visit the young man at home. The patient’s reaction taught him “what the horse and buggy doctors of 100 years ago did so well. I understood for the first time the difference between healing and cure.”
It was the sense of this difference, of the need not only for cures for physical diseases, but of the necessity of healing in an empathetic relationship between patient and physician that has become the focus of his career. And among his tools for healing are those of the writer he also is: story (conflict), character, metaphor.
“The situation (facing a patient) may be routine for you, but for the patient, it’s not. When they come to see you, there is story,” he said, urging medical professionals to listen to their patients and to “the words patients use to tell us their story.”