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The doctor will see you now. As in, really see you. Maybe even listen to you.
That's the philosophy of Dr. Abraham Verghese, best known for writing "Cutting for Stone," a novel that has sold more than a million copies. In medical circles, he's also known for advocating the old-fashioned one-on-one physical exam, the kind in which doctors and patients actually talk to each other and build a relationship.
"A CAT scan of the brain can show you a stroke, but only an exam can show you the results of that stroke," said Verghese, who teaches at Stanford University School of Medicine. "It's a time-honored tradition for people to give you the story of what's ailing them by pointing at various body parts. We shouldn't skip that step, that opportunity to bond."
Verghese (pronounced ver-GEESE) is the third guest in this fall's Talking Volumes program at the Fitzgerald Theater, where he will speak Wednesday.
"Cutting for Stone," his first novel, was published in 2009 and stayed on the New York Times bestseller list for two years. A book-club favorite, it is the saga of twin brothers, Marion and Shiva Stone, whose mother (an Indian nun) dies giving them birth. They are raised in the shadow of the Ethiopian revolution, which Verghese himself experienced as a young man. The brothers both grow up to be doctors, but become estranged over the woman they both love, their nanny's daughter, who becomes an Eritrean guerrilla. The twins' father, British physician Thomas Stone, is missing in action for most of the story, until the dramatic conclusion brings the three together.
Dr. Robert Meiches, an internist and geriatrician who is CEO of the Minnesota Medical Association, has read "Cutting for Stone" twice. He agrees with Verghese that the success of health care depends greatly on a trusting patient/physician relationship.
"One of the best examples he gives of that in the book is what to do in an emergency -- offer words of comfort," Meiches said. "Obviously, reading it appealed to me as a physician, but it's also a wonderful, whimsical story," he said. "The prose is written in an interesting fashion, in a way that makes you think."
People, not iPatients
Verghese, who has a substantial following due both to the popularity of his writing and his views on practicing medicine, was a guest speaker at the most recent TED (Technology, Entertainment and Design) Conference.
"I joke, but I only half-joke, that if you come to one of our hospitals missing a limb, no one will believe you till they get a CAT scan, MRI or orthopedic consult," he told the conference in a taped speech that has received nearly a million page views online.
Verghese has broad experience as a physician, from treating AIDS patients in a Tennessee backwater during the early years of his career to his current position as a teacher and associate chair at Stanford University's medical school. He laments that doctors' increasing reliance on testing and technology has turned people seeking medical care into what he calls iPatients.
"All the transactions around the patient are taking place on computers," he said. "When you want information on a patient, you go to the computer. When you want to consult other doctors, you also go to the computer. From the patients' perspective, it seems like they are merely icons for the real patients -- the iPatients online. The iPatient gets wonderful care. Meanwhile, the real patient has no idea what's going on."
There's a real skill to bedside manner, he said. "It's like any craft, whether it's cabinetry or writing or medicine. You get better and better at listening to and analyzing patients' stories and matching them to your repertoire. You get better at picking up on nuances, and there's a great deal of satisfaction in that."
Being a good observer is equally important in writing. It is a skill consciously developed, he said, particularly in internal medicine.
"It's very much about finding all the disparate clues, putting them together and coming up with a diagnosis. In many ways, writing requires those elements, too, to put together a cogent story. Medicine is good training to be a writer."
Verghese sees fiction as a similarly collaborative venture: "The writer brings the words, the reader must provide imagination, and then, you hope, alchemy happens."
At the end of "Cutting for Stone," Marion, who mistrusts both his brother and his father for good reason, must take a leap of faith to reconnect with them. Asked what his own most significant leaps of faith have been, he said that uprooting his career and family to attend the Iowa Writers' Workshop was certainly one, but another was "getting married. It hasn't worked out, twice."
The New York Times review of "Cutting for Stone" criticized Verghese for going into what the reviewer felt was too much detail, including graphic descriptions of surgeries. Undaunted, Verghese defends his style.
"As a reader, I like detail," he said. "God is in the details, there's authority in the details. Updike on golf, Tom Clancy on submarines, C.S. Forester on sailing. ... I wouldn't know port from starboard, but I know I'm in good hands because he does."
He also believes in irony.
"Every story has to be about conflict or crisis and resolution," he said. "Most stories that appeal to me are ironic in the end, in the sense that you get what you want but at a price that looking back, you would not have been willing to pay. Life itself is ironic. For me, it would be hard to write a novel that is not."
Kristin Tillotson • 612-673-7046