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'The patient has become invisible'

February 4, 2009
Everything I do centres on my work as a doctor," says Professor Abraham Verghese whose first novel (and third book), Cutting for Stone, is getting a big release across America and Canada in a few weeks. Dr Verghese, professor of Theory and Practice of Medicine in the Department of Medicine at Stanford University, will travel to over a dozen American cities to talk about his novel.

Conferring a starred review, the influential Publishers Weekly wrote: 'Verghese turns his formidable talents to fiction, mining his own life and experiences in this magnificent, sweeping novel that moves from India to Ethiopia to an inner-city hospital in New York over decades and generations.'

A graduate of the Iowa Writers Workshop in 1990, Dr Verghese made national news when he published My Own Country, about his experience in dealing with AIDS in rural Tennessee. The soul-stirring book, published in 1994, was one of the first pieces of literature on AIDS to create worldwide impact.

In his second book The Tennis Partner, published four years later, he dealt with his relationship with an enigmatic and troubled younger physician who was addicted to sex and illegal drugs. Both books were bestsellers.

Cutting for Stone starts in 1954 in a dilapidated hospital in Addis Ababa, Ethiopia (where Verghese was schooled). It introduces us the twins, Shiva Stone and Marion, who are orphaned by their Indian mother's death and their English father's disappearance. Both a develop passion for medicine.

The novel unfolds against the background of the socialist revolution in Ethiopia. Leaving behind the turmoil, Marion moves to New York but can he really put his complicated past behind him? Will he be able to deal with the complexities haunting his twin? Would he come across his father?

The characters in his novel, Dr Verghese says, heed medicine's call, far removed from the sophisticated hospitals in the West. There is not the kind of separation that exists between the patients and the doctors as in the West. "In this setting, the nature of suffering and the moral obligation to the patient and society are no longer abstract terms," he asserts.

Dr Verghese, known as an inspiring teacher who emphasises the need for residents and other doctors to know patients better through better bedside attention, speaks to's Arthur J Pais about medicine, the debt he owes his professors at the Madras Medical College, and, of course, his novel.

Why are you so concerned about medicine at the bedside?

I have watched for over two decades how the patient in America has become invisible, and this is something that also happens in some cases in India now. It is as if the patient in the bed is merely an icon for the real patient who exists in computers.

You recounted recently in The New England Journal of Medicine how on your first day as attending physician at Stanford you suggested to the ward team to get out of the 'bunker.'

I took them to see the patients. They had the images, the laboratory results and other information right in front of them. But I knew the most crucial element wasn't there. I tell the residents that they cannot use the charts as surrogate for the patient, that they are not going to deal with 'iPatient.' I urge them not to construct a patient based on just lab tests and imaging. They have to meet the real patient in a hospital bed before that.

You compare the standard procedure by residents and doctors to the Dow Jones index.

In the essay I write about how the iPatient's blood counts and emanations are tracked and traded like a Dow Jones Index. While this is happening, the real patients keep the beds warm and thus the folders with their names stay alive on the computer.

What you have been doing at Stanford has been getting a lot of attention...

We are pushing to emphasise and improve bedside examination skills in students and residents. At Stanford, the internal medicine department has instituted regular bedside rounds and faculty-development sessions showcasing good bedside technique. We also encourage them (the residents) to be more sensitive to the feelings of the patients. We hope that such efforts are taught at all medical schools.

Where did you get the inspiration for these efforts?

I think a lot of it owes to my medical days at the Madras Medical College and especially to the physicians who taught me there, professors like K V Thiruvengadam. In the tradition I learned, the patient's body tells the story. The doctor works using the bedside examination and technology to determine a treatment course.

What do you remember most of KVT?

KVT had wonderful aphorisms such as "let the spleen palpate your fingers rather than the other way around" (in the context of how to feel the belly). He would go on to say again in the context of feeling that elusive organ "don't dig for gold as there is no gold there."

I particularly remember the patience and excitement with which he taught us the simplest things; even though he had said and done those same things with thousands of students over the years, each time he repeated it as if it was the first time and indeed for us his students it was.

I remember that as a teacher when I find myself engaged in a tautology but it is an important and necessary one, a way of passing on the ritual of medicine, a way of passing on the lessons of Sushustra and Hippocrates down through the ages to KVT and now through me and on.

Image: Dr Abraham Verghese. Photograph: Joanne Chan.

Also read: 'Malnutrition kills more children in India than any other country'

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