The Art of Bedside Care is Fading

“We’ve become ‘i-Patients,’” Abraham Verghese told a standing-room-only crowd in a sweltering auditorium at Stanford University’s Main Quad Wednesday night.  “We’ve lost the art of the physical exam. The patient is in the computer.”

Verghese’s deep concern for preserving bedside medicine stems from his transformational experience of treating AIDs patients in rural Tennessee at the onset of the disease and publishing a best-selling memoir, My Own Country: A Doctor’s Story. He shared his deep empathy for patient suffering to train medical students at the Center for Medical Humanities & Ethics, which he established at the University of Texas in San Antonio.

“I am skeptical of more machinery, rather than more touch in medicine,” Verghese said.

His reputation as a physician, teacher and writer led to the internist’s appointment in 2007 as tenured professor at Stanford School of Medicine. 

Verghese, whose first novel, Cutting for Stone, remained on the New York Times’s bestseller list for more than a year and whose second memoir, The Tennis Partner: A Story of Friendship and Loss has been re-issued, joined Stanford lecturer Hilton Obenzinger Wednesday night in a conversation as part of the University’s “How I Write” series. 

“People picture me wearing two hats as a physician and a writer, but I am entirely a doctor and write through that filter,” he said. Verghese credits playwright Anton Chekov—and the physician who treated him toward the end of his life—as the catalysts for his approach to bedside medicine and his stories. Chekov, also a famous physician, suffered the ordeal of tuberculosis and visited a luxurious spa in the Black Forest of Germany toward the end of his life.

Verghese, reciting from memory, recalled Chekov’s spasmodic episode of hemoptysis. Rather than prescribing medication, even an oxygen pillow, Chekov’s normally rule-abiding physician ordered a bottle of the hotel’s best champagne, which delighted the playwright. He died moments after sipping from his glass.

“I never thought to order champagne for a dying patient,” Verghese said. “I, too, treated prominent, dying physicians. I realized that the physician helps the patient reach an epiphany. We take [the patient] to the ‘ah-ha’ moment of his or her life.”

The deep relationships Verghese formed with his AIDS patients in Johnson City, TN, when treatment was virtually nonexistent and all he could do was help them through very painful and early deaths, shaped his approach to primary care and led to his debut work, My Own Country. 

“I learned so much about manhood from the gay men I treated—not what we typically think of as masculine,” Verghese said. “I see plenty of machismo on display in the ER.” 

Verghese attended the Iowa Writer’s Workshop at the University of Iowa, where he earned a Master of Fine Arts degree in 1991 and learned from well-known author and instructor, Frank Conroy, that memoir is artifice.  It’s a combination of recollection and reconstructed scenes. 

“I asked some of my patients to recall what they could when we first met," he said. "I also worked with an editor who insisted that I was clearly a character in the story. I could not be an observer in that book.”

Verghese wanted to do for medicine what Emile Zola did for Paris. “Miasma and pain were in the air on every page. I wanted every character to be involved in medicine.”

“Besides medicine, geography is my other ‘character,’” Verghese said. “When I was in East Tennessee, I saw things the natives never saw. In Cutting for Stone, I wanted to bring my two countries together: Ethiopia, where I was born, and the U.S., where I practiced medicine.”

About writing, teaching the theory and practice of medicine and serving as senior associate chairman at Stanford’s department of internal medicine, Verghese writes when he can, and slowly. It took him eight years to finish Cutting for Stone. 

“I’ve written hundreds of pages that my editor said didn’t belong in the book,” Verghese said. “I’ve had moments of despair. But sometimes it helps to be deeply unhappy; you can pour all your angst onto the page."

He added that, “Writing is not a planned process for me. I discover the story in the writing. I write in order to know what I’m thinking.”