Abraham Verghese: “Literature is the best medicine”

After the success of The water pactthe writer-doctor Abraham Verghese proposes the previous novel, now translated into Italian and published by Neri Pozza.

The author of Indian origins, raised in Ethiopia where part of the book is set, he confirms himself as a great contemporary narrator capable of broad historical and geographical brushstrokes and an intense tenderness for his characters. This time the plot lets us navigate from Madras until’Addis Ababa Of Haile Selassie in a hypnotic intertwining of forbidden love stories and medical investigations starring twins, all filled with detailed surgeries. The novel reaffirms, as the professor of medicine at Stanford does in this conversation, how literature teaches an empathy that is also useful to science, promoting healing through deeper understanding.

Why is emotional listening to the patient the most powerful diagnostic tool for the character of Doctor Ghosh in “The Door of Tears”?

«There is a surprising statistic: an American doctor interrupts a patient after seven seconds of conversation. But the relationship with the patient is not transactional, it is relational. It is not only important to listen to the patient’s story, but also to his body. When the narrative of the symptoms ends, we need to read the body to understand what it says about who the person is. Today, this aspect is highly at risk. We are full of data “of” the patient, but not “about” the patient. Too often our attention is focused on x-rays, lab results, biopsy. We should bring it back “to” the patient. The data must be reconnected to the pain point, it must be located on the body rather than in the abstract. I don’t know if I can explain myself…”.

Perfectly, I think of some health insurance doctors in Italy, with ten people in the waiting room, who talk by writing on the computer, looking at the patients’ e-mails, answering the patients’ phone calls. It’s not their fault, they do stunts in a system that dehumanizes the diagnosis.

«The system is poorly designed. The digitization of medical data is a remarkable development from the era of unobtainable paperwork. But it doesn’t serve eye contact and human interaction. Finally, today, thanks to the artificial intelligence that we apply here at Stanford University, you can have a normal conversation with the patient, without taking notes, without getting distracted, while the AI ​​documents and diagnoses what is relevant and what is not. And”.

What is not yet programmable in AI is empathy. How important is it to you, as a doctor and as a novelist?

«It’s central. When someone is sick, they don’t come to present you with scientific facts, they come in a state of stress. And he needs to be reassured. Somehow, the complexity of modern means has made us lose sight of this aspect.”

What’s your secret of how to make characters so alive quickly?

«There is a saying in writing: the character’s character is determined by the decisions he makes under pressure. It’s true in life too. If you put a character in a high-tension situation, there may come a point where he seems to be telling you that he would never do what you had in mind for him to do because he has other plans. If you let him do it, it means that you are in his shoes, which is also very important in medicine. This is why I teach students the importance of literature. You can study childhood abuse, but to understand it viscerally you have to read a book like The Carolina bastard by Dorothy Allison. Your heart beats, your blood and stomach boil. You can study the end of life in medical texts. But if you want to understand the feeling, read on The death of Ivan Ilyich by Leo Tolstoy and you will know how isolated you feel when life is about to end.”

Speaking of literature, a doctor must judge a patient to find a cure, while an author is better off not judging the characters. How do you manage this conflict?

«In reality we try not to judge patients. We must heal human beings in all their variations. The doctor must also check your heart rate. If a patient makes you angry, you need to calm down. The Canadian doctor William Osler said: “It is not important which disease this patient has, but which patient has this disease”.

You often remember the difference between healing and curing…

«In Western medicine we focus a lot on healing, forgetting the importance of healing the trauma of the disease. Imagine coming home and finding that your money and computer have been stolen. You will have perceptible stress for the theft and emotional stress for the violation of the sanctity of the home. If the police arrest the thief and bring back the stolen goods, you will be treated. But not healed from the trauma. If you fracture the radius of your hand, diagnosis and treatment are simple, but some wonder: why me? Why now? Why the right hand? Western medicine is excellent at treating the physical part, but has almost ignored the spiritual part.”

Why, instead of recognizing how many lives have been saved by rationality, has the pandemic rekindled doubts about science?

«We made the mistake of believing that if we solved the scientific puzzle everyone would do what we said. There were so many unknowns and different recommendations in the beginning. Here in America we have lost ground because the government has sometimes antagonized scientists. I think our leaders should read To Fish by Camus. What happened with Covid was already there, the same doubters, the same profiteers, those who wanted to help, those who fled. Again, we need more literature.”

Some saw doctors as heroes, others as “bad guys”. How can we bring back the old respect for the doctor?

“Hard question. The Italian doctor Fabrizio Benedetti used the expression “placebo without the placebo” demonstrating that the tone of voice, the place where you meet the patient, how you present yourself, in my case with gray hair, the white apron and the tie, contribute to healing. In Western medicine we must pay more attention not only to what is administered but also to “how” it is administered.”