A Passionate Pursuit
by Anne-Kathleen Kreger"No greater opportunity, responsibility or obligation is given to an individual than that of serving as a physician. In treating the suffering, he needs technical skill, scientific knowledge and human understanding. He who uses these with courage, with humility and with wisdom, can provide a unique service for his fellow man and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this. He should be content with no less."
These words, from "Harrison’s Principles of Internal Medicine," spoke to medical student Abraham Verghese in 1973. Years later, when the book was revised, this paragraph was left out.
By this time a board-certified physician and medical school faculty member, Abraham Verghese, M.D., passionate about the pursuit of medicine, wrote the book’s editors to complain about this omission. In the book’s recent edition, this charge to physicians in its original form was reinserted.
Today, half a century after these words were first written, they continue to resonate. Dr. Verghese, the Marvin Forland, M.D. Distinguished Professor in Medical Ethics, shares these words and his personal passion for medicine with medical students.
As director of the Center for Medical Humanities and Ethics, Dr. Verghese is a key player in the Health Science Center’s effort to produce well-educated, empathetic physicians.
This important center, established two years ago, assists students in successfully and compassionately negotiating the increasingly complex world of high-tech health care.
"We don’t believe it’s necessary to inject ethics and humanism into our students," Dr. Verghese said. "Indeed, I think they come to us with the right qualities and our job is to keep this alive, to make sure the rigors of medical training do not snuff out the wonderful idealism and compassion."
"There is no one more qualified than Dr. Verghese to lead this effort," said Steven A. Wartman, M.D., Ph.D., executive vice president for academic and health affairs and dean of the School of Medicine. "Dr. Verghese is a rare combination of master physician, superb humanitarian and outstanding writer."
Dr. Verghese credits Dr. Wartman for his vision in establishing this center, which has already attracted national attention.
Dr. Verghese has been nationally recognized for both his clinical and literary skill. He is board-certified in three areas internal medicine, pulmonary diseases and infectious diseases and he is widely published in scientific literature. A graduate of the prestigious Iowa Writers’ Workshop, he has published two widely acclaimed books and a plethora of articles in the New Yorker, Wall Street Journal, New York Times, Washington Post, Esquire, Sports Illustrated and Atlantic.
His first book, "My Own Country," about his experiences as an infectious disease specialist at the dawn of the AIDS epidemic, was a finalist in the 1994 National Book Critic’s Circle Awards. Award-winning director Mira Nair later made the book into a movie.
Dr. Verghese’s second book, "The Tennis Partner," which chronicles his friendship with a medical student battling addiction, was a New York Times notable book and national bestseller. The book’s movie rights were recently optioned, so the "The Tennis Partner" could be made into a movie in the next few years.
Although writing and medicine seem to be disparate disciplines, they share tremendous parallels, according to Dr. Verghese.
"In medical school, you are taught to observe, to pick up the significant details and to bring them all together into a diagnosis," Dr. Verghese said. "That same art of observation is fundamental to the process of writing."
A master of metaphor, Dr. Verghese constantly makes connections between literature and medicine. In fact, it was a novel that first attracted Dr. Verghese to medicine.
Born in Ethiopia to Indian parents who were expatriate physics teachers, the young Verghese recognized early on that he did not feel the same affinity for math as his father, mother and older brother.
When the 11-year-old Verghese read Somerset Maugham’s "Of Human Bondage," he felt an irresistible urge to become a physician.
But his path through medical school was not easy. At 17 he began medical school in Ethiopia. During his third year, however, civil war broke out, Emperor Haile Selassie was deposed and the university was shut down.
As the medical school’s doors closed, so did the pathway to Dr. Verghese’s dream. Dr. Verghese immigrated to the United States, but transferring to an American medical school was not even a possibility because of the differences between medical education systems.
Instead Dr. Verghese worked as an orderly in a succession of New Jersey nursing homes.
"It was quite a humbling experience and a real eye-opener to what happens to patients when the doctors are not around," Dr. Verghese recalled. "I always look at that as some of the most precious medical training I ever received."
He had almost abandoned his dream of becoming a physician, until, once again, a book called him to medicine.
Working on the wards one evening, he spotted a stray textbook left by a medical student. This textbook "Harrison’s Principles of Internal Medicine" was the same book that Dr. Verghese had used in medical school, the book that contained the passage that had so eloquently spoken to him.
"I looked through it, I saw the student’s notes, and I suddenly had this huge sense that I had to finish this," Dr. Verghese recalled.
Dr. Verghese then immigrated to his parents’ home country of India to complete medical school.
"I was a different person when I went back," Dr. Verghese said. "I’d lost that opportunity to study medicine once. When I was given the chance again, I didn’t waste it. I was very passionate about what I was doing."
After graduating from Madras University, the young physician returned to the United States for an internal medicine residency at East Tennessee State University, a small, recently established medical school in the Smoky Mountains. He later completed a prestigious infectious diseases fellowship at Boston University, and then returned to Johnson City, Tenn., where he became the local AIDS expert.
Although his Tennessee experiences would later become fodder for his first book, a non-fiction memoir, during his years in Johnson City, Dr. Verghese found solace in writing fiction.
"Working with HIV was uniformly a very sad time for me, and sometimes there was nothing I could do about the inexorable downhill decline of my patients," Dr. Verghese recalled. "But by the vehicle of fiction, I could make reality whatever I wanted to make it. And so all I wrote was fiction."
Today, Dr. Verghese believes that fiction and the humanities in general play an important role in medical training.
Quoting novelist Dorothy Allison, Dr. Verghese calls fiction "the great lie that tells us the truth about the way the rest of the world lives."
At an AIDS benefit honoring actress Sharon Stone (far right) in 1995,
Dr. Verghese addresses a star-studded crowd.
For example, during the cardiology module, second-year students enact physician-author Richard Selzer’s play "Follow Your Heart."
Through this activity, students become intimate spectators in the life of the main character, a woman who has lost her husband. When his heart is harvested and transplanted, saving the life of another man, the woman’s only wish is to hear the sound of her husband’s heartbeat again.
Through the integrated science-humanities curriculum, students learn about the heart’s function but also, in a larger sense, about the heart’s meaning. Second-year students Benjamin DuBois and David McDermott say the center enriches their understanding and elevates their medical training.
DuBois commented, "We learn about the science of transplant. We learn about the heart’s physiology and anatomy. And then the center really brings in the humanity, a very important yet often overlooked aspect."
"The center really fosters in you whatever spark brought you to medicine," McDermott agreed. "I get a lot out of it. I only wish they’d work more of it into the curriculum."
"And Dr. Verghese is incredible. We are so fortunate to have him here," DuBois added.
Student response to the center has been overwhelmingly positive, and the center has attracted the attention of the community, as well as other medical schools around the nation.
Thanks to a grant from the Mind Science Foundation, the center is pioneering efforts to understand devolution of empathy among medical students in training. The center hosted the spring conference of the American Society for Bioethics and Humanities, and the center’s associate director, Dr. Jones, was recently named editor of the Journal of Medical Humanities, now based out of the Health Science Center.
During her first week of medical school, student Dominique Kalil was astounded to see Dr. Verghese on campus. As an undergraduate student studying history, Kalil had stumbled upon Dr. Verghese’s books, which inspired her to change her career path and pursue medical education.
"I had a rather shocking epiphany after reading Dr. Verghese’s books, because for the first time, I saw science and art merge exquisitely," Kalil noted. "Dr. Verghese has been and continues to be an inspiration to me and to my classmates."
Although Dr. Verghese’s bestselling non-fiction memoirs have inspired many, Dr. Verghese has refocused his writing on his real love, fiction. His work-in-progress, "Cutting for Stone," is a medical saga, which he aims to complete by the year’s end. Just as Maugham’s novel called the young Verghese, Dr. Verghese hopes that his novel will inspire future physicians.
But Dr. Verghese doesn’t just write and talk about humanism, he literally exemplifies this concept.
Three months of his year are spent as an attending physician, and every Wednesday afternoon, he accompanies students on the internal medicine rotation.
The model of the compassionate physician, Dr. Verghese truly teaches by example.
And his example makes an impact. According to students, Dr. Verghese embodies the words of renowned Harvard Medical School professor Dr. Francis Peabody, who wrote, "The secret of patient care is in caring for the patient."
As Dr. Verghese guides tomorrow’s physicians, this won’t be a secret for long.
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