NRI's doctor's book makes waves in US

Stanford University medical professor Abraham Verghese is getting ready for another bout of book tours, this time for his bestselling novel Cutting for Stone's paperback edition.

The novel, set in Ethiopia and America and about an Indian Catholic nun who gives birth to twins, the estranged father of the boys and the troubled life the boys face in America, has received very good reviews.

Verghese wrote the book over six years. "I was not in a hurry to write it," he says. "I did not have a contract that said I should produce a book every second or third year. I also knew that while I am a storyteller, the book was also serving a bigger purpose, to illuminate the life of medicine, how idealism and patient care are very important anywhere… How the doctors with very few resources can still bring out healing."

Verghese, professor and senior associate chair for the theory and practice of medicine at the Stanford University School of Medicine, was the founding director of the Center for Medical Humanities & Ethics at the University of Texas Health Science Center, San Antonio, where he is now an adjunct professor. He is the author of the nonfiction My Own Country, a 1994 NBCC Finalist and a Time Best Book of the Year, and The Tennis Partner, a New York Times Notable Book. A graduate of the Iowa Writers' Workshop, he has published essays and short stories that have appeared in The New Yorker, Granta and The New York Times.

Discussing the book in an interview with his publisher Knopf, Verghese said, 'There is a line in the Hippocratic Oath that says: …I will not cut for stone, even for patients in whom the disease is manifest… It stems from the days when bladder stones were epidemic, a cause of great suffering… There were itinerant stone cutters — lithologists — who could cut either into the bladder or the perineum and get the stone out. But because they cleaned the knife by wiping it on their blood-stiffened surgical aprons, patients usually died of infection the next day. Hence the proscription, "thou shall not cut for stone".'Verghese found it 'a curious thing to say when we recite the oath in this day and age.'

"It isn't just that the [book's] main characters have the surname Stone," he says. "I was hoping the phrase would resonate for the reader just as it does for me, and that it would have several levels of meaning in the context of the narrative." It pains him to see that the patient in America "is unseen and unheard," he says. "The patient is presented to me by the intern and resident team in a conference room far away from where the patient lies. The patient's illness has been translated into binary signals stored in the computer. When we do go to the bedside to make rounds, often physicians are no longer at ease. It is as if the patient in the bed is merely an icon for the real patient, who exists in the computer. But none of these tests done at a distance substitute for being with the patient, for the 'words of comfort' aspect of treatment. When one knows how to look, the patient's body reveals many things — it is an illuminated manuscript."

From his Indian medical days, he had suspected why many people prefer alternative medicine, and that suspicion became stronger in America. In Cutting for Stone, there is a sense of at least a few physicians doing things the old fashioned way — or the way alternative medicine practitioners do now in America.

'The fact that patients with chronic illness increasingly seek the attention of naturopaths, refelexologists, acupuncturists, and others has a lot to do with the fact that these individuals will spend time and put hands on the patient, where the physician does that infrequently or in a cursory fashion,' he has said. 'When your head is wrapped around the latest gene-array test or 'evidence-based medicine'—as though what preceded it was witchcraft—then you might underestimate the importance of 'words of comfort'.'

Image: Doctor Abraham Verghese