This transcript has been edited for clarity. This discussion was recorded on March 16, 2020.
Robert A. Harrington, MD: Hi. This is Bob Harrington from Stanford University, here on theheart.org | Medscape Cardiology. For those of you who have listened to this podcast over the years, you probably have noticed that I enjoy talking to physician writers—people who opine on some large societal issue, or colleagues who are writing fiction. I have the honor and the pleasure of having my office right next door to one of the world's great physician authors, Dr Abraham Verghese. Abraham is the Linda Meier and Joan Lane Provostial Professor at Stanford University and the vice chair of education in the Department of Medicine. Abraham has a lot of interests, and some of those we've talked about on this podcast. He's very interested in the bedside examination, and most recently he created a center at Stanford for an understanding of the patient-physician relationship. He has also written quite eloquently about storytelling and the ritual of medicine.
Abraham and I have an opportunity to talk on a frequent basis and one of the things that we often talk about is reading—not medical journals and science, but fiction, literature, and poetry—and the joy and sometimes relief that reading can bring to one's professional and personal life. I thought it would be fun to have a conversation with Abraham about reading and what it can add to our lives.
From your perspective both as a writer and a reader, what do you see as the life benefits of reading that might be offered to a physician, a nurse, physician assistant, or others involved in cardiovascular medicine?
With Literature, You Can Imagine Life 'Viscerally'
Abraham Verghese, MD: I'm obviously biased toward literature, but I think reading plays an important role in our ability to imagine things. If you think about the extraordinary act of taking those little signals on a page that we call words and then translating them into a mental movie in your head, which is what we do with a novel, I'm convinced that if we don't exercise that part of our brains sufficiently, then we actually have an atrophy of our imagination. Some of our ability to imagine in other spheres of life, I would imagine, would suffer.
But more than that, despite our fairly broad worlds, we still have a fairly narrow experience of what it is to be the other. It's hard to put oneself in someone else's shoes. But the beautiful thing about literature is that when it works well, it offers one that opportunity to live in someone else's world, and I think that is particularly germane to medicine. Anybody who wants to read about end of life could begin by reading a textbook about end of life and all the stages of grieving and death and so on. But if you want to feel it viscerally, there is nothing like reading, for example, The Death of Ivan Ilyich by Tolstoy. We love to teach this because you have this wonderful, powerful character who is full of himself and full of power, and then he is brought to his knees by this disease. One by one, his friends and his family seem to drop away. He has the sense that he has become an impediment to their progress and that they would be quite relieved if the sickness finally took him. The only person who demonstrates the sort of empathy that I think would be emblematic of what we in medicine would love to see in our physicians is his servant, Gerasim, who sits with him, keeps his legs warm, and helps him with his most embarrassing functions. Reading is a wonderful way to viscerally get what it feels like and what our role is.
That is one example of why I think we need literature, but more than that, my sense is that we underestimate the power of fiction to change the world. I love to ask people, "What do you think ended slavery in America? Was it a president? Was it a revolution? Was it a political scientist somewhere? No, it was Uncle Tom's Cabin." This wonderful book captured the public's imagination. It brought to people's attention and understanding what it was to be a slave, and then the whole idea of slavery became unpalatable in this country.
A similar thing happened in Britain. One of my favorite novels, A.J. Cronin's The Citadel, about a Welsh mining town and the health conditions there, so captured the British public's imagination that it led to the birth of the National Health Service. I think fiction has that power. For all its wonderful attributes, our postmodern, scientific era is so focused on the science and the facts and the quantitative nature of things, that I think we do ourselves a disservice by not exercising that other side of our brain.
Harrington: It's mesmerizing to hear you describe your love of literature and the role that it can play in our lives. I was struck by your three examples: one from American literature, one from British literature, and one from Russian literature. Each one of those societies has a long tradition of producing authors who are in many ways producing commentaries on current state of life. You mentioned one of the great Russian authors, but a series of great Russian authors not only presented us with a wonderfully enthusiastic picture of the human condition but also explored some of the more depressing and dark sides of the human condition.
When you are looking for literature to teach, to uplift, and to experience the other perspective, how do you tease that out?
Reaching for Relevant Literature
Verghese: I think in medicine we have had this notion that it's good for our medical students to embrace literature and it'll help round them out for the reasons that I just described. At one point in my career, given that some of my books were being taught in the burgeoning medical humanities programs, I had the experience of starting a humanities program at the University of Texas in San Antonio at the Health Science Center. I found it to be quite a challenge because we're feeding our medical students with this gush of knowledge in the first 2 years, and although they arrive with tremendous enthusiasm, they become very bottom-line oriented. "Is this going to be on my test? Otherwise, why do I want to read part of Ivan Ilyich?" And then ironically, that third and fourth year is when they most need it and when we have the least access to them, in a sense, because they are scattered all over. I enjoyed doing that for a while, but I came back to the sense that the best way we teach literature is at the bedside in the context of the patients we're caring for.
In much the same way you would cite a seminal paper, you trot out your favorites. We're recording this during a very poignant time in medicine, and I find myself reaching for Camus' The Plague, a book that I've loved and gone to several times. The profound wisdom as it applies to our day and age is just striking, because I think the very nature of any outbreak, the handmaiden to any outbreak, is that it comes with a metaphor. SARS was the metaphor of the Chinese plague and then it became the Asian plague. Every outbreak has its particular metaphor. One of Camus' narrators says this about the citizens of Oran toward the end of the plague:
"They went on doing business, arranged for journeys, and formed views. How should they have given a thought to anything like plague, which rules out any future, cancels journeys, silences the exchange of views. They fancied themselves free, and no one will ever be free so long as there are pestilences."
It's full of profound little nuggets like that which are just echoing for me very differently right now, given our collective experience with COVID-19, something we have never seen before, but not something we should not have expected.
Harrington: It's interesting that you picked that particular passage to read, because as I reflect on the news from last night and the trouble that cities are having conveying the message of social distancing and so on, how is it that those of us who are in the profession are thinking of this constantly and our friends and neighbors outside the profession are maybe not thinking of it the same way? Camus noted that a long time ago, didn't he?
Verghese: He was so aware of that. But what is even more profound to me is that we are, in a sense, under siege. You and I are working in offices with skeletal staffing and the traffic has vanished in our town. For every sort of psychological nuance of what I'm feeling, whether it be fear or concern for my colleagues or worry about the future, he seems to have found a way to echo every single thing that I could possibly think about. I think that is the power of literature. I think of good literature as the great lie that tells the truth about how the world lives. And in a sense, that is the reason we go to literature as our touchstone, to find out that great truth of how we live.
Harrington: You and I are of the age where we grew up reading extensively. I was an English literature major as an undergraduate and found, when I went to medical school, that my ability to consume large amounts of information was aided by the fact that I was very comfortable with reading constantly. Since I was a child, I found that a daily respite from life could be found in a book, and I continue that to this day. Do you think the generations of today are reading like the generation that you and I are from?
Is the Younger Generation Reading Literature?
Verghese: I don't think they are, and I don't think I am either, to be honest. I find myself increasingly connected to the little screen in my left hand. I think we all are and it's insidious. Not only are we keeping up with our various updates and messages, but we're slowly being conditioned to absorb information in bite-size nuggets. The luxury of taking on a big book has been forgotten. But I think it's a mistake to bemoan that too much, because with every generation there will be a pausing and a rediscovery of things. I have a sense that the pendulum will swing back. I notice in myself that more and more I'm experiencing great literature in the form of audio books. It's a completely different experience, one that I don't think I quite appreciated until the past couple of years.
As a writer, you always try to read your sentences out to see how they sound and make sure that the rhythm isn't being thrown off by some jarring little juxtaposition that you have made there. But I don't think I've quite appreciated how profound it could be to listen to the whole thing. It's made me even more conscious of how I listen. A lot of people listen to podcasts and so on, which I think is wonderful—this being a case in point. But I also think that it does not take much encouragement from us to point people to literature that could be as profoundly meaningful to them as the podcast on the latest something.
A Unique Collaboration Between Reader and Writer
Harrington: I'm smiling as you speak because it makes me think again how one of the great joys and the great disappointments in my own reading is when somebody would make a movie of a book that I had been particularly fond of. There was that moment of great joy when the character sounded and looked like I had envisioned from my reading, and also moments of disappointment when I would say, "This character is nothing like I thought." You've had that experience, I take it.
Some of the great books of my childhood were the Tolkien series, which I read numerous times over the years through middle school and high school and college and young adulthood. When they finally made the movies, I was overjoyed with how much they had captured the vision and the voices and the persona of characters that I knew really well.
Verghese: I think it's almost exceptional that a movie does not in some way disappoint you. I remember hearing one of my teachers at the Iowa Writers' Workshop talk about how there were two arcs of a story: One part of the arc was the writer providing the words, and an equally important part was the reader providing their imagination. And in this collaborative way, in middle space, you created this fictional dream. It really was not yours; it was a collaborative effort with the reader. If you provided too many words and too much explanation and robbed them of their ability to imagine, then you had done them a disservice. If you provided too few words, then you also disappoint them. For example, God knows what the hell Finnegans Wake is about.
The great beauty of a work of art, like Dickens' Bleak House, is that it does not exist on the page. It exists in this collaborative moment between writer and reader. I think it's not unusual to then go to a movie and find that a particular director's vision and their fictional dream of this book cannot possibly be exactly like yours, and you are destined for that sort of disappointment.
I watch more movies than I ever have watched before because of the accessibility. This is not in any way to detract from that, but there is a certain degree of passivity in watching a movie, and in some ways, it's all being delivered to you. There are still nuances required of you. I think the more challenging filmmakers, like Kurosawa and Fellini, will really challenge you in a way that I think a writer does. But for the most part, you are able to tune out and just sit there and be manipulated, which is its own satisfaction.
I like to remind my medical students that the reason William Osler had a stack of books at his bedside had nothing to do with medicine—they were great reads. Parenthetically, I tried to make my way through Osler's list of books at his bedside because it's been published, and frankly, they were just beyond me, beyond this era. They are not relevant as much as they could be to our time and place. But I think the principle applies. And I look around and I see all the great physicians I admire have a side to them about reading, about exercising their right brain. As our young physicians come to know that, I'm hoping that will inspire them. Of course, many of them are wonderful readers—I know that from their book clubs and whatnot. But many more, including my distinguished colleagues, say to me, "I'm a nonfiction sort of guy. I only read serious stuff." And I say, "Really? Serious?" And then I tell them about Uncle Tom's Cabin and The Citadel because I think they are missing something.
Transcending Life With Poetry
Harrington: I could not agree more. At my own bedside table, I have a stack of books that I am working my way through and they are a combination of fiction and nonfiction. As you know, I take great joy in reading fiction and I read it every day. I have my own ritual at the end of the day. I unwind by trying to read a minimum of 15-20 minutes to a maximum of 45-60 minutes. I do think it helps me process my day and escape for a little bit, and to think about the other things that are important in life other than the day-to-day job. With that, Abraham, I want to take the prerogative of asking you what you are reading today.
Verghese: I don't write much poetry—I think I have one published poem to my credit—but I love reading poetry. Somebody defined poetry as that moment when your heart and your mind are saying the same thing. The abstractness of poetry, the soaring nature of its imagination, is very stimulating to me as a writer. Often before I go to bed and when I wake up and start to write—when I'm about to enter my writing sort of moment—I will read a poem to just remind myself how possible it is to transcend all the barriers that limit us in our day. We're limited by the fact that I cannot jump into your head and know what you are thinking. I cannot cross over to death and report back. But by the vehicle of poetry, and literature, for that matter, you transcend all these barriers. And very much like literature, I think it provides you instructions. I was reading a poem last night by John Stone—I scribbled it down in my little notebook which I carry around. John Stone was a friend of mine. You probably know him as a cardiologist at Emory who started their emergency medicine program, but he passed away a couple of years ago. He was a well-known poet and this was one poem that I happened to write down. It's called "Talking to the Family." May I recite it for you?
Harrington: Absolutely. I will certainly enjoy it and I suspect our listeners will enjoy it as well.
Verghese: It's from his book The Smell of Matches, which has been living by my bedside for the past couple of months. Things don't seem to move away from there very quickly. The poem, "Talking to the Family," goes like this:
My white coat waits in the corner
like a father.
I will wear it to meet the sister
in her white shoes and organza dress
in the live of winter,
the milkless husband holding the baby.
I will tell them.
They will put it together
and take it apart.
Their voices will buzz.
The cut ends of their nerves
I will take off the coat,
and replace the light bulb in the hall.
I think this conveys the extreme roles that we have. There is ordinariness of our lives, but also profound moments that we have the privilege to witness and sometimes don't have words for. He does not really say what we're to make of this, except to say, "I feel this. I hope you can identify with it."
Harrington: It's taking the nobility of what we do and the privilege of what we do and juxtaposing it with the ordinariness of all of our lives that we're trying to balance. It's a wonderful way of thinking about that balance that we're all trying to achieve. It's a very profound poem to read for what we're all going through today. We're all spending our days struggling with this epidemic, struggling with getting ready to try to quell a surge in patient cases. And at the same time, we're all going home at the end of the day to change the light bulb and make dinner. It's a juxtaposition that sometimes literature and poetry can do far greater justice to than just us talking.
Verghese: Are you a poetry reader?
Harrington: For several years, you and I have had a ritual of having dinner together with our partners, bringing a favorite poem, and reading poetry. You know that one of [my wife] Rhonda's and my favorite poems is E.E. Cummings' "I Carry Your Heart With Me." That is a very special one.
The Covenant of Water
Harrington: I'm going to take editor's prerogative. Many of us are big fans of you as an author, including Cutting for Stone, and we've been waiting a few years for your latest production. What can your readers out there expect?
Verghese: As you know from being in the office next door to me, it's been quite a saga with this book. For one thing, I love long books. I love the experience of entering a world and passing through the centuries. I finally put down the book and it's Tuesday. I love that feeling of being transported. And so, unbeknownst to me, it seems that I have the bug to write a long novel. I've just delivered my novel to my publishers and they are extraordinarily excited by it. It is really long. We all feel that I could do well to trim it. I'm engaged in that process and it's not as hard as one would think. There is something very interesting about putting something aside for a few weeks and coming back to it; immediately you see some of the redundancy.
The title of the book is The Covenant of Water, and it's very much a saga that has a strong element of medicine. It begins in 1900 in the south of India where my parents are from, although I didn't grow up there myself; I grew up in Africa. It covers three generations of a family in which one or more members of each generation drowns. There is a condition of familial drowning, and the conceit of the book revolves around that. But really, what is medicine but life plus-plus. The book is really about love. It's about family. It's about joys, sorrows. It's just about a life lived.
Harrington: Abraham, thank you for sharing that. Many of us are anxiously waiting to get our hands on the book so that we can read it and share those stories with you.
I want to thank you, Abraham, for joining us here on theheart.org | Medscape Cardiology. Professor Verghese is the vice chair of education in the Department of Medicine here at Stanford and is the Linda Meier and Joan Lane Provostial Professor at Stanford University. Abraham, it has been a real delight having you join me to talk about reading and literature. Keep it up.
Verghese: The pleasure was mine. Thank you, Bob.
Bob Harrington, MD, is chair of medicine at Stanford University and current president of the American Heart Association. (The opinions expressed here are his and not those of the American Heart Association.) He cares deeply about the generation of evidence to guide clinical practice. He's also an over-the-top Boston Red Sox fan.
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Cite this: Yes, There Is a Role for Poetry and Fiction in a Pandemic - Medscape - Apr 01, 2020.