The Great Lie that Tells the Truth: Abraham Verghese (Transcript)

Full text of best-selling author and physician Abraham Verghese’s talk: The Great Lie that Tells the Truth at TEDxStanford conference.

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Abraham Verghese – Best-Selling Author and Physician

When I was a boy, I loved stories. I loved the way the little signals on the page, that we call words, could transport me out of my bedroom portals onto a Spanish galleon, onto the wine-dark sea, onto a British frigate, fighting in the Napoleonic Wars.

I love the novels of C. S. Forester. I loved his character, Horatio Hornblower, following him as he became midshipman, then a lieutenant, then a captain, then a Commodore, an admiral. Wonderful ways to travel the world.

But it was also sensing that there were fundamental truths that were emerging from these novels. They were teaching me much more than school taught me. For example, when I was a schoolboy, I came across this particular line: “I thank God daily for the good fortune of my birth, for I’m certain I would have made a miserable peasant.”

And I was growing up in Africa, surrounded by many people who were less well off than we were. And I don’t think until that moment it had registered that my lot could have been different. And when I became an adult, I stumbled onto this following quote from Dorothy Allison. And she said; “Fiction is the great lie that tells the truth about how the world lives.”

And that exactly captured my sense of what stories were all about from the time I was a boy. I went into medicine because I thought medicine was very much about story, and I was never disappointed. And I see my writing, such as it is emerging, out of that same passion for medicine and story.

And I wanted to share with you a passage that I’ll recite for you, that has to do with the death of this gentleman who, in his time, was the most famous physician in the world. This is Anton Chekhov; not to be confused with this [Pavel Andreievich] Chekov.

Chekhov, unfortunately, died young, of tuberculosis of a very treatable condition. And in the last year of his life, he married. He married the stage actress, Olga Knipper, and she knew that he was going to die, he knew he was going to die, and they had a wonderful year together.

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And in the last year of his life, he suddenly decided he wanted to go to the Black Forest of Germany, to the Badenweiler spa. And being a dying man, Olga was not about to deny him, so she took him there. And when he first got there, it seemed magical. His color peeked, he stopped coughing as much, and he had a lot of energy.

But then on the fifth day, he broke out with massive hemoptysis, coughing up of blood, which is a terrifying symptom for both the patient and a physician because not only are you losing blood, the airway is compromised. And so, they called the spa physician, a man by the name of Dr. Schwer.

And the passage that I am about to recite is from Troyat, its wonderful biography of Chekhov and the passage goes like this: “The windows were wide open but Chekhov could not stop panting, his temples were bathed in sweat’. Doctor Schwer arrived at two o’clock and Chekhov, in a final reflex of courtesy, leaned back against the pillows and said, “Exterbe, I am dying”, mastering his weak German.

Doctor Schwer ordered a camphor injection but Chekhov’s heart failed to react. Dr. Schwer was about to send for an oxygen pillow when Chekhov lucid to the end protested in a broken voice, “what’s the use, doctor”, he said “before it comes, I will be a corpse.”

And so Dr. Schwer ordered a bottle of champagne. When it came, Chekhov turned to Olga, his wife, and he said “it’s been so long since I’ve had champagne”. He drained the glass, he lay down. He turned to his left side, he stopped breathing. He had passed from life to death with characteristic simplicity.

It was July, the second, 1904, three o’clock in the morning. A large black winged moth had flown in through the window and was beating maddeningly against the lamp. The sound was very distracting. Doctor Schwer withdrew after a few words of consolation.

All of a sudden, there was his joyous explosion. The cork had popped out of the champagne bottle, foam was fizzing out after it. The moth found its way out into the sultry night, silence returned at last. When dawn broke, Olga was still sitting and staring at her husband’s face. She would write later that there were no everyday sounds, there were no human voices, there was only peace, beauty and the grandeur of death.”

I don’t know about you but I love that passage, I love it because it’s so tender, it’s about one of my heroes but I also love it because I identify with Dr. Schwer. I’ve had the privilege or the misfortune of taking care of several dying physicians, particularly in the AIDS era but also subsequently, that’s a very difficult thing.

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You’re drawn to them as comrades in arms who have fallen in the battlefield, so to speak. But at another level, by definition, you have a very difficult patient on your hands. And here’s Dr. Schwer, who’s retired from, I don’t know, an academic setting where he’s gotten away from the publish and perish or from a busy private practice and he’s found this gig in the Baden Wyler spa in the Black Forest of Germany, where the worst thing he might have to deal with is an ankle sprain and perhaps a upset stomach and all of a sudden he’s called in the middle of the night to take care of the most famous physician in the world at the time, who was dying. And he tries to cure, he administers the camphor injection, he’s about to get oxygen and nothing he does is really going to count and Chekhov stops him and then instead of giving up at that point, he orders a bottle of champagne. It does something incredible, which at least in the telling seems to set in motion everything that follows.

Dr. Schwer functions as a catalyst and I love that story because it illustrates that we in medicine, a very often engaging story, most often we have little bit parts, we’re privileged to enter the dramatic story but every now and then, we get to be catalyst.

Now, you all know and I won’t belabor this point that the essence of story from the time of Aristotle, who spoke of the arc of story, stories are about conflict, crisis and resolution, or in a more modern way in Hollywood they talk about the three DS, how drama equals desire plus danger and I think we in medicine are good at superficially labeling the stories.

If you come into our hospital complaining of chest pain, you become an ROMI, rule out myocardial infarction. And the next day with any luck, you become a MIRO, myocardial infarction ruled out. And you travel down increasingly narrow shoots and you might wind up with a cabbage coronary artery bypass graft and I think these acronyms are sort of a simple entry into story but I think we often miss in medicine the real heart of story, which to me is the epiphany.

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Now, that is a term introduced by James Joyce. James Joyce was talking about epiphany in the context of a story and he spoke of it as that moment when the soul of the Communist object seems to us somehow radiant, the object achieves epiphany. I think of it as that aha moment in a story when your consciousness is suddenly expanded or that of the character or both at the same time and to illustrate epiphany, I’d like to use one of Joyce’s own beautiful stories ‘the dead’, which is from his collection ‘The Dubliners’, it’s the very last story and it was made into movie and the images are borrowed from that.

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