Full text of best-selling author and physician Abraham Verghese’s talk: The Great Lie that Tells the Truth at TEDxStanford conference.
Listen to the MP3 Audio here:
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.
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.
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.
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.
Basically, it revolves around a couple, Gabriel Conroy, who’s an academic and his wife, Greta. And it happens on January 6th, on the Feast of the Epiphany, 1904, same time as Chekhov. And every year on the Feast of the Epiphany, Gabriel’s elderly aunts, two aunts, spinsters, hold this feast and there’s much celebration. There’s great food, there’s great drinks and Gabriel has a little speech that he has to give and he’s quite tense about the speech until that moment, kind of like a TED talk, until that moment when he finally gets to deliver it and it goes off pretty well.
And Gabriel is quite satisfied and there’s more food and wine flowing and then finally the evening’s winding down and Gabriel’s looking forward to it because they’ve left the kids at home and because it’s snowing, they’ve booked a room at an inn nearby. And he’s looking forward to this occasion without the kids, make love to his wife, have a very tender evening with her and he proceeds to go down the stairs to get his coat, her coat, his coat, and as he goes down the stairs, his wife hasn’t quite followed him.
Irish tenor begins to sing this beautiful song called ‘the lass of Aughrim’, a haunting beautiful melody and when Gabriel looks up from the coat rack, he sees Greta having come halfway down the landing and he does not recognize her. Her eyes are closed, framed against that stained glass window, the veil around her, conjuring up this Marian image. He’s never seen his wife like that and in the next moment as the song unfolds, her eyes open and they’re glistening with tears. It’s a la Pieta image and Gabriel is astonished and the song eventually ends.
She comes down the retire to the inn and he’s so looking for this moment and she unpins her hair, comes cascading down and he asked her ‘what are you thinking about?’ because she still seems preoccupied and she says ‘I’m still thinking about that song, ‘the lass of Aughrim’, it reminds me of a boy Michael Fury, who used to love me.
Gabriel immediately becomes jealous, he feels its jealousy rising and he says ‘What’s happening to this Michael Fury, where is he now?’
And she says ‘Well, actually he’s dead.’
And he was deflated and he says ‘And what did he die of?’
And she says ‘Well, I think he died from me’. And she begins to cry and she goes on to tell him that when she was a young girl living in Galway, Michael Fury was an invalid convalescing from a very serious illness, and she and him used to go on walks and to improve his health, he would sing and he had a beautiful voice that he would sing the lass of Aughrim and just before she moved to Dublin, he got quite sick and was confined to his sickbed.
She couldn’t visit him to say goodbye and the night before she was leaving, she heard rocks being tossed at her window and when she went to the window, she saw Michael Fury in the cold and the rain, standing there having left his sickbed to come to say goodbye.
And she says to him ‘You shouldn’t be here, you should go back to your sick bed’ and he says ‘if you leave, I don’t care if I live anymore’.
And at this point, Greta freaks into sobs, lies on the bed and gradually drifts off to sleep and poor Gabriel, this is much worse than a headache. All his plans are off but more than that, he’s standing there, feeling that his life is somewhat hollow when compared against the kind of love that Michael Fury had. He’s feeling like a penny boy for his aunts and he’s feeling like a course vulgari and entertaining the crew at the dinner compared to what he’s just heard. He’s never known this about her and it makes his whole life change in comparison.
And as he looks out of the window and sees the snow falling all over Ireland, falling over the plains, falling over the waves of Shannon, falling over that cemetery where Michael Fury lies buried, drifting onto the crosses and the fence, falling on the living and the dead, he has his epiphany, which is this ‘better pass boldly into that other world in the glory of a passion than to fade and wither with age… better to pass boldly into that other world in the glory of some passion than to fade and wither with age’.
Ladies and gentleman, that’s the heart of story and I think we all struggle to find our epiphanies, both in our stories but in stories around us. I want to share with you as I wind on my own epiphany, which came in the AIDS era.
I was a young physician and for a decade, we had no treatment for HIV and I presided over the death of hundreds of young men. Most of them, my age, a very difficult thing. And I remember one morning being in clinic and looking at the clinic roster and seeing that a young man, who I’d gotten to know very well because you knew them very well as you watch this trajectory, was coming to clinic and I was sort of pleased.
I hadn’t seen him in a while, just then the phone rang and it was his mother to say, he’s not coming to clinic, he’s too weak to come to clinic but he’s not sick enough to be put in the hospital and in any case, there wouldn’t be much I could do for him in the hospital.
And that didn’t sit well with me, all day I wrestled with that. And that evening, for my own purposes, I decided to drive out to his house in the country to a trailer, you know, an hour drive for my own needs but when I got there, I found to my amazement that my visit had a profound effect on the family, on him. It helped the family come to terms with his illness, it helped him understand and take away some of the fear of death because we were able to talk about it and I was able to promise him that he would not suffer, that I would be there through the end.
And as I left the house that day, I realized this is what the horse-and-buggy doctor of 150 years ago did so well. In the absence of half a quarter of the things, a fraction of the things we have today, they were able to heal even when they could not cure.
If you think about it, if you have a fracture of your arm, at one level it’s a physical problem, it’s a mid-radius fracture, mid-shaft fracture, non-displaced. At another level, there’s always a spiritual violation ‘why me, why now?’ and with diseases like AIDS or cancer, again there’s a physical loss.
A virus infecting cells, cells that are gone berserk but there’s an incredible sense of ‘why me, why now, what did I do to deserve this’, that sense of spiritual violation, I think, we in Western medicine didn’t address as well as we should have and my epiphany was to understand that even when we could not cure, we could heal. And we could heal by our presence, we could heal by being with the patient, we could heal by connecting with the family. We could tap into that age-old tradition, the Ministry of healing.
Ladies and gentlemen, I think that stories are the way we find meaning our lives. Stories are equipment for living. The epiphanies we read about and we discover as we analyze our own stories are what allow us to change the prow of our ship and point it in a slightly new direction.
Stories are how we connect with each other, only connect. In the words of Albert Einstein, who was paraphrasing Cameron, ‘not everything that can be counted counts, and not everything that counts can be counted for the things that can’t be counted, you will need story.’