3 Lessons – Abraham Verghese’s Commencement Speech

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Abraham Verghese is a physician of many talents. He teaches internal medicine at Stanford, he writes opinion pieces, and he has published two memoirs and one novel. Many know him for the celebrated 2009 novel Cutting For Stone, which reached the New York Times bestseller list. Verghese also has a unique biography: he was born in Ethiopia to Indian parents, started his medical training there until civil unrest led him to finish it at Madras Medical College in Chennai, and came to the U.S. as a foreign medical graduate seeking residency. He became a resident in Tennessee, and went on to fellowship in Boston before returning to practice in Tennessee. Though atypical in its diversity of location, Verghese so far seems to have, on paper, a typical path in terms of going from one medical requirement to another.

It is here, in 1991, that he turned–he chose to put medicine on hold and go to Iowa for two years to get his MFA at the Iowa Writers’ Workshop at the University of Iowa. With him went his family. After earning his MFA, Verghese went back to practicing medicine, this time in Texas. He drew on his past work with HIV/AIDS patients in Tennessee and Boston to write his first memoir, My Own Country. He also wrote in The Tennis Partner, his second memoir, about his relationship with a colleague in Texas who suffered through drug abuse. Verghese directed the Center for Medical Humanities and Ethics at The University of Texas Health Science Center at San Antonio for 5 years, before moving to Stanford, where he focuses on passing along the tenets of bedside medicine and clinical excellence.

When I read Verghese’s writing, whether fiction or nonfiction, two things stand out to me. First, he is extraordinarily humble in facing his patients. He elevates the patient to a higher status than the physician. Not all physicians do this in their stories or their memoirs. The second thing that stands out to me is his capability to show beauty even in the face of gross suffering. If I think of writing as cathartic, I think of Verghese’s writing as wringing suffering onto a page but then outlining it with emotional insights. These insights allow the writing to remain not just terribly beautiful, but hopeful.

Verghese addressed the 2014 Stanford School of Medicine graduating class with a beautiful speech on the humanity and art of medicine, much of which he thinks gets lost in our modern lust for more technology. You can read the moving and sometimes hilarious speech here. Below are my three favorite bits of advice:

1. Future physicians have to be ready and determined to change the parts of the system we don’t like:

The EMR with its drop-down boxes, its ready-made templates and the way it can populate pages at a stroke of a button, would suggest that every patient, even ones missing limbs and unconscious, have bilateral normal reflexes, normal gait, normal cranial nerves. I like fiction, I read fiction, I even write fiction for God’s sake, but I don’t think fiction has a place in the medical record. You will need courage and determination to push back when things detrimental to your time with and your care of the patient are being thrust at you. Electronic medical records don’t take care of patients: You and our amazing colleagues in nursing and the other health-care professions care for patients; people take care of other people.

2. We have to remember that serving patients is a privilege, a hallowed tradition and bond.

Your presence, your garb, the setting are all leading the patients to expect a ritual, they are most aware of it, and incredibly, as part of that ritual, they have given you the privilege of touching their body, something that in any other walk of life out of a special context will be considered assault, but they allow it of you….It is no accident that if you read letters from patients complaining about their care, about their hospitalizations, it often uses language such as “he or she never touched me” or “he or she never laid a finger on me.” The ritual is timeless and it matters.

3. There’s still one thing we can do, we must do, when there is nothing more we can do:

You can heal even when you cannot cure by that simple human act of being at the bedside — your presence. May you discover as generations before you have, the great happiness and satisfaction inherent in the practice of medicine, despite everything.

I’ve bookmarked Verghese’s speech to come back to if I find myself faltering on what purpose I am serving in medicine, and why I am joining the profession. I also enjoyed the subsequent interview he did with the Stanford Medicine magazine, which you can read here.