In our rush to practice sound scientific medicine, it’s easy to lose sight of the fact that we are treating human beings, who are most likely vulnerable, apprehensive and in need of moral support in their darkest hours. more»
I first encountered Dr. Howard Spiro at a medical humanities conference in Williamstown, Massachusetts, some 20 years ago. As a guest speaker, Dr. Spiro shared the podium with Dr. Robert Coles. The two made quite a pair: both distinguished practitioners of the art of medicine; one from Harvard, the other from Yale. Dr. Spiro wore a brown bow tie that day. I recall that detail exactly, because it was the kind of bow tie you had to tie yourself; and I remember suppressing an impulsive urge to discreetly snug it up for him. Curiously, I didn’t actually make his personal acquaintance until nearly a decade later.
One evening in December of 2002 my friend and colleague Dr. David Elpern and I traveled to New Haven to attend an evening lecture at the Yale Humanities in Medicine program. During the drive down, Dr. Elpern told me that Dr. Spiro had founded the lecture series back in 1983. Later that evening over dinner at Mory’s, we learned from Dr. Spiro that he had gotten up a fledgling online journal of similar import, the Yale Journal for Humanities in Medicine.
By that time a few of my early pieces had been published in JAMA and BMJ. Dr. Spiro was eager to hear all about them. I don’t recall whether he asked me to consider submitting something to YJHM at that time or not. At some point I did send him a piece, which he graciously accepted for publication.
Sometime later, after he offered to review my book Patients Are a Virtue, Dr. Spiro asked if I would consider doing a monthly column for the journal. “What would we call it?” I asked him. “Call it what you like,” he said. Shortly after that my “Notes from a Healer” began to appear in the electronic pages of YJHM.
And so began a collegial relationship that lasted up until the time of his death. (Dr. Spiro approved the submission for my March “Notes from a Healer” column days before entering the hospital for a cardiovascular event that would ultimately end his life.)
Every month for the past five years I would send Dr. Spiro a piece for the column, which he would critique, usually in a few brief lines, before okaying it for publication. These critiques were not those of a typical editor. Many times he would comment about something in his own life or how the piece I submitted moved him personally.
“Engineers are among the most difficult patients, for they are convinced there’s a detectable reason/cause for anything/everything.”
“Wise, indeed. One learns with age.”
“You are sounding more like O Henry with time.”
“Your usual beautiful turns. I confess I would have seen the opportunity/really the genius of America in their story, but suum cuique!”
Occasionally, he would point out a grammatical error; and red-faced, I would shoot off a corrected copy with my thanks appended. At some point, he would finally bestow his signature stamp of approval: “Imprimatur.”
Dr. Spiro rubbed shoulders with some of the medical greats of his era. Many times I only learned of these relationships through casual comments he would make on pieces I sent him. For example, in response to one of my submissions he wrote:
“I knew Leon Eisenberg—admired him—look at his CV. I cannot believe that he would want to be considered a mere psychopharmacologist.”
After researching Dr. Eisenberg’s biography, I wrote back, “I took your advice. You were obviously correct in pointing out that the man was much more than just that.” I included an article from Harvard’s FOCUS Online which I thought Dr. Spiro might enjoy . Dr. Eisenberg’s story about the schlemiel was priceless.
Sometimes Dr. Spiro and I exchanged correspondence on matters of medical practice as well. Once, I discovered an article that referenced a paper of his. I sent him the link with a few observations:
“Reading through this review, I couldn’t help but think that you would enjoy it. As it turned out, you were mentioned toward the end of the article.”
‘Stress,’ the American gastroenterologist Howard Spiro writes, ‘increases vulnerability’ to other ulcer-causing agents ‘like H. pylori’. Medical fascination with bacterial causation has, he says, resulted in culpable neglect of the roles of the mind, the emotions and the dietary and behavioural patterns of everyday life. (A Modern History of the Stomach: Gastric Illness, Medicine and British Society, 1800-1950 by Ian Miller)
Dr. Spiro was obviously pleased: “Thanks, glad I am remembered! I worked on stress in the 1940′s, thanks to Selye’s idea of the ‘alarm reaction’ and published my first medical papers back then.”
In turn, I wrote back: “Perhaps my perspective is somewhat skewed, but it seems to me that precious few specialists seem to be able (or willing) to relate to such patients on a humane level these days, a demonstration of the lost art of medicine.”
Dr. Spiro’s assessment: “Boy, are you right! When I was young, we talked to patients. Lab data and images were scanty. Since 80% of patients get better with time and the right hand of fellowship, the clinician counted. But that will return after disenchantment spreads.” He had entitled this reply I-Thou.
On a professional level, Dr. Spiro was supportive of my clinical practice as a physician assistant. He strongly advocated for the advancement of “mid-level practitioners” as he called us, feeling that we were the answer to the primary care clinician shortage problem. “The expertise you demonstrate in the way you care for your patients is evident in your writing,” he wrote. “I argue with my colleagues, many of whom feel that medical practice should be regarded as the exclusive domain of the physician.”
“As you may know—or more likely may not—for the last 20 years I have been pushing the idea that physician assistants or nurse-practitioners should be doing pediatrics and general internal medicine. Very few in the internal medicine business agree.”
“Your enthusiasm, amity, empathy for your patients—and your prolific writing skills—continues to reassure me that physician extenders—if I can call you that—should constitute our general docs and pediatricians. It’s a canard that they will not recognize serious problems! I keep wondering why you do not talk about that—or maybe you do, indirectly, or in other places.”
This past fall Dr. Spiro wrote that he would be traveling to Arizona to give a medical humanities presentation at one of the medical schools there. “I would like to use you as an example of a clinician who not only practices humane medicine, but writes about it well. Send me a copy of your CV. I imagine you to be somewhere around 45, give or take.”
I sent him my résumé with the caveat that he was off on my age by more than a decade. “Hah! You write with the vigor of someone in his early thirties,” he quipped.
Toward the end it was evident that Dr. Spiro was becoming a bit forgetful. When the name of George Bascom resurfaced in one of our e-mail exchanges, he wrote: “Tell me again how you knew him.”
“It was you who knew him personally,” I wrote back. “I only knew him through his poetry. In any event, he was a fine mensch who continues to influence clinicians from beyond the grave.”
“If you didn’t know him personally, a word like mensch—which I take to be a personal assessment—might be out of place,” he replied. The response stung.
I took a deep breath and typed out a reply. “According to the dictionary, a mensch is someone to admire and emulate, someone of noble character. It’s meant as a compliment to highlight the rarity and value of that individual’s qualities.”
I suppose those words might just as well have been written to describe Dr. Spiro himself.
“I attended the funeral of a pediatrician in New Jersey last weekend. The place was packed. This fellow was revered in the community. His patients just loved him. And here’s the thing: he was such a humble guy.”
We pulled on our coats in the locker room and gathered our belongings, preparing to head out after the morning workout in the pool. One of my swimming buddies has a link to New Jersey: his wife’s family is from there. The pediatrician of whom he spoke was a cousin of his father-in-law.
“Google him if you get a chance,” my friend said, as we walked down the hallway past the front desk. “Be sure to read the condolences in the guest book—the comments are amazing. There must be at least 120 of them.”
“What town did he practice in?” I asked, as we exited the building.
My friend told me the name of the small town.
“Is that anywhere near Paterson?” I asked.
“I wonder if he knew the pediatrician William Carlos Williams. Williams practiced in Paterson and wrote Life along the Passaic River. He was also a poet.”
“A poet-pediatrician,” my friend smiled.
“You might have heard of Robert Coles,” I went on, “the child psychiatrist who teaches literature at Harvard. As an undergraduate, Coles did a paper on Williams. His advisor suggested that he send it to Williams. Coles did, and he received a reply from Williams, who wrote that the thesis wasn’t bad for a Harvard man.”
We walked to our cars and stowed our bags.
“Williams invited Coles to visit him. They struck a chord. Coles eventually ended up practicing psychiatry at Keesler Air Force Base in Biloxi, Mississippi. That was back in the ’60s, during the school integration crisis. In New Orleans he witnessed the mob of people jeering at Ruby Bridges, the little black girl who had to be escorted to her school every morning by federal marshals.
“Coles got to meet Ruby and her family professionally. He couldn’t believe the kid’s ego strength. He kept waiting for her to break. How much abuse could a 6-year-old girl take? Finally, at one of their sessions, he told Ruby that her teacher had noticed her lips moving as she walked to school. He asked her what she was saying.
“She told him that she was praying. ‘Praying for your safety?’ Coles asked. ‘No,’ she said, ‘I was praying that God would forgive those angry people, because they really don’t know what they’re doing.’
“Later, Coles complied an anthology of Williams’ writings called The Doctor Stories. He also published a posthumous tribute to Williams, House Calls.”
My friend smiled. “Good story. It’s all connected.”
I shut the door of my car. “Ripple effect—like stones cast in a pond.”
When I got home, I did an online search for Robert Rento. In a few clicks I had accessed his obituary. Here are several salient excerpts.
For over 40 years he evaluated students at Passaic County Technical Institute where he was known for making a connection with each and every child. “This was not so much a job to him as it was a calling,” recalled one nurse.
At her father’s core, daughter Susan Cottle said, was “a God-given ability to get on an elemental level with another human, often with humor or kindness as the connective tissue.”
“And he was an excellent communicator. When he walked out of that treatment room after seeing a kid, those parents knew exactly what was going on.”
Dr. Rento took advantage of his semi-retirement to reach far beyond his Clifton roots, traveling to Nepal, China, and Brazil with volunteer, non-profit medical teams to provide aid to children. These trips touched him deeply and re-invigorated his desire to continue his life’s work as a physician. In 2009 he received the Humanitarian Award from the Knights of Columbus for this work.
Dr. Rento will be remembered for his strength of character, for “getting the job done,” for his love of story-telling, his boundless energy, and perhaps mostly for the kind, competent manner in which he cared for those in need and all those he loved.
Some will bear witness through their words, others through their actions; still others—precious few—through the lives they lead.
Like stones cast into a pond, they resonate through the murky depths, generating those ripples which spread wider and wider until they are finally embraced by the great arc of the far shore.
Since acquiring an iPad, I’ve gotten used to checking the Weather Channel app every night before retiring. Most times the predictions are humdrum, but every once in a while I’m brought up short by an unanticipated forecast.
Last night the app carried a winter weather advisory. A major storm would strike our area shortly before noon today. The advisory called for 3 – 5 inches of snow over the course of the afternoon and night, ending in sleet and freezing rain.
I got up early this morning to run several errands before the storm. I topped off the tank in my car and brought back additional gasoline in a 2-gallon container for the snow blower, should the need arise. I pulled the snow shovels out of the garage and cleared extraneous debris from the driveway. Last night my wife had made a big pot of chicken soup for dinner. I turned on the burner and let it simmer. After working outside in the cold, there’s nothing like coming in to a bowl of steaming soup .
I gave myself a pat on the back, pleased that I had been able to prepare for the weather in advance. But even the best laid plans can’t anticipate everything.
Mid-morning I stared at a reply that popped up shortly after I e-mailed the editor at one of the medical journals I write for. Entitled “Away,” the automated message informed me that the editor would be indisposed for an undetermined period of time. Several personal contacts were listed, among them his spouse and granddaughter—not the sort of contacts that you would typically find in an automated e-mail.
Immediately, I shot off a couple of messages to some friends, asking whether they’d heard anything recently about the state of this editor’s health. I’m probably jumping to conclusions, I muttered under my breath as I pounded the keyboard; but I couldn’t help it—my clinical nose was twitching. I feared something was up.
The snow started to fall shortly before noon. Within an hour the yard was blanketed white. Snow lay on the bare branches of the maples in back of the house and accumulated on the cars parked in the street. Outside the window of my office it continued to come down steadily. This was certainly no ordinary snow, I mused, recalling the advisory. Such a rate of descent portended more than a mere dusting.
Another message popped into my Inbox. This one was from the editorial assistant. She confirmed my fears: the editor was indeed in the hospital. She didn’t know the particulars. She imagined that he wanted to keep things quiet—no fanfare, no fuss. She admitted that she was worried too. She would let me know as soon as she heard anything more. Meanwhile, outside the snow continued to fall.
Soup—piping hot, chocked full of fine noodles with bits of celery, carrots and corn. I lifted a spoonful from the edge of the shallow bowl to my lips and blew softly to cool it off. The dog perched at my side, eyeing the spoon and begging for cracker crumbs.
Years ago a friend and I had visited the editor at his townhouse. For lunch he had warmed up some homemade soup on the stove.
How different the hospital must have looked through his eyes from the bed. This esteemed professor emeritus who had attended so many patients over the course of his lengthy career was now at the mercy of his own attending physicians, a patient himself.
A thick layer of heavy wet snow accumulated on the driveway. I downed a cup of fresh brewed coffee, pulled on my cap and coat and stepped outside into the winter whiteness. I grabbed the shovel on the back porch and started pushing the snow off the driveway, herring-boning my way down the long expanse of macadam to the street. As I worked the snow continued to descend. The wet snow stuck to my woolen cap and my coat; soon I was blanketed with the wet whiteness.
“Do you tip your barber?” the editor had written after reading the manuscript of my piece Haircut. “I still do, though people tell me it’s no longer done.”
“When I read your latest, I was reminded of the stout cigars I used to love when I was stationed overseas.”
“Crafted with your characteristic twist, served up with a touch of grace—imprimatur!”
Imprimatur!—that was his stamp of approval: Let it be printed! I learned a bit of Latin phraseology through our casual correspondence. He was a wonderful mentor, even when he wasn’t aware that he was teaching.
By the time I reached the street the upper driveway was once again covered in snow. I shouldered my shovel and trudged back to the top. For the second time that morning I threw myself into my work.
Afterwards, I pulled the car into the driveway off the street. My wife let our little white terrier out and handed me the leash. We took a short walk around the block. Several times the dog stopped to shake the snow from her rough coat. She bounded through the snow like a miniature sheep, tugging at her leash.
Back home I brushed the snow from my cap and coat in the mud room. I dried the dog with an old towel, kicked off my boots and stepped into the warm kitchen. The soup still simmered on the back burner of the stove.
I hurried upstairs to check my e-mail. A new message from the editorial assistant informed me that the editor had suffered a stroke during cardiac catheterization. No one knew anything more at that point. I dashed off a quick reply, thanking her for the timely update.
Outside the snow continues to descend. The bare maple branches bend precariously under the weight of the wet snow. It will only be a matter of time until one of the weaker ones snaps.
It’s a fine spring day, the last of April. I’ve been sitting outside in the back yard all afternoon, plowing through Michael Collins’ memoir Blue Collar, Blue Scrubs: The Making of a Surgeon.
The first-born in an Irish-Catholic family of eight boys, Collins pursued an undergraduate degree in liberal arts from Notre Dame University before taking a job with a construction company breaking concrete for a living. Although he enjoyed the hard work, the long hours, the camaraderie (as well as the beer consumed on the job and in the pubs afterward), Collins reached a point where he needed to make a decision about what he wanted to do with the rest of his life. The answer he hit upon was to become a doctor.
It was an uphill battle. Collins had to spend two years completing pre-requisite courses in chemistry, physics and biology and sit for the MCAT just to be able to apply to medical school. Although he aced his science courses, his MCAT scores were average. Rejected by 7 of the 8 medical schools to which he applied, when Collins pleaded with the Dean of Students at Loyola in Chicago to be given a chance, he got in.
Blue Collar, Blue Scrubs describes his journey through medical school up to the beginnings of his orthopedic surgical residency at the Mayo Clinic. Collins spins the tale with wit, humor and pathos.
Throughout his training, while immersed in the seemingly overwhelming tedious task of rote memorization, Collins lapses into philosophical thought. “What, then, makes us human? A beating heart? A cogitating brain? Or is there something more, something, for want of a better word, we call a soul?”
At the conclusion of the first autopsy he witnesses, a pathologist tells him: “You have now peered into the deepest recesses of the human body and discovered the secrets of life.” As he files out of the room with his fellow students, Collins muses that “we haven’t even come close.”
Throughout his rigorous training Collins somehow manages to hold on to his humanity. He never loses sight of why he wanted to become a doctor in the first place: to render assistance to his fellow human beings, to alleviate their suffering.
It is good for seasoned clinicians to be reminded of such altruistic motives. Whenever I lose a patient to a terminal illness, I gravitate to the family. I sit with significant others, share the information I have at hand and prepare myself to listen to what they have to tell me. To do otherwise would be a disservice both to them and to myself; for in these instances, I’ve discovered that I need such interactions to help myself heal.
Patients are not the only ones who suffer.
Apropos modern medical practice, there’s an old saying attributed to the automotive repair business: “Go to Midas, get a muffler.” Midas is in the business of selling mufflers, of course. If you consult their mechanics about an odd noise in the exhaust system, most likely they’ll replace your muffler and tailpipe. This might not fix the problem, but payment has exchanged hands in the transaction. more»
The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.
Sometimes I wonder whether we as a society have not over-medicalized life. We spend so much of our time browsing health columns, monitoring vital signs, ruminating on our symptoms, consulting our doctors. Many of us have become so health conscious that we balk at deviating from the straight and narrow path. When it comes to our health, we have become risk averse.
Even those of us who spend their days in clinical practice recognize that medicine does not encompass all of life.
Perhaps we need to learn to practice minimal medicine.
These thoughts ran through my head as I read Mark Bittman’s final NYT Minimalist culinary column. Over a span of thirteen years Bittman authored nearly 700 weekly columns for the NYT Dining section. As it turns out, the culinary arts share a good deal with medical practice.
“I discovered that you never cook with someone else without learning something,” Bittman writes. “In every case, there’s a two-way transfer of knowledge. If they know less than you do, you grow from teaching. If more, of course, you grow from learning.”
Bittman’s words bring to mind Sir William Osler’s description of medical teacher and student: “the pupil and the teacher working together on the same lines, only one a little ahead of the other. This is the ideal toward which we should move.” After 25 years of practice, Osler observed, “I have learned … to be a better student, and to be ready to say to my fellow students, ‘I do not know’.”
Osler reckoned that “no man can teach successfully who is not at the same time a student.”
Here’s Bittman musing again: “Usually, I was either taught to make something or I modeled it myself, as best I could. I refused to buy into the notion that there was a ‘correct’ way to prepare a given dish; rather, I tried to understand its spirit and duplicate that, no matter where I was cooking.”
Osler advocated that “the practical shall take the place of didactic teaching.” To acquire the skills necessary to perform medical procedures, students are encouraged to “see one, do one, teach one.” In 1867 the physician Oliver Wendell Holmes argued that the “most essential part of a student’s instruction is obtained … not in the lecture-room, but at the bedside.”
Bittman maintains that, “as Jacques Pépin once said to me, you never cook a recipe the same way twice, even if you try.”
How true. And you never perform a physical examination or surgical procedure in exactly the same way. There are always confounding factors which necessitate workarounds and thinking outside the box.
Medical practice, like cooking, is always a compromise. Like their culinary counterparts, clinicians “almost never have the time, the ideal ingredients or equipment, or all of the skills we’d like.”
“Shop avidly, keep a full refrigerator and pantry,” Bittman advises; “pull things out and get to work.”
Where would the good clinician be without a well-stocked surgery?
“My growing conviction that the meat-heavy American diet and our increasing dependence on prepared and processed foods is detrimental not only to our personal health but to that of the planet has had an impact on my life.”
A nutshell of sound dietary advice, one every practicing clinician should take to heart.
Bittman concludes: “What I see as the continuing attack on good, sound eating and traditional farming in the United States is a political issue.”
What I see as the continuing attack on good sound traditional medical practice has lately become a political issue as well.
The only other sound’s the sweep
Of downy wind and snowy flake. —Robert Frost
I sit on a wooden stool by the window in the kitchen, watching the snow come down. Across the street in a yellow cone of lamplight tiny flakes swirl about as though encased in a snow globe. Each one in its own time descends to rest against the frozen earth.
Forty years ago after the last bell of the day, I sat on a similar stool in a high school classroom, listening to my teacher reminisce about his boyhood. Outside the second-story windows snow lay along the sills in fluffy mounds, muffling the sounds from the street.
“I never had much direction in life,” my teacher mused, taking a sip of coffee from his thermos. “Maybe that’s why I eventually ended up following in my dad’s footsteps.”
He was a tall man with reddish-brown hair that hinted at his Scotch-Irish ancestry.
“My dad was raised on a small farm across the river. My grandfather continued to live there after my dad left home. When I was a boy we would visit my grandfather on the farm. It was tucked away back in the hills off a winding blacktop road. You turned off onto an unmarked dirt lane and followed it a quarter mile to the farmhouse.
“My grandfather was a big man. He and my dad didn’t always see eye to eye. When things went well, the two of them would sit on the porch and talk. Sometimes they took a leisurely stroll out to the orchard, leaving me behind to play in the yard. When they had words, my dad would quietly walk me to the car; and we would head back out the dusty lane to the road.
“One winter day we made the trek to the homestead. The fields lay buried beneath a thick white blanket of snow. It started to snow again shortly after we arrived, and by late afternoon it was coming down heavy. My dad decided we had better go before the roads got bad, so we headed out in the old Chevy down the lane. The plow had already gone by, throwing a big mound of snow at the entrance. We couldn’t get through, and we couldn’t turn around.
“My dad left me in the car with the motor running and the heat on and walked back down the lane to the house. After what seemed a long time, he appeared with my grandfather. Each of them carried an old coal shovel. In the yellow beams of the headlights I could see them working together to clear the pile of snow from the end of the lane.
“When they finished, my grandfather reached out his hand for the shovel my dad had been using. My father hesitated, then surrendered it. Together they disappeared into the darkness through the swirling snow.”
My teacher stood quietly by the lab bench, thermos in hand, staring out through the high vaulted windows. I shifted on the stool. “What happened?” I asked.
“It wasn’t long before my dad came back. He dusted himself off as best he could and slid in behind the wheel. He gave it the gun and we broke through onto the plowed road.”
After a brief moment of silence he said: “That was the last time I saw my grandfather alive. The darkness had swallowed him up; he disappeared into the falling snow forever.”
Although he was a chemistry teacher, we had been talking about writing, how to craft a story, an impression. He was very interested in writing and had managed to produce several stories and the beginning of a work of science fiction.
Somehow I managed to find the words: “Maybe one day you’ll write that down, just like you told it to me.”
Sitting on the stool by the kitchen window this evening as the snow swirls down in the light across the street, I wonder if he ever had.
“Look what I found at the Salvation Army store!” my wife beams, holding up a crinkled document in her hand.
The yellowed paper had caught her eye when she dropped off our yearly donation of old clothing that afternoon. She purchased it for two dollars.
I take the heavy paper document in my hand and run my fingers along the edge. It measures six by eight inches. The printing is script, all Latin, except for the calligraphied name and signature at the bottom. I read the title. It appears to be a diploma dated June 6, 1965, conferring an undergraduate degree from Smith College on Francesca Morosani Thompson.
“I researched the name,” my wife continues, showing me the page on her MacBook. “Here—you can read it for yourself.”
A black and white photograph is posted above a few short paragraphs of text. Underneath the picture appear the woman’s name and dates of birth and death—the obituary of Francesca Morosani Thompson, M.D.
My eyes dart rapidly across the lines of virtual type. Francesca M. Thompson was born in Litchfield, Connecticut, in 1945. She attended Smith College where she earned an undergraduate degree in social work, then went on to pursue her M.D. at Cornell University Medical School. Dr. Thompson subsequently completed a residency in orthopedic surgery at the Hospital for Special Surgery in New York, where she served as that institution’s first female orthopedic resident.
After completing a fellowship in foot and ankle surgery, Dr. Thompson became the chief of the Adult Orthopaedic Foot Clinic at St. Luke’s-Roosevelt Medical Center in New York; a co-director of the Combined Foot and Ankle Fellowship at the Hospital for Special Surgery, and a clinical assistant professor of orthopedics at Columbia University’s College of Physicians and Surgeons.
Midway through her promising career she developed multiple myeloma—cancer of the bone marrow—in 1986.
Dr. Thompson received the first autologous bone marrow transplant for treatment of multiple myeloma, at that time an experimental procedure where the patient’s marrow is extracted, irradiated and returned to the body. The treatment bought her another decade of life.
As a physician Dr. Thompson documented the journey of her illness in a book, Going for the Cure.
Shortly before what would be her final hospitalization, Dr. Thompson scrubbed in as attending surgeon with her fellow and resident. She completed the 5-hour surgical procedure on the patient while sitting in a wheel chair.
Dr. Thompson’s life stands as a role model for women in orthopaedic surgery. She was kind yet firm, direct without being confrontational, and intelligent yet not condescending.
I finish the last line of the obit and turn my attention to the wrinkled document in my hand—a small piece of history that speaks to the soul of a courageous individual, one who strove to continue to practice humane medicine to the end.
“We are all fixing what is broken. It is the task of a lifetime.” —Verghese
By chance, when I was a boy searching for rocks to add to my growing collection, I found my first piece of pyrite — “fool’s gold.” This particular nugget was big, certainly much bigger than any crystalline mineral I had previously encountered. As I turned it over in my hand, it reflected a tarnished brassy light.
This treasure turned out to be nothing next to the tiny flakes of real gold that later, as an adolescent, I panned from the mountain streams of New Mexico. That brilliant yellow sparkle was unmistakable. Once you encounter the real thing, you never forget; it burns itself into your memory and you guard its image forever.
For me, now a seasoned clinician, Abraham Verghese’s 2009 novel Cutting for Stone is the real thing.
Against the backdrop of Ethiopia, a country so beautifully depicted that his descriptions can hurt, Verghese crafts the timeless narrative of two brothers, twins joined at the head by a mysterious cord identified at birth. In an emergency caesarean section the obstetrician who will become their surrogate mother clamps and divides this tube, uncertain if it contains meninges, gray matter or aberrant blood vessels. Thus separated at birth, the twins retain a mysterious bond between them throughout the rest of their lives.
Thomas Stone, their surgeon father, normally level-headed and dexterous in the operating theater, flounders on how to proceed with the delivery. Because of his lack of timely intervention, the mother exsanguinates on the table. Unable to cope with his perceived incompetence, Stone flees the hospital, the country, and, as we later learn, the continent. He appears again in the final section of the book where he will be called upon in his brokenness to perform a surgical miracle.
Meantime, the boys are adopted and reared by Hema, the obstetrician gynecologist, and Ghosh, the internist, at Missing (a mispronunciation of “Mission”) Hospital in Addis. Both boys are introduced to the practice of medicine at an early age. Each pursues it in his own fashion. Marion, the first-born, blossoms under the tutelage of Ghosh, the competent and kind clinician; while Shiva, his mother’s favorite, blazes his own unique path, pioneering and perfecting the techniques of fistula surgery that will save thousands of ill-fated young women.
Estranged from Shiva over a fiery young woman, Marion is forced to flee Ethiopia for political asylum. The paths of the brothers will converge seven years later in America, where, in a manner of speaking, they become reunited again.
In Cutting for Stone, Verghese gives us his best, exploring how the sins of fathers are visited upon subsequent generations, the intricate relationships between broken people, the history of modern medicine from clinical practice to the art of transplantation, the interrelatedness of human existence on this planet. The narrative is chocked full of medical aphorisms and old saws, a well-stocked larder for the practicing clinician.
Cutting for Stone was placed in my hands by a good friend who thought I might enjoy it. He and his wife had read it over the course of their recent two-month trek through Australia and New Zealand. I discovered a bookmark sandwiched between two pages — a dog-eared boarding pass from one of their intercontinental flights.
The read itself turned out to be a fascinating journey, one enriched by precious stone.