Physician Abraham Verghese Combines His Love of Books and Medicine

Hadn't he set out to be a fiction writer? It was time to start "Cutting for Stone" -- though he still didn't have much to start with.

"I had a scene of a nun giving birth to twins," Verghese recalls, "and I built on that and built on that." A hundred pages in, his major characters had emerged organically from that opening scene.

There were the twins themselves, Marion and Shiva, joined at the head and needing immediate surgical separation. There was their mother, who dies giving birth, and their grief-crazed father, who disappears. And there were the two mission-hospital doctors -- jack-of-all-trades Abhi Ghosh and no-nonsense gynecologist Kalpana Hemlatha -- who would raise the twins while embodying everything Verghese admires about hands-on medical care.

It was a good enough start for Evans to sell the novel to a high-end publisher, Alfred A. Knopf. But when Verghese's editor, Robin Desser, asked what happened next, he had to confess he didn't know.

Verghese says he thinks Desser was "scandalized" by this. Desser prefers to recall how excited she was by his initial submission.

"I just flipped when I read it," she says. "It had so many things a great novel would have right away."

That didn't stop her from raising the alarm a couple of years ago when he was floundering.

"Abraham, you have to come to New York," Verghese remembers her telling him. "We have to talk."

"Cutting for Stone" was two-thirds written. Marion and Shiva, wildly different personalities whose fates were intertwined, were about to be separated again, this time geographically. Marion was leaving Ethiopia for an internship at the kind of inner-city American hospital that is forced to staff itself with foreign physicians.

Any number of plot developments seemed possible.

But in order to finish his novel, Desser told Verghese, he simply had to know how the twins' story was going to end.

iPatients and Chekhov

Wildly different personalities whose fates were intertwined: We might be talking about Verghese the doctor and Verghese the writer.

Yet those personalities aren't as split as they seem. And when it comes to how Verghese's story ends -- well, his twinned careers have started to converge.

Ralph Horwitz, who chairs Stanford's school of medicine, understands this convergence as well as anyone. Horwitz recruited Verghese to fill two separate but closely related roles.

First, he wanted Verghese to supervise students during their internal-medicine rotations -- and in particular, to teach them how to do bedside exams.

A layman might wonder why one needs a specialist for this. But as technology has come to dominate modern medicine, doctors have taken to monitoring what Verghese calls "iPatients" through computerized hospital data, and direct doctor-patient interaction has become something of a lost art.

"Abraham is among the most skilled bedside clinicians I've ever encountered," Horwitz says, and he has an even rarer ability "to connect the clinical examination to the deeper ideals of medicine."

This brings us to Verghese's second role. Horwitz sees him as a public intellectual whose writing can spark discussion of a crucial problem: how to reconcile medicine's scientific and technical side with its "humanistic or Samaritan foundation."

To that end, he offered his recruit an unusual perk -- a second, hidden office without his name on it. There, two days a week, he could write anything he wanted.

"Medicine is very much about narratives," Horwitz says. "It is about a patient's story and how you come to understand it." By embedding this concept in his own work, Verghese can help shape the story of medicine itself.

Or at least he can try, as he's doing right now in Nashville.

On the screen behind him is a black-and-white photograph of a Russian luminary. "Want to venture a guess as to who this might be?" Verghese asks.

"Chekhov," someone says.

Chekhov it is. Verghese wants to tell the story of how he died -- and more to the point, how his physician behaved at his bedside.

Knowing that tuberculosis would soon kill him, Chekhov felt an urge to travel. His wife took him to a spa in Germany, where a crisis ensued. The spa physician decided to send for an oxygen pillow.

"What's the use, doctor?" Chekhov is reported to have said. "Before that arrives, I will be a corpse."

The doctor changed his mind and ordered champagne.

Chekhov emptied a glass, lay down quietly on his side and died.

"I've done some very unusual things at the bedside," Verghese tells his listeners. "But I don't think I ever would have thought of ordering a bottle of champagne."

He sounds like a doctor who thinks he's been somehow remiss -- and like a writer who wishes he'd conjured that ending himself.