PLEASE NOTE: This is a minimally-edited transcript that originates from a program that uses AI.
Anita Rao
This is Embodied from PRX and WUNC. I'm Anita Rao. Abraham Verghese has two acclaimed careers in medicine and in writing.
Dr. Abraham Verghese
Story is sort of fundamental to be a physician. I mean, if you think about it, when a patient comes to us, we get a history story is embedded in that word
Anita Rao
Today, a special episode featuring a live recorded conversation with bestselling author Dr. Abraham Verghese. We talk about how his work as an infectious disease specialist has informed his writing and how fiction has shaped the physician he's become. Plus I get him talking about topics he doesn't often discuss, like sex and relationships.
Dr. Abraham Verghese
By that criteria. I am a romantic, you know, I mean, I think the, the most powerful human emotions are in fact love and you know, trying to distinguish that, you know, falling head over heels in love feeling, which you know, doesn't last forever, and you need a different kind of love that allows it to be sustained.
Anita Rao
Those moments and much more just ahead, on Embodied.
Abraham Verghese has built a life at intersections of countries, careers and curiosities. He was born in Ethiopia in 1955 to two Indian immigrants. His medical training was split between Ethiopia, India, and the us and he's become renowned for his contributions to both medicine and literature authoring, critically acclaimed nonfiction like my own country and bestselling fiction like Cutting for Stone.
At the core of his success in both fields is his attunement to story. The ability to deeply understand people that served him as an infectious disease physician during the hiv aids epidemic is also what makes his writing so breathtaking. He is sensitive to the fragility of life and the fundamental human need for connection.
I personally know a lot of doctors. Many are in my immediate and extended family. Some are family friends, and I've been hearing stories about their craft since I was a little kid. There's a lot about practicing medicine that is hard to relate to or frankly makes my stomach turn. But reading the work of Dr. Verghese has helped me see what storytelling and medicine have in common. They hinge on uncovering the missing details and leaning in to curiosity. This is embodied a show about sex, relationships, and health. I am Anita Rao.
Today a special episode of the show, a recording of a live conversation I had with Dr. Abraham Verghese earlier this summer. He was on tour for his recent bestselling book, the Covenant of Water, and I was eager to talk to him about medicine, writing in the body, all while understanding how the worlds he builds in his novels reflect elements of his own life and the questions he's personally working through.
This event was recorded in front of an audience of 400 people in Pittsburgh, North Carolina, with McIntyre's books at the Farrington Barn. I started by asking Dr. Verghese about the moment that set him on the path to becoming a writer after he'd already established himself as a physician.
Dr. Abraham Verghese
I never had any ambition to be anything other than a physician, and even to this day, I sort of resist the notion that I wear. Two hats, you know, a writing hat and a, a doctor hat. I, I think of myself as all physician in the sense that I look out at the world through a, through a lens that was formed early as a physician. I mean, I recognize it's a bit disingenuous now. I clearly am a writer. You're not here to see me about your cough or your abdominal pain. Um, but I think the moment that I. I decided I really wanted to write was I was in Tennessee in a town of a population of 50,000. I had just trained in Boston in infectious diseases, and the thinking had been all, all across the country. That AIDS was very much at urban condition. Yeah. And certainly when I first got to the town in about 85, I saw no HIV. But then gradually I began to see. One patient and another. And in a fairly short time, I had accumulated almost a hundred people with HIV infection, which is an extraordinary figure, uh, for that town. The mystery of why a small town should have that much. HIV turned out to be not that big a mystery after all. Uh, it wasn't that the town was a hotbed of. Sexual intrigue and duplicity, which it might have been. But, um, instead, I, I had stumbled onto what I thought was a, a paradigm of migration that I was certain was happening in every small town. And the paradigm was very simply, young man grows up in a small town, leaves for the same reasons you and I might leave jobs, education, but they were also leaving because they were gay and didn't want to live that lifestyle. Under the close scrutiny of their friends and relatives, went to the big cities, found themselves, and sometimes decades later, the virus had found them. And typically their partners had died and now they were coming home to family. And there I was, uh, their physician and I, I wrote a scientific paper describing this. Phenomenon of migration, which I thought was happening elsewhere and the paper got a lot of attention, but I felt that the language of science didn't begin to capture the, the tragic nature of this voyage didn't begin to capture, you know, the heroism of these, these young men or the. Or the families, you know, who are extraordinary in the way they received them and cared for them. And it didn't begin to capture, capture my own grief at living through this again and again with every single patient. And that was really the moment that I, that I thought I would write. And I, I actually, I thought I would do it as a novel. And it's sort of strange how it turned out to be a nonfiction book. So to me, writing is a way of understanding what I'm thinking. And I, I think there's something magical about. Putting words to it that isn't quite captured by for me in any other way.
Anita Rao
Why do you resist the notion that you're someone who wears two hats?
Dr. Abraham Verghese
I, I, uh, I have a lot of good, good writer friends, and I, I always feel that I have, uh, the great luxury of having a day job. I love, and, you know, I, I can take my sweet time. Writing a book. It doesn't have to be tomorrow. And, uh, you know, if, if, if a book doesn't succeed, don't get me wrong, I want the book to do well, but if it doesn't, it's not the end of my life in, in any sense. And I think for many of my writer friends, everything is writing on the next book, the, the college Jewish, and for their kids and the payments and so on. I, I've been very fortunate to be un, you know, free of that pressure. So I'm sometimes asked for. Writing advice. And when I give the advice, people think I'm being facetious, but I'm actually quite serious. I always say, get a good day job one that you love, because I think there's, you know, there's nothing harder than to be writing under great financial pressure, you know, and I've never had that. Also, I think I, I, I feel like I'm not really a right in the league of some of my good friends, because, you know, since 1994. I've produced four books.
Anita Rao
Many of them bestsellers have
Dr. Abraham Verghese
Joyce Carol Oates has written a novel since breakfast this morning. You know, so I think the kind of productivity I associate with real writers is something that I, I just could not do. And, you know, probably if I had a choice, I wouldn't do it at all. I'd rather be doctoring. So maybe that's why I resist the, the, the cap.
Anita Rao
So you recently gave a commencement speech at Harvard, and in it you used a quote that I've heard you use a lot, which is fiction is the great lie that tells the truth about how the world lives. What were some of the central truths you were hoping to explore in Covenant of Water?
Dr. Abraham Verghese
You know, I, I, I, I love that quote because to me. It seems fairly self-evident. We raise our children with stories, and it's always shocking to me that when people come of age, especially my male medical colleagues, they somehow feel that they're above fiction. You know, I'm a serious kind of guy. I read non-fiction biographies and I said, really? Have you heard of Uncle Tom's cabin? Because Uncle Tom's cabin effectively ended slavery in this country. One novel. Took the country by storm and made the idea unpalatable. Uh, in the uk, a novel called the Citadel, again, caught the public's attention and is given credit for starting the National Health Service, this novel describing medical conditions in a small town. So, you know, it's, it's my way of saying that fiction's important for children. We raise them on stories, we raise them on fables, we raise them on. You know, on increasingly complex stories, and it seems to me ashamed that as adults, we think we're we're beyond them. Uh, but that said the question you asked, what was my truth that I'm trying to convey, I must say, I think that's a tough question because, um, I don't really have an agenda with anything. I'm with a novel that I'm writing. I'm speaking as though I have this long. Library of novels. I've written, I've got two, but, but my agenda is very simply a good story well told. There's nothing more I'm trying to do. Um, and I'm conscious that if a story resonates with the reader, it's typically because there are elements in there that resonate for them, uh, as being true. And it's very individual. I mean, Proust said that the novel is an optical instrument that reads the reader.
Anita Rao
Hmm.
Dr. Abraham Verghese
cause I think each reader has a very different response to every novel. So I, I think of, I think of a novel as a collaborative act. Uh, the writer provides the words, the reader provides their imagination. And somewhere in middle space, this mental movie, this fictional dream takes shape. And it's very unique to each reader. And so that's why if you've ever loved the book and gone to see. The movie version of it, you've, you're often upset that they cast Antonio Bandera in the role that you picked for Tom Cruise or someone you know. And so getting back to your question, I mean, I, I, I get sent Master's thesis, I kid you not on cutting for stone, for example, where the thesis is all about how ESE uses. Union archetypes in order to, and I always think, oh my God, if only I was that clever. You know, because my ambition is simply not to lose the reader, to keep their attention. And the only way I know to do that is a good story well told, because that's what keeps my attention when I'm reading a novel. I mean, that said, I will say that, um, the other ambition I, I often have is I like. Bigger epic novels. I like the sense of entering a, a novel and um, very soon suspending disbelief and entering this other world and having decades and even centuries go by. And when I finally get to the end, it's Tuesday. You know, I don't know of any other instrument that suspends time in quite the same way. And so. I, I want to write shorter pieces, shorter novels, but I think the impulse is if it's working and you've pulled the reader into this world, by God, keep them there. You know?
Anita Rao
Just ahead. We'll talk more with Dr. Abraham Verghese about his writing process and the people and places from his own life that inspired his most recent epic novel, the Covenant of Water. You are listening to Embodied from North Carolina Public Radio, a broadcast service of the University of North Carolina at Chapel Hill. You can also hear Embodied as a podcast. Follow and subscribe on your platform of choice. We'll be right back.
This is Embodied. I am Anita Rao. Today, a conversation with writer and physician Dr. Abraham Verghese as a doctor. He's known for his focus on the human side of medicine. He founded a Center for Medical Humanities and Ethics in San Antonio, and established a patient-centered training program at Stanford Medicine. He's also a bestselling author. His latest book is The Covenant of Water. A generational epic that traces one family in Kerala, a part of South India that is surrounded and defined by water. But this family has an odd and tragic inheritance, and each generation at least one person dies by drowning. Dr. Verghese was recently on book tour and made a stop in North Carolina. I interviewed him in front of a live audience in Pittsboro, and we're sharing that conversation today. I had heard him talk before about how his writing process often starts with a particular image, mood or character that he can't get out of his head. So I asked him about the particular inspiration behind this book and why he chose to set it in Kerala, the place where his mother grew up.
Dr. Abraham Verghese
No, I sort of resisted the um, idea of setting a novel in India only because I wasn't born in India. I was born in Ethiopia to Indian teachers, and I spent most of my. Formative years, including the early part of medical school in Ethiopia before Civil War, uh, you know, interrupted my education. And even though I was very familiar with, with Canada, we'd go there every summer and eventually I finished medical school in India. I felt that I didn't have the authority to set a novel in India the way I did with, um, with Ethiopia, but I think that changed for me. Because of my mother. My mother, when she was in her seventies, uh, was asked by her namesake, her ne my niece, her granddaughter was asked, uh, am she, which means grandmother? What was it like when you were five years old? My niece was five years old, and my mother was just, you know, taken aback by that question. How does she describe to a 5-year-old child what her rich childhood was like? So my mother was. In order to answer this grandchild's question, she began to write in a school notebook. And she was a great artist, so she began to illustrate it too. And these were anecdotes from her childhood that we were very familiar with, except that by now, by the age of 70, they had become vastly exaggerated, I thought. And that that manuscript is a treasured document in our family, as you can imagine. And so when I was done with cutting for stone. And I was fishing around for the next book. And I, and I agree with you that geography matters to me. Geography is a character. I love the quote by Napoleon, that, that geography is destiny. 'cause it's been true in my life. You know, my parents left India, uh, at the time of independence because there were no jobs. And they traveled to Africa separately, met each other there, and that changed their destinies. And because. Because I was born in Africa, my destiny was different from them. So geography's, terribly important. Um, so after cutting for stone, I picked up my mother's document again and I suddenly had this notion that, you know, this is such a exotic part of India. And then within India, we are a community of Christians who date our Christianity back to St. Thomas the Apostle and 52 ad. So there were all these. I thought really interesting elements if I could only put it off. And I, I just had the inspiration of that moment that, that I, I need to try and, um, my mother actually became my number one researcher. She was so excited that I was going to set this novel in, in car. Uh, she was now by, by this time she was 90, it had been that much time or close to 90. And so. Mom became my number one researcher. And in fact, even a few weeks before she died, she called me up to give me another anecdote that she just remembered, and I didn't have the heart to tell her that. It was the same anecdote from the previous day. And just to give you an example of how different my parents' generation is from, from us, um, I, I said to my dad recently, my dad is 98 by the way. But until last year was doing really well. Getting on a treadmill twice a day for 30 minutes.
Anita Rao
Wow.
Dr. Abraham Verghese
Very slowly, mind you. Uh, but he hurt his knee and things have declined rapidly. But anyway, I said to my dad early on when the book had come out and was getting a great reception, I said, dad, mom must be watching over this. I said, it sort of facetiously. My dad jumped all over me. He said, of course she is, she is watching. What do you think? And I think it's an example of, uh, you know, just how concrete faith is to that generation, and it's part of what I wanted to capture is the, the sense of, um, especially my grandmothers, uh, heroic women that the world would never know anything about. And you and I all know people like that, you know, um, half of you in this room are like that. And I wanted to pay tribute to these incredibly strong women who, you know, had been through tremendous adversity and yet they were the glue that held their family together and they were so well thought of. So that's probably the only thing I knew about the book, is I'm gonna set it in Carla and it's going to be, begin with the character of a young bride off to her wedding, which was the true story of my great-grandmother, someone I never knew. But that was all I really had to start with.
Anita Rao
Let's have you read for us, uh, from the book.
Dr. Abraham Verghese
Uh, for those of you who read the book, you remember it begins with the young bride and you were essentially in our head for 15 or so pages, and then all of a sudden there's this leap out of her head into the head of the same girl, but now as a grandmother. So I thought that's the section I would read to you. I should also tell you that I. I auditioned to record the audio book and, um, people often wonder, well, why do you need to audition? You are the author. You know, I, I think it's disastrous generally for authors to read their own books and publishers will have nothing to do with your, your doing that. But I asked to audition only because I worried that someone, even of the caliber of me, Meryl Street. Would struggle with some of the tamal and Alam phrases in there. And so I mentioned this only because if my reading sounds a bit over the top to you is sort of how I learned to do it from the wonderful producers and audio text I was working with, uh, in recording the book. Sorry, it was a long preamble
Happened is happened. Our young bride will say when she becomes a grandmother, and when her granddaughter, her namesake, begs for a story about their ancestors. The little girl has heard rumors that theirs is a genealogy chock full of secrets, and that her ancestors include slavers, murderers, and a defrock bishop. Happened is happened child and the past is passed, and furthermore, it's different every time. I remember it. I'll tell you about the future, the one you'll make, but the child insists. Where should the story begin with? Doubting Thomas, who insisted on seeing Christ's wounds before he'd believe with other marchers to the faith. No. What the child clams for is the story of their own family of the widower's house, into which her grandmother married a landlocked dwelling in a land of water, a house full of mysteries. But such memories are woven from gosser threads. Time eats holes in the fabric, and these she must darn with myth and fable. The grandmother is certain of a few things. A tale that leaves its imprint on a lister tells the truth about how the world lives. And so unavoidably, it is about families, about their victories and wounds and their departed, including the ghosts who linger a story, must offer instructions for living in God's world where joy never spares one from sorrow. A good story goes beyond what a forgiving God cares to do. It reconciles families and unburdens them of secrets. Secrets whose bond is stronger than blood, but in their revealing, as in their keeping secrets can tear a family apart.
Anita Rao
Thank you so much. So you have introduced us in that passage to Big Amachi who we follow throughout the course of this novel. You, when you talk about the process of writing and writing characters, you talk about it as a process of discovery. It's not like you have every, every detail of their life and their journey from page one to page 800 mapped out, you're discovering things about them as you're writing them. Tell how, how do you do that? Like, tell us about that process of writing characters.
Dr. Abraham Verghese
Yeah. You know, I'm embarrassed to tell you about my writing process because clearly it's so inefficient. You know, um, I mean, I, I envy the writers who. Know the whole story before they begin. In fact, uh, John Irving, who's been a friend and mentor, uh, John knows the first and last line of every book. Wow. Before he begins, he knows the first and last line of every chapter. He has the chapters all listed with their titles. I mean, he may make changes as he writes, but by and large, he's got it. And John will say, he has said to me, Abraham, if you are. You have to know the whole story. You have to know what you're gonna hide under the table when you choose to reveal it to the reader. And if you are just making it up as you go along, Abraham, you're not a writer, you're an ordinary liar. And, uh, you know, I wish I could get to that place. And so. With this book and with the previous book, I, I had a large whiteboard. I drew out the whole story as I thought I had it figured out. But then every time I came to this place where a character was placed in crisis or under pressure, the character would almost decide they're not going to do this. It would actually surprise me, and, and they would go off in another direction and invariably they were right. And so I would then have to photograph the whiteboard and. Start all over again. And it was very reassuring. Uh, some time ago I had the, uh, great fortune of interviewing Michael Andante on stage in San Francisco, and Michael lives in Toronto, the same place John Irving lives. And so I asked Michael this question about knowing the whole novel, and I quoted John Irving and Michael said, you know, John said the same thing to me, you know, and he went on to say something very profound, which I thought was true. He said, I think. If you're finding the novel through the writing, eventually you get to the same place. Hmm. As John is where he begins. But John has done months of research ahead of time, and that was certainly true for me. I think it was about six years into writing this novel. I suddenly saw the ending. It surprises people to know. I didn't know, know the ending till then, but the moment I saw it, it was so reassuring. I felt a load. Fall off my chest because now I could make sure that every chapter, every scene was working its way towards that ending. I could get rid of extraneous things that, you know, might have been entertaining, but they weren't serving the story. Um, yeah. So I wish I could talk about a process. I'll make another confession. I, I, um, whenever I visit a bookstore such as the fabulous stores that, that you have access to in this area, but especially McIntyre. You know, I, I go inevitably at some point I go to the section that's, uh, it's got a special name. It's not rhetoric. It's, I'll remember it tomorrow probably, but it's the place where they have all the how to write books. Hmm. And I'll obsessively buy the latest. Uh, and I only gave that up fairly recently when I picked up this. You know, effectively one of those, how to write a novel in 30 days kind of things, and found that they were quoting me. So that tells you that I didn't have much to learn there. But
Anita Rao
Do you remember the quote?
Dr. Abraham Verghese
I'm sorry?
Anita Rao
Do you remember the quote?
Dr. Abraham Verghese
No, but it was like, you know, quoting me as though I knew what the hell I was doing, you know?
Anita Rao
So there is a curse at the core of this book. It is a drowning curse based on a real life disease that you had learned about. What were the aspects of the real life disease that you thought lent themselves well to exploring through a novel?
Dr. Abraham Verghese
Yeah. You know, it's kind of strange how, how this works. Maybe my subconscious mind knew more than I, than I consciously did, but as a long time teacher, medical students in. Five different medical schools now, uh, across the country. You know, I keep a, uh, I keep a collection of rare diseases in my back pocket. Not literally, don't worry. But, you know, there, these are rare conditions that every now and then when there's a lull, uh, you know, in the discussion, I'll chart it out in the form of a riddle or the form of a. Question. And so this disease, which is really quite rare in America, it's only been described, uh, in two kindreds in which it was familial. Uh, and this is somewhere in Pennsylvania, but for some reason this rare disease stuck in my head and I would often ask it of residents in the form of a, a riddle. What, what are the, what is the cause of drowning occurring in. Generation after generation and these individuals in these families are drowning in the most shallow bodies of water. And it's not cardiac because there are a couple of rhythm related things that could do this if you plunge into cold water. And so this disease was, is a rare disorder where you know, balance is affected. You compensate for it in general using your eyes and your feet being planted on the ground. But the moment you're in water. You no longer have those mechanisms for compensation and you can wind up sort of diving to the bottom instead of trying to come to the surface. And so I chose the disease because water is such a constant metaphor in Kerala. I mean, people literally swim before they walk. And so to have a condition that allowed, that made a child not want to enter water or flounder in it would have them really stand out. And I chose it also because one of the great joys of my professional life has been, you know, to have practiced this long and in that time seen diseases that were just, just had names in medical school with no understanding of what they were. And then over time, have them characterize better, maybe even the cellular and molecular mechanism. Fully elucidated, then finally a treatment. And so in my, you know, 40 plus years of practicing, I've seen that happen. And so I wanted to pick something so that each generation would, uh, know more about it and ultimately by the third generation it would be solved. So that's kind of where that came from.
Anita Rao
So one component of the disease, uh, in addition to disorientation in water is hearing loss and the, uh, character, big amachi son Phillipos struggles in particular with deafness and perceptions of him being deaf. Deafness is something that you have struggled within your own life. You identify as hard of hearing. How has your own experience with your hearing loss informed how you wrote Phillip posts?
Dr. Abraham Verghese
Yeah, I think that was, that was the part I was referring to as subconscious, because I don't think I picked it because of the hearing loss. And, um, the hearing loss is probably not the dominant feature of this disease. And I, I certainly took some liberties with my characters there, but I was writing this book during COVID, which was very poignant to begin with because it had echoes of my AIDS experience, except a new generation was at the front line. I mean, I was very much. In the, in the thick of it. But it was nice to see my junior colleagues coming of age with this new, new disease. And during COVID, I suddenly realized when we were all wearing masks, that I was lip reading a whole lot more than I had, uh, had ever imagined. And so, even though I had introduced this condition in there, the deafness became something that I would amplify. Not consciously ahead of time, but because in that moment it just seemed like, uh, you know, very important to me.
Anita Rao
Did writing the character Philip Post, help you process anything about your own journey and, and relationship with losing your hearing?
Dr. Abraham Verghese
I'm sorry, one more time. This is the hearing. No, seriously. One more time. Yeah. No, we're my thoughts. Were elsewhere for one moment.
Anita Rao
You're fine. Um, did writing about hearing loss help you process anything about your own relationship to it?
Dr. Abraham Verghese
I mean, I think it. I, I didn't realize how, how sad I was about the hearing loss. 'cause it's really is a, it gets in the way of a lot of stuff, especially the stuff that's most important to be practicing medicine.
Anita Rao
Yeah.
Dr. Abraham Verghese
Um, so I suppose in that sense it helps.
Anita Rao
Just ahead, we'll learn about the book that changed Abraham Verghese's life and set him on the path to becoming a physician. We'll also dig into how Dr. Verghese approaches writing sex and romance in his novels. As always, you can hear the podcast version of the show by following embodied on your platform of choice, and you can find behind the scenes content, including photos and videos from our live event with Dr. Verghese on Instagram. Find us by searching at embodied WC. Also follow us there to learn more about new episodes and get updates about future events. We'll be right back.
This is Embodied. I'm Anita Ra. Earlier this summer, I interviewed Dr. Abraham Verghese, a bestselling author and acclaimed physician. He was in North Carolina as part of a book tour for his most recent novel, the Covenant of Water. We talked about how his early career as the solo infectious disease physician navigating the HIV AIDS epidemic in a small town inspired him to start writing and how he's explored parts of his own upbringing and identity through fictional characters. We are gonna talk in just a moment about how he approaches writing about sex and romance in his work, but first yet another connection in his life between medicine and storytelling. Not only did practicing medicine lead him to writing, but reading fiction also led him to medicine.
Dr. Abraham Verghese
My brother, who is, who was clearly a, a genius at the age of eight, it was quite evident that. He had this precocious talent for math. He's now a professor at MIT. Uh, when he announced to my parents that he was going to be an engineer, their joy was something to behold, you know? And, um, I think that was my first awareness that in Indian families, which I think are very much like Jewish families, your choices in life are, you can be a doctor, engineer, lawyer, or failure. These are your choice. And I remember not wanting to feel left out when my brother said that, and so I announced I want to be a physician. Their silence was very much like yours because unlike my brother, I, my only aptitude seemed to be getting into trouble and I really, you know, had no particular sign of any particular talent. But I loved to read. Mm. And I was a precocious reader. I, I remember reading Lady Chatterley's Lover when I was nine, and, uh, I picked up the novel that was to change my life because the title held Great Promise and the title was of Human Bondage by Somerset Mom. And it turned out that the book was far better than anything I could have imagined. And for those of you who recall the protagonist, Philip as a, as a young boy with a club foot, and he appears on page one to be brought to his mother's deathbed. The short story is he is grown up in a foster family. He is bullied and is only escape as he wants to be an artist and he goes to Paris, but to become an artist and then six months into this living the life he dreamed about. He realizes that he, you know, he is not got the talent to make this, uh, worthwhile suffering like that. And so he returns to London with the, his tail between his legs to resume a professional education and he enters medical school, I think because of his club foot. And in his third year, the clinical year, Philip is on the wards. And all of a sudden he has this moment where he says, Philip saw humanity there in the rough, the artist's canvas. And he said to himself, this is something I can do. This is something I can be good at.
Anita Rao
Hmm.
Dr. Abraham Verghese
And those lines just leapt out at me and they said to me that not everybody could be a, a math genius or a genius like my older brother, but anybody with a curiosity about the human condition and a willingness to work hard could be a decent physician. That's what I took away. And I think books were also teaching me. You know how powerfully they can change the direction of this big ship that you're sailing, that's called life. And they can shift it in profound ways, you know, which is why it saddens me deeply too, to think that in America today we have books that are being excluded from libraries by virtue of the opinion of someone on the school board or the government decree. And you know, I think we need to trust readers enough. To allow the book to read them and for them to respond if there's echoes for them. But yeah, so that was the moment that I found my calling.
Anita Rao
One of the things that you write so powerfully about in the book, in so many different settings is the power of physical touch. What do you think it is about touch that can be so particularly healing for people who are. Struggling from, from medical conditions or, or, or who are in the process of trying to heal?
Dr. Abraham Verghese
Well, I'm not sure. I want to suggest that the touch itself is, is healing. I mean, there's a, there's a whole lot of slightly hokey literature on around that. Yeah. You know, I don't want to sort of claim any of that, but I'll just say that as a medical student, I was utterly fascinated by the kind of professors who could, you know. Uh, look at a patient and quickly percuss them, which is, you know, like an old time ultrasound, if you like. And, and then draw out what the chest x-ray was going to look like. Mm. And to me, that was a kind of magic. And so I've always enjoyed the physical exam of the patient. Essentially, you're reading the body for all the phenotypic clues that you can't get elsewhere. You can't order a test. But more than that, I think I've, I've become much more. Conscious of the strangeness of this ritual. I mean, if you think about it, when a patient comes to physician, you have a, a stranger coming to another stranger telling them things that they would not tell their rabbi or preacher or imam. And all of this is in a room whose furniture is nothing like the furniture in any room in your house or mine. And one individual is wearing a. White shamanistic outfit with strange tools in the pocket, and the other is wearing a paper gown that no one knows how to tie or untie. That's part of the mystery. That's part of the, and then incredibly one member of this dyad disrobe and allows touch, which you know, in any other context in our society is assault. But the great. Privilege of, of practicing medicine, which comes with a fiduciary responsibility, is that we are allowed to do this in the context of, you know, a skilled extraction of phenotypic clues that the bodies offering. And I think patients are very aware of ritual and they, they know that if, if, if after setting up this ritual, all you do is a half-ass proud of the belly. And put your stethoscope on the patient's gown, they are onto you. Mm-hmm. They know that they're not doing what the ritual deserves. It's just as you and I are great judges of the skills of a, a mechanic, a hairdresser, a barista. We may not know how to do what they do, but we always know when we see someone doing something with great skill and the signs of great repetition. So I've spent a career really trying to emphasize the importance of this to my students. And I remember one time when a patient had been too weak to come to the clinic, a patient that I'd gotten to know for so long, young man my age at the time, my thirties, and um, he was too weak to come to the clinic yet he wasn't sick enough for me to put him in the hospital. And even if I did, there wasn't much I could do. And so. It just sat with me all day, and at the end of the, that day, I, I decided to go and see him for my purposes. And when I did, I found to my astonishment that my visit had a profound effect on him and on the family, helping them to come to terms with the illness. And I, I stayed there for a while, and when I was leaving this trailer way out of the country, I remember thinking, you know, this is what the horse and buggy doctor of a hundred years ago. Did so well. In the absence of all the cures we now take for granted, you know, they were able to bring about a healing by which I mean a coming to terms by being there. And so I struggle to describe this. The analogy I use with my medical students is this. I say picture after rounds. You go back to your apartment and you find that the door is open, even though you locked it in the morning. You find your lock is in splinters. You find all your belongings are soon around and your valuables are all missing. At that point, you will suffer a, a physical loss of valuable stuff, but you'd also suffer a sense of spiritual violation. Someone broke into your sacred space, and if the police come by 10 minutes later and say, we found the person who robbed you. Here's all your stuff back at that moment, you're cured, but you're not healed. Your sense of violation may be so strong that you decide to leave to another apartment building. So I think all illness has those two components. A physical sense of, you know, something lost and a spiritual violation. And I think in western medicine we often forget how powerful, how powerfully we can act to help with the spiritual violation, but not by some magic. You know, mantra, but simply by acknowledging it's there by, by being there, by presence. And so that's the closest I can get to the. The touch and the healing part.
Anita Rao
Yeah, no, I like that a lot. You did a long series of podcast episodes with Oprah where you all went kind of part by part in the book, and there were listener questions that she put on a video, and there was one particular moment and one of the listener questions where. Uh, young Indian woman, probably about my age, said, um, so in Indian culture, we say uncle is a term of respect. And she said, Abraham uncle, I was reading your book and I couldn't believe that Abraham uncle was writing about sex.
Dr. Abraham Verghese
About sex?
Anita Rao
About sex. And she asked you a question about it. I don't know if you remember that interaction, but Embodied is a show. About sex, relationships, and health. So I needed to also ask you, Abraham Uncle, what is it like for you to write about sex?
Dr. Abraham Verghese
Yeah, I mean, uh, I don't remember that question to be honest. You know? And did they assume that, uh, that I, I mean, I had three children by then. I don you would think that they knew I wasn't asexual.
Anita Rao
Well, you write, I mean, you're the, there are a number of really beautiful sex scenes in this book. So she was, I think, nodding to Oh, I see. Okay. The way that you write these scenes. Really well,
Dr. Abraham Verghese
Well, thank you. I mean, I'm not sure that I set out consciously to, to sort of write a, a, a sex scene. But for example, the scene between Big Amachi. And her, her husband, her the, the older widower. I mean, he waits a long time
Anita Rao
Mm-hmm.
Dr. Abraham Verghese
Until he thinks that she is, I mean, she's a woman and she's, you know, ready for him. Not just, not just, uh, menstruating. And there's, in my thinking of that moment with my great grandmother, I have no idea what it was like. It seemed to me a profoundly tender and religious sort of. Moment. So I, I, I think, I'm not very, I think to be very graphic would actually rob from a scene like that. So I don't think I've ever been quite that graphic, but I don't think I ever think about sex scenes, you know? Yeah. Okay. Tomorrow I'm gonna write the sex scene. Yes. I'm not sure what more to say about that.
Anita Rao
But, but you are a, you are a romantic, you self-identify as a romantic,
Dr. Abraham Verghese
You think so?
Anita Rao
I, I've heard you say that. I've heard you say I'm asking you.
Dr. Abraham Verghese
Well, I mean, but expand on that. Why? Because of the way I.
Anita Rao
Well, I think the Roman, the romance in this book, it's so clear that there are such big stakes for the characters. Characters who want love and want romantic connection so badly, but also are so aware of the risk of losing it. I feel like that is so palpable in all of the relationships in the book.
Dr. Abraham Verghese
You know, I think that's, that's beautifully said, and I suppose by that criteria, I am a romantic, you know, I mean, I think the, the most powerful. Human emotions are in fact love. And you know, trying to distinguish that, you know, falling head over heels in love feeling, which, you know, it doesn't last forever. You need something, you need a different kind of love that allows it to be sustained. And I think the example of my, my parents in that generation was, it makes me humble to think how when I was young, I scoffed at arranged marriages because it seemed so. Primitive, you know, and now you look at Bumble and you know all these other apps you have, how exactly is that different? You know, it's the same thing about strangers connecting. And I think the difference of that era was that they tried their best to match people together who came from similar backgrounds as best they could. Obviously there were many disastrous ones. And then what counted wasn't the falling over a cliff? Love euphoria. What counted was your commitment to sort of making this forged love work? You know, it's something that I've not been, you know, entirely successful at in the past. And so, yeah, but I guess by the criteria of thinking of love as being important, as recognizing it as a, a driving force, I'd like to think in all our lives, um, yeah, the generation before me, my parents. You know, they're both physicists and they landed up in Ethiopia to teach physics, and they're utterly mysterious as to how they met and married. And they met within two or three weeks. And you know, we all, we always thought as her, as children, we thought that it had something to do with chemistry or perhaps physics, you know, but it's not the sort of thing. I don't know why I could ever ask my mom. Or dad directly about you just did not. So I think for their generation, this was not so much pretending it wasn't there, but it was very private. It was not something for anyone to know about or talk about. And I think we, we were much more at ease about putting names on this. Um, to harken back to that sex scene in, you know, 1,906 or something, I was trying my best to, to bring the coness and mindset. That I projected was true and is true. I thought of my grandparents' generation and, and yet describe an act that was incredibly, you know, in its own way, momentous, erotic, all those things. And so, uh, I think that's where that particular scene came from.
Anita Rao
My last question is, so you spent,
Dr. Abraham Verghese
Thank goodness 'cause we're getting closer and closer to you, very personal things, getting over
Anita Rao
here. So you spent 11 years writing this book. It came out about two years ago. How are these characters still with you in the day to day?
Dr. Abraham Verghese
Yeah, I think the characters are very much still with me. I mean, I think if you, when you get to the point that they feel truly alive for you at that point, mostly you think that the reader will also see them the same way. They become most alive for me when they do something that I hadn't predicted in a sense. You know, and there's a writing aphorism that goes, character is determined by decisions taken under pressure. And you can describe characters, their speech, they, they're, that, their job, but it's only when you put them under pressure and they respond that they become alive. So yeah, my characters are very much alive in my head. I mean. Uh, I don't dwell on them a lot, but it's not as though finished the book and they're, and they're gone. But what is even more gratifying is that they're, they're alive in the heads of readers who've encountered them. And so in that sense, they never die. And that's, uh, so satisfying as a writer to, to think that.
Anita Rao
Thank you so much to Dr. Abraham Verghese and the McIntyre's books in Fearrington Village for inviting me to host this conversation. You can find out more about Dr. Verghese and see photos from the live event at our website, embody w unc.org. You can also find all episodes of Embody the Radio Show there and subscribe to our weekly podcast.
Today's episode was produced by me and edited by Amanda Magnus. Kaia Findlay is our producer, Nina Scott, our intern, and Jenni Lawson, our technical director. This program is recorded at the American Tobacco Historic District, North Carolina Public Radio is a broadcast service of the University of North Carolina at Chapel Hill. I'm Anita Rao.