Advertisements
Feeds:
Posts
Comments

Posts Tagged ‘writing’


Abraham Verghese, MD, Physician and Notable Author

Curators: Larry H. Bernstein, MD and Aviva Lev-Ari, PhD, RN

LPBI

Series E. 2; 12.3

There are few who combine a career as physician, teacher and author as well as Abraham Verghese, whose name is a frequent byline in newspapers and magazines across the world, and more recently, in demand as aTED speaker. He himself is also a regular focus of attention in media – both medical and general – that range from National Public Radio, the New England Journal of Medicine, and the New York Times to The Guardian, and The Times of India.

His work as a physician informs his writing and the reflection that comes through his writing helps him empathize with his patients, and to see them individually, as human beings who are suffering, fearful and in need not just of treatment, but of comfort and reassurance. Imagining his patients’ experience has driven his work throughout his medical career. His emphasis on empathy and healing is the focus of his talks, nationally and internationally, as he stresses the importance of the patient-physician relationship in an era of advances in medical technology that often tend to de-personalize medical care.

“I still find,” he says, “the best way to understand a hospitalized patient is not by staring at a computer screen, but going to see that patient. For it is at the bedside that I can figure out what’s important to the patient and how the data you have accumulated makes sense.”

Abraham Verghese talks about medicine and fiction to Kim O’Dell of the Heinz Foundation after receiving the 2014 Heinz Award for Arts and Humanities.

Abraham Verghese, MD, MACP, is Professor and Linda R. Meier and Joan F. Lane Provostial Professor, and Vice Chair for the Theory and Practice of Medicine at the School of Medicine at Stanford University. He is also a critically acclaimed, best-selling author and a physician with an international reputation for his focus on healing in an era where technology often overwhelms the human side of medicine. In February 2014, he received a Heinz Award from Teresa Heinz and the Heinz Family Foundation. The awards given annually in the areas of Arts and Humanities; Environment; Human Condition; Public Policy; and Technology, the Economy and Employment, celebrate the enduring spirit of hope and the power of innovation.

Early Years

Born in Addis Ababa in 1955,  the second of three sons of Indian parents recruited by Emperor Haile Selassie to teach in Ethiopia, he grew up near the capital and began his medical training there. When the emperor was deposed, Verghese briefly joined his parents who had moved to the United States because of the war, working as an orderly in a hospital before completing his medical education in India at Madras Medical College. Both the civil unrest and this time as a hospital orderly were to leave a significant mark on his life and work.

After graduation, he left India for a medical residency in the United States and, like many other foreign medical graduates, he found only the less popular hospitals and communities open to him, an experience he described in one of his early New Yorker articles, The Cowpath to America.

From Johnson City, Tennessee, where    he was an internal medicine resident from 1980 to 1983, he moved to the Northeast for a fellowship at Boston University School of Medicine, working at Boston City Hospital for two years. It was here that he first saw the early signs of the HIV epidemic and later, when he returned to Johnson City as an assistant professor of medicine, he saw the second epidemic, rural AIDS, and his life took the turn for which he is now so well known – caring for a seemingly unending line of young AIDS patients in an era when little could be done other than help them through their premature and painful deaths. Long before retrovirals, this was often the most a physician could do and it taught Abraham Verghese the subtle difference between healing and curing.

First Books

Abraham Verghese’s early years as an orderly, his caring for terminal AIDS patients, the insights he gained from the deep relationships he formed and the suffering he witnessed were intensely transformative. These were the cumulative experiences around which his first book, My Own Country: A Doctor’s Story, is centered.

Such was his growing interest in writing in the late 1980s that he decided to take some time away from medicine to study at the Iowa Writers Workshop at the University of Iowa, where he earned a Master of Fine Arts degree in 1991. Since then, his writing has appeared in The New Yorker, Texas Monthly, Atlantic, The New York Times, The New York Times Magazine, Granta, Forbes.com, and The Wall Street Journal, among others.

After leaving Iowa, he became professor of medicine and chief of the Division of Infectious Diseases at Texas Tech Health Sciences Center in El Paso, Texas, where he lived for the next 11 years. In addition to writing his first book, which was one of five chosen as Best Book of the Year by TIME magazine and later made into a Showtime movie directed by Mira Nair, he also wrote a second best-selling book, The Tennis Partner: A Story of Friendship and Loss, about his friend and frequent tennis partner’s losing struggle with addiction. This was named a New York Times’ Notable Book.

Emphasis on the Physician-Patient Relationship

He left El Paso in 2002 and, as founding director of the Center for Medical Humanities & Ethics at the University of Texas Health Science Center San Antonio, he brought the deep-seated empathy for patient suffering that had been honed by his previous experiences to his new role in the medical humanities.

He gave the new Center a guiding mission, “Imagining the Patient’s Experience,” to emphasize the importance of interactive patient care. He saw empathy as a way to preserve the innate caring and sensitivity that brings students to medical school, but which the rigors of their training frequently suppress. In San Antonio, also, he became more focused on bedside medicine, inviting small groups of medical students to accompany him on bedside rounds. Rounds gave him a way to share one-on-one the value he placed on the physical examination in diagnosing patients and demonstrating attentiveness to patients and their families, a vital key in the healing process.

Dr. Verghese’s deep interest in bedside medicine and his reputation as a clinician, teacher and writer led to his recruitment to Stanford University School of Medicine in 2007 as a tenured professor and senior associate chair for the Theory and Practice of Medicine. He has since been named the Linda R. Meier and Joan F. Lane Provostial Professor Vice Chair for the Theory and Practice of Medicine at the Stanford School of Medicine.

In his writing and his work, he continues to emphasize the importance of bedside medicine and physical examination in an era of advanced medical technology. He contends the patient in the bed often has less attention than the patient data in the computer. His December 2008 article in the New England Journal of Medicine, Culture Shock: Patient as Icon, Icon as Patient, clearly lays out his viewpoint.

In his novel, Cutting for Stone, he also addresses the issue.

“I wanted the reader to see how entering medicine was a passionate quest, a romantic pursuit, a spiritual calling, a privileged yet hazardous undertaking,” he said. “It’s a view of medicine I don’t think too many young people see in the West because, frankly, in the sterile hallways of modern medical-industrial complexes, where physicians and nurses are hunkered down behind computer monitors, and patients are whisked off here and there for all manner of tests, that side of medicine gets lost.”

Today, as a popular invited speaker, he has more forums than his writing to expound on his views on patient care. He talks nationally and internationally on the subject, in addition to talks and readings from his books. He has also led the effort at the Stanford School of Medicine to establish the Stanford 25, where residents and students are taught techniques and skills to recognize the basic phenotypic expressions of disease that manifest as abnormal physical signs.

More About Abraham Verghese

Physician Returns: Stanford Medical Center Report

Bedside Manners: Q/A with Abraham Verghese in Texas Monthly

Treat the Patient, Not the CT Scan: Op Ed in the New York Times

Click on a topic or read the entire series.

Bedside Medicine
Books – General
Cutting for Stone
Cutting for Stone, Origin of the Title
Ethiopia
Favorite Writers
Fiction Writing
Future
Home
Medicine
Medicine and Writing
Success
Suffering
Training as a Writer

Bedside Medicine

You talk a lot about the lost art of bedside diagnosis. Can you describe what that is and why losing it is a bad thing?

As we’ve gotten very fancy in technology and the incredible detail with which we can see the body, we sometimes lose sight of how much we can see about the body just from examining the patient. The physical exam really allows you to order tests more judiciously and to ask better questions of the test.

Tell us about your vision for teaching medical students and physicians.

Yes. I’ve learned by coming full circle that the most important way we have to influence medical students and residents is really at the bedside, one by one. There really is no shortcut; there is no classroom lecture that can substitute. Stanford has such a wonderful reputation for research, and we wanted to try and make sure that it also had an equivalent reputation for the clinical training of our students and our residents.

So the clinical encounter at the bedside is terribly important. In other words, you can have all the theoretical knowledge in the world, and if your interaction with the patient is somehow clumsy and not done well, the relationship won’t even begin.

The computerized medical record, along with burgeoning technology, has seriously threatened the patient/physician interaction in the hospital.

I would contend, and I will keep saying this till the day it stops being true, that the patient in the bed has now become an icon for the real patient, who is in the computer, the patient I call the iPatient. The patient in the bed simply exists to signify that there is a file in the computer.

Now, of course, I’m being facetious. We clearly pay attention to the person in the bed, but what I mean to say is that looking at the body, orienting oneself from the body has become almost passé. The body is viewed as incidental, in many cases for good reason, because a mammogram or CT scan can perhaps see much more clearly than the human hand. Nevertheless, there are things that only the human hand can find, like whether it’s painful in a particular spot. That’s not something that any machine can tell you. There isn’t any machine in the world that can do a knee reflex and convey the information of a tendon reflex. There are elements of this exam that are so important, and in this era of biomarkers and other sexy tests, we have forgotten the value of the good physical.

What is it about the practice of medicine today that prompts doctors to rush into ordering tests vs. taking their time to do the bedside diagnosis?

For one thing, the tests are very, very good. The kind of detail you can get from a CAT scan is far superior to what your hand can tell you. On the other hand, only your hand can tell you where it hurts by pushing on a certain place. … We’re all intrinsically prone to allowing technology to take the place of common sense and I think that’s a danger. … The tests have become an easy shortcut. They’re an efficient, quick way to get information. But the great danger I see is this: I think that people fail to really connect with patients when they don’t examine them. I think the carefully done physical is a wonderful way to convey your attentiveness to the patient.

How can professors and medical schools help address the primary care shortfall?

It’s a struggle … but if you’re going to do it, you’re going to do it only by showing them the charm and the magic of being at the bedside. There is no passion and romance that you can illustrate to them in front of a computer, which is where a lot of care takes place these days. The only way to excite students about medicine is to do it one by one, by them seeing you being the kind of physician that they’d like to be.

Your two non-fiction books are very autobiographical. What’s the difference between penning fiction and non-fiction? How was the process of writing Cutting for Stone different for you than penning the other books?

I must say that fiction was always my first love; indeed, one of my first published stories as a very dark AIDS story titled ‘Lilacs’ which appeared in the New Yorker. That led to my getting a contract to write My Own Country, a non-fiction book about my AIDS practice and experience in small town Tennessee, followed by another memoir, The Tennis Partner (the story of the loss of a physician friend to drug addiction and suicide). These were things I had witnessed that I had to tell, but when I was done with the second book, I was keen to get back to fiction.

What was so different about writing a novel for me was that sense of discovering the story (unlike non-fiction, where you sort of know what happened and what you will write about–the story has presented itself so to speak, and now it is about selection). My ambition for the novel was tell a great story, an old-fashioned, truth-telling story.

All I had at the outset was an image of a beautiful Indian nun giving birth in a mission hospital in Africa, a place redolent with Dettol and carbolic acid scents, a place so basic, so unadorned, that nothing separates doctor and patient, no layers of paperwork, cubicles and forms. That is all I had. I did not know the whole plot or how it ended. (and see answer to next question as to how I eventually did plot, and even then there were surprises).

did know that I wanted the whole novel to be of medicine, by which I mean I wanted every person, scene and place to be informed by medicine, kind of the way that Zola’s novels are of Paris. I wanted very much to celebrate an aspect of medicine that gets buried in the way television depicts the practice: I wanted the reader to see how entering medicine was a quest, a romantic pursuit, a spiritual calling, an undertaking that could put you at some personal risk (of losing your selfhood, your obligation to family) but which could also save you. It’s a view of medicine I don’t think too many of my students see – we live in a world of haste where physicians and nurses are hunkered down behind computer monitors, and patients are whisked off here and there for this and that test, that side of medicine gets lost.

What inspired you to write each of your books? Was there a moment of epiphany for each one, when you decided that you simply had to put that story down on paper?

Many moments of epiphany in all of my books. There was no real moment in time when any of them started, but very often for me, writing about something is a way to understand it better, or just understand it in the first place. I became a character in the stories with a sense of discovering the import as I wrote rather than writing because I understood it.

Living through the time of AIDS in Tennessee, and helplessly with David as he was spiraling down in El Paso – writing these first two books helped me more deeply understand those experiences. With Cutting for Stone, I arbitrarily chose twins, then twins became the motive for the story, and ultimately they were the focus for the characters’ redemption. I could not have anticipated any of that when I began writing, but it became clear as I progressed. A series of epiphanies, you could say.

Was there a single idea behind or genesis for Cutting for Stone?

My ambition as a writer was to tell a great story, an old-fashioned, truth-telling story. But beyond that, my single goal was to portray an aspect of medicine that gets buried in the way television depicts the practice: I wanted the reader to see how entering medicine was a passionate quest, a romantic pursuit, a spiritual calling, a privileged yet hazardous undertaking.

It’s a view of medicine I don’t think too many young people see in the West because, frankly, in the sterile hallways of modern medical-industrial complexes where physicians and nurses are hunkered down behind computer monitors, and patients are whisked off here and there for this and that test, that side of medicine gets lost.

So I began with the image of a mission hospital in Africa, redolent with Dettol, the antiseptic of choice of the tropics; I wanted to portray a place so basic, so unadorned, that nothing separates doctor and patient, no layers of paperwork, technology or specialists, no disguising of the nature of the patient’s experience or the raw physician experience. It’s a setting where the nature of the suffering, the fiduciary responsibility and moral obligation to the patient and society are no longer abstract terms. In that setting I wanted to put very human, fallible characters-people like Sister Mary Joseph Praise and Thomas Stone. I wanted the whole novel to be of medicine, populated by people in medicine, the way Zola’s novels are of Paris.

Where did the idea for the story of these twins germinate and how did it grow?

When I actually sat down to begin to write this book, what kept recurring was an image of a beautiful, south-Indian nun who suddenly and precipitously goes into labor in a mission hospital in Africa. That act of her going into labor throws everyone for a loop and causes utter confusion at the hospital. That’s all I had to begin with.

I saw her succumbing in that labor, and I saw one of the twins becoming the narrator of the story and looking back in somewhat of an antique voice. So I kept writing, developing the ideas, themes, and characters.

I found some reassurance in a quote by E.L. Doctorow who says about writing that, ‘It’s like driving a car at night. You never see further than your headlights, but you can make the whole trip that way.’ It was often nerve wracking not to know what lay ahead. I’d heard master storytellers like John Irving say that if you’re just making it up as you go along, if you have no plot, then you weren’t a writer, but an ordinary liar!

Halfway through the book, I felt my characters were so alive that their choices were infinite. I had to know what was going to happen, so I met with my editor and we hammered out a plot. My relief at that point was huge; I could concentrate on language and the telling. What surprised me is that even then there were so many discoveries, so many truths that emerged unexpectedly. It affirms for me what I most love about writing, and that is that it is not a rational, logical process

One of the most striking elements of Cutting for Stone is the intimacy with not just one character, but an entire cast. Though Marion tells the story, we become deeply involved in each person’s struggles, not just his own. Which characters did you feel closest to while writing the book? And why did others feel more distant?

Characters, by the way, do not start out rounded. They emerge. I think Ghosh is the character whose emergence and whose full blossoming I loved most. He is essentially fair, kind and eminently faithful, a family man, and above all patient – all the qualities I would like to have myself, but don’t always. He is the consummate internist too, which I also aspire to be. He gives me something to strive for.

Hema, too, is someone I deeply understood – or understand as well as a male writing a novel can understand a woman. Thomas Stone is both more alien and familiar – a doctor caught up in the illusion that work can redeem his character failings. Shiva – I let him be distant, impenetrable, because that is the nature of his character. My editor would sometimes be frustrated with me because she could not ‘see’ Shiva, and I would say to her, ‘Yes! That is the point. There is a quality to him, an Asperger’s-like patina, that makes him hard to know.’

In your earlier books, you touch on the breakup of your personal life due to the strain of practicing medicine. Do these experiences echo through Dr. Stone’s choosing work over life – and to what degree?

Yes, I felt a great empathy for Stone and his feeling that medical work is the most wonderful work you can ever do and yet how he hurt the people around him by losing himself in a love for his work that was so extreme.

An aim of the novel was to show just how medicine and the magic word, ‘work’ can both heal and cripple, how it is a trap and yet it is a balm and as Yeats would say, the challenge is to find that balance between the ‘perfection of the life or of the work’ and in the book there are characters who exemplify both ends of that spectrum. Dr. Stone was very skilled, he focused on the moment and had great knowledge and wisdom, but it was not enough to save him. Perhaps there is some of my own life in that thought, who knows?

At the heart of this novel there is a love story – that of Sister Mary Joseph Praise and Dr. Thomas Stone – which informs almost everything that happens to each character in the book, and yet one of these characters is dead and one has not been seen by anyone for decades. How did you conceive of their relationship, and how do they exert such force on the novel even though neither is present for the majority of it?

Love to me has a quality to it like a trip wire – hence we ‘fall’ in love, instead of simply ‘arriving’ to love. Love comes down to a set of wills trying to match and sometimes mismatching in spectacular fashion; I think all love is unrequited unless we have a clone of ourselves and even then the love is unrequited. In my day job I see all too often that people’s appreciation of the existence of love, of the meaning of love, or of the idea that the meaning of life turns out to be love – all these are arrived at too late, when the love is long lost, or arrived at just before the moment of death.

The medical passages were fascinating. Do you keep a medical journal?

I don’t keep a journal as much as I write notes when I observe something I want to remember later, so I can recall the situation – the feelings, the interaction – at a later time. I have always scribbled. For some of the intense medical situations in the book, some very fine, accomplished surgeons allowed me over the years to be present as they worked, understanding that I wanted to be able to convey the wonder of surgery, of curing, of healing. It was an honor and I am deeply grateful to have been able to do this.

Where does the title ‘Cutting for Stone’ come from?

There is a line in the Hippocratic Oath that says: … I will not cut for stone, even for patients in whom the disease is manifest … It stems from the days when bladder stones were epidemic, a cause of great suffering, probably from bad water and who knows what else. Adults and children suffered so much with these – and died prematurely of infection and kidney failure.

There were itinerant stone cutters – lithologists – who could cut either into the bladder or the perineum and get the stone out, but because they cleaned the knife by wiping it on their blood-stiffened surgical aprons, patients usually died of infection the next day.

Hence the proscription, ‘hou shall not cut for stone.’ It has always seemed to me a curious thing to say when we recite the oath in this day and age. But I love the Hippocratic Oath (or oaths, because its origins and authorship are far from clear), and always try to attend medical school commencement. When the new graduates stand and take the oath, all the physicians in the room are invited to rise and retake the oath.

You bring Ethiopia to life so vividly – its contradictions of beauty and poverty. Addis Ababa (and Missing Hospital) is so much a part of each character though some come to it from other places or leave it for other places. Why did you decide to set much of this novel there? And how do you think the atmosphere of the place affected your life?

Even in this era of the visual, I think a novel can bring out the feel of a place better than almost any vehicle. It’s another thing that Somerset Maugham did so well. The few images one sees of Ethiopia are uniformly negative, about war and poverty. I wanted to depict my love for that land and its people, for their incredible beauty and grace and their wonderful character.

I wanted also to convey the loss many felt when the old order gave way to the new. Ethiopia had the blight of being ruled by a man named Mengistu for too many years, a man propped up by Russia and Cuba. My medical school education was actually interrupted when Mengistu came to power and the emperor went to jail. As an expatriate, I had to leave. It was my moment of loss. Many of my medical schoolmates became guerilla fighters, trying to unseat the government. Some died in the struggle. One of them fought for over twenty years, and his forces finally toppled the dictator.

What books have made the most difference in your life?

Several books were seminal in my coming to medicine, allowing me to see medicine as a calling, a romantic and noble pursuit. Of Human Bondage by Somerset Maugham was one such book. Also A.J. Cronin’s The Citadel and Keys of the Kingdom. That used to be how people came to be drawn to medical school. Now, perhaps television and movies fulfill that role.

My favorite novel has little to do with medicine despite its name, and happens to be a great love story – it’s Love in the Time of Cholera by Gabriel Garcia Marquez. Some writers read George Eliot’s Middlemarch every year. I read Love in the Time of Cholera.

What’s the best way to get a child interested in reading?

I don’t know the best way, and I wish someone would show me! But I do know it’s important. What we often forget is that when we read and enjoy a good novel, we are engaging in a collaborative act with the writer. The writer gives us the words, we provide the imagination, and somewhere in middle space, we jointly create this fictional dream, this mental movie. It requires effort on our part – it is not a passive act, but a creative one to read a book. The writer has to give you just enough words, not too many; just enough so that you can imagine the rest. If you have ever been horribly disappointed when your favorite book was made into a movie, because the actor looked nothing like the person you had conjured up in my mind, then you know what I mean.

I believe that, as the writer John Fowles has said, that if you don’t practice this skill of taking words on a page and turning them into pictures, then a part of the brain atrophies. I try to make this point with our medical students: that reading stories, novels, keeps a part of the brain alive, and it relates to the clinical imagination. I don’t know a single clinician I have greatly admired over the years who has not also enjoyed good literature or some aspect of the arts. I think it is no coincidence. That is where the right brain comes in. Medicine is, and will always be – no matter how much technology we introduce – an art and a science. You need both.

Your first two books are non-fiction, but you’ve said that you have always thought of yourself as a fiction writer first. How so?

Fiction is truly my first love. To paraphrase Dorothy Allison, fiction is the great lie that tells the truth about how the world really lives. It is why in teaching medical students I use Tolstoy’s The Death of Ivan Ilych to teach about end-of-life, and Bastard out of Carolina to help students really understand child abuse. A textbook rarely gives them the kind of truth or understanding achieved in the best fiction.

One of my first published short stories was ‘Lilacs,’ in which the protagonist has HIV. Its appearance in The New Yorker in 1991 was a part of what led to my contract to write My Own Country, a memoir of my years of caring for persons with HIV in rural Tennessee. While writing that book I found myself living through an intense personal story of friendship and loss that led to a second non-fiction book, The Tennis Partner. But after that, I passed up on an offer to write a third non-fiction book. I was keen to get back to fiction, to explore that kind of truth.

My true call to medicine came in the form of a book. By the time I picked up Of Human Bondage by Somerset Maugham I had already read Lolita and Lady Chatterley’s Lover. I was twelve, I think. Maugham’s protagonist, Philip, sets out for Paris to become an artist. Money is tight, and he lives on the brink of starvation, and finally finds he does not have the talent. He is crushed and disappointed but also relieved to have discovered what is not to be his calling. He returns to London and enters medical school. When after years of slogging away he enters the outpatient clinic for the first time, he realizes he has made the right choice. The particular lines that stayed with me, that have haunted me, were: ‘there was humanity there in the rough, the materials the artist worked on; and Philip felt a curious thrill when it occurred to him that he was in the position of the artist…’

The phrase ‘humanity there in the rough’ spoke directly to my twelve-year-old mind. I took it to mean that if one had no God-given talent to be an artist (or mathematician), one could aspire to be a doctor, perhaps even a good one. The beauty of medicine is that it is proletarian, and its prime prerequisite is that you have an interest in humanity in the rough. Many of us also come to medicine because we are wounded in some way. Thomas Stone is a great example, but so is Marion Stone.

Medicine plays a big part in your novel, and it is also something that unites people of different races and religions in Cutting for Stone: Hindus, Christians, Indians, Africans and Westerners all work for a common goal: curing the patient. Is this the message of your book?

Indeed, I wanted the whole novel to be of medicine, populated by people in medicine, the way Zola’s novels are of Paris. If I begin with a mission hospital in Africa, a place redolent with Dettol and carbolic acid scents, it is because I think that in a place so basic, the nature of the suffering, the fiduciary responsibility and moral obligation to the patient and society are no longer abstract terms. Indeed, nothing separates doctor and patient, no layers of paperwork, technology or specialists and you can’t disguise the nature of the patient’s experience or the raw physician experience.

Then I put in very human, fallible characters — people like Sister Mary Joseph Praise, Thomas Stone. To take the story to America was to contrast this world with Western medicine, its power and beauty, but also its failings. Contrasting an inner city underfunded non-academic center with a ‘Mecca’ of a tertiary referral center was also I think a good way to point out the strengths and weaknesses of both and also to highlight the very different people who inhabit such places.

But ultimately, I think the intent was to point out that even though medicine changes, the fundamental role of the physician, the need for their presence, does not change, and the importance of that presence is greater than ever. Cure is laudable but not always something we achieve, but comforting and healing is something we can do. It is the healing or Samaritan or priestly function of being a physician that we seem loath to claim.

A few months ago, a 40 year-old woman came to an emergency room in a hospital close to where I live,and she was brought in confused. Her blood pressure was an alarming 230 over 170. Within a few minutes, she went into cardiac collapse. She was resuscitated, stabilized, whisked over to a CAT scan suite right next to the emergency room, because they were concerned about blood clots in the lung. And the CAT scan revealed no blood clots in the lung, but it showed bilateral, visible, palpable breast masses,breast tumors, that had metastasized widely all over the body. And the real tragedy was, if you look through her records, she had been seen in four or five other health care institutions in the preceding two years. Four or five opportunities to see the breast masses, touch the breast mass, intervene at a much earlier stage than when we saw her.

http://www.ted.com/talks/abraham_verghese_a_doctor_s_touch?language=en#

https://www.youtube.com/user/TEDtalksDirector

TEDED – A doctor’s touch

Welcome to the Stanford Medicine 25 website. Remember, this site is NOT the Stanford Medicine 25; it is only a map to a territory, one that must be explored in person! The Stanford Medicine 25 consists of hands-on sessions in small groups. You can’t substitute for that, and we don’t try to. However, this site provides a place to go to remind ourselves of what we have learned, or are about to learn in a hands-on session.

http://stanfordmedicine25.stanford.edu/the25/

American College of Cardiology 2015 Annual Meeting: Simon Dack Lecture: “I Carry Your Heart” by Abraham Verghese, MD

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2015/04/08/american-college-of-cardiology-2015-annual-meeting-simon-dack-lecture-i-carry-your-heart-by-abraham-verghese-md/

Advertisements

Read Full Post »