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Presence: An essay by Abraham Verghese


Regular Scope readers are familiar with Abraham Verghese, MD, one of Stanford's great polymaths. He's a writer capable of commandeering both your mind and your heart, leaving you wiser and more caring than you were just moments before, as well as a teacher of medicine, of a medicine that focuses on patients — and physicians — as individuals and as humans much greater than their diagnoses.

In an essay that appears today in Health Affairs, Verghese is in top form. He takes readers into a museum (the Anderson Collection at Stanford) and then into, figuratively, several modern art paintings (including Mark Rothko's Pink and White over Red, shown above). For Verghese, the art forces him — or perhaps welcomes him — out of his daily routine. These paintings housed in a new, sleek building seem far from the bustling hospital, the buzzing of residents and students, and the glowing computer screen, relaying the demands of the electronic medical records (EMRs) and incessant emails. He writes:

After nearly a dozen visits, alone and with others, even though I wasn’t consciously trying to relate the art to the pedagogy of medicine, I began to make connections. My tool is the medical gaze, the desire to look for pathology and connection, and it would seem there was no opportunity for that within a pigmented square of uniform color or a rectangle of haphazard paint splashes. But in me a profound and inward sort of observation was taking form.

For example, take Pink and White over Red. A quick glance reveals mere blotches of color, nothing that special. Here's Verghese:

But having learned to sit with the painting, to be present, I viewed it differently. It seemed to represent my interior space, what I see on the back of my eyelids when I close my eyes, the image still etched with the glow of the window through which I was gazing. It is soothing. It is the womb. It is emotion. It is pre-consciousness.

In the most cursory reading of Rothko, I came across this: 'If you are only moved by color relationships, then you miss the point. I’m interested in expressing the big emotions—tragedy, ecstasy, doom.' And: 'Art is an adventure into an unknown world, which can be explored only by those willing to take the risks.'

Similarly, medicine, the kind of medicine that Verghese practices and teaches requires an adventure into an unknown world — an inherently risky undertaking. After reviewing EMRs, doctors can order lab tests or tweak prescriptions, using their training and the body of scientific evidence to guide them. But just being with a patient, holding the hand of someone who is dying, noticing small details such as "the outline of a cigarette packet in the shirt pocket," as Verghese writes, these actions, or non-actions, are risky. They're time-consuming and may seem unproductive. Nothing happened. We talked about cupcakes. Or flowers. Or a grandson. Or just sat together. Verghese concludes:

There are a few things that are timeless in medicine, unchanged since antiquity, which we can keep front and center as we bring about reform. One is the simple truth that patients want us to be more present. We as physicians want to be more present with the patient, as well, because without that contact, our professional life loses much of its meaning.

It is a one-word rallying cry for patients and physicians, the common ground we share, the one thing we should not compromise, the starting place to begin reform, the single word to put on the placard as we rally for the cause.

Presence. Period.

Verghese has translated his passion for valuing bedside care into an interdisciplinary program at Stanford titled, appropriately, Presence. For a special treat, check out Verghese reading the essay in this podcast.

Previously: Stanford physician-author Abraham Verghese to receive National Humanities Medal"I carry your heart": Abraham Verghese on the doctor-patient relationship and Abraham Verghese: "There is no panacea for an investment of time at the bedside with students"
Photo by Henrik Kam courtesy of the Anderson Collection

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