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“I carry your heart”: Abraham Verghese on the doctor-patient relationship

hands-holding-red-heartAddressing a room full of cardiologists for the annual Simon Dack Lecture, writer and physician Abraham Verghese, MD, reflected on a love poem: e.e. cumming's "i carry your heart with me".  It begins:

i carry your heart with me (i carry it in my heart)

"I’m always astonished by this poem, by the unabashed love it declares, by the lack of any self-consciousness. We have no doubt what a heart is to this poet. For him, it’s not a cliché," Verghese said in a speech released recently in JAMA Cardiology. "And yet these are words that define exactly what the word 'heart' means outside of a cardiology meeting like this."

Language is essential and at the core of the relationship between a doctor and a patient. But there is much more there too, a presence, a bond. Verghese continues:

I would say a patient’s feeling toward their physician, particularly to a cardiac physician, is a bit like love. You’re typically thrust on your physician because of some acute event in your life—the onset of chest pains, the onset of palpitations, syncope—and here comes this very capable, competent individual who cares for you.

What you feel for that person is love, and it’s a love that is somehow unrequited because the doctor has too little time and the doctor has many other palpable, measurable, quantifiable interests. Your physician is not there to talk to you about love. He is or she is not there to talk to you about your heart. He or she is there to talk to you about your doppelganger, about that other heart, that is burdened by ejection fractions and pressure gradients and many other such numbers—but not about your heart.

 Despite the need to spend copious amounts of time documenting cases, there is still time — and opportunity — to connect with patients, heart-to-heart. Verghese concludes:

The real heart awaits you the next time you see a patient. It will come, that heart, with another companion. It will come with the other heart for which you have tracings and images and all kinds of data, and when you recognize both hearts, when you listen and then you touch with skill, your own heart will be fulfilled.

Your head and your heart will be fulfilled. You will have accomplished a kind of poetry. You will have said, both to yourself and to the other (and you will have said without words): “i carry your heart; i carry it in my heart.”

The talk, which took place last year, also reveals the special connection "i carry your heart with me" holds for Robert Harrington, MD, professor of medicine, his wife, and his twin daughters — it is definitely worth reading or viewing in its entirety.

Previously: Physician-writer Abraham Verghese on ritual, technology and medical training, Abraham Verghese: "It's a great time for physician leaders to embrace design thinking and Abraham Verghese: "There is no panacea for an investment of time at the bedside with students"
Photo by Petr Kratochvil

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