The One You FeedExploring the Healing Potential of Spirituality with Abraham Verghese
In this episode, Abraham Verghese shares his unique perspective, shaped by his personal experiences and observations, that sheds light on the transformative power of spirituality in the healing journey. Through his writings and teachings, he emphasizes the need for compassion, kindness, and a human connection in medicine, recognizing that true healing goes beyond physical cure.
In this episode, you will be able to:
- Discover the transformative power of spirituality in your healing journey
- Uncover the role of human connection in healthcare and its impact on your well-being.
- Explore the influence of technology on medicine and its implications for your health
- Tap into the power of fiction to enrich your life and deepen your understanding
- Rediscover the joy of reading and its positive effects on your overall happiness
To learn more, click here!
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So many people are feeding off this lucrative truth that is medical care, trillions of dollars in this twenty percent of our GDP almost and we are all excavating from this, and what really matters, the human connection, is increasingly getting lost. You know, if we don't have that, what do we have?
Welcome to the one you feed Throughout time, great thinkers have recognized the importance of the thoughts we have. Quotes like garbage in, garbage out, or you are what you think ring true. And yet for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self pity, jealousy, or fear. We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit. But it's not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction, how they.
Feed their good wolf. Thanks for joining us. Our guest on this episode is Abraham Verghese, a graduate of the Iowa Writers Workshop and the author of books including the NBCC Award finalist My Own Country and the New York Times notable book The Tennis Partner for Geese was awarded the National Humanities Medal in twenty sixteen, has received five honorary degrees, and is an elected member of the National Academy of Medicine in the American Academy of Arts and Sciences. He lives and practices medicine in Stanford, California, and is Vice chair of the Department of Medicine at the Stanford University School of Medicine. Today, Eric and Abraham discuss his book, The Covenant of Water.
Hi, Abraham, Welcome to the show.
Eric. It's a great pleasure to be with you. Thank you.
It is a great pleasure to have you on your newest book called The Covenant of Water. I imagine it's a New York Times bestseller and been kind of all over the best seller charts. And Oprah is over the moon about this book. She thinks it's one of the best books she has ever ever read, and that's pretty high praise from somebody who does a lot of reading. So I'm excited to discuss your work with you. But before we get into that, we'll start like we always do, with a parable. There's a grandparent who's talking with their grandchild and they say, in life, there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love, and the other's a bad wolf, which represents things like greed and hatred and fear. And the grandchild stops think about it for a second. They look up at their grandparent, they say, well, which one wins, and the grandparent says, the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that you do.
Yeah, I'd never heard that before, and it really was thought provoking. Maybe because of my background, I immediately thought, well, it's going down one mouth, one esopha goes into one's stomach, even if two beace. I'm sure you've heard that before, you know. I really feel that you inevitably feed both pieces and the challenges finding a way to sort of use the energy of the so called bad wolf because you need both. I don't think that we are destined to be angels in this world, and sometimes it's the darkness that informs the light.
Absolutely absolutely is. Maybe we'll use that as a jumping off point to one of the places I wanted to go, and I wanted to talk about an earlier book of yours called The Tennis Partner. It's a book about a deep friendship you formed with somebody who also happened to be an intravenious drug addict. And I used to be that myself. I was a heroin Addict when I was younger, and so I was really interested in that Covenant of Water was pretty long. I didn't give me a chance to read a whole bunch of your other stuff. I'd read Cutting for Stone in the past. I now really want to read The Tennis Partner. But I was wondering if if you could share what it was like to be in close relationship with somebody who was self destructing.
Yeah. I think it was, you know, extraordinarily humbling for me, because by then I was a practicing physician attending on the wards, and I really thought I understood addiction, you know, But I don't think that I really did. At some level. My friendship with my former medical student who was a former tennis professional, and so you know, on the wards I was his teacher. On the courts, he was mine, and then at some point him telling me about his past and then eventually relapsing. It was so humbling. And I had the opportunity to visit one of the many places where physicians almost exclusively are being treated in large groups, and to see, you know, these very distinguished people in a big, giant AA circle fessing up the most amazing stories.
I immediately sort of.
Viscerally got it that this was really not about some sort of moral weakness temptation. I know this is a disease, and you know, I'm embarrassed to say that something that I should have understood maybe fifteen years before. That only really hit me then that, you know, these people were powerless under this disease, and when they were confronted as physicians, their first reaction was intense shame and that dangerous moment they could be suicidal, the often are, But the second was a relief because they knew that they were powerless. So I learned so much about addiction and you know, applied it to my own life in many ways. But it was a tragic and yet a very insightful story for me.
It is extraordinarily humbling working with addicts. I got sober, and you know, we're taught to help other people, and you just realize, like it doesn't matter what you do, you're not going to help everyone. I've lost way too many people over the years, you know who didn't make it. You know, my best friend who's the editor of this show, has gone through several battles with sobriety. While I've been in sobriety. I've been in sobriety a long time, and the most recent one, I mean I really thought like, I don't think he's going to make it, you know, And the guy listens to every single podcast episode I do, which are intended to help people. I'm like, it's not doing anything. It's so humbling, you know, like nothing I can do here, you know, despite all my knowledge, all my understanding, all my compassion. It's not to say that we don't have a role and that we don't influence, but ultimately it is something that is beyond us.
That was the hardest thing for me to really digest is that inevitably all of us around David, our well meaning efforts, were in a funny way, enabling him and my epiphany towards the end of the book and towards the end of his shortened life. I must tell you was you know, ultimately David was responsible for David. You know that there was only so much we could all do you know who knew more about his addiction than he did. Yeah, it's a hard journey.
Yeah, And an addiction is just so remarkably complex. It's a syndrome almost more than anything else. It has multiple causes, it's multivariate. I mean, there's just so much that goes into it and why some people are able to get sober and others not. If there is a creator who created all this and has something behind it, and I get a chance to have a conversation with them after squaring away some fairly fundamental universal basics, my top question is like, why do some people get sober and others don't?
Like?
What is it? And people will put forth all kinds of theories about it, but none of it really explains what is fundamentally a mystery to me.
Yeah, this might interest you. The good news in physicians with addiction is the incentive to sobriety is so huge because you lose your license, you're suspended, and unless you demonstrate sobriety you're not coming back, and then you're monitored. We are compassionate, but we're also firm, and so it's been nice to see that most physicians who go through treatment are successful long term. But it's very much because the livelihood depends on this, and I think that when you don't have those kind of incentives, it's maybe a little harder. I've also come to the feeling that we're all addicted. I mean it takes different shapes and forms. You know, you might not be addicted to alcohol or heroin, but it could be food, it could be sex, it could be reinforcement in other ways. So I think there's a degree of this where the good and bad wolf are always battling, is the bottom line?
Eric, Yeah, yeah, totally, totally I agree. What did you learn about yourself through that process? What did you learn about you?
Well, you know, it was a very painful time for me because I was going through a divorce. So in a curious way, our friendship, she's really quite deep on the courts and off the courts, was you know, a powerful reinforcement of myself. You know, I think men don't really write or talk adequately about their deepest friendships, which I think are as valuable as anything else. You know, you only realize how valuable when you lose it. Just like health, women write eloquently about their friendships. Gay men do, but we tend to couch them in sporting metaphors. You know, my tennis buddy, my football buddy, and so to me, it was really about rediscovering who I was. In a sense, entering this sobriety journey with him. You know, I had my own sort of issues. They were very similar, not addiction, but you know, here I was in a mess in my life, not what I had planned. And a lot of it comes back to you, know, to you, you are ultimately responsible. You know, I have to forgive, you have to move on, you have to acknowledge the higher power. All the things that he was going through I completely related to.
You write eloquently about medicine in general. It's a topic in a lot of your books. I mean, it's a huge topic. You've done ted talks, You've done a lot of different things around medicine. And there's an idea that has shown up in your work in a few different places that I would love to explore, and it's the idea of healing versus curing. Can you say more about that?
Sure?
Yeah?
I mean, first of all, I write about medicine because I think of medicine as life plus plus. I mean, what is medicine but life at its most acute, it's most intensely observed. But yeah, I mean I think that this concept healing versus curing, I always try to convey to my students, because you know, if you break your little finger, at one level, it's a you know, it's a fracture of your middle phalanx. It's not displaced, it's aligned. But another level, it's why me, why now on the eve of my big match or my big whatever. So I think every illness has the sort of spiritual component, and with diseases like HIV or cancer, that second part, that sense of violation of your spirit is huge, the hy me part. And I often think that in Western medicine we've done a great job of addressing the physical part, the fracture, but not necessarily addressing the spiritual violation. The example I use with my students is, you know, if you were to go home after this and find that your front door is open, all your valuables missing, your belonging strewn around, you've been robbed. At one level, you've lost stuff valuable to you. But there's also second kind of injuries, like someone came into my precious space and violated the sanctity. And if the cops come by a few hours later and say we caught the person, here's all your stuff back, you are cured, but you are not necessarily healed. You might even move out of that apartment just because how weird that feels. And I think I write a lot about the need for us to express caring in medicine, which I think is sort of a timeless idea. It's unchanged since antiquity. Someone in distress turns to you as a human being. They don't want machines, robots, they want a human to be the face of this care they're going to receive.
Yeah, my mother, she's eighty years old. She's a chronic back pain. And we did a back surgery for her mid June, which was a risky thing to do, but life was terrible. Things did not go well. The sheath that holds a spinal fluid rupture. She had to be put on a spinal drain. Then she got an infection. They had to go back in and cut out the infection. Anyway, this is a seven week process. We are in the hospital and it is amazing how different the experience is. When you have someone who is really kind, it feels like ten times more important than it does in normal life. Just kindness, you know, the people sweeping the room, or the medical assistance, or the nurses themselves. I mean their kindness gets a lot of people through what's a really difficult experience, because I think you're absolutely right. Anything that is going on physically with us has a mirror emotionally and mentally. There's a story we're telling ourselves about it, there's fears that we have about it, and both those actually need to be pretty well managed in order to heal and get through. And you know, in a hospital, rightfully, so they're focusing on the medicine part. But when the kindness comes with it too. Having just lived this, it makes such a difference. It almost chokes me up every time somebody does it in the hospital because it feels so important.
Yeah, you said that so well. I mean, my medical schooling was interrupted by civil war in Africa, where I was born, and I began, and I wound up working as an orderly or a nursing assistant in a hospital in Ryton Valley, New Jersey for a year and a half. And I look back on that now as the most valuable medical training I ever had, because I really saw what happens to the patient in the twenty three hours and fifty seven minutes that doctors are not in the room. Yep, you know, And it's given me a real solidarity with the nursing profession because I think that that's where care is expressed. You know, I had a hernie operation Iowa a long time ago, and after my surgery in the evening, one of those classic nurses with the nursing cap, you know, she checked me out and then she said, I'm going to give you a BackRub and brought some lotion rubbed my back and you know, there was nothing biologically that that BackRub was going to do for my discomfort, but it was the most powerful thing that I ever felt. I'll never forget that. I mean it is, yeah, probably unfashionable now, but you know, that's what nursing was like. And I think physicians should pick up a lot of that. And I think I try to voice that it's almost not unethical, but it's considered like it should be talking about this stuff. But you know what you should be These are human beings. This is what they want. They want kindness, they want care.
Yeah. Yeah, there's a story somewhere from your past about you're the doctor leading rounds and there's a patient who has soiled the bed. You want to share that story. I just think it sort of brings to life what you're talking about here.
Yeah, I think it's not uncommon amongst physicians of our generation that we felt much more of a solidarity with the nursing profession than I think it's possible now because of all the busyness around the hospital. But you know, the patient while we were there arounding, had obviously soiled themselves and I was about to say something, and the nurse steps in and says, do you all smell poop? And she and I sort of stepped forward and helped to change the patient, which is there's a method to it, and if you have two people, that's easy and quick. And you know, after all, the patient this way, that way, and probably a lesson that my students never forgot. So you know, we took a step forward and they recoiled. But I hope that memory lingers with them as it does for me.
Yeah. Yeah, it's a beautiful story of just leading by example.
It's about Karen. That's how it was fresh. Yeah.
So a question for you. In your book, the main character doctors tend to be surgeons, and I don't think you are a surgeon by trade? Why is that?
Yeah, I'm not a surgeon, So it's an interesting story. I thought I was going to be a surgeon. I had a wonderful mentor in medical school the second time around in India, and and you know, we got to do a lot of surgery. And ultimately when I came to the United States, you know, and I loved everything in medicine, pediatrics, and just about everything. In America in nineteen eighty they had a pyramidal surgical residency structure where they took maybe ten people, you know, seven would make it to the second year, five to the third year. We had to get to the fifth year. And it was very famous that foreign graduates would be spit out at the second and third year level. And I wasn't prepared to waste my time. And I loved it in general medicine just as much. But I think surgery never lost its romance for me. And it's inherently colorful. I mean, I could and I do write about things like leprosy and the Covenant of Water. But there's something about that, you know, the act of surgery that is inherently dramatic, just like a police procedure or spycraft. You know, it gets the reader's attention. It certainly has my interest, and it's much more interesting for me to research surgical stuff and hang out with my surgical colleagues and vicariously, you know, lived that surgical life that I never chose.
You mentioned leprosy there, and leprosy is a big, if I want to say, a big part. It plays a pretty big role in your latest novel. And I learned something that I did not know, which was that leprosy the reason people's flesh is falling off is not because the disease is rotting away their flesh. It's that they can't feel anything, and so they just do things to their body that eventually just causes it to I mean, fall apart or fall away. Do I have that correct?
Yeah?
In fact, I'm surprisingly even though leprosy is such an ancient disease, you know, mentioned in the Bible, it's a very recent insight. A famous hand surgeon an India, Paul Brown, he may not be the first, but he probably was the first to write about it. He was just puzzled why his patients, despite dressing their wounds, you know, just kept losing fingers and you know, losing toes. And he was driving by the place where the lepers were living and he saw a leper missing fingers, clumsily trying to flip chapati, you know, like a tortilla, and struggling with the spatula, and then finally she just sort of reached in there with their bare hands and flipped it over, and he realized that it was let proceeds primarily a disease of skin and nerves, and it's the nerve damage that renders them insensible to pain. In a sense, it's like diabetes and what happens with the diabetic foot and people getting ulcers and amputations. When you don't feel, you injure yourself. And the book that Paul Brown wrote is called The Gift of Pain. And really, in a way, pain is a gift because it protects us from noxious stimuli, and you lose that and you begin to traumatize yourself. So I always find it amazing that it was such a recent insight. We're talking about the early nineteen hundred is not when it should have been.
Yeah, talk more about the Gift of pain in a broader psychological or spiritual sense.
You know. One of the interesting critiques of my book book has been that all my characters seem to be good people or two good people. They're not many villains in my book. And I always sort of push back on that, first of all, because the public clearly doesn't mind that they're reading public, you know. They seem to enjoy my characters, especially like the strong heroic women. You know, heroic in the sense that it's sort of an unheralded heroism. It's the quiet heroism of people like my grandmother, who the world will never know about, but in her own way, she lived this heroic life. But I always think that my characters are not necessarily perfect people, but they are like most of us, working towards redemption. We are deeply flawed people who made terrible mistakes at times. But I think it's this wonderful human instinct to make it right to do good. And I think I have a lot of that in the book. And to me, pain of maybe your own acts of a mission or commission is often what drives you in later years to the right path, to the right action, you know. So it's not as simple as good and evil, you know. I think Lee Marvin, the wonderful actor who was well known for all his bad guy roles, was once asked, mister Marvin, why do you keep playing all these bad guys? And his answer was, Son, I've never played a bad guy in my life, and that's exactly it. You know, he would embrace these characters and the world might perceive them as bad, and so no one is inherently bad. We just sort of I mean, of course there are exceptions, but we do our best and sometimes we're deeply mistaken about what we think we're doing and then we regret it. Yeah, so I believe in that pain in that sense.
Yeah, it's interesting because, yeah, most people that we might think of as doing something bad, they don't think they are, like in their mind. It makes perfect sense. And I was also thinking about what you just said about you know, your characters being essentially good. They are, And I think the more get to know a particular character or person, the more we understand their behavior, right, the more we understand why they're doing that. I mean, I'm a big believer in the hurt people. Hurt people. You know, if you're a hurt person, you're going to pass that on unless you heal it. And then if you heal it, you know, people who are healed actually help heal other people. Again, there are exceptions to everything, of course, but that feels broadly very true to me.
Yeah, no, I completely agree. I mean, we've never been more divided as a nation, and especially in my field medicine, infectious disease, you know, all the vaccine anti vaccine. It takes some effort to get past the rhetoric and understand why do people feel the way they do, rather than just label them as they're the bad guy since they don't think the way I do. People have their reasons, and you know, it was just painful to watch people dying essentially because they didn't believe in vaccines, and not watching this firsthand, but you had to admire or accept the fact that this is indeed what they believed. It was part of their complexity, and you know, you couldn't condemn them, you could just be there.
Yeah, I think that is one of the hardest things to do for me, is to be a person who has strong values about certain things, a strong belief in the way we should treat each other in different things when people aren't doing that, in my mind, to still see them as human that's the wrong way to say. Of course I see them as human, but to have some degree of compassion, some degree of understanding, because if we don't, we don't change each other's mind by yelling at each other. It just doesn't work. I don't think it's ever worked, and I don't think it's ever going to work.
Right.
We change each other's mind by beginning to understand each other and show each other things that maybe we're not seen. And there's just not much room for that in the world today.
Yeah, well, that was something that I painfully realized during COVID, is that you're not going to change people's opinions by facts alone. You have to recognize that, you know, people want to hear certain things even if the facts are against it, for reasons that are to do with their own self interests that are easy to understand. You know, if you're a business person, you don't want to hear about closures for COVID, you don't want to hear about things that keep people from coming to your business, you know, so you will latch onto things that are supporting your point of view the facts, you know for a and this is what demagogues can do so well. They can tap into, you know, the desires of people, even if they are contrary to the reality that's just life.
Yeah, you have a lot of dog pictures on your Instagram. You're posting pictures of people's dogs. I'm just kind of curious what that's all about.
Just dogs, it's also cats. There's quite a few cats.
Okay.
It happened by accident. A friend of mine who you to have a lovely labrador, and I actually painted a little watercolor portrait of her lab and the lab passed away and she's retained that picture. So with her new dog, she sent me a picture of her dog, you know, with the book, and just got me going. So I began to solicit and get more picks like that, you know. But I love dogs. I have less experience with cats because one of my family members was allergic, so we never had cats. But I heard somewhere some all saw that if you have a story that's about a doctor and a dog, you're in good shape. Don't ask me why.
Where you say somewhere that what is it? A dog lives for you, a cat just lives with you.
I didn't really invent that. I think I heard that from somebody else. Also, Yeah, a dog lives for you, a cat lives with you. But I also think that dogs are wonderful emulators of how we might be. You know, treats every goodbye as though it's forever, you know, voice when someone shows up and opens the door, you know, and they are living accelerated lives. They have a lifespan that's so short compared to ours that every day is a week for them. And boyd, they live there days fully and lot to be learned from them, lot to be learned.
Yeah, we're recording this on a Wednesday, and on Friday, which is two days from now, I have to put one of my beloved dogs to sleep.
It's time.
Yeah, it's hard, but you know this idea of the grief being a sign of the great love, you know, and grieving a dog is easier to grieve than many different things in life because it's pretty uncomplicated, you know, Grieving a breakup, there's a lot of complexity. Even grieving a past parent, there's a lot of complexity right because of the relationship. But a dog, for me is it's an tremendous amount of pain, but it's a very clean kind of pure pain.
Well, I hope you feel that we have to Friday because it may be true, but it's going to be profound, as you know.
Yeah, I've put two other dogs to sleep in like the last four years, so they just all aged out in a rough timeframe. Oh, I have no doubt of what's coming. I'm already feeling it and have been for months. So I don't mean to say that like it's easy. I just mean it's a lot easier just to focus on the love.
I get you. They give you unconditional love, so you can just warn them. There's no need for anything else. I get it.
Yeah, yeah, Well, I have a kindle version of your book. I wish I had the hardcover because I would take a picture of my baby beansy and the book and send it to you. But if you get at I don't know. I've got the hard copy. You said somewhere. I'm fascinated by knowledge, but I'm more fascinated by wisdom. First, I guess, how do you tell the difference between the two, and what is wisdom to you?
There's a lot of data these days, you know, and there's a prevalent notion that, especially in medicine, that more data is better. But I'm not necessarily sure that's true. You know, sometimes more data, I mean, it's just more noise, more in attention to the telling details that really matter. The way they manifest in medicine is, you know, people haven't really listened to the story, they haven't really looked at the patient, but they have these reams of tests and stuff that have been done in almost a thoughtless fashion. You know. So I think sometimes data is an illusion. I mean, in general, as a scientist, I think the more data is the better, but sometimes not. There's a very influential book I read some years ago by a wonderful sort of ecologist thinker at Oberlin University, David Or and it's called The Art of Design, and it was talking about the sort of dichotomy between wisdom and knowledge. And they use an example in Indonesia of a village that had their rice planting based around the temple. The temple was the center of the village. The rice was planted or around it. There were rituals about when the plant went to Harvard, when to leave the landfallow. And then the WHO or sub organization came in with a high yield American rice and you know, tremendous productivity, but they wound up not only burning out the soil after ten years but destroying the social infrastructure of the village because it was more than about rice. And so I think we do that to ourselves in many different ways, in many different parts of our society. But I can only speak for medicine, where you know, increasingly so many people are feeding off this lucrative truugh that is medical care. You know, trillions of dollars in this twenty percent of our GDP almost and we're all excavating from this, and what really matters, the human connection, is increasingly getting lost, and you know, if we don't have that, what do we have.
You did a ted talk about how important the physical exam of a patient is, both for what you can find out and the healing that we talked about earlier, this being in contact with another human. And there's a couple of pictures you show in there that I thought were really telling, and one sort of showed hospital rounds and the way we have traditionally thought of them, which is a group of doctors gathered around the patient's bed. And then you showed another picture which is where more and more hospital rounds happen, which is a group of doctors gathered around a computer and the patient isn't even there. Their data is there, to your point, but they're not.
You know, first of all, I want to make sure that I don't come across as a luddite. I think that we're far better off than that black and white picture of you know, I think it was from the fifties or so.
Right.
Yeah, But the fact is, we have so much data. But what it has done is that come at the expense of our being at the pet side. It's almost as though the patient is an afterthought. I got into some hot water for writing a piece in the New Journal of Medicine where I said that the patient was merely an icon placeholder for the real patient who was in the computer, and I called it the eye patient. That's where I got into trouble because you know, like your iPhone, your iPad, I called, you know, the iepatient gets wonderful treatment all across America. The real patient often wonders, you know, where the heck is everyone? When are they going to talk to me? When are they going to tell me what's going on? Just to make clear, I think my generation allowed this to happen on our watch. We allowed the sort of creep of the computer and the taking us away from the bedside, and it's been insidious, and I'm just so pleased to see the new generation pushing back hard. But you know, we have to find the right balance. We need the data, we need all these tests, but not so many of them. But we also need the sanctity of listening to that person examining them, because the patient wants to feel that you've located the disease, not on some X ray somewhere, not on a biopsy report, but on their body. And I think it's by talking to them and by examining them that that process happens. You know, I don't want to commit myself to some sort of radiation and chemo based on some report somewhere. I want to feel like a human being I trust gave me the news and located it on me, and you know, together we entered this journey.
Yeah. I mean, I think data is, to your point, is not a problem. Actually it's a good thing. However, we can only process so much information about any one thing, right, And we see this in information overload, right, just broadly in culture. Is I just get so much that I don't even know what's important anymore. None of it actually sinks in none of it actually becomes actionable, none of it changes me or who I am. It's just more and more and more. It's like the opportunity cost, right, the opportunity cost of all that data is other things that I could be giving my attention to you, and like you, I tend to be a pretty firm believer, Like we got to find a middle ground on all this stuff.
Yeah, it's actually a very interesting time in medicine talking about data because of AI. I mean, we have AI algorithms that can look at test X rays and you know, they're rapidly learning and getting better and better machine learning and you know, so on, so that they're calling diabetes on X rays. They're calling out things we didn't think an extra could tell us. But they're actually processing massive amounts of data and you know, we actually can now know what it is. They were looking for a fair degree of accuracy, they're making predictions. So I think that we have already reached our data limits. And you know, if you have a chart this thick, which is not uncommon for you know, many patients with multiple diseases, sometimes we're missing patterns and I think AI can help us extricate some of those, but what I hope most of all is right now, we are the highest paid clerical workers in the hospital, spending so much time on the computer entering data for billing purposes, and that's what we do. And if AI could remove that and should be able to nature language processing, should be able to capture what we're saying and fill the chart out, I'm hopeful that finally we can spend more time doing what we want to do, what we're supposed to do, and that is talk to people, be with them.
You said somewhere that few doctors will admit this, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can, but it can also deepen the wound. I'd love to know, if you're open to sharing, do you have a sense of what your woundedness was that drove you into medicine, And I'd love to hear a little bit about how the practice of medicine can both heal that and how it can also make it worse.
Yeah, I think that many of us, not just in medicine, but in life. You come out of childhood and unless you're really fortunate, you can feel not okay. And I had no particular reason to not feel okay. I had, you know, lovely parents and great siblings. But for whatever reason, you can feel wounded. I think that that's maybe it's not universal, but it's pretty uncommon, and very often I find that people view medicine this noble thing that you enter to in a sense absolves you, and you know, sort of allows you to take on this mantle that makes your inadequacies, your woundedness go away, and the double edged sword there is that. Too often you can, you know, get this illusion that somehow, since I'm ministering to people, nothing can happen to me. The phenomenon of addiction amongst physicians comes from just that kind of humorous the sense that you know, I prescribe these medications all the time, but since I know so much about them, if I pop one, it's not going to hurt, you know. And one of the most memorable things I ever heard was a neurosurgeon who you know, was in one of these rehab places and had been caught. His addiction was such that he was visiting patients and stealing drugs from their medicine cabinets. And he talked about the time that he had never used a paint pill, had no occasion to. He had gone to a colleague for some back pain, and you know, with anybody else that colleague might have said, well, how's your marriage, how much are you drinking? How much wead are you smoking? But with a fellow physician, he just gave him some town all with codeine, and physician took it and he said, I felt this huge weight that was on my chest just slide up. You know. So you have these in obsessive, compulsive types, hard working types willing to put up with the sacrifice medicine needs, and there's sort of a cumulative injury that takes place. And you know, perhaps if they had dealt with their woundedness early on, not take an undismantle prematurely, they might have prevented this. But I don't know that for a fact, But that is my sense that were often wounded, maybe a little more so than other people in other walks of life. I don't know, And medicine heals us and it certainly does. You know, on my worst day, I walk into the hospital and there are things I see that make my troubles feel like well, forget that.
Yeah, I mean you could probably say, largely speaking, a huge amount of the psychologists and therapists out there are coming from a similar place. The wounded healer is an archetype for a reason. I mean, I do the work I do because of those things. You just said something there that I thought was really interesting, and it comes from your latest novel, The Covenant of Water. But it's talking about addiction and one of the characters goes through a period of opioid addiction, and you've got a line. I'm just going to read it. It does show a certain understanding to me of addiction, and in it they talk about the black pearl, which is just the opium, right, it's the opium that they get. Some might imagine the black pearl is the source for such inspiration, but that's absurd. The ideas are always there, but pain is the padlocked door, the stern gatekeeper locking them inside. The little pearl merely frees them, and the pen does the rest. They're talking about creativity and how that person sees opium as a source of creativity, and I think what you point to that's so true there is that I'm not sure that it puts anything into us creatively. As a musician, I had a strong belief in the creative abilities of drugs, right, And I think more importantly is they got past the pain in the padlocked door, and once that opened, then the ideas are there and they can flow. But this consciousness that is always sort of reducing and pain tends to reduce consciousness, right, mental or physical, It tends to shrink our world. When that sort of opens back up, we find oh there's a whole lot there.
Yeah, but it's a slippery slope, as you know, because I think many drugs can unlock the gates so that you can your creativity, can express yourself. But then, you know, then you get to the point where there's a sense that I need the drug for the creativity. And you know, yeah, for the most part, smoking a joint might make you feel like your guitar playing is awesome. But if you ever but it's later, it's not quite as awesome as you thought at the time.
You know, I've got lots of recordings that are a testament to that.
My goodness, you know, I do think that our daily life is so full of gated and censored ways of looking at the world. We miss so much. We miss so much about yes, the sound of things, the feel of things, And I think a lot of times what drugs do is slow us down in a way that we should be able to accomplish from time to time without that. You know.
Yeah, I am absolutely not, in any case advocating that you start doing OPIM so you become more creative. It turns bad for most of us. It doesn't work out well. But I thought that the insight of that pain gets opened up was a deep insight. And to your point, I think there are ways there. I've learned ways to get there. They're not as snap your fingers right as smoking a joint, but they also don't have the tremendous downside that for me, any sort of mind altering drug has, which is basically the ruination of my entire existence. It's pretty high price to pay to crank out a crappy three chord progression that you think sounds good at the time. When you put it in those terms, it's coming. Ah, this is not a good deal.
You know. What was the most impressive thing to me about learning so much about addiction and I actually use it a little bit of it in the Covenant of water is the power of you know, the the AA circles, and you know, they managed to repopulate the isolated world of the addict, and they forced them to give up their secrets. But there's a line in Covenant and I thought you were going there where the mother observing her son in solid recovery, says, you know, and part of that is he goes to church prayers every evening, and she says, if there wasn't a god, he would invent one, you know. And I think that came straight out of my admiration for what, you know, addiction circles and A and A all those things do so well, you know, they restore, you know, sort of a higher consciousness that is so beneficial to that individual. I'm all for it.
Yeah, that idea, if there wasn't a god, he'd invent one is a really tricky idea. Because I got sober at twenty four from a heroin addiction. I stayed sober about eight years, and I ultimately went back out and I never went back to the heroin, but I went back to drinking. And part of the problem for me was that I had built my spiritual foundation on something I didn't actually really believe in that I had invented I needed to have a higher power. I was told this is what it could be, and I just tried to believe in something I actually didn't And so when I came back, I was like, all right, I can't do that again. But I also do recognize the concept that believing in something greater than me is important for my recovery. So what might that be for me? What might that look like? And that can be a really beautiful journey if you embark on it in a truly wholehearted and curious way.
Yeah, my thesis is that the higher power is us. It's within us. You know, I've never subscribed easily to that sense of external God or higher power. People make assumptions about me because of the nature of the book and the community, which is a very religious community that I'm you know, this proselytizer Christian, and you know I am a Christian. I love the tradition of our community. But my sense is all these things are within us, you know, in the sense that we're finding that higher power, we give it different labels, and these are metaphors for the two wolves that you're feeding and how you keep them in balance is all it is, is my sense, and we have different language for it.
Yeah, So, given what you've just said there, some of the people in the book have a very strong faith. It's a prominent thing that stands out. Why did that feel like it was relevant or had to fit in there if it's not so much in alignment with you and your beliefs.
Well, actually it is in ligne with me, in the sense that I was writing about this particular community from which I come, which is a Christian community in India, but not Christians converted by you know, the Portuguese and the fourteen hundreds, or the Brits in the fifteen hundreds. These are Christians who have traced their anxioustry to Saint Thomas the Apostle, arriving in fifty two AD. So it's an old Christianity, and it still has vestiges of the Hinduism that they embraced before they became Christians. And I've always been struck by people's sort of great joy in their ritual and their satisfaction in it, and how well it informs their life. I've been envious, to be honest, you know, I think I've always felt that my Hindu friends when they visit the temple and you know, the rituals, they never quested it the way I think I did. It was just something they did and gave them great comfort. And I think that quality of Christianity I've always found admirable in my parents, my grandparents, and in my case, my brother and I'm a older brother and I both had to say sit through these services that we didn't quite understand. They were in this language Syriac, you know, so it's for a child, It just made no sense at all, and we were growing up, you know, in a very different environment than my parents, so we both drifted away from that, and I find myself gravitating back to the ritual. I mean recently I went to a church in Fremont where they have the same service in Syriac that I heard as a child. I still don't understand a word of it. Nobody does except a priest. But you know, the hair on the back of my neck stood on end because it felt so familiar, and there was something rich about seeing, you know, this community around me. So you know, I think it really doesn't matter. Like Pascal said, you know, is there a God? Isn't there a God, is it this particular God. I think it's much more about the ritual and finding the best that's in us, whatever means you choose to do that.
Yeah, I'm with you. I am envious often of people who have a certain type of faith, the underlying belief that they're a plan for everything, and that you know, like and that when I die, this in X, Y and Z is going to happen. I mean, it's an enormously comforting belief. I mean, if I could, I would certainly be like, sign me up. But I just can't. That doesn't mean, though that I haven't been able to find a deep and rich spiritual life. You know, for me, that path has largely been Buddhism and Zen Buddhism, but a variety of different things. You know, it's been the mystical traditions throughout all the faiths, you know, Hinduism and Christianity and Judaism and Buddhism. There's a mystical element which is about an experience right of some sort of connection.
Well, that's really well said. I mean, so my misunderstanding perhaps of the Higher Power in AA was you know, my sense that it was really trying to step away from the finding that very closely and just leaving it. As you know, when I meditate, which I tried to do from time to time, one of the things I use is to ask myself, who is the one observing my brain chattering away that I'm trying to quiet down? Yeah, well, to me, that's the higher power, and maybe that my higher power is now my God, the Trinity, Jesus, all that, whatever it is, doesn't matter because it's that quiet observing part that's my chattering brain go on, yeah, you know, and lets me have this false control that I have, but it's not always right what I'm doing. And so that's what I thought. But you've just articulated something more profound than that. So that's really interesting for me.
If you'll allow me to give you a little AA history because it's very interesting. Actually. So AA came out of something called the Oxford Group, which was a group in the thirties which was very very Christian, and it was largely a very Christian organization, right, I mean I got sober in nineteen ninety four in Columbus, Ohio. I mean, when people talked about God, they meant Jesus and God, right, like that version of it. But way back in nineteen thirty nine when they wrote the Big Book, they had the wisdom to use the word higher power and tack something onto the end of the third step, which was we turned our will in our lives over the care of God as we understood him. And those four words I think probably have saved countless lives because it gave the freedom and it came right from the part of AA's text. It gave the freedom to define those things in the way that you understand them. Now. Again, different groups are going to emphasize different things, but I don't think I would have gotten sober if those words weren't there. I think it would have been too big an ask for me. But I could say, Okay, what's my understanding of it? And so AA in its most pure form absolutely encourages that. Just depending on the group you're in and the community you're in and all that you know, there may be more or less openness to that. But I think there's a whole lot more openness to it today than there ever was. Right, I mean, AA is a different place than it was thirty years ago, forty years ago, I don't know, a long time ago. I'm not quite sure how old I am, but old.
Enough two sense that is just as powerful today as it was, you know when doctor Bill and.
Bob Doctor Bob and Bill Wilson. Yeah, I don't know that I can answer that, because it's something I've sort of drifted away from to some degree. But at its heart, yes, I think the fact that there are a lot of other options besides twelve step programs in today's recovery world is an unequivocally good thing, because it's not the right thing for everybody. But the core thing that they got figured out right from the very beginning was that one alcoholic talking to another healed both of them. And that power exists as strongly as it ever did when that happens. In my belief right, it still is there and it is so healing to both people that I do believe it has that power, that that magic is still contained in it.
Wonderful thing.
I don't know where I saw this. I don't know if it was a New Yorker story or as I prepare for people, I just pull stuff from all over the place, and I'm like, Okay, I don't don't quite know where I got it, but there's a beautiful story you wrote somewhere about learning to say I love you to your mother. Would you share a little bit about that. It really was a beautiful story.
Yeah. You know, my parents and our tradition is one of where you know, they were incredibly loving parents. They did so much for our futures and our education, but you know, expressing their emotions in this ancient Christian culture wasn't a strong suit for them, so it was not something that they felt the need to say. And I had a interesting relationship with my mother and my rebellious teens and later on, but in her old age, in her nineties, my mom moved to pal Alto, and you know, I would see her every day or every other day, and when I didn't see her, I would call. And one time I was in the car with my partner, Carrie, and I was speaking to my mother on the car phone, and at the end of the call, I said okay, and Carrie was nudging me say I love you. You know, she was mouthing and I said, I said I didn't because it just felt unnatural. I knew my mom would be embarrassed. But it happened again another time we were in the car and she's sitting there, and so she MoU would say I love you, and so I said I love you mom. My mother gave an embarrassed giggle and said thank you. But by then I was committed so that I kept every time I said goodbye, when it was on the phone, I would say I love you, mom. And then she gravitated to One day she said to me after a phone call, I haven't heard the magic word, so I hadn't said I love you yet, and then magically, at one point she said I love you too. It's pretty profound, you know. And my father is ninety six now living in Boston with my brother, and he gets on a treadmill twice a day he manages you know. Wow, he's very frail, but he at least he gets some walks, which is huge. But I've been saying this to him. I don't think i'll ever get him to say that back. It's just he's a strong, silent type. It's never in his nature. But I don't need for him to say it back. I realized that what this was about is I needed to say it.
You know.
I love the man for all, you know, for all his complicatedness and my complicated relationship with him at this stage in his life. What am I holding back? I love your dad? Why not?
Yeah, that's a beautiful story. And I just loved the idea of your mom kind of giggling and asking to hear the magic words, and you being willing to just continue to sort of say it even though she wasn't saying it back, and not taking that personal, and just sort of recognizing, like, you know, Okay, that's what it is.
It's just a.
Lovely little story. I want to talk about another line from the Covenant of Water that you wrote. It's a character describing themselves and a challenge, and it says, I understood my failing, my human limitation. It is to be consumed by one fixed idea, then another and another. But in nature, one fixed idea is unnatural, or rather the one idea, the only idea is life itself, just being living. Share a little more about.
That, Yeah, I mean, I think that came straight out of my own experience, you know, I think, and I witnessed this a lot in the professionals I mentor, and I although I think the younger generation is doing a much better job of balancing things than we are, you know, It's like I got to get into college, the right college, and then I got to get into medical school, and I got to get into the right residency program. And it's like, you know, these fixed ideas, and meanwhile, life is going by. And if you want to use the example of you know, living each day fully as though this was your last, then you really aren't doing that. You're spending eighty percent of it on this fixed idea. I mean not to say abandoned your training, but I mean allowing yourself to be open to the randomness of life while you pursue this one idea. But it's not the only idea. There are many ideas, and I wish and it's the kind of wisdom that you wish for when you were twenty, but you wouldn't have listened, unfortunately, So it just comes with time. But I purposely had a character in there who I gave that succession of fixed ideas and comes to a point where it has cost him and he feels like in pursuing the fixed idea, he neglected important things around him. And I think that happened to me. I think that I have great regrets about, you know, my marriage and my kids and how much time I might have spent to them, And you know, I'm in the business of trying to find redemption for myself and with them. And you can't waste too much time on what you did or didn't do. You just have to do it now. And it's part of that I love you stuff with my dad. My mom passed away, but I'm so glad I said that to her.
Yeah. I was having a conversation yesterday with someone that sort of mirrored this a little bit, and he was talking about how he was in a phase where he was being very productive at work and he noticed correspondingly being irritated with the people around him. And I was like, I understand that, because to me, that productivity can be my focus narrows down to one fixed idea. This is the only thing that's important, getting this thing done or making this thing happen or this accomplishment, and anything that's outside of that is simply an inconvenience and an irritation. Yeah, and yeah, when I came back across that line of yours as I was preparing, I was like, that's speaking to me.
And you know, medicine was terribly seductive that way, because if you were the intern who never left the hospital was always there. You know, that was a great thing. Nobody stopped to ask you if your marriage was coming apart as a consequence, or if your relationships were suffering. Yeah, you know, And I think that sort of false honor in doing this work because the work was noble, allowed many people to get off the hook when they should have been called for bad behavior. We have a lot of dry drunks whose behavior is awful even if they're not addicted. Yeah, and I think that's where the new generation is much more wise about balancing their lifestyle, their relationships and the way that we were not So you were asking about the woundedness and the flip side was using work as an excuse to not deal with any of your issues totally.
I mean, I think I have had workoholism tendencies in my past, for sure. I think I'm kind of past them to a large extent, but I certainly recognize that because you're praised for it. You're praised by always being the one at the office, always being the one doing the extra thing, and it is an easy escape because, particularly if we're good at what we do and we enjoy what we do, that's easier than the complication of a relationship that might be struggling in children who are difficult to deal with, And I don't know what to do with these kids. For three hours, all they're doing is yell. I mean work is like, oh yeah, I know. I'm just kind of right in my groove. People are approving of me, and it feels easy and I can just do it exactly. It's a pretty seductive path. But I do think most people will hit a point where they will recognize that they paid a price for that that they didn't realize they were paying very much. So you quoted Kafka somewhere who says a novel is the ax that breaks the frozen sea. Inside. I was wondering if you could just talk for a minute about the role fiction is played in your life. You know, why has fiction been so important to you?
Yeah, By the way, that quote, the novel is the acts that breaks the frozen sea is Kfka. It's a beautiful metaphor. And you know, I always find it fascinating that we raise our children and we were raised by stories by nurse three tales, by you know, biblical stories by Enid blytton whatever, it is we were raised on, and then when we've become serious adults, we somehow feel like, well, no more fiction for me. I'm a biography memoir kind of person. And yeah, I always feel that's a tremendous loss. John Falls, who wrote The French Lieutenant's Woman, used to say that if you don't have that practice of taking the little signals on a page week words and using them to make a mental movie in your head, you know, your imagination the writer's words, a part of your brain atrophies, and especially in medicine, I meet a lot of my serious colleagues who don't read fiction, and I always feel it's a great loss. I think that Camu said that fiction is the great lie that tells the truth about how the world lives. You know, I think we find ways to be When fiction resonates for us, it's because it tells us something we already into it as being true. Proost said that the reader is not so much reading the book as is reading themselves as they read the book. And so, you know, you find instructions for a living. You find handholds by these seminal books that have changed the course of your life, and in my case, one book brought me to medicine, and you know, I can sort of make my life, you know, categorize it by the milestones in terms of the books I read. I think that fiction is a powerful instrument and we aren't reading in enough of it. This is not just self serving, but I really think that we sort of lose a creative aspect. It's much easier to watch movies and watch TikTok, and you know, I'm just as guilty as that. But the act of taking that digital signal, using your imagination to create the characters who will look nothing like the ones they cost when you go see the movie. Finally, but that is an important piece I think of living. It's greatly satisfying, and it's getting harder to convince younger people to do that because, Yeah, I'm hoping the pendulum swings back, there'll be this tiredness over TikTok and whatnot, and they'll come back to the elemental joy of reading fiction.
Well, that is a beautiful place for us to wrap up. You and I are going to have a brief post show conversation afterwards where I'm going to ask you a couple questions about lessons that you've learned and fears that you've had to overcome. Listeners. If you'd like to get access to the post show conversation AD free episodes and support something that you love, you can go to one you feed dot net slash join and find out more about becoming part of the community. Abraham, thank you so much. The book was astoundingly good. I really liked it, and it's the book that as I started to prepare and I went back into it, I was like, I like it more. The more I think about it, you know, like the more I contemplate everything that happened, I'm like, God, this is really good. So I love the book. Thank you for coming on.
It's an honor to talk with you, an honor.
Eric.
Thank you so much for having me.
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