The One You Feed - Exploring the Healing Potential of Spirituality with Abraham Verghese

Episode Date: October 17, 2023

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!See omnystudio.com/listener for privacy information.

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OneYouFeed.net slash habits. Again, it's free and you can watch it whenever it works for you. Go to OneYouFeed.net slash habits. So many people are feeding off this lucrative trough that is medical care. Trillions of dollars in this, 20% of our GDP almost. And we are 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? 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. I'm Jason Alexander. And I'm Peter Tilden. And together, our mission on the Really Know Really podcast is to get the true answers to life's baffling questions like why the bathroom door doesn't go all the way to the floor, what's in the museum of failure, and does your dog truly love you? We have the answer. Go to reallyknowreally.com

and register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead. The Really No Really podcast. Follow us on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. 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. Verghese was

awarded the National Humanities Medal in 2016, 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 bestseller 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 is a bad wolf, which represents things like greed and hatred and fear and the grandchild stops they 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 a thought provoking. Maybe because of my background, I immediately thought, well, it's going down one mouth, one esophagus into one stomach, even if it's two beasts. I'm sure you've heard that before. You know, I really feel that you inevitably feed both beasts. And the challenge is 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 intravenous 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. It 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 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 or temptation. This is a disease. And I'm embarrassed to say that something that I should have understood maybe 15 years before that only really hit me then, that these people were powerless under this disease. And when they were confronted as physicians, their first reaction was intense shame. And that's a dangerous moment. They could be suicidal. They 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 who didn't make it. 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. 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 ultimately David was responsible for David. That there was only so much we could all do. Who knew more about his addiction than he did. It's a hard journey. Yeah. And addiction is just so remarkably complex. It's a syndrome almost more than anything else. It has multiple causes. It's multivariant. 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 their livelihood depends on this. And I think that when you don't have those kinds 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 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, it was a very painful time for me because I was going through a divorce. 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, which was 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 the 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 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, its 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 is 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 why 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 belongings strewn around, you've been robbed, at one level you've lost stuff valuable to you. But there's also a second kind of injury. It's 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're 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 80 years old. She's had chronic back pain. And we did a back surgery for her mid-June, which was a risky thing to do, but life was terrible. And things did not go well. The sheath that holds the spinal fluid ruptured. 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 10 times more important than it does in normal life. Just kindness, you know, the people sweeping the room or the medical assistants 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 Raritan 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 23 hours and 57 minutes that doctors are not in the room. 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 hernia operation in 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 back rub and brought some lotion and rub my back. And, you know, there was nothing biologically that that back rub 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 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 because it's considered like, you 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 a 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 rounding, had obviously soiled themselves. And I was about to say something and the nurse steps in and says, do y'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, it's easy and quick. And you have to roll 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 caring. That's how we express care. Yeah. Yeah. It's a beautiful story of just leading by example. It's about caring.

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, you know, I got to do a lot. I had a wonderful mentor in medical school the second time around in India, and, you know, I 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, just about everything. In America, in 1980, they had a pyramidal surgical residency structure where they took maybe 10 people, you know, seven would make it to the second year, five to the third year.

You 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 internal 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 a spy craft, 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, live 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, unsurprisingly, even though leprosy is such an ancient disease, you know, mentioned in the Bible, it's a very recent insight. A famous hand surgeon in India, Paul Brand, he may not be the first, but he probably was the first to write about it.

He was, you know, just puzzled why his patients, despite dressing their wounds, just kept losing fingers and losing toes. And he was driving by the place where the lepers were living, 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 a chapati, you know, like a tortilla, and struggling with the spatula. And then finally, she just sort of reached in there with her bare hands and flipped it over. And he realized that it was, leprosy is 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 then amputations.

When you don't feel, you injure yourself. And the book that Paul Brand 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 1900s, not when it should have been. Yeah. Talk more about the gift of pain in a broader psychological or spiritual sense. push back on that. First of all, because the public clearly doesn't mind that, the reading public, you know, they seem to enjoy my characters. They 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 have 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 omission or commission is often what drives you in later years to the right path, to the right action. So it's not as simple as good and evil. I think

Lee Marvin, the wonderful actor who was well known for all his bad guy roles, was once asked, Mr. 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. 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, characters being essentially good. They are. And I think the more we get to know a particular character or person, the more we understand their behavior, right? The more believer in the hurt people hurt people. If you're a hurt person, you're going to pass that on unless you heal it. And then if you heal it, people who are healed actually help heal other people. Again, there are exceptions to everything, 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, oh, they're the bad guys 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 whatnot, you know, 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. 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 seeing. And there's just not much room for that in the world today. People want to hear certain things, even if the facts are against it, for reasons that are to do with their own self-interest that are easy to understand. 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. So you'll latch on to things that are supporting your point of view.

And this is what demagogues can do so well. They can tap into, you know, the desires of people, even if they're 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. It's not just dogs.

It's also cats. There's quite a few cats. Okay. It happened by accident. A friend of mine who used to have a lovely Labrador, and I actually painted a little watercolor portrait of her lab when 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 it just got me going so i began to solicit and get more pics 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 old 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. Well, 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, treat every goodbye as though it's forever, you know, rejoice 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 boy, they live their days fully. And lots to be learned from them. Lots 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. Oh, sorry. It's time. Yeah, it's hard. But 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 a tremendous amount of pain, but it's a very clean kind of pure pain. Well, I hope you feel that way after Friday because it may be pure, 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 mourn them. There's no need for anything else. I wish I had the hardcover because I would take a picture of my baby, Beansy, in the book and send it to you. I don't know if 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 means just more noise, more inattention 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 Orr, and it's called The Art of Design. And he was talking about the sort of dichotomy between wisdom and knowledge. And he used 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 all around it. There were rituals about when to plant, when to harvest, when to leave the land fallow. And then the WHO or some organization came in with the high-yield American rice and, you know, tremendous productivity.

But they wound up not only burning out the soil after 10 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 trough that is medical care, you know,

trillions of dollars in this 20 of our gdp almost and we are 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 Thank you. I'm Jason Alexander. And I'm Peter Tilden. And together on the Really No Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor we got the answer will space junk block your cell signal the astronaut who almost drowned during a spacewalk gives us the answer

we talk with the scientist who figured out if your dog truly loves you and the one bringing back the woolly mammoth plus does tom cruise really do his own stunts? His stuntman reveals the answer. And you never know who's gonna drop by. Mr. Brian Cranston is with us today. How are you, too? Hello, my friend. Wayne Knight about Jurassic Park. Wayne Knight, welcome to Really No Really, sir. God bless you all. Hello, Newman.

And you never know when Howie Mandel might just stop by to talk about judging. Really? That's the opening? Really No Really. Yeah, really. No really. Go to reallynoreally.com. And register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead. It's called Really, No Really, and you can find it on the iHeartRadio app, on Apple Podcasts, or wherever you get your podcasts. 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 pictures you show in there that I thought were really telling. And one sort of showed hospital rounds in the way we would 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 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. I mean, 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 50s or so. But the fact is we have so much data, but what it has done is it's come at the expense of our being at the bedside. It's almost as though the patient is an afterthought. I got into some hot water for writing a piece in the New England 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 call, you know, the eye patient 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 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. 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 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 chest 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 x-ray could tell us.

But they're actually processing massive amounts of data. And we actually can now know what it is they were looking for. And with a fair degree of accuracy, they're making predictions. So I think that we have already reached our data limits. And if you have a chart this thick, which is not uncommon for 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.

Spending so much time on the computer, entering data for billing purposes. That's what we do. And if AI could remove that, and it should be able to, natural 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 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 damn 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 hubris, 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 pain pill, had no occasion to. He had gone to a colleague for

some back pain. And with anybody else, that colleague might have said, well, how's your marriage? How much are you drinking? How much weed are you smoking? But with a fellow physician, he just gave him some Tylenol with codeine and physician took it and he said, I felt this huge weight that was on my chest just slide off, you know. So you have these you know obsessive compulsive types, hardworking 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 taken on this mantle prematurely, they might have prevented this.

But I don't know that for a fact. But that is my sense, that we're 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. 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. 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. might imagine the black pearl is the source for such inspiration, but that's absurd. The ideas are always there, but pain is the padlock 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 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. 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 listen to it later it's not quite as awesome as you thought at the time. I've got lots of recordings that are a testament to that, my goodness. 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 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. Yeah, I am absolutely not in any case advocating that you start doing opium 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 kind of like 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 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, he prays 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 a 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 24 from a heroin addiction i stayed sober about eight years and I ultimately went back out and 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. I've never subscribed easily to that sense of an external God or higher power. People

make assumptions about me because of the nature of the book and that 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 line 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 the Portuguese in the 1400s or the Brits in the 1500s. These are Christians who have traced their ancestry to St. Thomas the Apostle arriving in 52 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. I think I've always felt that my Hindu friends, when they visit the temple and their 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, my older brother and I both had to sort of 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 the 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 there's a plan for everything and that, you know, like, and 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 try 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? Well, to me, that's the higher power. And maybe that my higher power is my God, the Trinity, Jesus, all that. Whatever it is, it doesn't matter because it's that quiet observing part that that's my chattering brain go on 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 30s, which was very, very Christian. And it was largely a very Christian organization, right? I mean, I got sober in 1994 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 1939, 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 and our lives over to 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 heart 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, 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, A is a different place than it was 30 years ago, 40 years ago. I don't know, a long time ago. I'm not quite sure how old I am, but old enough. Do you sense that it's just as powerful today as it was when Dr. Bill and Bob? Dr. 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 12-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. I'm Jason Alexander. And I'm Peter Tilden. And together on the Really Know Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor.

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It's called Really, No Really, and you can find it on the iHeartRadio app, on Apple Podcasts, or wherever you get your podcasts. 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 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, 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, you know, so

it was not something that they felt the need to say. And I had an interesting relationship with my mother in my rebellious teens and later on. But in her old age, in her 90s, my mom moved to Palo Alto. And 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, Kerry, and I was speaking to my mother on the car phone. And at the end of the call, I said, OK. And Carrie was nudging me. Say I love you.

You know, she was mouthing. And 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 mouthing, say I love sitting there and so she mouths saying 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 words. And so I hadn't said I love you yet. And then magically at one point she said, I love you too. It was pretty profound, you know. And my father is 96, now living in Boston with my brother. And he gets on a treadmill twice a day. He manages.

Wow. He's very frail, but at least he gets on 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 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 uh at this stage in his life what am i holding back i love your dad why not yeah that's beautiful story. And I just love 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 in 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 witness this a lot in the professionals I mentor and I see. Although I think the younger generation is doing a much better job of balancing things than we are

you know it's like I gotta get into college the right college and then I gotta get into medical school and I gotta get into the right residency program 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 80% of it on this fixed idea. I mean, not to say abandon 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 20. Yeah. 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 with them and you know i'm in the business of trying to find redemption um for myself and with. 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 and my mom. 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. When I came back across that line of yours,

as I was preparing, I was like, that's speaking to me. And medicine was terribly seductive that way, because if you were the intern who never left the hospital, who was always there, 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. 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. And I think that's where the new generation is much more wise about balancing their lifestyle, their relationships, in a 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 workaholism 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 and children who are what to do with these kids for three hours. All they're doing is yelling. 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. 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 has played in your life. You know, why has fiction been so important to you? Yeah, by the way, that quote, the novel is the ax that breaks the frozen sea, is Kafka. 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 nursery tales, by, you know, biblical stories, by Enid Blyton, whatever it is we were

raised on. And then when we become serious adults, we somehow feel like, well, no more fiction for me. I'm a biography, memoir kind of person. And I always feel that's a tremendous loss. John Fowles, 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 we call 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 Camus 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 intuit as being true. Proust 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 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 I can sort of make my life, 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 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 I'm just as guilty 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 I'm just as guilty of that. But the act of taking that digital signal, using your imagination to create the characters who will look nothing like the ones they cast when you go see the movie finally, but that is an important piece, I think, of of living it's greatly satisfying and it's getting harder to convince younger people to do that because there's 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 oneufeed.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 I, 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. If what you just heard was helpful to you, please consider making a monthly donation to support the One You Feed podcast.

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The One You Feed podcast would like to sincerely thank our sponsors for supporting the show. I'm Jason Alexander. And I'm Peter Tilden. And together, our mission on the Really Know Really podcast is to get the true answers to life's baffling questions like why the bathroom door doesn't go all the way to the floor, what's in the museum of failure, and does your dog truly love you? We have the answer. Go to reallyknowreally.com and register to win $500, a guest spot on our podcast or a limited edition sign jason bobblehead the really know really podcast follow us on the iheart radio app apple podcasts or wherever you get your podcasts