Book Review

The Tennis Partner: A doctor's story of friendship and loss

Darwin's Audubon: Science and the liberal imagination

The Power of Hope: A doctor's perspective

N Engl J Med 1999; 340:398-399February 4, 1999

Article

The Tennis Partner: A doctor's story of friendship and loss
By Abraham Verghese. 347 pp. New York, HarperCollins, 1998. $25. ISBN: 0-06-017405-6

Darwin's Audubon: Science and the liberal imagination
By Gerald Weissmann. Approximately 309 pp. New York, Plenum, 1998. $28.95. ISBN: 0-306-45981-7

The Power of Hope: A doctor's perspective
By Howard Spiro. Approximately 289 pp. New Haven, Conn., Yale University Press, 1998. $35. ISBN: 0-300-07632-0

These three books, which differ so in style and content, are persuasive evidence that the tradition of the physician-author lives on. The beauty of thought and clarity of word they convey merit the attention of any doctor.

Abraham Verghese has already made his literary mark with My Own County, a widely praised book about his medical and personal experiences when AIDS invaded a small rural community. Since then, Verghese, a specialist in infectious diseases, has moved to El Paso, Texas, where he is professor of medicine at Texas Tech University. His new book, The Tennis Partner, is an autobiographical novel. It tells the story of Verghese's encounters with a drug-addicted physician, David Smith, an Australian tennis player who quits professional tennis to study medicine at Texas Tech. Verghese forms a bond with Smith on hospital wards and tennis courts. There, the games they play, at first hesitant but ultimately furious, are a metaphor for Smith's battle against cocaine addiction and Verghese's struggle to make something of Smith. But the bright, capable, deceitful, and self-deceptive Smith is as unable to win the final game as he is to find a life free of cocaine. The denouement is not a surprise, but it nevertheless shocks. Verghese writes lyrically about tennis and with sensitivity about the despair of addicted physicians. The book begins with a scene in the Talbott–Marsh Recovery Clinic, a real clinic for addicted physicians. Its head, G. Douglas Talbott, is past president of the American Society of Addiction Medicine and a pioneer in the treatment of addicted physicians. The Tennis Partner is rooted in the hopelessness and waste of drug addiction. Verghese uses his literary gift to deal with the problem in ways not possible in a technical paper.

In contrast to Verghese's lean prose — as unadorned as a service ace — Gerald Weissmann's Darwin's Audubon can border on the baroque. But the baroque style has many admirers and merits, and it suits Weissmann nicely. Readers who can follow the sinuosities of Weissman's odd connections and unexpected thoughts will appreciate this quirky book almost as soon as they begin it. The 24 essays in Darwin's Audubon have been previously published, mainly in Hospital Practice. Collecting them in a single volume is a convenience and gives readers an idea of the scope of Weissmann's interests. Among my favorites are “Puerperal Priority,” a beautiful account of the discoverers of the cause of puerperal sepsis; “Foucault and the Bag Lady,” which decries the displacement of hopelessly schizophrenic patients from psychiatric hospitals to the sidewalks; “No Ideas but in Things,” a marvelous essay about William Carlos Williams; and “Losing a MASH,” Weissmann's story of his own experiences as an army doctor. Best of all is “Wordsworth at the Barbican.” I won't tell you what this is about — all these short pieces are erudite, amusing, and stimulating: read them.

The Power of Hope is a reworking of Howard Spiro's Doctors, Patients, and Placebos, published in 1986, and presented now with new ideas and considerations. Strictly speaking, it is not a literary work but a distillation of the experiences and thoughts of a physician who has practiced his art and profession for over 40 years. Yet the originality and elegance of this book justify its inclusion in this review. The Power of Hope has an important theme and challenges the reader with controversial ideas. Spiro emphasizes the difference between the perceptions of the doctor (disease) and those of the patient (illness). He tells us that the principal shift in mainstream medicine has been from the ear to the eye — doctors have lost the art of listening because they are too busy looking at images on x-ray boards or through endoscopes. “Physicians,” Spiro writes, “learn how to cure but little about how to care.” What Spiro is leading us to is his detailed contemplation of the placebo. What is a placebo? How does it exert its effects? Is the use of a placebo legitimate only in the setting of a clinical trial? Is it ethical for a physician to treat an individual patient with a placebo? Must the doctor always tell the patient, “You will (may) receive a placebo”? Who has the authority to judge whether the use of a placebo is ethical? (“In medical practice ethicist has come to mean those people who evaluate how doctors act with patients but who themselves rarely take care of patients.”)

Spiro moves from the placebo to alternative medicine. He argues that alternative medicine is a gussied-up placebo — a placebo with special qualities that distinguish it from the usual sugar pill. In a close analysis, Spiro deals with numerous “unconventional” approaches to the sick, from shamanism to Christian Science, always wondering if they do help the sick, and if so, by what mechanism. His examination is sympathetic, but he criticizes alternative medicine for refusing to be judged by the standards required of mainstream medicine. (“The holistic alternative medicine movement represents the romantic reaction to the sway of reason in medicine in our postmodern time.”) Yet Spiro also condemns the proposition that every ailment has a molecular or structural basis, and he blames our medical schools and teaching hospitals for inculcating doctors with the “scientific fallacy” of medical reductionism (“the more medical science does for disease, the less physicians do for patients”).

In The Power of Hope Spiro raises many disquieting questions about medicine and medical practice. He writes mainly for the lay public, but any doctor could profit from reading his book. Every page offers common sense and the perspective of a wise physician who has thought hard about doctors and patients, not as theoretical entities, but as real people.

Robert S. Schwartz, M.D.