Healing art: The long partnership of medicine and literature

The tales of a semi-literate Aids sufferer in rural Tennessee or a promising young medic destroyed by a love affair with intravenous cocaine – the subjects of Abraham Verghese's non-fiction books – are different when told by a distinguished doctor, now a celebrated author, than when mumbled or spilt out by themselves. To write is to edit. The minute you put something down, you leave something out.

Now Verghese has turned from non-fiction which can read like a novel to a novel which, when in full song, reads peculiarly like fact and will probably win every award going: Cutting for Stone, (Chatto & Windus, £17.99). Open the book at random – page 280, it turns out - and here we are: "Two days after the General's execution, the hospital staff, led by Adam and W W Gonad, had a welcome-back party for Ghosh. They bought a cow, hired a tent and a cook..."

Already, here are hints: the "exotic" setting, the detached language of the clinician, the names. We are in post-colonial territory, and whispers of VS Naipaul and Evelyn Waugh are rustling off the page. If we try the Page 99 Test (by page 99 of any book we should have a clear view of what the author is up to) we get a 10,000-foot view of the landscape below. A probationary nurse in the Missing Hospital, Addis Ababa (it was meant to be the Mission Hospital but a junior clerk spelt it phonetically) is noting the birth of Japanese twins ("the word 'Siamese' eluded her") who are the narrator and his brother, conjoined lightly at the scalp.

The mother, a nun, Sister Mary Joseph Praise, is dying on the delivery table. Hemlatha, the obstetrician, a stoutish woman with mesmerising green-brown eyes who has not many pages before had her hand up the leg of an arrogant French DC3 pilot, twisting his balls for flight safety infractions, is injecting adrenaline into the dying woman's heart: "Whenever I've had to resort to adrenaline to the heart it has never worked... But surely it must have worked, somewhere, with someone. Why else was it taught to us?"

The twins are Marion and Shiva Stone: sons of a British father and Sister Mary Joseph Praise. Verghese's novel, narrated by Marion, leads us in a tremendous, compassionate, technically exuberant sprawl through post-colonial Ethiopia via Kenya to the US. "Post-colonial" suggests a grudging worthiness from which Cutting for Stone is mercifully free; and to mention Addis Ababa and Nairobi and JFK is as misleading as saying that Dickens wrote about London. This is a big book and, along with Naipaul and Waugh and Dickens, there is also a strong flavour of William Boyd, both in the sense of place and in the way heredity and brotherhood get their grippers into a man and shape the narrative of his life.

Yet beneath all this lies something far more curious. Abraham Verghese, like his narrator, is a doctor: a distinguished professor of medicine at Stanford University. He is an Indian brought up in Ethiopia whose journey is at least superficially close-coupled to his narrator's. It is hard, reading Cutting for Stone, to avoid that illegitimate reader's question: "I wonder if this is him?"

The point is largely irrelevant to the experience of the novel. But very early, a huge theme emerges: "I venerate the sight of the abdomen or chest laid open... It allows me to see the cabalistic harmony of heart peeking out behind lung, of liver and spleen consulting each other under the dome of the diaphragm... My fingers 'run the bowel' looking for holes that a blade or bullet might have created, coil after glistening coil, twenty-three feet of it compacted into such a small space... I have yet to see the serpent's head. But I do see the ordinary miracles under skin and rib and muscle, visions concealed from their owner. Is there a greater privilege on earth?"

Cutting for Stone takes its title from one of the better-known forms of the Hippocratic Oath. Anxious to preserve the distinctions between physician and surgeon (the latter descended from barbers), one of the vows is: "I shall not cut for stone." To present surgery as a greater privilege than mere medicine is ironic. But it is surely true. As the descendant of a line of doctors, and a failed doctor myself – I gave up; I could give a thousand excuses but I think the real one was it was just too much hard work – and with a young doctor now coming up in the extended family, I was brought up with the sense of privilege that society extends doctors (and, alas, that doctors all too often have abused).

Doctors say things to people that, were they not doctors, would get them a punch in the eye. They do things to people that, were they not doctors, would get them a long prison sentence.

The other thing doctors do is write. It's a long list. Americans Jerome Groopman and Atul Gawande; our own Jed Mercurio; Richard Gordon in the satirical corner, but in his early books as enlightening about the reality of doctoring as anyone. Further back, everyone knows that AJ Cronin was a doctor, as was (though unsuccessfully) Sir Arthur Conan Doyle. But what about Schiller and Keats and WS Maugham; Chekhov and Bulgakov and William Carlos Williams; Robin Cook (Coma) and Michael Crichton (Jurassic Park); Smollett, Marat, St Luke, Carlo Levi, Oliver Wendell Holmes, Georg Büchner and Sir Thomas Browne... the list goes on and on, before we even get to those who wrote on medical or paramedical (read: sex) subjects, like Alex Comfort and Oliver Sacks.

The great majority of these doctors turned to writing instead of practising medicine. For men like Verghese (who has also written for the New Yorker, Granta, and other publications even a full-time writer would kill to get into) who is also a full-time practising and academic doctor, we can only stand back awestruck at his energy.

It's tempting to ask why these medics turn to the pen and the MacBook. The answer, I think, is twofold. The first is that medicine, in the end, is about finding out what's wrong and fixing it - in a way, the theme of Cutting for Stone itself. Anyone who thinks that writing isn't a way of trying to do the same thing has never written, nor read with care.

But the more important thing, I believe, is that medicine, like writing, is about stories. Sometimes I wondered why I had gone into such a poor-paying, low-status trade, until I realised that not only had my father comforted me with stories when I was four and my mother terribly ill in hospital, but my upbringing had been to the background music of his stories. A woman with her leg. A man who was dying. A boy with this, a girl with that, Mrs Beelby with her specimens dropped through the letterbox even on Christmas Eve. When he died last year, I found a letter from the Chief Medical Officer of the GPO complimenting him on his reports (he was their regional medical examiner): "always good medicine, good English and a delight to read".

Doctoring is in a way primarily about stories. Doctors – when allowed time by NHS targets – listen to people's stories: a lump, an itch, an unsteadiness. They recast them into medical stories: a tumour, a psoriasis, incipient neuropathies. Then they act upon those stories and bring about yet another one: a recovery, a decline, a death, a survival against the odds. It is a storyteller's art as much as a statistician's science. Read some of the older clinical writing, like Paton's celebrated and mysteriously beautiful case study of Hexamethonium Man from 1954.

In medicine, there are times when one can do nothing. The novelist can always do something. But in both cases, and seldom better exemplified than in Verghese's lovely book, there is a heart to be uncovered. If you require any confirmation of Verghese's scope, consider (a) how many novels you have read with a bibliography, and (b) how many bibliographies contain Pye's Surgical Handicraft, Boot and Saddle in Africa, The Diagnosis of the Acute Abdomen in Rhyme, and Waugh in Abyssinia.

Michael Bywater's recent books include 'Big Babies' and (with Kathleen Burk), 'Is This Bottle Corked?' (Faber)