'Need art to make meaning of our lives, technology to boil coffee': Dr Abraham Verghese

The physician-author talks about writing, his life in medicine, AI and more

60-Dr-Abraham-Verghese Dr Abraham Verghese | Christopher Michel

Interview/ Dr Abraham Verghese / physician and author

The first thing you notice about a person says a lot more about you.

For Dr Abraham Verghese, it is shoes. They help put himself in the shoes of the patient he is seeing. “We all are supposed to do that, to try to do that. A part of you has to be objective and yet you have to sort of try to imagine what [the patient] is going through,” he tells THE WEEK over Zoom from Texas, where he is attending a book fest, in early November.

I think I have been blessed to have had some very strong and charismatic women in my life. Both my grandmothers were, in their own way, quietly heroic women―the kind of heroism that the world will never know.
It has taken a lot of time to really grasp that life is a terminal condition. Nobody survives. And so in that sense, we have to have a role that is larger than just making people better because we can’t do it all the time.
I know this sounds a bit disingenuous, but I think of myself as all-physician. And I am looking out at the world through the lens of a physician.
[Obama] had a hard time being effective. And I don’t know if that was his failing or his inability to build consensus, or it was just the determined opposition to someone like him.

His latest book―The Covenant of Water―has made him put on his travel shoes more often this year. A week or so before the interview, he was in Spain to promote the book’s Spanish edition. While his previous three books, too, had done well, the latest one is seeing success on a whole different scale―the book has made it to many a ‘best books of 2023’ list, is the 101st pick of Oprah’s Book Club and has already sold more than a million copies.

It has been a whirlwind year for him, no doubt. But he seems untouched by the busyness that surrounds him when he sits down for the interview at 7am, Texas time. He speaks in a calm, unhurried tone, with not even a hint of irritability or discomfort despite nursing a cold. Even when the audio acts up at our end, he is patient. These are qualities that show up in and at his work―both as author and physician. (He is professor and Linda R. Meier and Joan F. Lane provostial professor, and vice chair for the theory and practice of medicine at the School of Medicine at Stanford University, California.) Be it the creative or the clinical side, he is, as Stanford Magazine describes him, the human whisperer.

In an hour-long conversation, Verghese talks about his early life in Addis Ababa, his Madras days, his life and medical practice in the US and what it means to be a writer. Excerpts:

Q/ Why do you write, Dr Verghese?

A/ I began writing first to tell the story of something that I was living through, which at the time was very unusual. I thought I was living in a small town in Tennessee as an infectious disease specialist and everybody expected that I would see, in 1985, maybe one patient with HIV every other year because it was considered an urban disease, you know, more a function of big cities. But in a few years, I had about a hundred people with HIV infection that I was caring for, which was much more than anybody predicted. And it turned out to be a story that I thought was happening all over America. And it represented boys who had grown up in that town, who left for the big city and lived there for decades. And at some point the virus found them and now they were coming back to their hometowns because they were sick. So I wrote a scientific paper describing that, but then I felt that the language of science didn’t begin to capture the heartache of the families, the tragedy of that whole journey. That was the moment I became a writer. (His first book―My Own Country: A Doctor’s Story―came out in 1994.) And then I just sort of have kept going, I have kept writing ever since then. I think partly it is because I love to read. I came to medicine because of certain books, certain novels that inspired me. And so once I published that first book, I had this ambition to write the kind of novel that would inspire another generation of readers to go into medicine.

Q/ I read that writing became an escape for you while treating patients with HIV. Is it still an escape? Or, is it something else now?

A/ Yeah, I think when I first started writing about HIV, I was writing fiction, short stories. And it was a kind of escape. In my fiction, I was able to do the things I couldn’t do in reality, which is turn back time and get into people’s heads. I think it is still sort of an escape. I think what happens is once you have published a book and it has been recognised, then you become more self-conscious. So it becomes less of an escape and you become more mannered, if you like. But yeah, it is a bit of an escape. Mostly it is a pleasure. Sometimes, it feels like a lot of work.

Man and his modes: Verghese at his writing desk, with the whiteboard, where he doodled the characters and storyline of The Covenant of Water, in the background | Christopher Michel Man and his modes: Verghese at his writing desk, with the whiteboard, where he doodled the characters and storyline of The Covenant of Water, in the background | Christopher Michel

Q/ How do you see art or literature? As escapism? Entertainment? Education?

A/ Well, all of it, but I actually think that fiction, especially reading novels, has an important function in people’s lives. I think when a book is a book that we find deeply meaningful and that we remember and that is important to us, it is usually because it resonates with some truths that we already recognise. [Marcel] Proust, the French writer, said that every book, every novel becomes an optical instrument by which we examine ourselves. So every reader frames the book in terms of [his/her] own personality. I am struck by the kind of responses I am getting from readers about my book. It is very individual. Every reader makes their own mental movie of the book from the words. So I think fiction has an important role in our lives. And I worry that when your attention span is confined to Instagram and short bursts like that, and when it is all visual and when you don’t have the experience of taking words and making pictures in your head, then a part of your brain just doesn’t get exercised. And I think you lose something.

Q/ You said in an interview that Covid-19 had echoes of the epidemic―AIDS―that made you a writer. So what effect has Covid-19 had on you?

A/ I think Covid-19 had a lot of influence on all of us. But the difference was that I was much older than when HIV came along. And I was not so much on the frontline as my younger colleagues in the ICU and in the emergency room [were]. Even though I was caring for patients, I didn’t feel quite the way I did during HIV when I thought I was very much on the frontline. And also, I don’t think that Covid had the same sort of social prejudice that HIV had in the early years. So I think it was very poignant. It was very sad to see the extent of it, to see people dying with this illness and not having their family members be able to come close because of masking and all that. So it affected us all very deeply. But I think it shaped the younger generation more than anything. But it had echoes for me of the early years that shaped my medical career.

A clay model of The Stone Woman, an artwork that appears in the novel | courtesy Abraham Verghese A clay model of The Stone Woman, an artwork that appears in the novel | courtesy Abraham Verghese

Q/ Your experience with treating HIV patients brought you face to face with what you call the conceit of cure. You have also said that HIV humbled you. How does a doctor come to terms with the limitations of his profession?

A/ When you are a young physician, you are full of yourself. And you just assume that you can fix most things. And if you can’t, it is not your fault. It is [because] the patient came too late (laughs). There is an arrogance of youth. And I think that was especially true in my speciality―infectious disease…. People went into the speciality because it was all about cure. You could really make a dramatic difference if you made the right diagnosis, I don’t know, in a bone marrow transplant patient with an infection and so on. And then HIV came along and for many, many years, we had no treatment, no cure. And I think it humbled many of us. And it helped us understand that even when you couldn’t cure, you still had an important role. And I think that is still true. It has taken a lot of time to really grasp that life is a terminal condition. Nobody survives. And so in that sense, we have to have a role that is larger than just making people better because we can’t do it all the time.

Q/ Did that in any way make you lean towards bedside medicine?

A/ Actually, what led me to bedside medicine was the wonderful training I had in India. So I had my medical education in two places―in Ethiopia to begin with and then when the civil war broke out there, I eventually finished in India [Madras Medical College]. But in both cases, there was a British system of education that put great emphasis on learning to read the body as a text. It is an art that is dying, that is not done very well anymore. But I loved it. And I had the most wonderful teachers, unforgettable people who were incredibly skilled at reading the body. And so I sort of really fell in love with that. And it is ironic that my reputation in America in academic medicine has a lot to do with bedside medicine (laughs). And yet it is not as though I learned some special skills in my postgraduate years. I am calling on my memory of my wonderful teachers in Madras, whose lessons are still with me. I can hear their voice.

Q/ You mentioned your experience of civil unrest in Ethiopia, and later you were a nursing assistant in the US, both of which have shaped you, your life and your work. Could you elaborate on that?

A/ I think they were all very influential. I was of Indian origin, but born in Ethiopia, and I still speak the language very well. On the other hand, there was a big community of Malayali teachers hired from the same place, largely Christians, Syrian Christians. So the paradox of growing up in a St Thomas Christian community while being in another land, which I suppose is not that different from kids who are growing up these days in the Gulf, Dubai―they are very much in the Malayali community, but they are elsewhere.

And then the civil war was very dislocating. It was very traumatic. I think there were 30 of us or less than that in our medical school class, and some of them were arrested and tortured, and many of them became guerrilla fighters for the other side, so to speak. One of them, after 22 years of being a guerrilla fighter, became the prime minister of Ethiopia, and I had the opportunity to interview him for a magazine many years later. So, it was a tremendously impactful occurrence in my life to be displaced like that.

And I wound up coming to America and working as a nurse’s helper for one and a half years before I was able to transfer to a medical school in Madras because the Indian government took me in. So all those things are hugely influential.

I think, as a writer, I often feel that I am always on the outside looking in. Whether I was in Africa, even when I was in India, I was very, very comfortable in Madras and had all my great friendships and relatives there. But even there, at some level, I didn’t have quite their experience because I wasn’t born there. I wasn’t as fluent as they were. And of course, in America, I am an immigrant. I am an American citizen, but still, at some level in my head, I feel I am an outsider looking in, which is a great perspective to have as a writer. It’s not a bad thing, necessarily.

Women who inspire: (From left) Verghese’s elder brother George Jr, mother Miriam, Verghese and his father George Sr | Courtesy Abraham Verghese Women who inspire: (From left) Verghese’s elder brother George Jr, mother Miriam, Verghese and his father George Sr | Courtesy Abraham Verghese

Q/ Why did you decide to take time off medicine and then go for the Iowa Writers’ Workshop?

A/ I think I felt that that was the lesson that my patients were teaching me, that if you want to do something, don’t postpone your dreams, don’t take forever to do that. I was also getting quite burnt out being the only person providing HIV care in that town. I felt that I wanted to keep doing this, but in order to do it and not get totally burnt out, I needed to take some kind of a break. So I wanted to tell the story, and I applied to the Iowa University Writers’ Workshop. The only criteria for admission are two short stories. Nothing else really matters. When they took me, I decided to go. If they hadn’t taken me, I was still planning to give up my tenured position and take a year off to write this story while working in emergency rooms or whatever else I could do to make money.

Q/ How did the workshop help?

A/ It is a very interesting place. The Iowa Writers’ Workshop was one of the first to offer a master’s degree or a PhD where your thesis was a collection of short stories or a novel or a chapbook of poetry. Over the years, it has turned out some wonderful American writers, from Flannery O’Connor to John Irving to Tracy Kidder. But the Iowa method, which is still the method they use there now, and it is widely emulated, is very simply you met once a week and you discussed two of the students’ stories. When your story came up, you kept quiet while your fellow students and the writer-in-residence discussed it. You very quickly found out that the kind of story that Ammachi [grandmother] thinks is cute and your spouse thinks is so nice doesn’t usually fly there. In fact, the moment that your spouse or your Ammachi doesn’t like your story (laughs), you probably have found your voice. But the most important thing Iowa did, I think, is it gave you the time, because you only met once a week and the rest of the time was yours to read, to find your voice, to write. And I knew that I would not have that kind of time again, and I had never had that kind of time. So I took full advantage of it. I think I was in my mid-30s. By contrast, I think many of the students were straight out of college. They were in their mid-20s and they were too young to appreciate how precious this time was. But I wasn’t. I was very conscious of it.

Q/ Your second book, The Tennis Partner (1997), was also nonfiction and personal. Your fiction, be it Cutting for Stone (2009) or The Covenant of Water, also comes from a personal space. Does it come easy to you, opening up a part of yourself like that?

A/ I think the second book, as you said, was nonfiction, but I wrote it somewhat reluctantly. I mean, the first book about HIV, I thought I was going to do that as a novel (laughs). It turned out to be better told as nonfiction. Nonfiction, at least in America, outsells fiction five to one, ten to one. For some reason, if something really happened, readers are more interested in it than if you make it up. So in general, even though novels make a lot of splash, nonfiction makes money for publishers. So there was a lot of pressure for me to write another nonfiction story. And I had just lived through another experience with the death of a friend.

But I was really keen to write fiction because I think it is very liberating. My fiction, I mean, even though it draws on things I know, it draws on my experience, I don’t think it is autobiographical in the sort of broadest sense. But I do write about what I know. So the first novel was set in Ethiopia and the character goes to medical school. But that’s about the only resemblance―I didn’t have a twin, my mother was not a nun.

Verghese’s maternal grandmother | Courtesy Abraham Verghese Verghese’s maternal grandmother | Courtesy Abraham Verghese

Q/ With The Covenant of Water, you said you wanted to write about the landscape. Did the geographical aspect come to you first or the characters?

A/ First of all, it is not as though I am a novelist with 20 books. And so I can say this is my rule. I am just telling you how these things happen. But for me, it seems the most important decision is geography―where you locate the book. So my first [novel] was located in Ethiopia. It would not be the same book if I located it in New Jersey or somewhere else. Similarly, I think making the decision to put the novel in Kerala is huge because I think geography affects everything. Napoleon said that geography is destiny. And that is certainly true in my life. Every change of geography has changed my destiny.

But I had hesitated [to set my novel in Kerala] even though I was very familiar with Kerala, coming there every summer for vacation. As I mentioned, growing up in a Malayali household and community, I didn’t have quite the familiarity perhaps that you do or someone born there does. So I hesitated. But ultimately, my mother had written this wonderful longhand document for my niece, her granddaughter, because her granddaughter asked her, ‘What was it like when you were a little girl?’ And seeing that manuscript with all its illustrations reminded me how rich it would be to set a novel in the unique era of the 1900s in Kerala with all its wonderful rituals, particularly the rituals of the St Thomas Christian community that are not that well-known to people certainly outside of India, but even within India. I am not sure that they are all that well-known.

Q/ You doodle. You had a whiteboard when you were writing The Covenant of Water. You also sculpted a clay model of the ‘Stone Woman’ (an artwork that appears in the novel). How are these processes essential to your writing?

A/ I think they are ways of you thinking aloud. Even though I wanted [the whiteboard] to be kind of the whole architecture of the novel, like a house plan, like a blueprint, [it] never quite worked out [that way]. Once [you] start building, you suddenly feel like, ‘Oh, well, the veranda doesn’t belong here, the sun comes that direction (laughs)’. I kept changing the plan. So I look at them now as just artefacts of the creative process. They weren’t the causative agents that made me write in a certain way. They were just part of the process.

Q/ The Covenant of Water was unputdownable. Do you write with that intention―to make a book that is unputdownable?

A/ Yeah, I suppose. When you write fiction, as opposed to nonfiction, you really have to work very hard to get the reader to suspend their disbelief in the first few pages. You want them to forget that they are sitting in a hot room and that they are unhappy with their mother-in-law and that there’s work tomorrow. You want them to forget all that and enter this world in two or three pages. And then you have to work very, very hard to keep them in this fictional dream with their disbelief suspended. So I think it is much harder to write fiction than nonfiction because when something really happens, we have an inherent interest in it. But when you write fiction, I think you just have to work very hard. So I am not sure about my goal being to make it unputdownable as much as to make it a very believable world and to make the reader want to keep turning the page to have this urge of, ‘Well, what happened next? What happened next?’ Not quite in the sense of a murder mystery where the ‘what happened next’ is pretty compelling. Somebody has been killed, and you have to find out who did it. I think with literary fiction, it is a different kind of ‘what happened next’. But yeah, it is very much on my mind.

Talk of the town: Verghese discussing his book at an event organised by Malayala Manorama in Kottayam, Kerala | Jince Michael Talk of the town: Verghese discussing his book at an event organised by Malayala Manorama in Kottayam, Kerala | Jince Michael

Q/ I wanted to talk about the women characters in The Covenant of Water. I thought you wrote them with understanding and empathy, and I think it is rare when it comes to male writers. Did it come naturally to you?

A/ Does it come naturally for a middle-aged male to enter a woman’s head? (Laughs.) No, I don’t think it comes naturally. But I think I have been blessed to have had some very strong and charismatic women in my life. Both my grandmothers were, in their own way, quietly heroic women―the kind of heroism that the world will never know. Those ammachis who labour away, and they are so critical to the welfare of a family. And they suffer a lot. They have gone through a lot of hardship. But their faith is so strong. They just keep going on. So I think that was my role model. First of all, the two of them, because they had both been through considerable adversity―losing a child. Each of them had lost an adolescent boy. One to typhoid, one to rabies. And they lived in the confines of the house that they married into. I don’t think they had ever travelled far from it. And to me, they were so noble, despite not having the trappings of what we would consider power.

And I think my mother was also tremendously influential. She was very brave to set off in the 1940s, just after independence, reading this ad in the newspaper, and went off to Ethiopia in a sari, a single woman. Can you imagine? In a place that she never knew anything about, had to look up on a map. I think that I have been surrounded by strong women role models, if you like, of the kind of women I wanted to put in my fiction.

Q/ Love and loss are two prominent themes in The Covenant of Water. What does love mean to you, and what does loss?

A/ It is funny when people ask me questions like that. I am always destined to disappoint them with the answer. Because when I am writing, I am not thinking of themes. It is like when you were studying in college, and you get these questions, what is the theme of the novel? What is the underlying operating archetype? I think when you are a writer, you are just trying to tell a good story. So I think it is after the fact that readers impose these sort of meta constructs on a book about themes. So I am not sure that I had any agenda around love and loss, except that as a physician, I think I am much more conscious of mortality than perhaps many people are. I am not being morbid. I feel I am accurately portraying the kind of death and carnage that was pretty common in the era I was describing. People died from infectious disease. They died from drowning. They died from trauma. Whereas I think most lay people are in a bit of a denial about their mortality. I am not, and I think that because I am not, I am also more in awe of life. I think we are all living on borrowed time. This is not a permanent state we are in. This is an ephemeral conversation; it will disappear one day. Or, we will, the conversation might linger. So I think that sensibility does come into my writing, but not consciously like that. It is not my agenda that I am going to write about loss, I am going to write about love. I think the things that move me in life are love, are loss, just like they move all of us. So it is nothing special.

USA-OBAMA/ARTS Top honour: US President Barack Obama awards the 2015 National Humanities Medal to Verghese at the White House in Washington in September 2016 | Reuters

Q/ How much do you love your characters?

A/ Well, I grew to love them. I think initially they are two-dimensional constructs, but then as you revise and revise and revise, they become very, very real to you. Big Ammachi [from The Covenant of Water] became as real as one of my grandparents. So they all become very real. One of the criticisms (laughs) of my book was that my characters are all too nice. I didn’t have anybody who was bad. But in a way, that’s my view of how we are. I really don’t think there are very many people who are inherently evil. There are, but not many. Most of us are trying to do our best, and sometimes we have made terrible mistakes, and we are trying to find redemption. In a sense, I have always had trouble with the Christian theme of we are sinners and we have to confess. But in a funny way, I think I have echoed that theme with my characters, because I do think that people are mostly good and trying to do good and often have made mistakes that they are trying to compensate for.

Q/ Did you have to ‘kill your darlings’ in the book?

A/ Yeah (laughs), I think that’s a famous saying in writing that you have to kill your darlings. But when they say kill your darlings, it doesn’t mean killing your favourite characters, by the way. What it means is, as you know, if you think a piece of writing is very, very cute, you have written 10 pages, but you love this one paragraph, that’s the paragraph your editor and you, if you have some wisdom, are going to realise that it is just not working.

Q/ Was it difficult to do that?

A/ I think as a writer, I have always been very conscious that I cannot be objective about my writing. I think most readers don’t realise how critical an editor is to the process. I actually think editors should be listed on the book, because honestly, you have to trust someone experienced who has the ability to say, ‘This section is lovely, but it doesn’t belong in this book. This section is great, but you should expand on it.’ You lose all objectivity. You are no longer able to see.

Q/ There is tragedy in The Covenant of Water, but there is also hope. Do you think art has to be hopeful?

A/ Well, again, I am not starting out with an agenda of themes, like I want to bring hope to this, but I think hope is a necessary human quality for us to go on, to wake up every day and despite whatever trials we are facing, the desire to go on is because, I think, one clings to some hope that if things are not good, that they will be better. I don’t think I was consciously trying to impose hope on my world or anything like that.

Q/ We talked about mortality and how you view it. There is a lot of research happening on reversing age and attaining immortality. What is your view on that?

A/ I think the biggest things we can do to live longer are actually things that are not as sexy as creams that we apply or injections we take. It is much more going to be about very simple things, like diet and exercise will prolong life a lot more than many other things. I think it is interesting. It is very human to want to live longer, and we are living long. I think, in general, people are healthier for the most part. And, medical technology is advanced to the point where things we might have died of―like the two things I mentioned my uncles who I never met died from―they are both eminently treatable conditions. So I am interested in longevity from that point of view. I think there is a lot of other stuff out there that is yet to be proven.

Q/ Do you identify yourself as a physician first and then a writer?

A/ I know this sounds a bit disingenuous, but I think of myself as all-physician. And I am looking out at the world through the lens of a physician. And when I approach the writing, it is very much the same lens and I am looking at human beings in some detail. But unlike in my day job, I am also allowed to get into their heads and allowed to imagine things about them. But it is the same lens. I always resisted when people try and [make] me wear two hats―a writer hat or a physician hat. I certainly don’t feel that way, I don’t feel quite so schizophrenic.

Q/ You wrote an interesting paper―Culture shock: Patient as icon and icon as patients―where you contend that the patient in the hospital bed gets less attention than the patient data on the computer. Do you think we are too much in awe of technology?

A/ I think there is a great danger, both in India and elsewhere, any place that has access to sophisticated medicine. We are getting so enamoured with the data, the images, the CAT scan, the MRI. But sometimes we can lose sight of the human being and sometimes you could wind up spending people’s money in a way that is so destructive. When what they really need is something simpler and they need to be listened to, they need to be cared for. But a lot of medicine, both here certainly and also in India, has become very much like a business machine, trying to improve the bottom line, which is understandable to some degree. But it has really changed the practice of medicine.

Q/ I read that you first look at the patient’s shoes. Is that true?

A/ We all are supposed to do that, to try to do that. A part of you has to be objective and yet you have to sort of try to imagine what [the patient] is going through. One of the hardest things that happens to physicians is that we can get so disease-focused that we forget about the individual who has a disease. A very famous American physician who died in 1919 used to say, ‘It is much more important to know what patient has the disease than what disease the patient has.’ I think that remains true. I think it is much less about specific diagnosis than it is about getting to know this person in front of you and the illness that they have and sometimes the outcome depends much less on the nature of the illness than on the nature of the patient.

Q/ Do you think AI will take over our jobs?

A/ I think AI is going to do a lot of things (laughs). But there is a big misconception about AI; it is neither artificial, nor is it intelligent. It is actually parasitising material already existing in the world by writers like me. In fact, there is a movement afoot to try and make sure that AI pays us for poring through our novels and coming up with ways to imitate us. So I think it is an interesting phenomenon, it will generate a lot of interesting quasi art. But ultimately, we respond to human beings, individuals making art. I am not sure whether we are moved by, except in the abstracts, technology creating art even if it has some similitude where it feels real. Even so, I don’t think it is quite the same thing.

Q/ There is a thinking that science and technology have shaped the world today. Where do you think art stands in what is being called the age of AI?

A/ Art gives meaning to our lives. If we were mechanical creatures, then we wouldn’t need art. But art is in a way tapping into our subconscious and tapping into our complex motivations. I mentioned Proust talking about novels being an optical instrument that allows you to look into yourself. Similarly, I like a lot of modern art, but it is very subjective. The artist presents you something and you bring your life history and your biography and your eyes and you look at this thing and you tell yourself a certain story. My belief is that we need art to make meaning of our lives. We need technology to boil our coffee and to allow us to talk on Zoom, but it doesn’t necessarily give us meaning.

Q/ There is this notion that fiction is somehow less important than nonfiction, that there is little you can learn from it. I know you don’t agree with that. But why do you think people see it like that?

A/ It is really puzzling to me. We raise our children with stories. We use stories from the very earliest stage. If you think about your own childhood, it is a succession of small stories that impacted you. And it is always puzzling to me why people stop reading fiction, to their great detriment. At least in America, the majority of readers are women. One could argue that they have perhaps more time. That’s not a really good argument, but it’s being made. Very often, especially in medicine, I find my colleagues have this sense, ‘Oh well, I am a serious kind of person, so I don’t read fiction; I read biography, I read memoir.’ I am always struck by that, because fiction, time and time again, has the ability to change societies. You think about Uncle Tom’s Cabin in America. That novel ended slavery in America. One book captured the public’s imagination and made slavery unpalatable. Similarly, in the UK, one book―The Citadel by A.J. Cronin―depicting medicine and health care in a small Welsh mining town created the National Health Service. It caused such a public sentiment.

When fiction sweeps through society, it has a particular role in shaping us. And, a part of the reason that to me medicine feels very unimaginative at times in terms of the way people seem to understand it is because we have become so left-brained in our orientation. And we are not tapping into the right brain and all its wonderful mystical associations. All the stuff that Freud and everyone else would tell us is terribly important in driving us.

Q/ What is your next book going to be? Fiction or nonfiction?

A/ I am not even thinking about a next book right now. One of the common things is that when you have done something, then it is assumed that you are going to keep doing it. You are going to create another one, another one. And with every book, I have always felt that I have nothing more to say, that I put everything I know into it. And, I think when you do something that’s worked well, there is immediately the sense of, ‘Oh, what’s next? You’re gonna do this again. When will you do it again?’ And I must say, I feel free of that pressure. So that’s probably why it took 14 years between the last book and this book.

It is not that I don’t want to create these works, but it is not easy for me to do that. And I can’t just do it on demand. It has to sort of come organically, because I feel I have something to say, and there is a story that’s compelling. So I am not in any rush to write another one right away. I probably will write. I enjoy writing. But I don’t feel compelled to churn out another bestseller, first of all, because it is impossible to do. I think it is incredibly lucky to have had one novel do well, and then to have a second one do even better. There is no formula. With every book, you start from zero. And it is long, tortuous. This book especially was really, really hard. I actually had to switch publishers, because they were impatient with me, and I thought that they didn’t get the story. So at some great financial peril, I had to return the money they advanced me, find a new publisher. So, I would be very, very cautious about jumping in to do this again, unless I felt compelled to.

Q/ You received the National Humanities Medal from former president Barack Obama in 2015. When Obama, the first black president was sworn in, there was a feeling that America had come of age. And then Donald Trump came to power. Did we celebrate too soon? Or, were we naive enough to think that America had moved beyond race and colour?

A/ It has been a very curious time. I am a great fan of Obama. I thought he was remarkably articulate. But that said, he had a hard time being effective. And I don’t know if that was his failing or his inability to build consensus, or it was just the determined opposition to someone like him. Donald Trump has been a very curious phenomenon. As a writer, you sit back and observe all these things. But it is not just America. You look around the world, in India, everywhere, there is sort of shocking polarities in the way countries are moving that are unexpected. You sort of assume progress comes with open-mindedness and generosity of spirit and inclusion rather than exclusion. But that is not the case. And as a writer, you just come back to the sense that, well, we are human, and we are infinitely more complex than anyone can outline on a piece of paper.

Q/ You are a physician, professor, writer. How do you find time to do all this?

A/ Well, I take my time, I am very slow. Fourteen years to produce another book is a long time (laughs). I am not in any great hurry. I love my day job. I love teaching medical students. I love practising medicine. I love writing, too. But thank God, I don’t have to use the writing to pay the bills. I am doing it out of love, and when it does well and it is successful, it is always a tremendous delight. People assume that I am juggling all these things at the same time, but it is really not quite like that. I don’t play golf, I don’t watch a lot of TV, so I suppose that frees up a lot of time.