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Internacional Journal of Cardiovascular Sciences. 2015;28(4):335-337
POINT OF VIEW
Literature and Cardiology
Ana Luisa Rocha Mallet1,2, Luciana Andrade1, Maria Clara Marques Dias3
Universidade Estácio de Sá – Faculdade de Medicina – Rio de Janeiro, RJ – Brasil, Universidade Federal do Rio de Janeiro – Hospital
Universitário Clementino Fraga Filho – Rio de Janeiro, RJ – Brazil
2
Universidade Estácio de Sá – Faculdade de Medicina – Rio de Janeiro, RJ – Brazil
3
Universidade Federal do Rio de Janeiro – Departamento de Filosofia – Rio de Janeiro, RJ – Brazil
1
Abstract
In the 64th Cardiology Session of the American College of Cardiology, held in March 2015 in California, the opening
lecture was given by Dr. Abraham Verghese, certainly not known for his publications in cardiology journals. By
reading a poem, this professor of Internal Medicine at Stanford University discussed the relationship between
science and literature, encouraging the cardiologists to entertain a unique moment of deep thinking about the
work and the daily connection of medical professionals with the hearts of patients.
Keywords: Teaching; Humanities; Cardiology; Medicine in literature
Introduction
Cardiology is the medical specialty that has most used
technological advances in recent years, often with a
questionable involvement from the point of view of the
actual benefit for the patients. Since technological
advances are undisputable, it is also undisputable that
the doctor-patient relationship has become more distant
and deteriorated. Patients are dissatisfied with the
attention and the care they are receiving from physicians
on all levels of healthcare. This is not different in
cardiology. The patients are broken down into their
various organs, and go to several specialists; neurologists,
cardiologists, endocrinologists, gastroenterologists ...
And they may not have one to be called their doctor. In
cardiology, you may have a cardiologist to take care of
your blood pressure, another one to look after your
arrhythmia, another one for your anticoagulation and
another one to treat your coronary disease. And who
takes care of the patient?
This situation is also distressing for healthcare
professionals and has motivated many discussions on
medical education. An initiative that attempted to bring
the medical professionals closer to those seeking their
attention has been the introduction of humanities studies
in the medical curriculum. Among these initiatives, the
literature appears as a prime opportunity to reassess the
predominantly technical perspective of the medical
education, which is visibly depleted.
Abraham Verghese started the opening lecture at the 64th
cardiology session of the American College of Cardiology
by reading the poem “I carry your heart with me (I carry
it in)” by E.E. Cunning.
Who is Abraham Verghese? Born in Ethiopia, currently
a professor at Stanford University, he is the author of the
best-selling “11th Commandment”. His talk was preceded
by a conversation with Eric Topol, in October 20141. With
this love poem, he remembered that when we talk about
a heart, we talk about two “hearts”. One that is
randomized, participates in meta-analyses, undergoes
high-tech tests, receives various medications and
procedures, and another heart — one that can be moved
by a poem, a heart that suffers, the heart of each patient,
Corresponding author: Ana Luisa Rocha Mallet
Rua Riachuelo 27 – Centro – 20230-010 – Rio de Janeiro, RJ – Brazil
E-mail: [email protected]
DOI: 10.5935/2359-4802.20150048
Manuscript received on August 14, 2015; approved on September 18, 2015; revised on September 28, 2015.
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Mallet et al.
Literature and Cardiology
which is often unattainable. The first heart has received
much attention in modern medicine. What about the
second heart? Perhaps this call for humanity was the
cause of the great impact of the lecture.
Literature, through the expansion of human experience
and mindsets, aesthetic emotion, makes it possible to
imagine other realities and other stories, new experiences
that can help people get closer.
Literature and medicine as an academic discipline
emerged in 1972 at the University of Pennsylvania. The
journal Literature and Medicine published by John
Hopkins in 1982 contributed to its recognition. Since 1995,
30% of American universities have been offering
literature courses in medical schools2.
Literary excerpts addressing medical conditions could
be a first attempt to introduce literature in medical
education. The two texts below express much more
strongly and accurately some common situations in
medicine. Marguerite Yourcenar describes heart failure
in “Memoirs of Hadrian”3 in much greater detail and
vigor than the traditional “dyspnea, edema,
hepatomegaly” — a visceral translation of a major
epidemic in cardiology:
“My dear Mark,
Today I went to see my physician Hermogenes ... I took off my cloak
and tunic and lay down on a couch. I spare you details which would
be as disagreeable to you as to me, the description of the body of a man
who is growing old, and is about to die of a dropsical heart.
It is difficult to remain an emperor in presence of a physician, and
difficult even to keep one’s essential quality as man. The professional
eye saw in me a mass of humours, a sorry mixture of blood and lymph.
This morning it occurred to me for the first time that my body, my
faithful companion and friend, truer and better known to me than my
own soul, may be after all only a sly beast who will end by devouring
his master. [...] my swollen limbs no longer sustain me through the
long Roman ceremonies. Distress! This approaching end is not
necessarily immediate: I still retire each night with hope to see the
morning. [...] To say that my days are numbered signifies nothing;
they always were, and are so for us all. But uncertainty as to the place,
the time and the manner, which keeps us from distinguishing the goal
toward which we continually advance, diminishes for me with the
progress of fatal malady. A man may die at any hour, but a sick man
knows that he will no longer be alive in ten years’ time. My margin
of doubt is a matter of months, not years. [...] the soothsayer who told
me that I should not drown seems to have been right ... a moment’s
suffocation will settle the matter. Shall I be carried off by the tenth of
these crises or the hundredth? That is the only question. [...] Running,
even for the shortest distance, would today be as impossible for me as
for a heavy statue, a Caesar of a stone; but I recall my childhood races
[...] never doubting that the perfect heart and healthy lungs would
re-establish their equilibrium.”
Int J Cardiovasc Sci. 2015;28(4):335-337
Point of View
In the classic “The Death of Ivan Ilyich”4 by Leo Tolstoy,
the experience of illness and death is described as drama
not found in textbooks dealing with the finiteness of life.
“What tormented Ivan Ilych most was the deception, the lie, which
for some reason they all accepted, that he was not dying but was simply
ill, and he only needed to keep quiet and undergo a treatment and then
something very good would result.” He however knew that do what
they would nothing would come of it, only still more agonizing
suffering and death. This deception tortured him—their not wishing
to admit what they all knew and what he knew, but wanting to lie to
him concerning his terrible condition, and wishing and forcing him
to participate in that lie. Those lies—lies enacted over him on the eve
of his death and destined to degrade this awful, solemn act to the level
of their visitings, their curtains, their sturgeon for dinner—were a
terrible agony for Ivan Ilych.
[...] The awful, terrible act of his dying was, he could see, reduced by
those about him to the level of a casual, unpleasant, and almost
indecorous incident [...]. He saw that no one felt for him, because no
one even wished to grasp his position [...] At certain moments after
prolonged suffering he wished most of all (though he would have been
ashamed to confess it) for someone to pity him as a sick child is pitied.
He longed to be petted and comforted.
Conclusion
Literary examples can be used with students during their
medical education so that in their increasingly busy and
stressful everyday life they do not fail to realize that
diseases happen on real people and each one reacts
differently to the process of getting ill. The attempt to get
closer to the heart — often unattainable — does not
prevent from attempting this connection, which can be
established by uttering words.
“Science is crude, life is subtle — and it is for the correction of this
disparity that literature matters to us”
Roland Barthes5.
Potential Conflicts of Interest
This study has no relevant conflicts of interest.
Sources of Funding
This study had no external funding sources.
Academic Association
This manuscript is part of the Post-doctoral research in
Comparative Literature by Ana Luisa Rocha Mallet from
Universidade do Estado do Rio de Janeiro.
Point of View
The opinions expressed in this manuscript are solely those of
the authors. The International Journal of Cardiovascular
Sciences welcomes different points of view in order to stimulate
discussions to improve the diagnosis and treatment of patients.
Int J Cardiovasc Sci. 2015;28(4):335-337
Point of View
Mallet et al.
Literature and Cardiology
References
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Topol EJ, Verghese AC. Cutting for Stone’s Verghese talks prose,
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Hawkins AH, McEntyre MC, eds. Teaching literature and
medicine. New York: Modern Language Association; 2000.
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Yourcenar M. Memórias de Adriano. Rio de Janeiro: Nova
Fronteira; 2005.
Tolstoi L. A morte de Ivan Ilitch. São Paulo: Editora 34;
2006.
Barthes R. Aula. 14a ed. São Paulo: Cultrix; 1996.
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