Cutting for Stone, a novel by Abraham Verghese, MD, opens with an agonizing scene of blood, death and resurrection. Dr. Thomas Stone, a British expatriate surgeon, the backbone of Missing Hospital outside Addis Ababa, Ethiopia, finds his assistant, Sister Mary Joseph Pride, an Indian nun sent by her order from Madras, in the last throes of an obstructed labor. Through the first hundred pages, all surrounding the events of that tragic day, the members of an accidental family are introduced and assembled.
Dr. Verghese slowly gathers all the pieces into that cusp of healing or failure which is an operating theatre: Hema, the Indian ob-gyn; her secret admirer, the gnome-like internist Dr. Ghosh; Stone and Sister Mary; and her twins, soon to enter the world, Marion and Shiva.
Marion narrates this novel, but the story really belongs to the entire family. Hema and Ghosh merge their little households to care for the twins, and grow into a life-long loving relationship as a result. The twins are mentored in the medical world by their adoptive parents. They separate during the revolution which overthrew Emperor Haile Selassie. But all are reunited by tale’s end, once again in a backwater operating room, this time in the Bronx.
The story line follows Verghese’s own life. Born to Indian expat teachers in Addis Ababa, he started medical training there, but left the country during the revolution, returning to Madras and finally to another forgotten outpost in the US to complete his medical residency.
But the power of this book is not in the journey, unique as it may be. Rather, Verghese is a master of many skills. His characters are slowly, and carefully realised, revealing quirks and changes as they are buffeted by larger events. We care deeply about each of them, seeing them as honest, flawed and human. Ghosh evolves from a master diagnostician of the old school, who has no lab facilities, a single X-Ray machine older than he is, and few treatment choices left for the patients by the time he sees them. When Thomas Stone leaves the hospital, Ghosh must take over the surgical cases. Despite paralytic fears of failure, his love of curing wins out, and he becomes a serviceable craftsman, remaining reluctant in his trade. Along the way, he teaches Marion, through aphorism and example, not only the skills of understanding and caring for illness, but also his optimistic and loving approach to life.
Hema, the sudden mother of two, lets her instincts well up and drops her practice for several years, devoting herself fiercely to the practical Marion and his dreamy brother, Shiva. Later, Shiva follows her on her rounds, and, without any formal medical training, literally writes the book on the care of gynecologic fistulas. (These are injuries resulting from the twin practices of child marriage and female circumcision common at that time in the highlands of East Africa.)
Marion and Shiva have the telepathic communication uniquely available to identical twins. But their unspoken rivalry over a housekeeper’s daughter leads to tragedy for all involved, and eventually to Marion fleeing the continent to finish his residency in the down-trodden Our Lady of Perpetual Succor, the Bronx general hospital every bit as third-worldish as Missing in Ethiopia.
Verghese has plotted with care, and every scene included plays out for good or ill as the story progresses. The structure of this novel reminds me a bit of Thomas Mann, with his Germanic passion for order and sense. While the story is thrilling, and knocks the reader off center at times, the use of several edge of the envelope medical situations displays Verghese’s occasional need for a medicus ex machina to reach the climax. But his intelligence as a writer, and his love for the characters overcomes this flaw, which might be evident only to someone like myself, well-versed in the surgical specialties relied on for plot fodder.
Cutting for Stone is a full-bodied tour through mid-century Ethiopia, with stops in India and America’s Northeast. Verghese knows his subject, knows his people, and most of all knows his story. Complex, human, and honest, this book is immersing and rewarding.