Cutting for Stone, by Abraham Verghese, MD, 688 pages, Vintage, $16.
In the pantheon of Hindu cosmology, the god Shiva is what would be known as a “heavy.” God of destruction, he holds a trident in one hand and fire in another, even as his four other arms orchestrate the dynamics of the cosmos. Long before the Big Bang Theory, Hindu philosophers viewed the expansion and contraction of the universe as the rhythmic backbeat in the Great Dance of Shiva.
In Part One of Cutting for Stone, Dr. Abraham Verghese, an American physician born in Ethiopia to Indian parents, orchestrates a dynamic and vivid convergence of developing characters that culminates in a violent operating room scene. Into this surgical spectacle is born Shiva, namesake of the Hindu god and Siamese twin to Marion, the protagonist and narrator of Verghese’s novel. Their mother dies in childbirth, and the obstetrician Hema—now foster mother of the twins—literally dances with one in each arm on a sea of their mother’s life blood, setting the novel’s epic story of destruction and creation into motion.
Verghese is a physician, writer and professor of medicine at Stanford University, where he is senior associate chair for the theory and practice of medicine. Three days a week he teaches medical students and house staff; the other two he writes in a secret office provided by the university. And the man can write. His first two books were authentic and compelling memoirs of his practice experience. In 1994 he released My Own Country: A Doctor’s Story of a Town and Its People in the Age of AIDS, and in 1998 he published The Tennis Partner: A Doctor’s Story of Friendship and Loss. In these he earned credibility as a thoughtful and humane physician, and as a gifted writer.
Cutting for Stone, Verghese’s first novel, begins at impoverished “Missing” (Mission) hospital in Addis Ababa, the 8,000-foot-high capital city of Ethiopia. The novel’s principal backdrop is Ethiopia’s revolution during the sixties and seventies, resulting in the coup that deposed emperor Haile Sellasie and put army official Mengistu Haile Mariam, an ostensible representative of the people, in charge. As is often the case, U.S. money and arms supported the incumbent dictatorship.
Verghese is careful to view history with a humanitarian “retrospectoscope” that shows neither side as completely good or evil. Sellasie, in his paternalistic delusion, believes he is taking care of his people, even as he succumbs to the corruption of absolute power. The rebel leader, Mengistu, is cut from the same cloth. The story of Cutting for Stone evokes a theme similar to another recent book, Stones for Schools by Greg Mortenson. Both books confirm a contemporary axiom which seems to hold true: educate girls, rather than provide guns for blind rulers, and you will do far more to set an impoverished country on the road to progress.
Verghese’s characters are as widespread in personality as the setting. The improbable parents of Shiva and Marion are a young and devout Carmelite nurse from India, Sister Mary Joseph Praise, and a fanatically skilled but tortured alcoholic surgeon from Britain, Dr. Thomas Stone, who flees Ethiopia after the twins are born. Stone is also the author of a textbook, A Short Treatise on the Practice of Tropical Medicine.
Shiva and Marion are adopted and raised by two Indian doctors, Hema and Ghosh, who do their best to give the boys a family while fostering and passing on their own love and devotion to medicine. Hema is deftly described by Verghese as a physician “who listens first, and then thinks” when with a patient. Ghosh is a gifted diagnostician, the teacher responsible for investing Marion, the older twin, with a love of medicine and learning.
In each of these physicians, Verghese reveals his own gravitas as a physician and teacher. Ghosh, for example, asks a medical student, “What first aid treatment in shock is administered by ear? Words of comfort.” For its part, Stone’s textbook is the source for pearl after pearl of medical wisdom, including:
• “The operation with the best outcome is the one you decide not to do.”
• “Thou shalt not operate on the day of a patient’s death.”
• “Call no man happy until the day he dies.”
This last pearl is from Herodotus, allegedly quoted by Sir William Osler on hearing the news of his son’s death on the battlefield.
Verghese admits the basis for much of Stone’s imaginary textbook is derived from the real Bailey and Love’s Short Practice of Surgery (1932). In various interviews Verghese has said that his hope in writing the novel was “to tell a great story, an old-fashioned, truth-telling story.” In addition, he wanted to show how “entering medicine was a passionate quest, a romantic pursuit, a spiritual calling.” His description of Ghosh captures a universal quality of the classic physician: “[His] quiet careful manner, his way of being with patients that made them feel they were the focus of all his attention and that there was nowhere else he had to be.”
While it may have special appeal to the medical reader, Cutting for Stone has something for everyone. It is a novel of vast scope with all the classic elements of a great story: love, history, birth, death and revolution. Verghese’s prose is powerful and vivid, sometimes even a little over the top. His description of the dreadful city of Aden is memorable: “The city was at once dead and yet in continuous motion, like a blanket of maggots animating a rotting corpse.” On the other hand, the beginnings of filial love certainly deserve a more deft and subtle description than, “[My] twin brother and I announced our presence in her womb and our unstoppable desire to trade the nourishment of the placenta for the succor of her breasts.”
In Cutting for Stone, medicine and surgery meet history. The novel’s title is taken from the Hippocratic Oath: “I shall not cut for stone, even for patients in whom the disease is manifest, and will leave this operation to be performed by practitioners, specialists in this art.”
Verghese’s tale suggests that the practice of medicine is more than merely a trade. In ministering to others, he writes, physicians may “heal [their] own woundedness.” When Marion is overwhelmed in his early studies of surgery, he confides in his adviser, “Why must I do what is hardest?” She answers that he is an instrument of his creator and should not leave the instrument sitting in its case. “Play, and leave no part of your instrument unexplored. Why settle for Three Blind Mice when you could play Gloria?”
At the conclusion of the novel, Verghese devotes a full 10 pages of acknowledgements to every person, place and influence that contributed to the telling of his story. He saves the best for last, telling us something essential about himself: “Medicine is a demanding mistress, yet she is faithful, generous and true. She gives me the privilege of seeing patients and of teaching students at the bedside, and thereby gives meaning to everything I do. Like Dr. Ghosh, every year at commencement, I renew my vows with her: I swear by Apollo and Asclepius and Hygieia to be true to her, for she is the source of all … I shall not cut for stone.”
Dr. Flinders teaches at the Santa Rosa Family Medicine Residency Program. Jessica Flinders is a family nurse practitioner in private practice in Petaluma.