Cutting for Stone: A Novel

by Abraham Verghese Narrated by Sunil Malhotra

Overview

A sweeping, emotionally riveting first novel-an enthralling family saga of Africa and America, doctors and patients, exile and home.

Marion and Shiva Stone are twin brothers born of a secret union between a beautiful Indian nun and a brash British surgeon at a mission hospital in Addis Ababa. Orphaned by their mother's death in childbirth and their father's disappearance, bound together by a preternatural connection and a shared fascination with medicine, the twins come of age as Ethiopia hovers on the brink of revolution. Yet it will be love, not politics-their passion for the same woman-that will tear them apart and force Marion, fresh out of medical school, to flee his homeland. He makes his way to America, finding refuge in his work as an intern at an underfunded, overcrowded New York City hospital. When the past catches up to him-nearly destroying him-Marion must entrust his life to the two men he thought he trusted least in the world: the surgeon father who abandoned him and the brother who betrayed him.

An unforgettable journey into one man's remarkable life, and an epic story about the power, intimacy, and curious beauty of the work of healing others.


From the Compact Disc edition.

Editorial Reviews

Abraham Verghese's My Own Country, an incandescent memoir of the author's early years as a doctor caring for HIV patients in rural Tennessee, was one of those books that seemed to make an indelible impression on everyone who read it. His next work, The Tennis Partner -- the tale of a friend's struggle with drug addiction -- was also nonfiction, but his storytelling gifts were clearly so outstanding that it could only have been a matter of time before he turned to fiction.

Written 14 years after his auspicious literary debut, Cutting for Stone is Verghese's first novel, and it shows him not entirely in control of his new medium. But for all the book's faults, it is vastly preferable to most recent fiction and wonderfully refreshing in its utter lack of irony, cynicism, self-involvement, or hipness. Verghese puts his artistry at the service of his all-embracing humanism, rather in the manner of 19th-century social realist novelists like George Eliot. In fact Somerset Maugham, also a medical doctor, provided an early inspiration for Verghese, especially in his comparison of the physician's vocation with that of the artist in his classic novel Of Human Bondage (1915). Verghese sees his dual callings in a similar light. "My ambition as a writer," he says of Cutting for Stone, "was to tell a great story, an old-fashioned, truth-telling story. But beyond that, my single goal was to portray an aspect of medicine that gets buried in the way television depicts the practice: I wanted the reader to see how entering medicine was a passionate quest, a romantic pursuit, a spiritual calling, a privileged yet hazardous undertaking."

Verghese has lived and practiced in the United States for many years but fears that in American hospitals "the patient is becoming invisible.... It is as if the patient in the bed is merely an icon for the real patient, who exists in the computer." He felt that the kind of medical story he wanted to tell needed to be set in Ethiopia, where he was born (of Indian parents) in the 1950s and lived until his family had to flee after General Mengistu's 1974 military coup. In Cutting for Stone, he says, "I wanted to portray a place so basic, so unadorned, that nothing separates doctor and patient, no layers of paperwork, no technology or specialists, no disguising of the nature of the patient's experience or the raw physician experience. It's a setting where the nature of the suffering, the fiduciary responsibility and moral obligation to the patient and to society, are no longer abstract terms."

This is the rationale for the novel's Missing (a local mispronunciation of "Mission") Hospital in Addis Ababa, where early in the 1950s a forbidden and scarcely acknowledged love between an Indian nursing sister and a British surgeon produces identical twin boys: Marion, the narrator, and the brilliant, enigmatic Shiva. The mother, Sister Mary Joseph Praise, dies in childbirth; the father, Dr. Thomas Stone, fails to save her and is so grief-stricken that he flees the country, abandoning the two boys whom he vigorously denies are his. The boys are adopted by Missing's Indian gynecologist, Dr. Kalpana Hemlatha, familiarly known as Hema, who subsequently marries a genial colleague, Dr. Ghosh. The courtship between Hema and Ghosh is depicted with earthy charm, in contrast with the unearthly, almost mystical bond between Stone and Sister Mary.

Verghese follows the makeshift family's progress through several decades. Ethiopian by birth, the two boys are nevertheless perpetual foreigners, ferengi; their relationship with their housekeeper's beautiful and provocative daughter, Genet -- almost but never quite a sister -- underlines that fact. In accordance with their status as ferengi, they attend a rather pretentious British school rather than the perfectly adequate state one. ("I am convinced," Marion says, "that one can buy in Harrods of London a kit that allows an enterprising Englishman to create a British school anywhere in the third world. It comes with black robes, preprinted report cards for Michaelmas, Lent, and Easter terms, as well as hymnals, Prefect Badges, and a syllabus. Assembly required. ") Hema and Ghosh train the boys for medical careers as a matter of course, proudly initiating them into what Ghosh celebrates as his "romantic and passionate pursuit." Eventually, Marion is hounded out of Ethiopia for political reasons and goes to New York, where he joins the stream of young Indian doctors invited to America to staff rural or inner-city hospitals -- places where few American physicians want to work.

The medical scenes, whether at Missing or at Our Lady of Perpetual Succour in the Bronx, are uniformly well done, but Verghese is not always as successful in other areas: he succumbs to crass melodrama, for example, in his treatment of Genet, who is not so much a character as a vehicle for many contradictory veins of Ethiopan history and culture: tribal pride, female circumcision, militarism, Eritrean separatism, etc. Verghese has tried to squeeze too much material into his plot, linking personal tales with historical forces in the manner of the 19th-century novelists he admires, but he hasn't quite pulled it off. He is at his best when most personal, most earthbound.

His love for Ethiopia is palpable. "The fragrance of eucalyptus stoking a home fire, the smell of wet grass, of dung fuel, of tobacco, of swamp air, and of the perfume of hundreds of roses -- this was the scent of Missing. No, it was the scent of a continent." His evocations of the taste of injera bread soaked up with fiery wot, of the sound of a cow calling its calf with "soothing and auspicious sounds," of "the great banks of clouds that spilled over the Entoto Mountains" enrich his story at every turn. He is equally adept at making us see our own country through the eyes of a foreigner. Marion's first impressions of New York City are brilliantly realized; so are his reflections on the differences between the kind of medicine practiced back in Africa and "the artful, lavish, disposable-everything, lucrative, and incredibly effective American brand of medicine," and his thoughts on the two cultures' opposing attitudes toward death. "It was as if in Ethiopia, and even in Nairobi, people assumed that all illness -- even a trivial or imagined one -- was fatal; they expected death. The news to convey in Africa was that you'd kept death at bay…. In America, my initial impression was that death or the possibility of it always seemed to come as a surprise, as if we took it for granted that we were immortal."

Verghese's great strength as a novelist is his ability to speak straight from the heart -- indeed, he seems unwilling to speak any other way, and is possibly incapable of doing so. His weakness is his uncertainty with the genre, and in Cutting for Stone he has made artistic choices that lend an unfortunate note of artificiality to parts of his tale. The first hundred pages or so make the book look almost like a Rushdie-esque magic realist novel, complete with mystically communicating twins, an apparent virgin birth, divine intervention, and other anti-realist devices. Soon, though, the author settles into the more or less realistic mode that seems to come more naturally to him. His novel is often awkward but nearly always affecting, for aside from being an engaging tale in its own right it comprises a moral self-portrait and a valuable philosophical statement. --Brooke Allen

Brooke Allen is the author of Twentieth-Century Attitudes; Artistic License; and Moral Minority. She is a contributor to The New York Times Book Review, The New Criterion, The New Leader, The Hudson Review, and The Nation, among others. She was named a finalist for the 2007 Nona Balakian Citation for Excellence in Reviewing from the National Book Critics Circle.

W. Ralph Eubanks

Even with its many stories and layers, Cutting for Stone remains clear and concise. Verghese paints a vivid picture of these settings, the practice of medicine (he is also a physician) and the characters' inner conflicts. I felt as though I were with these people, eating dinner with them even, feeling the hot spongy injera on my fingers as they dipped it into a spicy wot. In The Interior Castle, Saint Teresa's work on mystical theology, she wrote, "I began to think of the soul as if it were a castle made of a single diamond or of very clear crystal, in which there are many rooms, just as in Heaven there are many mansions." Cutting for Stone shines like that place.
—The Washington Post

Publishers Weekly

Lauded for his sensitive memoir (My Own Country) about his time as a doctor in eastern Tennessee at the onset of the AIDS epidemic in the '80s, Verghese turns his formidable talents to fiction, mining his own life and experiences in a magnificent, sweeping novel that moves from India to Ethiopia to an inner-city hospital in New York City over decades and generations. Sister Mary Joseph Praise, a devout young nun, leaves the south Indian state of Kerala in 1947 for a missionary post in Yemen. During the arduous sea voyage, she saves the life of an English doctor bound for Ethiopia, Thomas Stone, who becomes a key player in her destiny when they meet up again at Missing Hospital in Addis Ababa. Seven years later, Sister Praise dies birthing twin boys: Shiva and Marion, the latter narrating his own and his brother's long, dramatic, biblical story set against the backdrop of political turmoil in Ethiopia, the life of the hospital compound in which they grow up and the love story of their adopted parents, both doctors at Missing. The boys become doctors as well and Verghese's weaving of the practice of medicine into the narrative is fascinating even as the story bobs and weaves with the power and coincidences of the best 19th-century novel. (Feb.)

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Library Journal

Focusing on the world of medicine, this epic first novel by well-known doctor/author Verghese (My Own Country) follows a man on a mythic quest to find his father. It begins with the dramatic birth of twins slightly joined at the skull, their father serving as surgeon and their mother dying on the table. The horrorstruck father vanishes, and the now separated boys are raised by two Indian doctors living on the grounds of a mission hospital in early 1950s Ethiopia. The boys both gravitate toward medical practice, with Marion the more studious one and Shiva a moody genius and loner. Also living on the hospital grounds is Genet, daughter of one of the maids, who grows up to be a beautiful and mysterious young woman and a source of ruinous competition between the brothers. After Marion is forced to flee the country for political reasons, he begins his medical residency at a poor hospital in New York City, and the past catches up with him. The medical background is fascinating as the author delves into fairly technical areas of human anatomy and surgical procedure. This novel succeeds on many levels and is recommended for all collections. [See Prepub Alert, LJ10/1/08.]
—Jim Coan

Kirkus Reviews

There's a mystery, a coming-of-age, abundant melodrama and even more abundant medical lore in this idiosyncratic first novel from a doctor best known for the memoir My Own Country (1994). The nun is struggling to give birth in the hospital. The surgeon (is he also the father?) dithers. The late-arriving OB-GYN takes charge, losing the mother but saving her babies, identical twins. We are in Addis Ababa, Ethiopia, in 1954. The Indian nun, Sister Mary Joseph Praise, was a trained nurse who had met the British surgeon Thomas Stone on a sea voyage ministering to passengers dying of typhus. She then served as his assistant for seven years. The emotionally repressed Stone never declared his love for her; had they really done the deed? After the delivery, Stone rejects the babies and leaves Ethiopia. This is good news for Hema (Dr. Hemalatha, the Indian gynecologist), who becomes their surrogate mother and names them Shiva and Marion. When Shiva stops breathing, Dr. Ghosh (another Indian) diagnoses his apnea; again, a medical emergency throws two characters together. Ghosh and Hema marry and make a happy family of four. Marion eventually emerges as narrator. "Where but in medicine," he asks, "might our conjoined, matricidal, patrifugal, twisted fate be explained?" The question is key, revealing Verghese's intent: a family saga in the context of medicine. The ambition is laudable, but too often accounts of operations-a bowel obstruction here, a vasectomy there-overwhelm the narrative. Characterization suffers. The boys' Ethiopian identity goes unexplored. Shiva is an enigma, though it's no surprise he'll have a medical career, like his brother, though far less orthodox. They become estranged overa girl, and eventually Marion leaves for America and an internship in the Bronx (the final, most suspenseful section). Once again a medical emergency defines the characters, though they are not large enough to fill the positively operatic roles Verghese has ordained for them. A bold but flawed debut novel. First printing of 150,000. Author tour to Austin, Boston, Dallas, Denver, Iowa City, Los Angeles, New York, Portland, Ore., Raleigh/Durham, San Antonio, San Francisco, Seattle, Toronto, Washington, D.C.

Product Details

BN ID:	2940169320923
Publisher:	Penguin Random House
Publication date:	02/03/2009
Edition description:	Unabridged
Sales rank:	688,522

Read an Excerpt

The Coming

After eight months spent in the obscurity of our mother’s womb, my brother, Shiva, and I came into the world in the late afternoon of the twentieth of September in the year of grace 1954. We took our first breaths at an elevation of eight thousand feet in the thin air of Addis Ababa, capital city of Ethiopia. The miracle of our birth took place in Missing Hospital’s Operating Theater 3, the very room where our mother, Sister Mary Joseph Praise, spent most of her working hours, and in which she had been most fulfilled.

When our mother, a nun of the Diocesan Carmelite Order of Madras, unexpectedly went into labor that September morning, the big rain in Ethiopia had ended, its rattle on the corrugated tin roofs of Missing ceasing abruptly like a chatterbox cut off in midsentence. Over night, in that hushed silence, the meskel flowers bloomed, turning the hillsides of Addis Ababa into gold. In the meadows around Missing the sedge won its battle over mud, and a brilliant carpet now swept right up to the paved threshold of the hospital, holding forth the promise of something more substantial than cricket, croquet, or shuttlecock.

Missing sat on a verdant rise, the irregular cluster of whitewashed one- and two-story buildings looking as if they were pushed up from the ground in the same geologic rumble that created the Entoto Mountains. Troughlike flower beds, fed by the runoff from the roof gutters, surrounded the squat buildings like a moat. Matron Hirst’s roses overtook the walls, the crimson blooms framing every window and reaching to the roof. So fertile was that loamy soil that Matron—Missing Hospital’s wise and sensible leader—cautioned us against stepping into it barefoot lest we sprout new toes.

Five trails flanked by shoulder-high bushes ran away from the main hospital buildings like spokes of a wheel, leading to five thatched-roof bungalows that were all but hidden by copse, by hedgerows, by wild eucalyptus and pine. It was Matron’s intent that Missing resemble an arboretum, or a corner of Kensington Gardens (where, before she came to Africa, she used to walk as a young nun), or Eden before the Fall.

Missing was really Mission Hospital, a word that on the Ethiopian tongue came out with a hiss so it sounded like “Missing.” A clerk in the Ministry of Health who was a fresh high-school graduate had typed out the missing hospital on the license, a phonetically correct spelling as far as he was concerned. A reporter for the Ethiopian Herald perpetuated this misspelling. When Matron Hirst had approached the clerk in the ministry to correct this, he pulled out his original typescript. “See for yourself, madam. Quod erat demonstrandum it is Missing,” he said, as if he’d proved Pythagoras’s theorem, the sun’s central position in the solar system, the roundness of the earth, and Missing’s precise location at its imagined corner. And so Missing it was.


Not a cry or a groan escaped from Sister Mary Joseph Praise while in the throes of her cataclysmic labor. But just beyond the swinging door in the room adjoining Operating Theater 3, the oversize autoclave (donated by the Lutheran church in Zurich) bellowed and wept for my mother while its scalding steam sterilized the surgical instruments and towels that would be used on her. After all, it was in the corner of the autoclave room, right next to that stainless-steel behemoth, that my mother kept a sanctuary for herself during the seven years she spent at Missing before our rude arrival. Her one-piece desk-and-chair, rescued from a defunct mission school, and bearing the gouged frustration of many a pupil, faced the wall. Her white cardigan, which I am told she often slipped over her shoulders when she was between operations, lay over the back of the chair.

On the plaster above the desk my mother had tacked up a calendar print of Bernini’s famous sculpture of St. Teresa of Avila. The figure of St. Teresa lies limp, as if in a faint, her lips parted in ecstasy, her eyes unfocused, lids half closed. On either side of her, a voyeuristic chorus peers down from the prie-dieux. With a faint smile and a body more muscular than befits his youthful face, a boy angel stands over the saintly, voluptuous sister. The fingertips of his left hand lift the edge of the cloth covering her bosom. In his right hand he holds an arrow as delicately as a violinist holds a bow.

Why this picture? Why St. Teresa, Mother?

As a little boy of four, I took myself away to this windowless room to study the image. Courage alone could not get me past that heavy door, but my sense that she was there, my obsession to know the nun who was my mother, gave me strength. I sat next to the autoclave which rumbled and hissed like a waking dragon, as if the hammering of my heart had roused the beast. Gradually, as I sat at my mother’s desk, a peace would come over me, a sense of communion with her.

I learned later that no one had dared remove her cardigan from where it sat draped on the chair. It was a sacred object. But for a four-yearold, everything is sacred and ordinary. I pulled that Cuticura-scented garment around my shoulders. I rimmed the dried-out inkpot with my nail, tracing a path her fingers had taken. Gazing up at the calendar print just as she must have while sitting there in that windowless room, I was transfixed by that image. Years later, I learned that St. Teresa’s recurrent vision of the angel was called the transverberation, which the dictionary said was the soul “inflamed” by the love of God, and the heart “pierced” by divine love; the metaphors of her faith were also the metaphors of medicine. At four years of age, I didn’t need words like “transverberation” to feel reverence for that image. Without photographs of her to go by, I couldn’t help but imagine that the woman in the picture was my mother, threatened and about to be ravished by the spear-wielding boy-angel. “When are you coming, Mama?” I would ask, my small voice echoing off the cold tile. When are you coming?

I would whisper my answer: “By God!” That was all I had to go by: Dr. Ghosh’s declaration the time I’d first wandered in there and he’d come looking for me and had stared at the picture of St. Teresa over my shoulders; he lifted me in his strong arms and said in that voice of his that was every bit a match for the autoclave: “She is CUM-MING, by God!”



Forty-six and four years have passed since my birth, and miraculously I have the opportunity to return to that room. I find I am too large for that chair now, and the cardigan sits atop my shoulders like the lace amice of a priest. But chair, cardigan, and calendar print of transverberation are still there. I, Marion Stone, have changed, but little else has. Being in that unaltered room propels a thumbing back through time and memory. The unfading print of Bernini’s statue of St. Teresa (now framed and under glass to preserve what my mother tacked up) seems to demand this. I am forced to render some order to the events of my life, to say it began here, and then because of this, that happened, and this is how the end connects to the beginning, and so here I am.



We come unbidden into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. My intent wasn’t to save the world as much as to heal myself.
Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.

I chose the specialty of surgery because of Matron, that steady presence during my boyhood and adolescence. “What is the hardest thing you can possibly do?” she said when I went to her for advice on the darkest day of the first half of my life. I squirmed. How easily Matron probed the gap between ambition and expediency. “Why must I do what is hardest?”

“Because, Marion, you are an instrument of God. Don’t leave the instrument sitting in its case, my son. Play! Leave no part of your instrument unexplored. Why settle for ‘Three Blind Mice’ when you can play the ‘Gloria’?”

How unfair of Matron to evoke that soaring chorale which always made me feel that I stood with every mortal creature looking up to the heavens in dumb wonder. She understood my unformed character.

“But, Matron, I can’t dream of playing Bach, the ‘Gloria’ . . . ,” I said under my breath. I’d never played a string or wind instrument. I couldn’t read music.

“No, Marion,” she said, her gaze soft, reaching for me, her gnarled hands rough on my cheeks. “No, not Bach’s ‘Gloria.’ Yours! Your ‘Gloria’ lives within you. The greatest sin is not finding it, ignoring what God made possible in you.”

I was temperamentally better suited to a cognitive discipline, to an introspective field—internal medicine, or perhaps psychiatry. The sight of the operating theater made me sweat. The idea of holding a scalpel caused coils to form in my belly. (It still does.) Surgery was the most difficult thing I could imagine.

And so I became a surgeon.

Thirty years later, I am not known for speed, or daring, or technical genius. Call me steady, call me plodding; say I adopt the style and technique that suits the patient and the particular situation and I’ll consider that high praise. I take heart from my fellow physicians who come to me when they themselves must suffer the knife. They know that Marion Stone will be as involved after the surgery as before and during. They know I have no use for surgical aphorisms such as “When in doubt, cut it out” or “Why wait when you can operate” other than for how reliably they reveal the shallowest intellects in our field. My father, for whose skills as a surgeon I have the deepest respect, says, “The operation with the best outcome is the one you decide not to do.” Knowing when not to operate, knowing when I am in over my head, knowing when to call for the assistance of a surgeon of my father’s caliber—that kind of talent, that kind of “brilliance,” goes unheralded.

On one occasion with a patient in grave peril, I begged my father to operate. He stood silent at the bedside, his fingers lingering on the patient’s pulse long after he had registered the heart rate, as if he needed the touch of skin, the thready signal in the radial artery to catalyze his decision. In his taut expression I saw complete concentration. I imagined I could see the cogs turning in his head; I imagined I saw the shimmer of tears in his eyes. With utmost care he weighed one option against another. At last, he shook his head, and turned away.

I followed. “Dr. Stone,” I said, using his title though I longed to cry out, Father! “An operation is his only chance,” I said. In my heart I knew the chance was infinitesimally small, and the first whiff of anesthesia might end it all. My father put his hand on my shoulder. He spoke to me gently, as if to a junior colleague rather than his son. “Marion, remember the Eleventh Commandment,” he said. “Thou shall not operate on the day of a patient’s death.”

I remember his words on full-moon nights in Addis Ababa when knives are flashing and rocks and bullets are flying, and when I feel as if I am standing in an abattoir and not in Operating Theater 3, my skin flecked with the grist and blood of strangers. I remember. But you don’t always know the answers before you operate. One operates in the now. Later, the retrospectoscope, that handy tool of the wags and pundits, the conveners of the farce we call M&M—morbidity and mortality conference—will pronounce your decision right or wrong. Life, too, is like that. You live it forward, but understand it backward. It is only when you stop and look to the rear that you see the corpse caught under your wheel.

Now, in my fiftieth year, I venerate the sight of the abdomen or chest laid open. I’m ashamed of our human capacity to hurt and maim one another, to desecrate the body. Yet 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—these things leave me speechless. 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. The gut that has slithered past my fingers like this in the African night would by now reach the Cape of Good Hope, and 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?

At such moments I remember to thank my twin brother, Shiva—Dr. Shiva Praise Stone—to seek him out, to find his reflection in the glass panel that separates the two operating theaters, and to nod my thanks because he allows me to be what I am today. A surgeon. According to Shiva, life is in the end about fixing holes. Shiva didn’t speak in metaphors. Fixing holes is precisely what he did. Still, it’s an apt metaphor for our profession. But there’s another kind of hole, and that is the wound that divides family. Sometimes this wound occurs at the moment of birth, sometimes it happens later. We are all fixing what is broken. It is the task of a lifetime. We’ll leave much unfinished for the next generation.

Born in Africa, living in exile in America, then returning at last to Africa, I am proof that geography is destiny. Destiny has brought me back to the precise coordinates of my birth, to the very same operating theater where I was born. My gloved hands share the space above the table in Operating Theater 3 that my mother and father’s hands once occupied.

Some nights the crickets cry zaa-zee, zaa-zee, thousands of them drowning out the coughs and grunts of the hyenas in the hillsides. Suddenly, nature turns quiet. It is as if roll call is over and it is time now in the darkness to find your mate and retreat. In the ensuing vacuum of silence, I hear the high-pitched humming of the stars and I feel exultant, thankful for my insignificant place in the galaxy. It is at such times that I feel my indebtedness to Shiva.

Twin brothers, we slept in the same bed till our teens, our heads touching, our legs and torsos angled away. We outgrew that intimacy, but I still long for it, for the proximity of his skull. When I wake to the gift of yet another sunrise, my first thought is to rouse him and say, I owe you the sight of morning.

What I owe Shiva most is this: to tell the story. It is one my mother, Sister Mary Joseph Praise, did not reveal and my fearless father, Thomas Stone, ran from, and which I had to piece together. Only the telling can heal the rift that separates my brother and me. Yes, I have infinite faith in the craft of surgery, but no surgeon can heal the kind of wound that divides two brothers. Where silk and steel fail, story must succeed. To begin at the beginning . . .

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