CUTTING FOR STONE by Abraham Verghese. Alfred A. Knopf, 2008. Paperback. 541 pages. $26.95.

Most readers of novels in the West are also consumers of modern medicine—a world of diagnosis and treatment enabled by pharmaceuticals, biotechnologies, insurers, and medical professionals. Abraham Verghese’sCutting for Stone is about the human side of care-giving, about the kind of professionals who take time to warm the tip of their stethoscopes in nurturing palms before auscultative steel makes contact with a patient’s skin. The characters in this gentle, empathetic novel are the kind of people who listen carefully and ask questions such as, “Tell us, please, what treatment in an emergency is administered by ear?”

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Sandip Roy interviews Abraham Verghese for the radio show New America Now

Before this debut work of fiction, Verghese, who teaches and practices at Stanford University’s School of Medicine, had authored two works of non-fiction:My Own Country and The Tennis Partner. Just as the much-honored My Own Country gave voice to AIDS patients in small-town Tennessee, Cutting for Stonebrings alive the voiceless communities huddled around so-called “backwater” hospitals in Ethiopia and, to a lesser extent, inner-city America. And just like the real-world HIV victims who return to rural hometowns from the big-city lights and blights of places like San Francisco, the unmoored characters in Cutting for Stone are in search of familial love and acceptance. The people—real and fictional—who populate Verghese’s compassionate novel grow to understand that home is “not where you are from, but where you are wanted.”

The novelist does not evenly distribute his ardor for home between his place of birth (Ethiopia), his place of ancestors (India), and his place of work (United States). Ethiopia is rendered vividly and lovingly—a brutally real, and at the same time romantically mythical, world of rare, thin air that Verghese’s characters breathe into their bones. India is glancingly considered through sepia-tinged memories of R. K. Narayan’s Malgudi stories. And the no-nonsense business of the American brand of medicine (humorously punctuated with Indian Foreign Medical Graduates) is presented as an earnest trampoline from which Verghese’s protagonist—Marion Stone —bounces to return to his beloved African home.

The prologue to the novel is a sly synopsis of the arc of Marion Stone’s life. Much like a book review, the prologue hints at much of the story, but doesn’t give away the specifics that give life its full meaning. In the way that one might enjoy samosas both before and after a full meal, it is a treat to re-read these opening pages after completing the novel. But since eating too many of the appetizers in advance of dinner can spoil the efforts of the master chef, this review will only briefly render the lives that inhabit Cutting for Stone.

Marion Stone’s story begins rather inauspiciously in an Addis Ababa mission hospital: he is born fused at the head with his twin brother, Shiva. While the birth involves a risky operation because one whole being has to be cleaved in two, life outside the womb presents greater separation. Marion and Shiva’s biological parents are unlikely lovers: Thomas Stone, a stoic surgeon whose loveless childhood in India stole from him the ability to express affection, and Sister Mary Joseph Praise, a nun whose Carmelite calling constrained earthly passions.  Sister Mary dies in childbirth, and the grief-stricken Stone flees from Ethiopia after softly saying about his sons, “Please get them out of my sight.”

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Verghese affectionately gives life to Marion and Shiva in the loving hands of their nurturing adoptive parents, Hema and Ghosh. Both parents practice medicine at the Mission Hospital, which charmingly is called “Missing Hospital” because “Mission” is “a word that on the Ethiopian tongue came out with a hiss so it sounded like ‘Missing’.” It is this knowing fondness that imbues life in, and around, the hospital.

Verghese is a sympathetic story-teller who seems incapable of creating flat, uni-dimensional characters. Whether major or minor, the people in his novel are memorably alive. Hema is an obstetrician whose gift is not only to bring life into the world, but also to balance that professional calling with a protective maternal instinct. Her gynecological training and practical instincts (“The Hippocratic oath is if you are sitting in London and drinking tea. No such oaths here in the jungle.”) find an astute student and son in Shiva. As for Ghosh, “practicing medicine and teaching medicine were completely connected,” and it is this connection and his paternal love that enable him to pass along his calling to Marion.

In and around the home they make for Marion and Shiva, Hema and Ghosh have an extended family: the solid, unwavering Matron of Missing Hospital, the priestly Gebrew, the serving-yet-never-servile Almaz, the Eritrean Rosina, and her precocious daughter, Genet, who teaches (and un-teaches) Marion about love. There are many in the outer circle, including Ethiopian Emperor Haile Selassie, whose long reign and the revolts that followed it serve as the novel’s background, giving Cutting for Stone an autobiographical feel.

Indeed, Verghese writes like a memoirist who has lived a blessed life; even the spoiled fruit do not seem to upend his apple-cart. It is not that Verghese doesn’t see the shadow side of humanity, but rather that he understands that the mistakes we’ve made—the errors in judgment and the ethical lapses—make us fully human. In suggesting that “life is in the end about fixing holes,” he writes both literally about the surgeon’s profession and metaphorically about the work of living that we all do. “We are all fixing what is broken. It is the task of a lifetime. We’ll leave much unfinished work for the next generation.”

From his work with AIDS patients to his teaching medical students to be more compassionate, Verghese has done much in his professional life. He has also found time to write books that are required reading in the curricula of pre-med and medical students; Cutting for Stone is a welcome addition to what is now a physician’s literary triptych.

But even if you are not a doctor or planning a career in the caring profession, as a consumer of medicine you may be wondering about the question at the end of the opening paragraph: what treatment in an emergency is administered by ear? The question was asked by Dr. Thomas Stone and answered by his son. Dr. Marion Stone’s response—“words of comfort”—echoes the answer to this book reviewer’s question: What does a gentle, empathetic novel such as Cutting for Stone consist of?  Words of comfort.

For all of RCO’s care-giving physicians: ranging from the midwife who earned 20 rupees and a sari per birth to Deepinder Singh, M.D., whose care is priceless—with Drs. Kumar, Raman, Gordon, Bhargava, Culp, Rachamallu, and Prasad in between.

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