By Joel Potash MD
I was reluctant to pick up “Cutting for Stone” because Dr. Abraham Verghese’s non-fiction writing doesn’t present him as a very admirable person: He exposes his own faults. But he sure writes an engrossing novel. At some 600 pages (in paperback), I found it hard to put it down. Filled with medical details, it will appeal to medical professionals as well as to a general readership.
The title comes from Hippocrates’ proscription to physicians in ancient Greece not to “cut for stone,” referring to the temptation of physicians to respond to patients suffering pain from kidney stones by operating on them, even though they lacked the necessary skills and could cause more harm than good. Rather, these patients should be referred to surgeons, then thought of as lesser healers.
Stone is also the name of a mysterious surgeon who finds his way to Ethiopia, where he is assisted at Mission Hospital by a nun/nurse Sister Mary Joseph Praise in caring for all comers, in spite of limited facilities and supplies. Sister is a devotee of St. Teresa of Avila, known for her passionate writings about Christ.
Sister gives birth to twins, Marion and Shiva, and dies during the process. Stone, father of the twin boys, is dismayed at his inability to save Sister’s life and disappears. Another couple, both physicians, care for the twins.
While emotionally joined as twins, Marion and Shiva are quite different. Marion decides to study medicine and eventually finds his way to a residency in the United States, the American counterpart of the Ethiopian Mission Hospital: underfunded, caring for all comers and especially a haven for the poor/uninsured.
The arduous training of a surgeon will strike a familiar note for physicians and should elicit amazement and sympathy from others. Marion, in reality “cutting for stone,” becomes involved in trying rare surgical procedures, including the earliest liver transplants in desperate circumstances. Shiva eventually apprentices himself to a gynecologist and become famous for repairing bladder/vagina fistulas caused by the birth process, a timely topic worldwide.
The theme of caring for the underprivileged resonates with what happens today. Much of the training of medical residents takes place in large public hospitals where poor and uninsured patients are beneficiaries of care at the same time they provide technical practice to the future doctors.
After Verghese introduces his characters, he creates tension for the reader by abruptly leaving a story or character and cutting to another event or characters. As readers, we are left hanging, almost breathlessly, waiting for the end of the original story or the return of the character.
For example, Sister Mary Joseph Praise is in labor with twins who are locked together in a way that makes delivery impossible, and she is heavily bleeding. As readers we are fearful, but Verghese switches to other events while we wait anxiously to return to the labor room to find out what happens. It takes a long time for the twins’ father, Stone to reappear, near the end of the novel, and in a surprising way.
Another interesting aspect of the novel deals with the reign/dictatorship and downfall of Emperor Haile Selassie of Ethiopia, a part of history of which I was unaware and which bears similarities to the struggles with current dictators/tribal leaders and their subjects who seek greater freedom and more democratic forms of government: Egypt and Afghanistan come to mind.
Joel Potash MD is Professor Emeritus of the Center for Bioethics and Humanities at Upstate and a voluntary clinical professor in the Department of Family Medicine.