Fiction that takes us from Ethiopia to the suburbs
‘Cutting for Stone’ By Abraham Verghese (Knopf, 560 pp., $26.95)
Abraham Verghese is a doctor, an accomplished memoirist (My Own Country) and, as he proves in Cutting for Stone, something of a magician as a novelist. This sprawling, 50-year epic begins with a touch of alchemy: the birth of conjoined twins to an Indian nun in an Ethiopian hospital in 1954. The likely father, a British surgeon, flees upon the mother’s death, and the (now separated) baby boys are adopted by a loving Indian couple who run the hospital. Filled with mystical scenes and deeply felt characters — and opening a fascinating window onto the Third World —Cutting for Stone, while not perfect, is an underdog and a winner. Shades of Slumdog Millionaire. — Jocelyn McClurg | USA Today
‘Cutting for Stone’ by Abraham Verghese
Reviewed by ERICA WAGNER | The New York Times
“I will not cut for stone,” runs the text of the Hippocratic oath, “even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.”
Those words provide an epigraph partway through Abraham Verghese’s first novel, “Cutting for Stone,” and also explain the surname of its narrator, Marion Stone, along with his twin brother, Shiva, and their father, the almost entirely absent surgeon Thomas Stone. Absent in body only: in spirit, Thomas’s disappearance after their birth haunts and drives this book.
Yet until the reader comes across the oath, well into the novel, the title may seem pleasing to the ear but puzzling to the mind: it tries to do too many jobs at once. It neither suggests the book’s action — as, say, “Digging to America” does — nor evokes its mood, as “Bleak House” does. Still, Verghese strives for the empathy of Anne Tyler and the scope of Dickens. If he doesn’t quite manage either, he is to be admired for his ambition.
Verghese is a physician and an already accomplished author. His two nonfiction books, “My Own Country,” about AIDS in rural Tennessee, and “The Tennis Partner,” a moving and honest memoir of a difficult, intimate friendship, are justly celebrated. His commitment to both his professions is admirable: currently a professor at the Stanford University School of Medicine, he also holds an M.F.A. from the Iowa Writers’ Workshop. But why mention qualifications? What do qualifications matter where fine writing is concerned? Not at all, is the correct answer, and yet qualifications like Verghese’s are tribute, at the very least, to his stalwart effort. This effort is both the making and the unmaking of “Cutting for Stone.”
The plot of this big, dense book is fairly straightforward. Marion and Shiva Stone are born one dramatic afternoon in 1954 in Addis Ababa, the same day their mother — a nun, Sister Mary Joseph Praise — dies of complications from her hidden pregnancy. The boys are conjoined at the skull, yet separated at birth; they are raised by Dr. Kalpana Hemlatha, a forceful woman known as Hema, and Dr. Abhi Ghosh, both immigrants from Madras and both doctors at the hospital where the boys’ natural parents also worked. Missing Hospital, it’s called: “Missing was really Mission Hospital, a word that on the Ethiopian tongue came out with a hiss so it sounded like ‘Missing.’ ” They grow up amid the political turmoil of Ethiopia (its actual chronology altered slightly by Verghese to suit his fictional purposes), and in 1979 Marion flees, first to Nairobi and finally to New York, where he qualifies as a surgeon. Shiva, too, goes into medicine, specializing in treating vaginal fistula, for which work he is acclaimed in this very newspaper, a sure sign of his renown. Almost supernaturally close as children, the brothers become more and more distant as the novel progresses; they are dramatically reunited at its end — through the mysterious agency of the long-vanished Thomas Stone.
As a novelist, Verghese looks to models like Salman Rushdie and John Irving: the novel is capacious, not to say baggy, in the way those writers’ novels can be, and it is tinged, albeit lightly, with a sense of magic, though one senses that Verghese in his soul is too much a realist ever to be quite convinced of his own attempts in this department. (The brothers’ being joined — but only briefly — at the head is an example of this slightly half-hearted effort.) Much more forceful are his vivid descriptions of surgery, vivid enough that those with weaker stomachs may find them disturbing. One would, I suppose, be ill advised to use this novel as a textbook for liver transplantation or bowel surgery, but it might almost be possible. The trouble is that for all the author’s passion, this kind of writing periodically stops the book in its tracks: “Hema smiled, as if to say, Very little escapes me, my dear man. And then she was thinking of . . . rugaeform folds, of the median raphe that separated one bollock from the other, of the dartos muscle, the cells of Sertoli.” Hema’s mind, as the author then says, is racing: but the reader’s goes into a stall.
The novel is crippled, too, by the use of back story. There is a feeling of Greek drama about the narrative: a lot of the real action happens offstage. We finally learn, toward the end of the novel, what made Thomas Stone the man he is, with all his strengths and deficits, yet by then the tale seems curiously belated and less than fully integrated into the novel. The same is true for the later events in the life of Genet, Marion’s childhood sweetheart, the daughter of his nanny, who joins a band of Eritrean guerrillas but reappears fleetingly in Marion’s life to devastating effect. Verghese’s weakness is the weakness of a writer with too much heart: it’s clear he loves his characters and he just wants to cram in every last fact about them, somehow. Great novels are not built merely on the agglomeration of detail.
This is a first novel that reveals the author’s willingness to show the souls, as well as the bodies, of his characters. In Verghese’s second profession, a great surgeon is called an editor. Here’s hoping that in the future the author finds stronger medicine in that line.
(Erica Wagner is the literary editor of The Times of London and the author, most recently, of the novel “Seizure.”)
‘Cutting for Stone’ by Abraham Verghese
Reviewed by Poornima Apte
More than a decade ago, in 1994, Dr. Abraham Verghese made headlines when he wrote of his struggles as a doctor in a small town in Tennessee, helping his patients fight back the growing AIDS epidemic. His nonfiction book, My Own Country, became a finalist for the National Book Critics Circle Award and the story of medicine in small town America was one Dr. Verghese brought home beautifully with it. My Own Country was set in Johnson City, Tennessee and Dr. Verghese showed us how American doctors are often loath to practice in small towns like it—leaving the locals to the care of “foreign medical graduates.” Dr. Verghese, an immigrant with South Indian roots, born and brought up in Ethiopia before political unrest forced him to flee, was one such foreign medical graduate.
Now, years later, Dr. Verghese has written his debut fiction novel, Cutting for Stone, and in here, he uses one of fiction’s favorite axioms: Write what you know. The story in Cutting for Stone seems to be modeled after at least a few of Dr. Verghese’s own experiences. Quite like Dr. Verghese, Marion Praise Stone, the novel’s protagonist, is also a doctor with South Indian roots, born and brought up in Ethiopia, who eventually immigrates to the United States in the wake of political unrest. The novel is written in the voice of Marion who narrates a grand tale—one of his birth along with his twin brother, of life growing up in the shadow of a missionary hospital in Ethiopia, of gradually increasing political strife in the country and finally of the life of an expatriate American doctor.
In an interview, Verghese said that his ambition in writing this fiction debut was “to tell a great story, an old-fashioned, truth-telling story.” The scope of Cutting for Stone—set as it is, on three continents—and spanning at least a few decades—is as ambitious as it gets. As the novel opens, Sister Mary Joseph Praise is leaving India (just as the country gains independence) for Ethiopia. She is a nun chosen by her diocese to cater to the dying in Africa. In Missing (an Ethiopian corruption of “Mission”) hospital in Addis Ababa in Ethiopia, an unlikely relationship develops between her and the hospital’s chief surgeon, Dr. Thomas Stone. The product of the relationship is twin boys—Marion and Shiva Praise Stone. The twins are born conjoined at the head and before Sister Praise can receive the proper medical care, she bleeds to death in childbirth. The father, Dr. Stone is so distraught by all these happenings, that he completely walks out of Missing—leaving his twins behind. This huge act of abandonment will stay with Marion till the very end until he finally makes a tentative peace with it.
The twins are adopted by two other doctors at Missing Hospital—Hema and Ghosh—who do their best to give them a normal, healthy life. When they become teenagers, a deep misunderstanding develops between the brothers that slowly simmers and threatens to permanently sour their relationship. Cutting for Stone is set against large political events in Ethiopia—the coup that deposed the country’s emperor and put an army official, Mengistu, in charge; and the rise of the Eritrean Liberation Front, an organization that eventually brought about independence for Eritrea. In the novel, one of Marion’s friends is charged by the authorities for subversive activities. The authorities determine Marion to be guilty by association, and soon he is forced to flee the country for the United States.
Dr. Verghese describes the everyday workings of Missing hospital and of life in Ethiopia beautifully. He has said that his goal in writing Cutting for Stone was to show how “entering medicine was a passionate quest, a romantic pursuit, a spiritual calling.” And his descriptions of Hema’s career at Missing and especially that of the adoptive father, Ghosh, certainly fit that bill. Yet many of the situations in the story feel overly melodramatic. Verghese’s writing is often punctuated with dramatic similes and metaphors. And while he uses his doctor’s expertise to good effect, sometimes it feels like one is reading extended versions of Gray’s Anatomy, as in here:
With the colon swollen to Hindenburg proportions it would be all too easy to nick the bowel and spill feces into the abdominal cavity. He made a middle incision, then deepened it carefully, like a sapper defusing a bomb. Just when panic was setting in because he felt he was going nowhere, the glistening surface of the peritoneum—that delicate membrane that lined the abdominal cavity—came into view. When he opened the peritoneum, straw-colored fluid came out. Inserting his finger into the hole and using it as a backstop, he cut the peritoneum along the length of the incision.”
One of the other challenges of Cutting for Stone is its uneven pacing. With numerous side trips and distractions, frustratingly enough, just one event that the book opens with—the twins’ birth—takes Verghese nearly 150 pages to narrate. Although the pace does quicken somewhat after this, it remains shaky till the end.
The reader will also be struck by just how many times the doctors resort to God as a healer. In a country like Ethiopia (or India) where medical resources are limited and where destiny is a frequent explanation for why things go awry, perhaps this is understandable. Yet, I found it unnerving to have it come up so often in conversation even among science professionals. For example, a doctor like Marion Stone chalks up an appearance by an individual at a particular place and time to “a disturbance in the universe.” While I personally found it hard to digest such lines of thought, perhaps this would not be as big a problem for other readers.
As in My Own Country, Dr. Verghese is best when he describes the failings of the American medical system especially when it comes to serving the poor. “The poorest in America are the sickest,” he writes, “Poor people can’t afford preventive care or insurance. The poor don’t see doctors. They show up at our doorsteps when things are advanced.”
Dr. Verghese also does a good job at character development—Marion, the gifted twin Shiva, Hema, Ghosh and even Missing’s chief operator, a woman named simply as Matron—are all beautifully portrayed in the book. All in all Cutting for Stone is a good first effort. It is grand in scope and creates characters the readers can empathize with. Had Dr. Verghese toned down the melodrama a fair amount and paced the story better, Cutting for Stone would have been an even better read. Lessons for the next one, perhaps?