Cutting for Stone -- A great reading experience

Cutting for Stone, this  intriguing first novel by Dr. Abraham Verghese pulls the reader into the story at once. His characters are people you want to know more about. The story takes place in countries scattered over  three continents and involves a variety of ethnic and religious groups:  Indians, British, Ethiopians, Eritreans, Americans, and more.  People worship one or many gods. All struggle. Some win, some lose, some find peace.  

Young, beautiful Sister Mary Joseph Praise from India is the operating room nurse assisting a brilliant British surgeon Dr. Stone at a mission hospital in Addis Ababa in Ethiopia.  She learned to know him on the ship coming from India, nursing him to health when he became deathly ill.  He may be a great surgeon but is a flawed human being. Personal relationships are not his strength.

The unexpected premature  birth of the twins  Marion and Shiva to  this nun  is the setting for this novel of passion, personal and political trauma,  and family rifts, and a resolution that leaves one wondering – and yet content. 

The question I am asked is the meaning of the title “cutting for stone.”   The Internet informs me that the phrase derives from the Hippocratic Oath that doctors swear on graduation from medical school.  No surgeon cuts for stone (kidney?) if there is someone better equipped to that. 

This theme of cutting is introduced early in the novel at the impending birth of the twin boys, the main characters.  The Matron of Missing Hospital  stands helplessly over  Sister Mary Joseph’s dying body. She says to Stone, a skilled surgeon: “Your patient, Dr. Stone.”  She wants him to cut, to do a C-section, but he is helpless, unable to function because he loved the woman dying  before  him.  He attempts an abortion with an anatomy book propped in front of him, planning  to crush  the skull and pull the infant out. 

Fortunately,  Dr. Hemalatha, gynecologist, arrives to “cut,” perform a C-section, only to discover that there are two babies waiting to be born. She names them Marion and Shiva.   The babies are joined at the head by a shaft, which she cuts not knowing whether that will start a massive bleed or be the babies’ salvation.  That mashing of one baby’s head is key to later events. Her cut saves their lives.

Both boys become surgeons and Marion, who should have been born second in a normal birth, is the first to see the light of day in a C-section.  I am reminded of the story of Jacob and Esau, sons of the patriarch Isaac, who all their lives vied with one another for their father’s affection, with firstborn Esau selling his birthright to his brother.  

The author enjoys double meanings, so “cutting for stone” as well as  other terms and events have  more than one meaning that weave in and out of the action.  The setting for the book is Missing Hospital, yet the original name for this institution is Mission Hospital. Because it was often misspoken by native speakers, some clerk registered it as Missing Hospital, and that’s what it became.  People and objects are often missing in this novel.  Yet missing does not mean the matter is ended. 

Missing is a finger of Dr. Stone’s hand which he self-amputated when it became infected.  Because he only has four fingers on that hand he is able to poke into body cavities with greater facility than someone with five.  The finger shows up later in a bottle of formaldehyde and becomes a symbol of something bigger than a mere digit.

Missing also is the doctor’s memory of how he impregnated this young nun. It is a mystery to him although he knows he was deeply in love with her.  

Missing also is a letter the desperate young nun wrote to her lover, Dr. Stone, before her death.  It doesn’t show up until the end in the “afterbird,” the Amharic mispronunciation of “afterbirth.” It reveals the events leading up to the  conception.

Missing is Stone as the father of these boys during  their growing up and development. 

But back to “cutting for stone.” The twin boys are brought up by Hema and Ghosh, surgeons at Missing Hospital, in a loving home. Both boys become surgeons, Marion through formal education, Shiva through self-education. Shiva  becomes a  surgeon of women with fistula, a tragic condition that afflicted countless African women  because they were married too  young, received nonexistent prenatal care and came too late for help after the baby was already jammed down the birth canal and hospitals where C-sections could be performed  too distant.  The result was a fistula, or tear between bladder and vagina, causing persistent dribbling of urine.  Such women soon reeked and were ostracized by husband, family and community.  Shiva becomes the world’s expert on fistula surgery and leading advocate for women  in Third World countries for better care of women.

Women with fistula found their way to Shiva by bus, foot, and donkey.  They often came with a piece of paper in their hand that simply said in Amharic “Cutting for Stone.”   Shiva Stone was the expert without having taken the Hippocratic oath.

This is a great novel because, first of all, it is a good story.  It makes the reader want to know what’s coming next.  What will happen to the twins? Will they ever be united with their absentee father?  The reader soon begins to care for them and their generous caretakers Hema and Ghosh and about the conflicts in their lives, which, though in a different culture, are not so different from ours – family tensions, personal traumas, political turmoil.   

The novel is also gripping because the actions of the main characters move them ahead—or backwards. There is clear cause and effect. The twins, their father, their adoptive parents,  and other characters in the story live out their lives using their strengths and weaknesses,  but not without consequences.  

I recommend the book. I understand it has already sold millions.