Abraham Verghese

"Cutting for Stone"

(Reviewed by Poornima Apte FEB 2, 2009)

Cutting for Stone by Abraham Verghese

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?

  • Amazon readers rating: from 412 reviews

Read a chapter excerpt from Cutting for Stone at the author's website

 

Editor's note: Cutting for Stone was a finalist for the 2010 Pen/Hemmingway Award.



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Bibliography: (with links to Amazon.com)

Nonfiction:

 

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About the Author:

Abraham VergheseAbraham Verghese was born in 1955 to well-educated, South Indian, Christian parents who migrated to Ethiopia to teach. He grew up near Addis Ababa and began his medical training there. When Emperor Haile Selassie was deposed, he completed his training at Madras Medical College in Chennai, India and went to the United States for his residency as one of many foreign medical graduates. Like many others, he found only the less popular hospitals and communities open to him, an experience he described in one of his early New Yorker articles, The Cowpath to America.

From Johnson City, Tennessee, where he was a resident from 1980 to 1983, he did his fellowship at Boston University School of Medicine, working at Boston City Hospital for two years. It was here that he first saw the early sign of the HIV epidemic and later, when he returned to Johnson City as an assistant professor of medicine, he saw the second epidemic, rural AIDS, and his life took the turn for which he is most well known – his caring for numerous AIDS patients in an era when little could be done and helping them through their early and painful deaths was often the most a physician could do.

Exhausted from the strain of his work with his patients and having by then begun to write seriously, he decided to take a break and applied to and was accepted to the prestigious Iowa Writers Workshop at the University of Iowa, where he earned a Master of Fine Arts degree in 1991. He had cashed in his retirement plan and his tenured position to go to Tennessee with his young family. After Iowa, he accepted a position as Professor of Medicine and Chief of the Division of Infectious Diseases at Texas Tech Health Sciences Center in El Paso, Texas, where he lived for the next 11 years. Despite his title, he was the sole infectious disease physician for a busy county hospital -- Thomas Hospital -- for many years.

In 2002, Dr. Verghese came to San Antonio, Texas as founding Director of the Center for Medical Humanities & Ethics at the University of Texas Health Science Center at San Antonio, where he focused on medical humanities as a way to preserve the innate empathy and sensitivity that brings students to medical school but which is frequently repressed through the rigors of their training.

His deep interest in bedside medicine and his reputation as a clinician, teacher and writer led to his being recruited to Stanford University in 2007 as a tenured professor. Dr. Verghese is Professor for the Theory and Practice of Medicine at the Stanford University School of Medicine and Senior Associate Chair of the Department of Internal Medicine.

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