by Abraham Verghese
Disappearing bookstores notwithstanding, contemporary novels are a dime-a-dozen. Most, in my opinion, are not worth your time; but every year a handful of truly great works of fiction rises – like cream – to the top. Cutting for Stone, published in 2009, is one such book. To summarize in one sentence: it is about becoming a whole person by embracing every aspect of one’s self. A powerful quote from the book explains that “[t]he key to your happiness is to … own who you are, own how you look, own your family, own the talents you have, and own the ones you don’t.” To develop this idea of owning one’s self, Abraham Verghese takes the reader on a journey through the life of an Anglo-Indian man, born and raised in Ethiopia, who eventually becomes a trauma surgeon in New York City. There is so much information, insight, and wisdom in this book that it gets better with each reading.
A good book, in my opinion, is one that forces me to consult my dictionary throughout the reading. If I need to consult a globe and a world almanac, the book rises even higher in my estimation. Finally, what lifts a book into the category of literature is how it references great works which have come before. Quotes from Shakespeare are easy to spot, but there are other great thinkers and writers – representing the accumulation of human civilization – whose influence we are less aware of and to whom a great writer pays homage.
In addition to telling a good story, Abraham Verghese uses the English language to give depth and significance to themes and motifs used throughout Cutting for Stone. To begin with, the author assigns several meanings to the title: the last name of the main character and his twin is Stone. Bernini, one of the world’s greatest stone cutters, has a part in the book, too. The main character and his twin represent duality as well as cohesion: they start out conjoined, are surgically divided, then emotionally separated, and finally reconnected in a profoundly spiritual way. Parenthood is another theme which Abraham Verghese explores in depth. The boys’ adoptive parents create a beautiful and loving family which their birth parents could never have provided. Despite being identical twins, Marion and Shiva are opposites, or mirror images of each other. Where Marion is curious, sensitive, and ethical, Shiva is experimental, analytical, and mechanical in their respective approaches to life. Surgery, i.e., cutting people open, is one of the main themes. Verghese uses holes as a metaphor for openings, injuries, losses, and areas of potential growth. The creation and repair of different types of holes, through surgery and other means, occupy each of the main characters throughout the book.
Cutting for Stone is initially set in Ethiopia, a nation with an interesting history going back some 400,000 years – to the dawn of man. Modern Ethiopia, as we recognize it today, became a monarchy in the late 1800s under the rule of Emperor Abeto Menelik. To strengthen his imperialist aims, this emperor entered into a treaty with Italy which permitted Italy to occupy Eretria in exchange for the Italians’ recognition of Ethiopia as a sovereign nation as well as to provide Menelik with arms and security forces to quash any threats to his power. Before the treaty could be ratified, the Italians quickly took advantage of their military position in Eretria and began encroaching into Ethiopian territory. Despite having lost 30 per cent of its population due to the Great Ethiopian Famine (1888-1892), Ethiopia handily routed the Italians in what is still considered their finest hour. In 1935, Italy invaded Ethiopia again and this hostile action elevated then emperor, Haile Selassie, to the world stage where he successfully asked the League of Nations to intervene. By 1941, the Italian occupiers were gone. Eretria, however, remained a British Protectorate until 1951, and then it was policed by Ethiopian troops in a caretaking role.
Eretrians bitterly opposed Ethiopian rule but were so divided by their religious alliances that they had no ability to unify and fight for independence. When the warring factions began attacking the Ethiopian occupiers in 1962 – the year that Marion and Shiva were born – Haile Selassie shuttered the Eretrian parliament and seized control of the region. From inside the sanctuary of the mission hospital, the boys witnessed Haile Selassie devolve from hero to despot. In 1974, a Soviet-backed coup ousted Haile Selassie and replaced him with the brutal dictator, Mengistu Haile Mariam, who cracked down hard on Eretrian separatists and anyone remotely associated with them. Ragtag insurgent groups formed and hid out in unpopulated mountain ranges in order to commit terrorist acts against Ethiopia. A climate of suspicion and paranoia permeated Addis Ababa during this time, when friendships and political alliances could be beneficial one day and grounds for execution by hanging the next.
The story of Marion and Shiva begins when a young Carmelite nun leaves India to spread Christianity in Yemen. She endures this harrowing ocean voyage – from Madras to Aden – through stormy seas by nursing a young doctor back to health from debilitating seasickness so that he can treat the other passengers, who have contracted typhoid fever. Doctor and nun work tirelessly to save their patients and discover that together they accomplish more than they could as individuals (the whole being greater than the sum of the parts). At the end of the sea voyage, the doctor expresses a wish that Sister would be his operating room assistant in Addis Ababa, but she has orders to stay in Yemen and so they part ways.
This doctor, Thomas Stone, left India for Ethiopia after Indian Independence limited the potential for a white Englishman to pursue a medical career and live in the country safely. Sister Mary Joseph Praise, an Indian by birth, wanted to stay but was ordered by her Mother Superior to save Arabic souls through medicine. When she arrived at the mission hospital in Addis Ababa, many months later, she had been through a trauma about which she could not and would not speak. Sister Mary Joseph Praise found peace in the operating room of the mission hospital assisting Dr. Thomas Stone and serving him so perfectly that she was essentially his right hand. On the day she failed to show up for work, Dr. Stone fell apart and his patient died as a result.
The title, “Cutting for Stone” comes from the original Hippocratic Oath that physicians – as opposed to surgeons – took in ancient Greece. Physicians swore to heal patients through nourishment and medicine and to leave surgery – i.e., cutting for kidney stones – to the surgeons (whose patients usually died the same day). No one at the mission hospital had noticed that Sister Mary Joseph Praise was pregnant until she went into labor. The resident obstetrician, Dr. Kalpana Hemlatha, was traveling on the day of the twins’ birth, so the caesarean section fell to Dr. Stone to perform, except that he was constrained by his own rule not to operate on the day of the patient’s death. Rather, he thought to abort what he assumed was a single baby in an effort to save the mother, his implicit other half. Fortunately, Dr. Hema returned in time to stop the abortion but not the death of the mother. Devastated, Dr. Stone fled Ethiopia leaving his sons orphans. The gaping hole in their world needed to be filled: Hema became a wife and mother and Dr. Abhi Ghosh, who had long dreamed of marrying Hema, had his dearest wish fulfilled. Two people left, two new people arrived, and a family was formed, all in an instant.
Hema easily cut Marion and Shiva’s physical connection, barely more than a membrane; even so, for years they would sleep with their heads touching. The boys seemed to share a spiritual connection as if the two together made a single complete person. In their late teens, however, Shiva hurt Marion so deeply that he tried to eliminate his twin from his life and the two lives diverged. Their adoptive parents recognized that the boys had some bad blood between them concerning their “sister” Genet, an Eritrean girl whose mother worked for the family, but blamed Marion for the trouble that eventually befell the young Muslim girl.
While Marion excelled at scholarship, Shiva was unable to tolerate academia and dropped out of school. He learned the intricacies of female anatomy in order to repair obstetric fistulae by working with Hema as she delivered babies and performed gynecological surgeries. In countries such as Ethiopia, where female circumcision and young brides are common, prenatal care is rare; and obstetric fistulae are a frequent and devastating problem. The unfortunate women suffering from this condition leak urine and feces continually. They become pariahs whose husbands reject them and whose families of origin refuse to take them back. Shiva witnessed a young girl with this condition and it set the course of his life.
Cutting for Stone is an ambitious novel which allows Abraham Verghese to show his virtuosic ability to weave history, geography, medicine, religion, and politics together with family relationships, friendships, ethics, humanity, and spirituality. It is a beautiful story, beautifully crafted, and definitely worth your time. Don’t be intimidated by words you cannot pronounce and facts you do not know. Own these holes in your education and fill them with knowledge, because “the greatest sin is not finding … what God made possible in you.”