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Samuel Johnson wrote one of the world’s best books and set it in Ethiopia. His History of Rasselas, Prince of Abissinia is peppered with insightful and pithy commentary on the foibles of humans who, for example, believe happiness possessed by others to keep alive the hope of obtaining it for themselves.1 To say that Abraham Verghese’s entertaining novel, Cutting for Stone, about two generations of surgeons in Ethiopia and the USA, has better characterisation and plot structure than Dr Johnson’s smaller work but fails to rise to the same stature, does neither an injustice.
Abraham Verghese is a professor of medicine at Stanford University California and a writer of books, essays and short stories, who was born and brought up by Indian parents in Ethiopia. This is a well-crafted novel and Verghese is meticulous in acknowledging his sources, including those for some of the work’s best lines: “I owe you the sight of morning” for instance, and “squared her shoulders to the unloveliness”.
Verghese draws on surgical emergencies with which he is obviously familiar to create dramatic pivot points in his narrative. The first is the traumatic birth, at the Ethiopian Missing (sic) Hospital, of the conjoined male twins Shiva and Marion (both grow up to be surgeons, one intuitive and one fully trained). The boys’ mother dies at their birth and their surgeon father immediately deserts them. Then comes the volvulus operation on the pro-land reform resistance fighter Mebratu, the decision of one of the boys to be a fistula surgeon, and the repair of a traumatically lacerated inferior vena cava in New York. Finally, one of the boys develops fulminant hepatitis and requires an operation in the USA involving his brother where the senior surgeon (yes, his name is Stone) finally is revealed to be the twins’ father. Surgeon Stone asks a clinical question in the form of a bon mot from his own text book to a hall of US medical students. This allows one of his sons Marion (named after Marion Sims the famous gynaecologist) to indirectly reveal his identity: “What first-aid treatment in shock is administered by ear?” The answer “Words of comfort”. The surgical interweaving continues as one of the boys becomes fascinated by medicine’s food metaphors, allowing a recitation of poetically rich diagnostic lists: “the nutmeg liver, the sago spleen, the anchovy sauce sputum…current jelly stools…strawberry tongue of scarlet fever…strawberry angioma, the watermelon stomach, the apple core lesion of cancer, the peau d’orange appearance of breast cancer”. The same son is also drawn to medical smells: “the musty ammoniacal reek of liver failure…the freshly baked scent of typhoid fever…the sewer breath of lung abscess, the grapelike odour of a Pseudomonas-infected burn, the stale urine scent of kidney failure, the old beer smell of scrofula”. This authorial indulgence in the posy of therapeutics has an abstract interest, particularly for a medically-trained reader, but risks subtracting from the relevant characterisation and eroding the flow of the narrative.
Writing a novel structured around surgical knowledge is necessarily a qualitatively different task to constructing one to work out a philosophical principle related to how human beings should behave, to reveal rare insights about human character, or pen related vivid descriptions of nature or people. In the former case the risk is that the reader occasionally comes too close to the face of the author. This happens periodically in Cutting for Stone, briefly diverting the reader’s suspension of disbelief and considerable enjoyment of the tale. In the early chapters, for example, nurse Sister Mary Joseph Praise (the twins’ dead mother) notes “rose spots that appeared on the second febrile day”, then later “the thrust of his ventricle against his skin” and again “large confluent purple patches”. It seems out of character for this particular nurse to be thinking in such an abstract way. The descriptions of love making also seem a little laboured, as if the author was wishing he could describe some medically-related fact pertaining to the encounter. Perhaps the most sympathetic character, the late-developing surgeon Ghosh, dies of leukaemia contracted by doing too many x rays without lead protection and one wishes dramatically that he could have remained at Missing for the boy to come back and unburden himself to. Some of the novel’s particularly gripping incidents actually involve no direct use of medical knowledge: the near crash of an airplane coming in to land and the death of rebel after a coup who steals one of the boy’s motorcycle and has his body buried down a well to prevent reprisals.
One of the most telling features of the final segments of the book is the description of how foreign-trained doctors are underpaid by US taxpayers through Medicaid and Medicare, to staff second-tier hospitals for the poor in dangerous areas. The US hospital where Marion works, Our Lady of Perpetual Succour in the Bronx, has a helipad on the roof funded entirely by a rich hospital solely so its surgeons can harvest organs for lucrative transplant surgery. This becomes a poignant feature in view of President Obama’s current attempts to reform the US healthcare system.
Overall, Cutting for Stone is a carefully constructed novel with interesting characters, an exotic setting and a rich, usually well-integrated and always accurate use of surgical knowledge. Its characters go on journeys that involve many triumphs of the heart. When Marion returns to the Missing Hospital in Ethiopia, for example, he looks one day at the backing of the framed print of Bernini’s Ecstasy of St Teresa he had used to personify his dead mother. He finds a letter from her to his father, the one Stone had never read, placed there by the kindly surgeon Ghosh. Its contents in a strange way redeem the love of his father and mother and nicely round out their hesitant love affair. Cutting for Stone is an exotic and moving “page turner” that can be highly recommended to health professionals and their families, and those with a strong interest in the inner workings of contemporary surgery and its socio-political dimensions.
Provenance and peer review Commissioned; not externally peer reviewed.
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