Cutting for Stone (Verghese)

Cutting for Stone
Abraham Verghese, 2009
Knopf Doubleday
541 pp.
ISBN-13: 9780375714368

A sweeping, emotionally riveting first novel—an enthralling family saga of Africa and America, doctors and patients, exile and home.

Marion and Shiva Stone are twin brothers born of a secret union between a beautiful Indian nun and a brash British surgeon at a mission hospital in Addis Ababa. Orphaned by their mother’s death in childbirth and their father’s disappearance, bound together by a preternatural connection and a shared fascination with medicine, the twins come of age as Ethiopia hovers on the brink of revolution.

Yet it will be love, not politics—their passion for the same woman—that will tear them apart and force Marion, fresh out of medical school, to flee his homeland. He makes his way to America, finding refuge in his work as an intern at an underfunded, overcrowded New York City hospital. When the past catches up to him—nearly destroying him—Marion must entrust his life to the two men he thought he trusted least in the world: the surgeon father who abandoned him and the brother who betrayed him.

An unforgettable journey into one man’s remarkable life, and an epic story about the power, intimacy, and curious beauty of the work of healing others. (From the publisher.)

Author Bio
Where—Ethiopia, Africa
Education—M.D., Madras Medical College (India); M.F.A.,
  Iowa Workshop (USA)
Currently—lives in Palo Alto, California, USA

Abraham Verghese is Professor and Senior Associate Chair for the Theory and Practice of Medicine at the Stanford University School of Medicine. He was the founding director of the Center for Medical Humanities & Ethics at the University of Texas Health Science Center, San Antonio, where he is now an adjunct professor.

He is the author of My Own Country, a 1994 NBCC Finalist and a Time Best Book of the Year, and The Tennis Partner, a New York Times Notable Book. A graduate of the Iowa Writers' Workshop, he has published essays and short stories that have appeared in The New Yorker, New York Times, Atlantic Monthly, and Granta. He lives in Palo Alto, California. (From the publisher.)

Abraham Verghese is the 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. He was born in Ethiopia to parents from Kerala in south India who, along with hundreds of Keralites, worked as teachers.

Dr. Verghese began his medical training in Ethiopia, but his education was interrupted during the civil unrest there when the Emperor Haile Selassie was deposed and a military government took over. He came to America with his parents and two brothers (his elder brother George Verghese is now an engineering professor at MIT) and worked as an orderly for a year before going to India where he completed his medical studies at Madras Medical College in Madras, now Chennai.

In his written work, he refers to his time working as an orderly in a hospital in America as an experience that confirmed his desire to finish his medical training; the experience had given him a first-hand view of patients' experience in the hospital with its varying levels of treatment and care. He has said the insights he gained from this work helped him "imagine the suffering of patients," which became a motto for some of his later work.

After finishing his medical degree from Madras University in 1979, he came to the U.S. as one of hundreds of foreign medical graduates, or FMGs, from India seeking open residency positions here. As he described it in a New Yorker article, "The Cowpath to America," many FMGs often had to work in the less popular hospitals and communities, and frequently in inner cities. He opted for a residency in a brand-new program in Johnson City, Tennessee affiliated with East Tennessee State University. He was a resident there from 1980 to 1983, and then secured a coveted fellowship at Boston University School of Medicine in 1983, where he worked for two years at Boston City Hospital and where he saw the early signs of the urban epidemic of HIV in that city.

Returning to Johnson City in 1985 as assistant professor of medicine (he later became a tenured associate professor there), he encountered the first signs of a second epidemic, that of rural AIDS. His work with the patients he cared for and his insights into his personal transformation from being "homoignorant," as he describes it, to having a understanding of his patients resulted a few years later in his first book.

Exhausted from the strain of his work with his patients, with his first marriage under strain 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 Iowa City 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—Thomason Hospital—for many years. His skills and commitment to patient care resulted in his being awarded the Grover E. Murray Distinguished Professorship of Medicine at the Texas Tech School of Medicine.

During these years in El Paso, he also wrote and published his first bestselling book, My Own Country: A Doctor's Story, about his experiences in East Tennessee, but also pondering themes of displacement, Diaspora, responses to foreignness and the many individuals and families affected by the AIDS epidemic. This book was one of five chosen as Best Book of the Year by Time magazine and it was later made into a movie by Mira Nair with TV Lost series star Naveen Andrews playing his role.

His second book, The Tennis Partner: A Story of Friendship and Loss, also written during his time in El Paso, is another eloquently written personal story, this time about his friend and tennis partner, a medical resident in recovery from drug addiction. The story deals with the ultimate death of his friend and explores the issue and prevalence of physician drug abuse. It also concludes the account of the breakdown of his first marriage, an integral part of the narrative in both My Own Country and The Tennis Partner. This book will be reissued shortly.

In 2002, Dr. Verghese went 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. In San Antonio, besides developing a formal humanities and ethics curriculum that was integrated into in all four years of study, he invited medical students to accompany him on bedside rounds as a way of demonstrating his conviction about the value of the physical examination in diagnosing patients and in developing a caring, two-way patient-doctor relationship that provides benefits not only to patients and their families but to the physician, as well. At San Antonio, he held the Joaquin Cigarroa Chair and the Marvin Forland Distinguished Professorship.

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.

In 2009 Verghese published Cutting for Stone, bringing him both critical and popular acclaim. 

His writing and work continue to explore the importance of bedside medicine, the ritual of the physical examination in the era of advanced technology, where as he notes frequently in his writing, the patient in the bed is often ignored in favor of the patient data in the computer. He is renowned at Stanford for his weekly bedside rounds, where he insists on examining patients without knowledge of their diagnosis to demonstrate the wealth of information available from the physical exam.

Dr. Verghese has three children, two grown sons by his first marriage and a third by his second marriage. (From Wikipedia.)

Book Reviews
Even with its many stories and layers, Cutting for Stone remains clear and concise. Verghese paints a vivid picture of these settings, the practice of medicine (he is also a physician) and the characters' inner conflicts. I felt as though I were with these people, eating dinner with them even, feeling the hot spongy injera on my fingers as they dipped it into a spicy wot. In The Interior Castle, Saint Teresa's work on mystical theology, she wrote, "I began to think of the soul as if it were a castle made of a single diamond or of very clear crystal, in which there are many rooms, just as in Heaven there are many mansions." Cutting for Stone shines like that place.
W. Ralph Eubanks - Washington Post

Engrossing.... Endearing.... A passionate, vivid, and informative novel.... [Verghese] paints a colorful, fact-filled, and loving portrait.... Verghese is at his best describing the landscape, the genial wisdom of the man who raises [twin brothers Marion and Shiva], the political upheavals that rupture the land he loves, and.... the medical and surgical challenges that confront this family of doctors.... Cutting for Stone is worth reading. Verghese is clearly a compassionate man in love with words and the subject matter to which he applies them.
Julie Wittes Schlack - Boston Globe

A novel set in Africa bears a heavy burden. The author must bring the continent home to help the reader sit in a chair and imagine vast, ancient, sorrowful, beautiful Africa. In the last decade I’ve read books narrated by characters homesick for Africa; books by or about child soldiers; books about politics; books full of splintering history. Cutting for Stone is the first straightforward novel set in and largely about Africa that I’ve read in a good long time–the kind Richard Russo or Cormac McCarthy might write, the kind that shows how history and landscape and accidents of birth and death conspire to create the story of a single life. Perhaps it is because the narrator is a doctor that you know there will be pain, healing, distance, perspective and a phoenix rising from the ashes of human error. Marion Stone reconstructs his half-century with a child’s wonder.... Verghese knows that beauty is the best way to draw us in.... The landscape and the characters who live and work [at Missing Hospital] create something greater than a community, more like an organism. The intimacy of the twins...the ghostly purity of their mother and the daily rhythms of the hospital create an inhabitable, safe place, on and off the page. In lesser hands, melodrama would be irresistible...but Verghese has created characters with integrity that will not be shattered by any event.... Verghese makes the point in his gentle way that violence begets violence; that fanaticism is born from pain.... Cutting for Stone owes its goodness to something greater than plot. It would not be possible to give away the story by simply telling you what happens. Verghese creates this story so lovingly that it is actually possible to live within it for the brief time one spends with this book. You may never leave the chair.... Lush and exotic...richly written.
Susan Salter Reynolds - Los Angeles Times

Abraham Verghese is a doctor, an accomplished memoirist 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 is an underdog and a winner. Shades of Slumdog Millionaire.
USA Today

Blood is thicker than water, and more copious, in this expansive novel about identical twin boys born in Addis Ababa in 1954 and instantly orphaned–their mother dies, their father flees. Raised by doctors at the hospital, Shiva and Marion soon begin practicing medicine themselves, but their lives unhappily diverge. The twins have a telepathic connection, and Marion, the narrator, believes he can recall their relationship in the womb. Verghese, a doctor, has an affinity for unstinting detail and unscientific intuition. The exhaustive gore of the medical procedures is matched by a poetic perception of the outside world–arriving in New York, Marion misses the cacophony of Addis Ababa’s roads, observing that in America ‘the cars were near silent, like a school of fish.’ Verghese bends history and coincidence to his narrative needs–characters cross paths when they should and find the information they seek–creating a story much like the human bodies Marion painstakingly describes: beautiful [and] amazing.
The New Yorker

Lauded for his sensitive memoir (My Own Country) about his time as a doctor in eastern Tennessee at the onset of the AIDS epidemic in the '80s, Verghese turns his formidable talents to fiction, mining his own life and experiences in a magnificent, sweeping novel that moves from India to Ethiopia to an inner-city hospital in New York City over decades and generations. Sister Mary Joseph Praise, a devout young nun, leaves the south Indian state of Kerala in 1947 for a missionary post in Yemen. During the arduous sea voyage, she saves the life of an English doctor bound for Ethiopia, Thomas Stone, who becomes a key player in her destiny when they meet up again at Missing Hospital in Addis Ababa. Seven years later, Sister Praise dies birthing twin boys: Shiva and Marion, the latter narrating his own and his brother's long, dramatic, biblical story set against the backdrop of political turmoil in Ethiopia, the life of the hospital compound in which they grow up and the love story of their adopted parents, both doctors at Missing. The boys become doctors as well and Verghese's weaving of the practice of medicine into the narrative is fascinating even as the story bobs and weaves with the power and coincidences of the best 19th-century novel.
Publishers Weekly

Focusing on the world of medicine, this epic first novel by well-known doctor/author Verghese (My Own Country) follows a man on a mythic quest to find his father. It begins with the dramatic birth of twins slightly joined at the skull, their father serving as surgeon and their mother dying on the table. The horrorstruck father vanishes, and the now separated boys are raised by two Indian doctors living on the grounds of a mission hospital in early 1950s Ethiopia. The boys both gravitate toward medical practice, with Marion the more studious one and Shiva a moody genius and loner. Also living on the hospital grounds is Genet, daughter of one of the maids, who grows up to be a beautiful and mysterious young woman and a source of ruinous competition between the brothers. After Marion is forced to flee the country for political reasons, he begins his medical residency at a poor hospital in New York City, and the past catches up with him. The medical background is fascinating as the author delves into fairly technical areas of human anatomy and surgical procedure. This novel succeeds on many levels and is recommended for all collections.
Jim Coan - Library Journal

There's a mystery, a coming-of-age, abundant melodrama and even more abundant medical lore in this idiosyncratic first novel from a doctor best known for the memoir My Own Country (1994). The nun is struggling to give birth in the hospital. The surgeon (is he also the father?) dithers. The late-arriving OB-GYN takes charge, losing the mother but saving her babies, identical twins. We are in Addis Ababa, Ethiopia, in 1954. The Indian nun, Sister Mary Joseph Praise, was a trained nurse who had met the British surgeon Thomas Stone on a sea voyage ministering to passengers dying of typhus. She then served as his assistant for seven years. The emotionally repressed Stone never declared his love for her; had they really done the deed? After the delivery, Stone rejects the babies and leaves Ethiopia. This is good news for Hema (Dr. Hemalatha, the Indian gynecologist), who becomes their surrogate mother and names them Shiva and Marion. When Shiva stops breathing, Dr. Ghosh (another Indian) diagnoses his apnea; again, a medical emergency throws two characters together. Ghosh and Hema marry and make a happy family of four. Marion eventually emerges as narrator. "Where but in medicine," he asks, "might our conjoined, matricidal, patrifugal, twisted fate be explained?" The question is key, revealing Verghese's intent: a family saga in the context of medicine. The ambition is laudable, but too often accounts of operations—a bowel obstruction here, a vasectomy there—overwhelm the narrative. Characterization suffers. The boys' Ethiopian identity goes unexplored. Shiva is an enigma, though it's no surprise he'll have a medical career, like his brother, though far less orthodox. They become estranged over a girl, and eventually Marion leaves for America and an internship in the Bronx (the final, most suspenseful section). Once again a medical emergency defines the characters, though they are not large enough to fill the positively operatic roles Verghese has ordained for them. A bold but flawed debut novel.
Kirkus Reviews

Discussion Questions
1. Abraham Verghese has said that his ambition in writing Cutting for Stone was to "tell a great story, an old-fashioned, truth-telling story." In what ways is Cutting for Stone an old-fashioned story-and what does it share with the great novels of the nineteenth century? What essential human truths does it convey?

2. What does Cutting for Stone reveal about the emotional lives of doctors? Contrast the attitudes of Hema, Ghosh, Marion, Shiva, and Thomas Stone toward their work. What draws each of them to the practice of medicine? How are they affected, emotionally and otherwise, by the work they do?

3. Marion observes that in Ethiopia, patients assume that all illnesses are fatal and that death is expected, but in America, news of having a fatal illness "always seemed to come as a surprise, as if we took it for granted that we were immortal" (p. 396). What other important differences does Cutting for Stone reveal about the way illness is viewed and treated in Ethiopia and in the United States? To what extent are these differences reflected in the split between poor hospitals, like the one in the Bronx where Marion works, and rich hospitals like the one in Boston where his father works?

4. In the novel, Thomas Stone asks, "What treatment in an emergency is administered by ear?" The correct answer is "Words of comfort." How does this moment encapsulate the book's surprising take on medicine? Have your experiences with doctors and hospitals held this to be true? Why or why not? What does Cutting for Stone tell us about the roles of compassion, faith, and hope in medicine?

5. There are a number of dramatic scenes on operating tables in Cutting for Stone: the twins' births, Thomas Stone amputating his own finger, Ghosh untwisting Colonel Mebratu's volvulus, the liver transplant, etc. How does Verghese use medical detail to create tension and surprise? What do his depictions of dramatic surgeries share with film and television hospital dramas—and yet how are they different?

6. Marion suffers a series of painful betrayals—by his father, by Shiva, and by Genet. To what degree is he able, by the end of the novel, to forgive them?

7. To what extent does the story of Thomas Stone's childhood soften Marion's judgment of him? How does Thomas's suffering as a child, the illness of his parents, and his own illness help to explain why he abandons Shiva and Marion at their birth? How should Thomas finally be judged?

8. In what important ways does Marion come to resemble his father, although he grows up without him? How does Marion grow and change over the course of the novel?

9. A passionate, unique love affair sets Cutting for Stone in motion, and yet this romance remains a mystery—even to the key players—until the very conclusion of the novel. How does the relationship between Sister Mary Joseph Praise and Thomas Stone affect the lives of Shiva and Marion, Hema and Ghosh, Matron and everyone else at Missing? What do you think Verghese is trying to say about the nature of love and loss?

10. What do Hema, Matron, Rosina, Sister Mary Joseph Praise, Genet, and Tsige—as well as the many women who come to Missing seeking medical treatment—reveal about what life is like for women in Ethiopia?

11. Addis Ababa is at once a cosmopolitan city thrumming with life and the center of a dictatorship rife with conflict. How do the influences of Ethiopia's various rulers—including Italyand Emperor Selassie—reveal themselves in day-to-day life? How does growing up there affect Marion's and Shiva's worldviews?

12. As Ghosh nears death, Marion comments that the man who raised him had no worries or regrets, that "there was no restitution he needed to make, no moment he failed to seize" (p. 346). What is the key to Ghosh's contentment? What makes him such a good father, doctor, and teacher? What wisdom does he impart to Marion?

13. Although it's also a play on the surname of the characters, the title Cutting for Stone comes from a line in the Hippocratic Oath: "I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art." Verghese has said that this line comes from ancient times, when bladder stones were epidemic and painful: "There were itinerant stone cutters—lithologists—who could cut into either the bladder or the perineum and get the stone out, but because they cleaned the knife by wiping their blood-stiffened surgical aprons, patients usually died of infection the next day." How does this line resonate for the doctors in the novel?

14. Almost all of the characters in Cutting for Stone are living in some sort of exile, self-imposed or forced, from their home country—Hema and Ghosh from India, Marion from Ethiopia, Thomas from India and then Ethiopia. Verghese is of Indian descent but was born and raised in Ethiopia, went to medical school in India, and has lived and worked in the United States for many years. What do you think this novel says about exile and the immigrant experience? How does exile change these characters, and what do they find themselves missing the most about home?
(Questions issued by publisher.)

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