Bridging across two continents and three distinct times, Abraham Vergheses Cutting for Stone proves to be a timeless work of literature that pulls at the heartstrings of anyone who dares to read it. Set in the backdrop of Ethiopia during a time of turmoil and revolutionary changes, as well as in two major cities in the Eastern United States, this fictional novel appears to parallel important junctures in Vergheses own life. He was born in Ethiopia (near Addis Ababa) to Indian parents, and had started his medical training there. However, the civil unrest caused by the deposition of the Emperor, Haile Selassie forced Verghese to move to the United States to pursue his residency. Once in the United States, Verghese found that, like many other foreign medical students and graduates, only unpopular residencies in unfashionable hospitals and communities were open to him. However, through hard work he was eventually able to move up the ladder of prestige, and is now a professor of internal medicine at Stanford University. Once again, although this novel is considered a work of fiction, one cannot help but notice the distinct similarities between the timeline of his own life and that of Marion Praise Stone, who is the main character and also the narrator. Verghese incorporates much of his own experience in crossing from one culture to another, and shows the great difficulties that most, if not all immigrants must overcome, especially when it comes to learning about a healthcare system that is, in most cases, totally different from the one they are used to.
The story begins with that of Marions birth parents, Dr. Thomas Stone, a highly acclaimed (as well as the only) surgeon at Missing Hospital in Ethiopia, and Sister Mary Joseph Praise, a nun and a nurse at the same hospital. The two had met on a ship from Madras. An illness spread through the people on the ship, infecting Thomas Stone as well. Sister Mary Joseph Praise nursed him back to health, after which the two teamed up to provide care to the other sick passengers. It appears at this point that the two fall in love, and eventually end up at the same hospital in Addis Ababa, Missing Hospital. Missing is not the actual name of the hospital; rather, it is the result of mispronunciation of Mission in Amharic (the national language of Ethiopia) and typographical error. Here at Missing Hospital, Dr. Stone and Sister Mary become an invaluable, inseparable team. Other important people from this hospital include Dr. Hema, an OB/GYN from India, and Dr. Ghosh, an internal medicine specialist who is also from India, and Matron, the woman who is in charge of running the entire hospital. Everything was running smoothly until one day, Sister Mary goes into labor while Dr. Hema (the resident obstetrician) was away. Unknown to anyone working at Missing, Sister Mary was pregnant with twin boys who were conjoined at the head. She ends up dying due to the complications she suffered through labor, but leaves her legacy in the form of twin boys, who are named Marion and Shiva by Dr. Hema after Dr. Thomas Stone ran away from the situation and the responsibility.
Dr. Hema and Dr. Ghosh become the adoptive parents of Marion and Shiva. From the moment of their birth, the two boys were inseparable, and as Marion describes it, they were Shivamarion, rather than two separate individuals. They ate, they slept, they played, and they even breathed together. Approximately a year after their birth, a girl named Genet was born to one of the helpers of Dr. Hema and Dr. Ghoshs household, Rosina. Genet immediately became a playmate for Shiva and Marion. As time passed and the three children grew older, the differences between Shiva and Marion became more and more apparent than ever. Shiva was at near genius level, but did not apply himself to school, causing his grades to suffer. Marion, on the other hand, was not as intelligent, but was a hard worker, and studied constantly to be at the top of the class. Many major events occur during their teenage years that would change the course of both lives forever. These include external conflicts caused by the political turmoil of the country at the time, as well as internal strives which mainly center around Genet (during which Marion is deeply scarred by his brother and Genet, the two people he loves most).
Eventually, Shiva decides to assist Dr. Hema without getting a degree, and Marion is accepted and attends medical school along with Genet. Genet, however, gets swept up in the underground political movements that are going on, and drops out. During this time, Marions adoptive father and lifelong mentor, Dr. Ghosh, passes away from leukemia caused by the old x-ray machine used at Missing. Before Marion can get through his residency, Genet yet again causes more trouble for him, causing Marion to flee the country. He ends up in a residency in an unpopular hospital in the poor area of New York. Here, he goes through a surgical residency, during which a happenchance meeting with his birth father, Dr. Thomas Stone occurs.
Seven years after Marion first moved to the United States, Genet yet again causes more trouble for him, this time nearly costing his life. He becomes mortally ill. Dr. Hema and Shiva are sent for immediately by the hospital staff, who fear that Marion does not have much more time to live. Once there, Shiva does his research, and suggests an option, a surgery that had never been done before on humans, but would pave the way for multitudes of sick patients. The groundbreaking surgery was done without a hitch, but in cruel twist of fate, Shiva develops incurable complications from the surgery, and passes away, and leaves Marion in a state of health much better than before.
The novel is divided into three stories; however, they flow seamlessly from one to another and intertwine. No detail proves unimportant, although it may seem as though it is at the time. Verghese beautifully shows just how connected Marion and Shiva are, even though they are at first emotionally, then physically separated from each other. Each action one brother does affects the other in some way, shape, or form. Graphic surgical details are included, which is not surprising considering the author is himself a physician. This detail, which may at first put some readers off as being too graphic and gory, creates instances during which the reader becomes Marion, becomes the surgeon working painstakingly to save the sick persons life. The shift of point of view from one character to another also allows the reader to see a certain situation (such as the birth of the twins) not just from one perspective, but all of the perspectives that are important to a given situation. Verghese is a master of intertwining various elements throughout the novel, whether it be the fate of the characters, the viewpoints of each person, or even the mingling of clinical terminology with the language that even a lay person will understand. Although the book may seem very long at first glance, the rich details provided allow the reader to actually experience not only the various beautiful settings described throughout the novel, but the actions and emotions going through the minds of the important characters.
However, one of the most compelling aspects of this novel is the vivid description of the clash of cultures that Marion encounters throughout his medical career. Although the most obvious instances are seen after he arrives in the United States, it certainly is not the first. Even before Marion steps foot in America, he deals with interactions that shape how he reacts to the shock of a new culture later on. Although he was born in Addis Ababa, he was borne of an Indian mother and British father, and raised by two Indian doctors. His household helpers were Eritrean and Ethiopian, and learned early on about the differences in various cultures. Once he came to the United States, even the ride to the Our Lady of Perpetual Succour hospital showed just how much Marion would have to adjust. In a conversation with the Arab taxi driver, Marion had unwittingly insulted him and faced down the barrel of his gun:
Yes, Hamid. Screw your courage to the sticking place Thank you, Hamid!
What? What you say?
I said, Thank you.
No, before that!
Oh, thats Macbeth Lady Macbeth, actually. My father used to say it all the time.
You insult me?... Screw me? Screw you!
I saw him reach into the glove compartment. He pulled out a gun.
Later on, after he started working as a resident, the difference in attitude between American doctors and Ethiopian doctors became apparent.
[I]n Ethiopia, and even in Nairobi, people assumed that all illness even a trivial or imagined one was fatal; they expected death. The news to convey in Africa was that youd kept death at bay In America, my initial impression was that death or the possibility of it always seemed to come as a surprise, as if we took it for granted that we were immortal, and that death as just an option
This difference in attitude when it comes to illness and dying is very important to examine. The United States is a very diverse country, with dozens, if not hundreds of different countries and cultures represented. Although it would be impossible to teach each physician about the beliefs and customs in medical care of each and every culture, it certainly would improve the communications between patients and doctors if physicians were educated in the fact that there are different cultures, and to take into consideration any wishes the patient or the patients family may have concerning medical treatment. Hopefully, as more and more people read this novel, people will come to realize that differences in medical culture are a very real problem, and that it is a very important issue that must be dealt with. I definitely recommend this book, this well-written piece of literature, to anyone who can devote the time to not just read through it, but appreciate the complexities of human emotion in times of joy and despair, as well as the richness different cultures provide the human experience.
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