Cutting for Stone by Abraham Verghese

The Barnes & Noble Review

Abraham Verghese's My Own Country, an incandescent memoir of the author's early years as a doctor caring for HIV patients in rural Tennessee, was one of those books that seemed to make an indelible impression on everyone who read it. His next work, The Tennis Partner -- the tale of a friend's struggle with drug addiction -- was also nonfiction, but his storytelling gifts were clearly so outstanding that it could only have been a matter of time before he turned to fiction.

Written 14 years after his auspicious literary debut, Cutting for Stone is Verghese's first novel, and it shows him not entirely in control of his new medium. But for all the book's faults, it is vastly preferable to most recent fiction and wonderfully refreshing in its utter lack of irony, cynicism, self-involvement, or hipness. Verghese puts his artistry at the service of his all-embracing humanism, rather in the manner of 19th-century social realist novelists like George Eliot. In fact Somerset Maugham, also a medical doctor, provided an early inspiration for Verghese, especially in his comparison of the physician's vocation with that of the artist in his classic novel Of Human Bondage (1915). Verghese sees his dual callings in a similar light. "My ambition as a writer," he says of Cutting for Stone, "was to tell a great story, an old-fashioned, truth-telling story. But beyond that, my single goal was to portray an aspect of medicine that gets buried in the way television depicts the practice: I wanted the reader to see how entering medicine was a passionate quest, a romantic pursuit, a spiritual calling, a privileged yet hazardous undertaking."

Verghese has lived and practiced in the United States for many years but fears that in American hospitals "the patient is becoming invisible.... It is as if the patient in the bed is merely an icon for the real patient, who exists in the computer." He felt that the kind of medical story he wanted to tell needed to be set in Ethiopia, where he was born (of Indian parents) in the 1950s and lived until his family had to flee after General Mengistu's 1974 military coup. In Cutting for Stone, he says, "I wanted to portray a place so basic, so unadorned, that nothing separates doctor and patient, no layers of paperwork, no technology or specialists, no disguising of the nature of the patient's experience or the raw physician experience. It's a setting where the nature of the suffering, the fiduciary responsibility and moral obligation to the patient and to society, are no longer abstract terms."

This is the rationale for the novel's Missing (a local mispronunciation of "Mission") Hospital in Addis Ababa, where early in the 1950s a forbidden and scarcely acknowledged love between an Indian nursing sister and a British surgeon produces identical twin boys: Marion, the narrator, and the brilliant, enigmatic Shiva. The mother, Sister Mary Joseph Praise, dies in childbirth; the father, Dr. Thomas Stone, fails to save her and is so grief-stricken that he flees the country, abandoning the two boys whom he vigorously denies are his. The boys are adopted by Missing's Indian gynecologist, Dr. Kalpana Hemlatha, familiarly known as Hema, who subsequently marries a genial colleague, Dr. Ghosh. The courtship between Hema and Ghosh is depicted with earthy charm, in contrast with the unearthly, almost mystical bond between Stone and Sister Mary.

Verghese follows the makeshift family's progress through several decades. Ethiopian by birth, the two boys are nevertheless perpetual foreigners, ferengi; their relationship with their housekeeper's beautiful and provocative daughter, Genet -- almost but never quite a sister -- underlines that fact. In accordance with their status as ferengi, they attend a rather pretentious British school rather than the perfectly adequate state one. ("I am convinced," Marion says, "that one can buy in Harrods of London a kit that allows an enterprising Englishman to create a British school anywhere in the third world. It comes with black robes, preprinted report cards for Michaelmas, Lent, and Easter terms, as well as hymnals, Prefect Badges, and a syllabus. Assembly required. ") Hema and Ghosh train the boys for medical careers as a matter of course, proudly initiating them into what Ghosh celebrates as his "romantic and passionate pursuit." Eventually, Marion is hounded out of Ethiopia for political reasons and goes to New York, where he joins the stream of young Indian doctors invited to America to staff rural or inner-city hospitals -- places where few American physicians want to work.

The medical scenes, whether at Missing or at Our Lady of Perpetual Succour in the Bronx, are uniformly well done, but Verghese is not always as successful in other areas: he succumbs to crass melodrama, for example, in his treatment of Genet, who is not so much a character as a vehicle for many contradictory veins of Ethiopan history and culture: tribal pride, female circumcision, militarism, Eritrean separatism, etc. Verghese has tried to squeeze too much material into his plot, linking personal tales with historical forces in the manner of the 19th-century novelists he admires, but he hasn't quite pulled it off. He is at his best when most personal, most earthbound.

His love for Ethiopia is palpable. "The fragrance of eucalyptus stoking a home fire, the smell of wet grass, of dung fuel, of tobacco, of swamp air, and of the perfume of hundreds of roses -- this was the scent of Missing. No, it was the scent of a continent." His evocations of the taste of injera bread soaked up with fiery wot, of the sound of a cow calling its calf with "soothing and auspicious sounds," of "the great banks of clouds that spilled over the Entoto Mountains" enrich his story at every turn. He is equally adept at making us see our own country through the eyes of a foreigner. Marion's first impressions of New York City are brilliantly realized; so are his reflections on the differences between the kind of medicine practiced back in Africa and "the artful, lavish, disposable-everything, lucrative, and incredibly effective American brand of medicine," and his thoughts on the two cultures' opposing attitudes toward death. "It was as if in 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 you'd 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."

Verghese's great strength as a novelist is his ability to speak straight from the heart -- indeed, he seems unwilling to speak any other way, and is possibly incapable of doing so. His weakness is his uncertainty with the genre, and in Cutting for Stone he has made artistic choices that lend an unfortunate note of artificiality to parts of his tale. The first hundred pages or so make the book look almost like a Rushdie-esque magic realist novel, complete with mystically communicating twins, an apparent virgin birth, divine intervention, and other anti-realist devices. Soon, though, the author settles into the more or less realistic mode that seems to come more naturally to him. His novel is often awkward but nearly always affecting, for aside from being an engaging tale in its own right it comprises a moral self-portrait and a valuable philosophical statement. --Brooke Allen

Brooke Allen is the author of Twentieth-Century Attitudes; Artistic License; and Moral Minority. She is a contributor to The New York Times Book Review, The New Criterion, The New Leader, The Hudson Review, and The Nation, among others. She was named a finalist for the 2007 Nona Balakian Citation for Excellence in Reviewing from the National Book Critics Circle.

From the Publisher

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.

The Washington Post - W. Ralph Eubanks

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.

Publishers Weekly

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. (Feb.)

Jim Coan - Library Journal

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. [See Prepub Alert, LJ10/1/08.]

Kirkus Reviews

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 overa 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. First printing of 150,000. Author tour to Austin, Boston, Dallas, Denver, Iowa City, Los Angeles, New York, Portland, Ore., Raleigh/Durham, San Antonio, San Francisco, Seattle, Toronto, Washington, D.C.

What People Are Saying

Tracy Kidder
"Abraham Verghese has always written with grace, precision and feeling [but] he's topped himself with Cutting for Stone. . . . A vastly entertaining and enlightening book."

Mark Salzman
"Absolutely fantastic! Holy cow, this book should be a huge success. It has everything: nuns, conjoined twins, civil war, and medicine-I was thinking that if Vikram Seth and Oliver Sacks were to collaborate on a four-hour episode of Grey's Anatomy set in Africa, they could only hope to come up with something this moving and entertaining. . . . A marvelous novel!"

Atul Gawande
"Cutting for Stone is a tremendous accomplishment. The writing is vivid and thrilling, and the story completely absorbing, with its pregnant Indian nun, demon-ridden British surgeon, Siamese twins orphaned and severed at birth, and narrative strands stretching across four continents. A tale this wild is perilous, but there is not a false step anywhere. Accomplished non-fiction writers do not necessarily make accomplished novelists, but with Cutting for Stone, Abraham Verghese has become both. This is a novel sure to receive a great amount of critical attention-and attention from readers, too. I feel lucky to have gotten to read it."

John Burnham Schwartz
"Abraham Verghese has long been one of my favorite authors. Yet, much as I admire his abundant gifts as both writer and physician, nothing could have prepared me for the great achievement of his first novel. Here is an extraordinary imagination, artfully shaped and forcefully developed, wholly given in service to a human story that is deeply moving, utterly gripping, and, indeed, unforgettable. Cutting for Stone is a work of literature as noble and dramatic as that ancient practice-medicine-that lies at the heart of this magnificent novel."--(John Burnham Schwartz, author of The Commoner and Reservation Road)

"A marvelous novel. To read the first page of Cutting for Stone is to fall hopelessly under the spell of a masterful storyteller; and to try to close the book thereafter is to tear oneself away from the most vivid of dreams. Cutting for Stone is a gorgeous epic tale, suffused with unforgettable grace, humanity and compassion. Verghese breathes such life into his characters that there is a poignant familiarity to them, one that lingers and haunts long after the dream is over. Verghese has once again set the bar and re-defined great medical literature-great literature period-for the rest of us."--(Pauline W. Chen, author of Final Exam)

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Reading Group Guide

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 anumber 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-England, Italy, 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?

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