The book came out two years ago. One look at the blurb : "A winner…Filled with mystical scenes and deeply felt characters…Verghese is something of a magician as a novelist." -USA Today, and I decided to take a pass.
I revisited the decision and finally tackled the book a couple of weeks ago, and am pleased to report that I did not rue my choice.
Some books draw you in because of the beauty of the language, others by the vividness of the characters, still others for their fast-paced absorbing story lines, drawing you along with the force of a rapid current. This book is a happy coincidence of all three, the only jarring notes being the predictability and facility of the 'loose end tie ups' at the end. But that much can surely be forgiven.
Author Abraham Verghese is a physician of Indian origin, who grew up largely in Ethiopia, with stints in India at medical school, followed by immigration to the US. He started as a writer of anecdotes, essays and articles, like this one entitled 'The Cowpath to America'.
Coming back to the main subject, 'Cutting for Stone' is a curious title. I thought that maybe the allusion was in some way related to the fact that it had as main characters Marion and Shiva Stone, till the realization arrived sometime while reading the book that the name Stone was itself derivative from the expression.
The term comes from the original Hippocratic oath: "I will not use the knife, not even on those suffering from the stone, but I will give way to those who are practitioners of this work.", the 'stone' referring to kidney or gall bladder stones, the pain of which could only be relieved by surgeons qualified and practiced in 'cutting for stone'.
There is a hefty dose of doctor's war-stories in this novel, many of them fascinating insights into the real situations that any general practitioner and surgeon would encounter. The overall plot is beside the point, it's the characters who draw you in: the nun Sr.Mary Praise Joseph, the expatriate British surgeon Thomas Stone, Hema, Ghosh, both doctors who are part of the staff at the Missing Hospital (an intentional misspelling of 'Mission'). Large parts of the story are told from the viewpoint of Marion, one of twins born to Sr.Mary Praise, fathered by Thomas Stone. It manages to cover a coming of age in the Ethiopia of Emperor Haile Selassie's heyday and deposing, a medical residency in New York and weaves effortlessly from setting to setting, in the tradition of the Grand Family Saga, but with fewer but far better etched characters.
Inherent in the war-stories though, is a thread that weaves itself through all of Verghese's writings, that of the doctor as a practitioner of the healing and cutting arts, less reliant on technology than he or she is on the years of memorizing the tomes of anatomy, the experience of opening up innumerable bodies and working through all the blood and tissue to join what was torn apart, or cut away diseased or dispensable organs, or deliver babies. The voice of the doctor at a teaching hospital comes through most clearly, and is one of the novel's clearest attractions. It carries on into many of his academic papers and newspaper, as in this one published in the New England Journal of Medicine, where he discusses the new meme that has taken over medical establishments of the 21st century, the iPatient.
"iPatients are handily discussed in the bunker,while the real patients keep the beds warm and ensure that the folders bearing their names stay alive on the computer."
Have you ever been to a doctor's office where the doctor studiously taps away at the keyboard as you list your symptoms? The visit precisely timed to the smallest possible duration, where the doctor has no time to listen to your prolonged griping about other miscellaneous ills that may plague you, beyond the present major symptoms to be diagnosed and medicated away, perhaps. There will of course be doctors who are more careful to ask about other things, but the fact of the matter is that they simply do not have the time, despite having the inclination.
Verghese himself gives an excellent example of the current state of the art medical care:
"My own experience as a patient in an emergency room in another city helped me see this. My nurse would come in periodically to visit the computer work station in my cubicle, her back to me while she clicked and scrolled away. Over her shoulder she said, “On a scale of one to five how is your …?”
The electronic record of my three-hour stay would have looked perfect, showing close monitoring, even though to me as a patient it lacked a human dimension. I don’t fault the nurse, because in my hospital, despite my best intentions, I too am spending too much time in front of the computer: the story of my patient’s many past admissions, the details of surgeries undergone, every consultant’s opinion, every drug given over every encounter, thousands of blood tests and so many CT scans, M.R.I.’s and ultrasound images reside in there."
Cutting for Stone harkens back to what may seem a bygone age to the US physician, but is still the norm in many parts of the world. No wonder that some doctors, fed up of the sterile, equipment-reliant gleaming acres of hospital floors, take time off from their work to go to distant countries, war zones, earthquakes and other calamities, where they must practice medicine with more heart and head than hi-tech.
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