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Cutting for Stone

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A stunning debut novel from the author of My Own Country: an enthralling family saga of Africa and America, fathers and sons, doctors and patients, exile and home.

Marion and Shiva Stone are twin scions 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 shared fascination with medicine, the brothers come of age as Ethiopia hovers on the brink of revolution. Yet it will not be politics, but love—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 work as an intern at an underfunded Bronx 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 father who abandoned him and the brother who betrayed him.

Cutting for Stone—intensely suspenseful, deeply moving, and unexpectedly funny—is both 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.

“Lauded for his sensitive memoir My Own Country, Verghese [now] 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. During an arduous sea voyage, Sister Mary Joseph Praise, a devout young nun, saves the life of an English doctor bound for Ethiopia, Thomas Stone . . . Seven years later, Sister Praise dies birthing twin boys: Shiva and Marion, the latter narrating his own and his brother’s dramatic, biblical story set against the backdrop of political turmoil in Ethiopia, the hospital compound in which they grow up, and the love story of their adopted parents, both doctors. 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 of the best 19th-century novels.” —Publishers Weekly (starred, boxed review)

“A marvel of a first novel. Verghese’s generosity of spirit is beautifully embodied in this gripping family saga that brings mid-century Ethiopia to vivid life. The practice of medicine is like a spiritual calling in this book, and the unforgettable people at its center bring passion and nobility–not to mention humor and humility–to the ancient art, while living an unforgettable story of love and betrayal and forgiveness. It’s wonderful.” —Ann Packer

“One of the best novels I’ve read in a long time.” —Robert Bly

Cutting the Stone is astonishing–the best book I have read in years. Verghese has a profound love and empathy for his characters and an extraordinary ability to bring his readers to worlds they could never imagine. Here at last is an epic–a great yarn of a novel–as ambitious in its reach as if from another century. Fathers, mothers, sons, children, love: what emotion is not examined? So many of us have been operating as if a sweeping narrative were as quaint as the buggy whip, and yet here comes Verghese to turn that assumption inside out. I wept through parts of this novel, as much for how we live lives of blindness, to ourselves and to others, until we are set on a course that cannot be altered, but just lived and then reconsidered. Bravo to Abraham Verghese!” —Marie Brenner, author of Apples & Oranges

“A grand, exquisitely drawn story of twin brothers that ranges from birth to death, and from Ethiopia to America. In Cutting for Stone, Abraham Verghese shows us with brilliance and passion where healing comes from, and how we move through suffering to embrace life. In the hands of this compassionate doctor/writer, the details are indelible: A wonderful book.” —Samuel Shem, author of The House of God and The Spirit of the Place

“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

“Prepare to be transported entirely by one of the finest writers of our time. Cutting for Stone by the astonishingly gifted, deeply compassionate writer Abraham Verghese will wrap around you from the very first page and will not let you go.” —Naomi Shihab Nye, author of Habibi

“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 as noble and dramatic as that ancient practice–medicine–that lies at the heart of this magnificent novel.” —John Burnham Schwartz, author The Commoner and Reservation Road

“Empathy for our frail human condition resonates throughout Abraham Verghese’s Cutting for Stone. By tracing the development of a narrator unlike any other in our literature–from his nearly mythic beginnings in Ethiopia to his immigrant life in contemporary America–Verghese demonstrates that the supreme skill of a physician lies not in his hands but in his heart. No contemporary novelist has written so well about the human body. Cutting for Stone is an amazing and moving achievement which reminds us of the miracle of being alive.” —Tom Grimes, author of A Stone of the Heart

“I finished Abraham Verghese’s Cutting for Stone last night–it’s 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. I would love to offer a quote for this. But what sort of quote do you think would be most helpful? Should it be: ‘a luminous exploration of the boundaries between self and other, public duty and private obligation that limns the notion of I-ness . . . etc. etc’? That’s how quotes usually look to me–like they were written by a literary theorist. Help! In any case, all of that is trivial. The main thing is, congratulations to Abraham, he’s written a marvelous novel!” —Mark Salzman

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.” —Atul Gawande

“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.” —Tracy Kidder

Cutting for Stone is nothing short of masterful–a riveting tale of love, medicine, and the complex dynamic of twin brothers. It is beautifully conceived and written. The settings are wonderfully pictorial. There is no doubt in my mind that Cutting for Stone will endure in the permanent literature of our time.”—Richard Selzer, surgeon and author of Letters to a Young Doctor

“The mixture of the generally unfamiliar but colorful venues of northeastern Africa and a distinctly different yet subtly similar part of the Bronx; a cast of complex but thoroughly conceivable characters; an intriguing medical drama of the highest intensity without deviation from scientific truth—in sum—leads to the diagnosis of an exciting novel and the assured prognosis of a memorable read! I’d prescribe Cutting for Stone not just for every surgeon and surgeon-in-training, but for any reader in search of an awesome tale.” —Seymour Schwartz, MD, Distinguished Alumni Professor at the University of Rochester and founding editor of Schwartz’s Principles of Surgery.

“Any doubts you might harbor about a 534-page first novel by a physician in his 50s will be allayed in the first few pages of this marvelous book. Abraham Verghese has written two graceful memoirs, but Cutting for Stone, his wildly imaginative fictional debut, is looser, bigger, even better. Verghese has the rare gift of showing his characters in different lights as the story evolves, from tragedy to comedy to melodrama, with an ending that is part Dickens, part Grey’s Anatomy. The novel works as a family saga, but it is also something more, a lovely ode to the medical profession. Verghese can write about the repair of a twisted bowel with the precision and poetry usually reserved for love scenes. The doctor in him sees the luminous beauty of the physician’s calling; the artist recognizes that there remain wounds no surgeon can men. ‘Where silk and steel fail, story must succeed,’ Marion muses. This one does.” —Jennifer Reese, Entertainment Weekly; Grade: A.

“Dr. Marion Praise Stone, the narrator of Cutting for Stone, [holds] his audience spellbound. Call him a little miracle, a fictional character so richly imagined and situated that neither he nor the book he lives in will ever be forgotten. Verghese’s first novel is a whopper, illuminating the magic and the tragedy of our lives, brimming with wisdom about the human condition. Such fun to read, too–with a huge cast, a sweeping multi-continental plot arc, a zillion lovely moments along the way: sharp descriptions, recurrent jokes, cultural observations and medical asides both witty and profound. (Wait till you get to the vasectomy.) In Cutting for Stone, we get all we were promised and then some. Verghese’s previous two books established [him] as a gifted memoirist, a devoted doctor whose skillful storytelling transformed sad stories into fine reading. Yet these books gave no hint of the incredible imaginative power found in this first novel, a power that recalls contemporary fabulists like Salman Rushdie and John Irving. Like Rushdie, Verghese takes us wholly away to a foreign place, culture and history. Like John Irving, he invents characters whose eccentricities are both mythic and adorable. To these achievements, Verghese adds his ability to dramatize matters of biology, medicine and surgery, allowing him to get to the heart, the brain, [and] the liver as few other writers can.” —Marion Winik, Newsday

“At its best, the first novel from physician Verghese displays the virtues so evident in his bestselling and much-lauded memoirs. He has a knack for well-structured scenes, a passion for medicine and a gift for communicating that passion. He gives readers clear, sensory and intricately detailed description, and he uncovers the unexpected significance of mundane actions and objects.” —John Repp, Cleveland Plain-Dealer

“Verghese creates a saga grand enough for the movies, yet sensitive in its explorations of character, purpose and place. Fascinating in its detailed depiction of the sights and sounds of its Ethiopian setting, the novel holds your attention throughout, for you care about the characters, both male and female, young and old. Plus, Verghese writes beautifully…A great, sweeping novel.” —Anne Morris, Dallas Morning News

“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.” —Jocelyn McClurg, USA Today

“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, The Boston Globe (March 19, 2009)

“Gripping . . . Admirably accessible, Verghese takes every opportunity to make the language of medicine fascinating to the outsider. . . . His novel has more in common with the large, ambitious, action-packed novels of the 19th century than with any more recent models. References to George Eliot’s Middlemarch are layered into the book, perhaps as an indicator of the kind of sweeping social novel Verghese is attempting. What’s most memorable about Cutting for Stone is Verghese’s compassionate authorial generosity toward his characters, particularly in his medical scenes. Verghese’s doctors never forget that they are operating on human beings. . . . Refreshing.” —Laura C. J. Owen, Minneapolis Star Tribune (March 6, 2009)

“Richly entertaining . . . A narrative that ranges as skillfully through the emotional register as it does across time and space . . . In its descriptions of the Ethiopia of Haile Selassie and Mengistu, Cutting for Stone convincingly evokes a place unfamiliar to most readers. But the novel’s defining characteristic, and its most impressive achievement, is its attention to an even more exotic world, that of the operating theatre. . . . The technicalities of surgery are lucidly laid out to achieve a kind of poetry. But Verghese the writer is more interested still in the anatomy of emotion that lies behind and ultimately connects both surgeon and patient. . . . Cutting for Stone honors the extraordinary, complex work of surgeons and physicians, but it also allows us to see them as ordinary men and women.” —David Horspool, The Sunday Times (London)

“[Cutting for Stone,] when in full song, reads peculiarly like fact and will probably win every award going . . . Whispers of V. S. Naipaul and Evelyn Waugh are rustling off the page. . . . A tremendous, compassionate, technically exuberant sprawl through post-colonial Ethiopia via Kenya to the U. S. ‘Post-colonial’ suggests a grudging worthiness from which Cutting for Stone is mercifully free; and to mention Addis Ababa and Nairobi and JFK is as misleading as saying that Dickens wrote about London. This is a big book and, along with Naipaul and Waugh and Dickens, there is also a strong flavour of William Boyd, both in the sense of place and in the way heredity and brotherhood get their grippers into a man and shape the narrative of his life. . . . We can only stand back awestruck at [Verghese’s] energy. . . . In medicine, there are times when one can do nothing. The novelist can always do something. But in both cases, and seldom better exemplified than in Verghese’s lovely book, there is a heart to be uncovered.” —Michael Bywater, The Independent (UK)

“There are some novels in which everything seems larger than life–the plots are elaborate, there are many characters, each with their own story, the setting teems with activity. In recent years, two good examples of such BIG books are Khaled Hosseini’s The Kite Runner and Leon Uris’s Exodus. Charles Dickens and other 19th century writers are known for their BIG novels. . . . Cutting for Stone [is] an irresistibly readable epic novel that, I think, well qualifies for this group. [It] is a BIG novel, ranging across generations and continents, taking the reader through political upheavals, romantic entanglements, the complexity of being human, and many different surgeries. When I finished reading this, I wanted to take the next flight to Ethiopia because the author made it sound so interesting. Like Afghanistan (Hosseini) and Israel (Uris), Verghese brought the setting of Cutting for Stone to life as a dynamic and three-dimensional character in its own right.” —Nancy Pearl, KUOW NPR

“In Abraham Verghese’s hands, [medicine] becomes something grander: the nucleus of a lifelong, globe-spanning saga of personal discovery and tangled, multifaceted humanity. . . . Rich with metaphorical resonance . . . Vivid, moving, deeply engrossing and richly rewarding.” —K. Ross Hoffman, Philadelphia City Paper

“Riveting . . . [Verghese] begins this entrancing novel with an opening sentence that is so full of implication it’s practically Dickensian. . . . Try to stop reading after that. You probably can’t, which is good because if you did, you’d miss one of the best books to come along in the past year. . . . In Marion, Verghese creates one of the unique voices in recent fiction, someone who sees both the matter-of-fact nature of life and the equally important mystical implications of every event. . . . As Verghese builds his story front-to-back, he also builds his characters in sharply drawn, believable individuals. . . . Fascinating.” —Greg Langley, The Advocate (Baton Rouge)

“Breathtaking . . . A global story about medicine and family relationships that achieves the literary heights of A Thousand Splendid Suns by Khaled Hosseini. . . . A masterful read.” —Chris Stuckenschneider, The Missourian


“The admixture of the generally unfamiliar but colorful venues of northeastern Africa and a distinctly different yet subtly similar part of the Bronx; a cast of complex but thoroughly conceivable characters; an intriguing medical drama of the highest intensity without deviation from scientific truth–in sum–leads to the diagnosis of an exciting novel and the assured prognosis of a memorable read! I’d prescribe Cutting for Stone not just for every surgeon and surgeon-in-training, but for any reader in search of an awesome tale.” —Seymour I. Schwartz, Distinguished Alumni Professor of Surgery, University of Rochester Medical Center, editor-in-chief of Principles of Surgery, and author of Surgical Reflections and Gifted Hands

“[An] astonishing, breath-taking and heartrending human epic about two little boys who become enamored of medicine, but whose paths violently diverge . . . A perfectly pitched, endlessly rewarding symphony of a debut novel. If you have time to read only one novel this year, make it this one.” —Sheila Anne Feeney, Newark Star-Ledger

“Stupendous . . . The best novel to come along so far this year. [Cutting for Stone] doesn’t really belong to any familiar genre. Rather, it has invented its own: the epic medical romance, surgery meets history. [Verghese is] an original talent; a writing that can deliver with both pen and scalpel. . . . Verghese’s eye is acutely diagnostic. Like Tolstoy (the comparison is not completely far-fetched), he spots the symptomatic, involuntary tics and twitches of body language and nails something bigger: the rough force of politics with which the twins Shiva and Marion . . . have to deal as they grow to maturity in embattled Ethiopia. . . . In War and Peace, the field hospital was a place of last resort for Tolstoy’s antagonists to discover the point of the life from which they are about to exit. For Verghese, the hospital is the world itself, laid out in a state of extreme emotional exposure—for Cutting for Stone is also, at its core, a story of erotic upheavals and familial betrayals. Its action takes place within the arc of the two terrifying procedures that form its beginning and end, and in this sense it reaches for the ambitions of Greek tragedy. . . . Beautiful and deeply affecting.” —Simon Schama, Financial Times

“Some of the best passages in [all of Verghese’s books] are those in which he reads the language of the body—its colours and betraying odours, its telltale pulses–and the emotions that obscure and interrupt that language. . . . While I don’t know Verghese personally, I know the streets and shops he evokes, the hospitals; I know that his setting, seemingly so rich and strange, is real. . . . Verghese’s achievement is to make the reader feel there really is something at stake—birth, love, death, war, loyalty. . . . The mythic arises seamlessly from the quotidian. . . . You conserve pages because you don’t want [the book] to end.” —Aida Edemariam, The Guardian (UK)
The ComingAfter eight months spent in the obscurity of our mother’s womb, my brother, Shiva, and I came into the world in the late afternoon of the twentieth of September in the year of grace 1954. We took our first breaths at an elevation of eight thousand feet in the thin air of Addis Ababa, capital city of Ethiopia. The miracle of our birth took place in Missing Hospital’s Operating Theater 3, the very room where our mother, Sister Mary Joseph Praise, spent most of her working hours, and in which she had been most fulfilled.When our mother, a nun of the Diocesan Carmelite Order of Madras, unexpectedly went into labor that September morning, the big rain in Ethiopia had ended, its rattle on the corrugated tin roofs of Missing ceasing abruptly like a chatterbox cut off in midsentence. Over night, in that hushed silence, the meskel flowers bloomed, turning the hillsides of Addis Ababa into gold. In the meadows around Missing the sedge won its battle over mud, and a brilliant carpet now swept right up to the paved threshold of the hospital, holding forth the promise of something more substantial than cricket, croquet, or shuttlecock.Missing sat on a verdant rise, the irregular cluster of whitewashed one- and two-story buildings looking as if they were pushed up from the ground in the same geologic rumble that created the Entoto Mountains. Troughlike flower beds, fed by the runoff from the roof gutters, surrounded the squat buildings like a moat. Matron Hirst’s roses overtook the walls, the crimson blooms framing every window and reaching to the roof. So fertile was that loamy soil that Matron—Missing Hospital’s wise and sensible leader—cautioned us against stepping into it barefoot lest we sprout new toes.Five trails flanked by shoulder-high bushes ran away from the main hospital buildings like spokes of a wheel, leading to five thatched-roof bungalows that were all but hidden by copse, by hedgerows, by wild eucalyptus and pine. It was Matron’s intent that Missing resemble an arboretum, or a corner of Kensington Gardens (where, before she came to Africa, she used to walk as a young nun), or Eden before the Fall.Missing was really Mission Hospital, a word that on the Ethiopian tongue came out with a hiss so it sounded like “Missing.” A clerk in the Ministry of Health who was a fresh high-school graduate had typed out the missing hospital on the license, a phonetically correct spelling as far as he was concerned. A reporter for the Ethiopian Herald perpetuated this misspelling. When Matron Hirst had approached the clerk in the ministry to correct this, he pulled out his original typescript. “See for yourself, madam. Quod erat demonstrandum it is Missing,” he said, as if he’d proved Pythagoras’s theorem, the sun’s central position in the solar system, the roundness of the earth, and Missing’s precise location at its imagined corner. And so Missing it was. Not a cry or a groan escaped from Sister Mary Joseph Praise while in the throes of her cataclysmic labor. But just beyond the swinging door in the room adjoining Operating Theater 3, the oversize autoclave (donated by the Lutheran church in Zurich) bellowed and wept for my mother while its scalding steam sterilized the surgical instruments and towels that would be used on her. After all, it was in the corner of the autoclave room, right next to that stainless-steel behemoth, that my mother kept a sanctuary for herself during the seven years she spent at Missing before our rude arrival. Her one-piece desk-and-chair, rescued from a defunct mission school, and bearing the gouged frustration of many a pupil, faced the wall. Her white cardigan, which I am told she often slipped over her shoulders when she was between operations, lay over the back of the chair.On the plaster above the desk my mother had tacked up a calendar print of Bernini’s famous sculpture of St. Teresa of Avila. The figure of St. Teresa lies limp, as if in a faint, her lips parted in ecstasy, her eyes unfocused, lids half closed. On either side of her, a voyeuristic chorus peers down from the prie-dieux. With a faint smile and a body more muscular than befits his youthful face, a boy angel stands over the saintly, voluptuous sister. The fingertips of his left hand lift the edge of the cloth covering her bosom. In his right hand he holds an arrow as delicately as a violinist holds a bow.Why this picture? Why St. Teresa, Mother?As a little boy of four, I took myself away to this windowless room to study the image. Courage alone could not get me past that heavy door, but my sense that she was there, my obsession to know the nun who was my mother, gave me strength. I sat next to the autoclave which rumbled and hissed like a waking dragon, as if the hammering of my heart had roused the beast. Gradually, as I sat at my mother’s desk, a peace would come over me, a sense of communion with her. I learned later that no one had dared remove her cardigan from where it sat draped on the chair. It was a sacred object. But for a four-yearold, everything is sacred and ordinary. I pulled that Cuticura-scented garment around my shoulders. I rimmed the dried-out inkpot with my nail, tracing a path her fingers had taken. Gazing up at the calendar print just as she must have while sitting there in that windowless room, I was transfixed by that image. Years later, I learned that St. Teresa’s recurrent vision of the angel was called the transverberation, which the dictionary said was the soul “inflamed” by the love of God, and the heart “pierced” by divine love; the metaphors of her faith were also the metaphors of medicine. At four years of age, I didn’t need words like “transverberation” to feel reverence for that image. Without photographs of her to go by, I couldn’t help but imagine that the woman in the picture was my mother, threatened and about to be ravished by the spear-wielding boy-angel. “When are you coming, Mama?” I would ask, my small voice echoing off the cold tile. When are you coming?I would whisper my answer: “By God!” That was all I had to go by: Dr. Ghosh’s declaration the time I’d first wandered in there and he’d come looking for me and had stared at the picture of St. Teresa over my shoulders; he lifted me in his strong arms and said in that voice of his that was every bit a match for the autoclave: “She is CUM-MING, by God!”Forty-six and four years have passed since my birth, and miraculously I have the opportunity to return to that room. I find I am too large for that chair now, and the cardigan sits atop my shoulders like the lace amice of a priest. But chair, cardigan, and calendar print of transverberation are still there. I, Marion Stone, have changed, but little else has. Being in that unaltered room propels a thumbing back through time and memory. The unfading print of Bernini’s statue of St. Teresa (now framed and under glass to preserve what my mother tacked up) seems to demand this. I am forced to render some order to the events of my life, to say it began here, and then because of this, that happened, and this is how the end connects to the beginning, and so here I am.We come unbidden into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. My intent wasn’t to save the world as much as to heal myself.Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.I chose the specialty of surgery because of Matron, that steady presence during my boyhood and adolescence. “What is the hardest thing you can possibly do?” she said when I went to her for advice on the darkest day of the first half of my life. I squirmed. How easily Matron probed the gap between ambition and expediency. “Why must I do what is hardest?”“Because, Marion, you are an instrument of God. Don’t leave the instrument sitting in its case, my son. Play! Leave no part of your instrument unexplored. Why settle for ‘Three Blind Mice’ when you can play the ‘Gloria’?”How unfair of Matron to evoke that soaring chorale which always made me feel that I stood with every mortal creature looking up to the heavens in dumb wonder. She understood my unformed character. “But, Matron, I can’t dream of playing Bach, the ‘Gloria’ . . . ,” I said under my breath. I’d never played a string or wind instrument. I couldn’t read music.“No, Marion,” she said, her gaze soft, reaching for me, her gnarled hands rough on my cheeks. “No, not Bach’s ‘Gloria.’ Yours! Your ‘Gloria’ lives within you. The greatest sin is not finding it, ignoring what God made possible in you.”I was temperamentally better suited to a cognitive discipline, to an introspective field—internal medicine, or perhaps psychiatry. The sight of the operating theater made me sweat. The idea of holding a scalpel caused coils to form in my belly. (It still does.) Surgery was the most difficult thing I could imagine.And so I became a surgeon.Thirty years later, I am not known for speed, or daring, or technical genius. Call me steady, call me plodding; say I adopt the style and technique that suits the patient and the particular situation and I’ll consider that high praise. I take heart from my fellow physicians who come to me when they themselves must suffer the knife. They know that Marion Stone will be as involved after the surgery as before and during. They know I have no use for surgical aphorisms such as “When in doubt, cut it out” or “Why wait when you can operate” other than for how reliably they reveal the shallowest intellects in our field. My father, for whose skills as a surgeon I have the deepest respect, says, “The operation with the best outcome is the one you decide not to do.” Knowing when not to operate, knowing when I am in over my head, knowing when to call for the assistance of a surgeon of my father’s caliber—that kind of talent, that kind of “brilliance,” goes unheralded.On one occasion with a patient in grave peril, I begged my father to operate. He stood silent at the bedside, his fingers lingering on the patient’s pulse long after he had registered the heart rate, as if he needed the touch of skin, the thready signal in the radial artery to catalyze his decision. In his taut expression I saw complete concentration. I imagined I could see the cogs turning in his head; I imagined I saw the shimmer of tears in his eyes. With utmost care he weighed one option against another. At last, he shook his head, and turned away.I followed. “Dr. Stone,” I said, using his title though I longed to cry out, Father! “An operation is his only chance,” I said. In my heart I knew the chance was infinitesimally small, and the first whiff of anesthesia might end it all. My father put his hand on my shoulder. He spoke to me gently, as if to a junior colleague rather than his son. “Marion, remember the Eleventh Commandment,” he said. “Thou shall not operate on the day of a patient’s death.”I remember his words on full-moon nights in Addis Ababa when knives are flashing and rocks and bullets are flying, and when I feel as if I am standing in an abattoir and not in Operating Theater 3, my skin flecked with the grist and blood of strangers. I remember. But you don’t always know the answers before you operate. One operates in the now. Later, the retrospectoscope, that handy tool of the wags and pundits, the conveners of the farce we call M&M—morbidity and mortality conference—will pronounce your decision right or wrong. Life, too, is like that. You live it forward, but understand it backward. It is only when you stop and look to the rear that you see the corpse caught under your wheel.Now, in my fiftieth year, I venerate the sight of the abdomen or chest laid open. I’m ashamed of our human capacity to hurt and maim one another, to desecrate the body. Yet it allows me to see the cabalistic harmony of heart peeking out behind lung, of liver and spleen consulting each other under the dome of the diaphragm—these things leave me speechless. My fingers “run the bowel” looking for holes that a blade or bullet might have created, coil after glistening coil, twenty-three feet of it compacted into such a small space. The gut that has slithered past my fingers like this in the African night would by now reach the Cape of Good Hope, and I have yet to see the serpent’s head. But I do see the ordinary miracles under skin and rib and muscle, visions concealed from their owner. Is there a greater privilege on earth?At such moments I remember to thank my twin brother, Shiva—Dr. Shiva Praise Stone—to seek him out, to find his reflection in the glass panel that separates the two operating theaters, and to nod my thanks because he allows me to be what I am today. A surgeon. According to Shiva, life is in the end about fixing holes. Shiva didn’t speak in metaphors. Fixing holes is precisely what he did. Still, it’s an apt metaphor for our profession. But there’s another kind of hole, and that is the wound that divides family. Sometimes this wound occurs at the moment of birth, sometimes it happens later. We are all fixing what is broken. It is the task of a lifetime. We’ll leave much unfinished for the next generation.Born in Africa, living in exile in America, then returning at last to Africa, I am proof that geography is destiny. Destiny has brought me back to the precise coordinates of my birth, to the very same operating theater where I was born. My gloved hands share the space above the table in Operating Theater 3 that my mother and father’s hands once occupied.Some nights the crickets cry zaa-zee, zaa-zee, thousands of them drowning out the coughs and grunts of the hyenas in the hillsides. Suddenly, nature turns quiet. It is as if roll call is over and it is time now in the darkness to find your mate and retreat. In the ensuing vacuum of silence, I hear the high-pitched humming of the stars and I feel exultant, thankful for my insignificant place in the galaxy. It is at such times that I feel my indebtedness to Shiva.Twin brothers, we slept in the same bed till our teens, our heads touching, our legs and torsos angled away. We outgrew that intimacy, but I still long for it, for the proximity of his skull. When I wake to the gift of yet another sunrise, my first thought is to rouse him and say, I owe you the sight of morning.What I owe Shiva most is this: to tell the story. It is one my mother, Sister Mary Joseph Praise, did not reveal and my fearless father, Thomas Stone, ran from, and which I had to piece together. Only the telling can heal the rift that separates my brother and me. Yes, I have infinite faith in the craft of surgery, but no surgeon can heal the kind of wound that divides two brothers. Where silk and steel fail, story must succeed. To begin at the beginning . . .
  • FINALIST | 2010
    PEN New England/Hemingway Foundation Award
© Joanne Chan
Abraham Verghese is Professor and Vice Chair for the Theory and Practice of Medicine at the Stanford University School of Medicine. The founding director of the Center for Medical Humanities & Ethics at the University of Texas Health Science Center, San Antonio, he is the author of My Own Country, a 1994 National Book Critics Circle Award Finalist and a Time Best Book of the Year; The Tennis Partner, a New York Times Notable Book; and, most recently, the critically acclaimed novel Cutting for Stone, which was a national bestseller. A graduate of the Iowa Writers’ Workshop, his essays and short stories have appeared in The New Yorker, The New York Times, The Atlantic Monthly, Esquire, Granta, The Wall Street Journal, and elsewhere. In 2016 Verghese received a National Humanities Medal from President Obama. He lives in Palo Alto, California. View titles by Abraham Verghese

About

A stunning debut novel from the author of My Own Country: an enthralling family saga of Africa and America, fathers and sons, doctors and patients, exile and home.

Marion and Shiva Stone are twin scions 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 shared fascination with medicine, the brothers come of age as Ethiopia hovers on the brink of revolution. Yet it will not be politics, but love—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 work as an intern at an underfunded Bronx 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 father who abandoned him and the brother who betrayed him.

Cutting for Stone—intensely suspenseful, deeply moving, and unexpectedly funny—is both 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.

“Lauded for his sensitive memoir My Own Country, Verghese [now] 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. During an arduous sea voyage, Sister Mary Joseph Praise, a devout young nun, saves the life of an English doctor bound for Ethiopia, Thomas Stone . . . Seven years later, Sister Praise dies birthing twin boys: Shiva and Marion, the latter narrating his own and his brother’s dramatic, biblical story set against the backdrop of political turmoil in Ethiopia, the hospital compound in which they grow up, and the love story of their adopted parents, both doctors. 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 of the best 19th-century novels.” —Publishers Weekly (starred, boxed review)

“A marvel of a first novel. Verghese’s generosity of spirit is beautifully embodied in this gripping family saga that brings mid-century Ethiopia to vivid life. The practice of medicine is like a spiritual calling in this book, and the unforgettable people at its center bring passion and nobility–not to mention humor and humility–to the ancient art, while living an unforgettable story of love and betrayal and forgiveness. It’s wonderful.” —Ann Packer

“One of the best novels I’ve read in a long time.” —Robert Bly

Cutting the Stone is astonishing–the best book I have read in years. Verghese has a profound love and empathy for his characters and an extraordinary ability to bring his readers to worlds they could never imagine. Here at last is an epic–a great yarn of a novel–as ambitious in its reach as if from another century. Fathers, mothers, sons, children, love: what emotion is not examined? So many of us have been operating as if a sweeping narrative were as quaint as the buggy whip, and yet here comes Verghese to turn that assumption inside out. I wept through parts of this novel, as much for how we live lives of blindness, to ourselves and to others, until we are set on a course that cannot be altered, but just lived and then reconsidered. Bravo to Abraham Verghese!” —Marie Brenner, author of Apples & Oranges

“A grand, exquisitely drawn story of twin brothers that ranges from birth to death, and from Ethiopia to America. In Cutting for Stone, Abraham Verghese shows us with brilliance and passion where healing comes from, and how we move through suffering to embrace life. In the hands of this compassionate doctor/writer, the details are indelible: A wonderful book.” —Samuel Shem, author of The House of God and The Spirit of the Place

“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

“Prepare to be transported entirely by one of the finest writers of our time. Cutting for Stone by the astonishingly gifted, deeply compassionate writer Abraham Verghese will wrap around you from the very first page and will not let you go.” —Naomi Shihab Nye, author of Habibi

“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 as noble and dramatic as that ancient practice–medicine–that lies at the heart of this magnificent novel.” —John Burnham Schwartz, author The Commoner and Reservation Road

“Empathy for our frail human condition resonates throughout Abraham Verghese’s Cutting for Stone. By tracing the development of a narrator unlike any other in our literature–from his nearly mythic beginnings in Ethiopia to his immigrant life in contemporary America–Verghese demonstrates that the supreme skill of a physician lies not in his hands but in his heart. No contemporary novelist has written so well about the human body. Cutting for Stone is an amazing and moving achievement which reminds us of the miracle of being alive.” —Tom Grimes, author of A Stone of the Heart

“I finished Abraham Verghese’s Cutting for Stone last night–it’s 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. I would love to offer a quote for this. But what sort of quote do you think would be most helpful? Should it be: ‘a luminous exploration of the boundaries between self and other, public duty and private obligation that limns the notion of I-ness . . . etc. etc’? That’s how quotes usually look to me–like they were written by a literary theorist. Help! In any case, all of that is trivial. The main thing is, congratulations to Abraham, he’s written a marvelous novel!” —Mark Salzman

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.” —Atul Gawande

“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.” —Tracy Kidder

Cutting for Stone is nothing short of masterful–a riveting tale of love, medicine, and the complex dynamic of twin brothers. It is beautifully conceived and written. The settings are wonderfully pictorial. There is no doubt in my mind that Cutting for Stone will endure in the permanent literature of our time.”—Richard Selzer, surgeon and author of Letters to a Young Doctor

“The mixture of the generally unfamiliar but colorful venues of northeastern Africa and a distinctly different yet subtly similar part of the Bronx; a cast of complex but thoroughly conceivable characters; an intriguing medical drama of the highest intensity without deviation from scientific truth—in sum—leads to the diagnosis of an exciting novel and the assured prognosis of a memorable read! I’d prescribe Cutting for Stone not just for every surgeon and surgeon-in-training, but for any reader in search of an awesome tale.” —Seymour Schwartz, MD, Distinguished Alumni Professor at the University of Rochester and founding editor of Schwartz’s Principles of Surgery.

“Any doubts you might harbor about a 534-page first novel by a physician in his 50s will be allayed in the first few pages of this marvelous book. Abraham Verghese has written two graceful memoirs, but Cutting for Stone, his wildly imaginative fictional debut, is looser, bigger, even better. Verghese has the rare gift of showing his characters in different lights as the story evolves, from tragedy to comedy to melodrama, with an ending that is part Dickens, part Grey’s Anatomy. The novel works as a family saga, but it is also something more, a lovely ode to the medical profession. Verghese can write about the repair of a twisted bowel with the precision and poetry usually reserved for love scenes. The doctor in him sees the luminous beauty of the physician’s calling; the artist recognizes that there remain wounds no surgeon can men. ‘Where silk and steel fail, story must succeed,’ Marion muses. This one does.” —Jennifer Reese, Entertainment Weekly; Grade: A.

“Dr. Marion Praise Stone, the narrator of Cutting for Stone, [holds] his audience spellbound. Call him a little miracle, a fictional character so richly imagined and situated that neither he nor the book he lives in will ever be forgotten. Verghese’s first novel is a whopper, illuminating the magic and the tragedy of our lives, brimming with wisdom about the human condition. Such fun to read, too–with a huge cast, a sweeping multi-continental plot arc, a zillion lovely moments along the way: sharp descriptions, recurrent jokes, cultural observations and medical asides both witty and profound. (Wait till you get to the vasectomy.) In Cutting for Stone, we get all we were promised and then some. Verghese’s previous two books established [him] as a gifted memoirist, a devoted doctor whose skillful storytelling transformed sad stories into fine reading. Yet these books gave no hint of the incredible imaginative power found in this first novel, a power that recalls contemporary fabulists like Salman Rushdie and John Irving. Like Rushdie, Verghese takes us wholly away to a foreign place, culture and history. Like John Irving, he invents characters whose eccentricities are both mythic and adorable. To these achievements, Verghese adds his ability to dramatize matters of biology, medicine and surgery, allowing him to get to the heart, the brain, [and] the liver as few other writers can.” —Marion Winik, Newsday

“At its best, the first novel from physician Verghese displays the virtues so evident in his bestselling and much-lauded memoirs. He has a knack for well-structured scenes, a passion for medicine and a gift for communicating that passion. He gives readers clear, sensory and intricately detailed description, and he uncovers the unexpected significance of mundane actions and objects.” —John Repp, Cleveland Plain-Dealer

“Verghese creates a saga grand enough for the movies, yet sensitive in its explorations of character, purpose and place. Fascinating in its detailed depiction of the sights and sounds of its Ethiopian setting, the novel holds your attention throughout, for you care about the characters, both male and female, young and old. Plus, Verghese writes beautifully…A great, sweeping novel.” —Anne Morris, Dallas Morning News

“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.” —Jocelyn McClurg, USA Today

“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, The Boston Globe (March 19, 2009)

“Gripping . . . Admirably accessible, Verghese takes every opportunity to make the language of medicine fascinating to the outsider. . . . His novel has more in common with the large, ambitious, action-packed novels of the 19th century than with any more recent models. References to George Eliot’s Middlemarch are layered into the book, perhaps as an indicator of the kind of sweeping social novel Verghese is attempting. What’s most memorable about Cutting for Stone is Verghese’s compassionate authorial generosity toward his characters, particularly in his medical scenes. Verghese’s doctors never forget that they are operating on human beings. . . . Refreshing.” —Laura C. J. Owen, Minneapolis Star Tribune (March 6, 2009)

“Richly entertaining . . . A narrative that ranges as skillfully through the emotional register as it does across time and space . . . In its descriptions of the Ethiopia of Haile Selassie and Mengistu, Cutting for Stone convincingly evokes a place unfamiliar to most readers. But the novel’s defining characteristic, and its most impressive achievement, is its attention to an even more exotic world, that of the operating theatre. . . . The technicalities of surgery are lucidly laid out to achieve a kind of poetry. But Verghese the writer is more interested still in the anatomy of emotion that lies behind and ultimately connects both surgeon and patient. . . . Cutting for Stone honors the extraordinary, complex work of surgeons and physicians, but it also allows us to see them as ordinary men and women.” —David Horspool, The Sunday Times (London)

“[Cutting for Stone,] when in full song, reads peculiarly like fact and will probably win every award going . . . Whispers of V. S. Naipaul and Evelyn Waugh are rustling off the page. . . . A tremendous, compassionate, technically exuberant sprawl through post-colonial Ethiopia via Kenya to the U. S. ‘Post-colonial’ suggests a grudging worthiness from which Cutting for Stone is mercifully free; and to mention Addis Ababa and Nairobi and JFK is as misleading as saying that Dickens wrote about London. This is a big book and, along with Naipaul and Waugh and Dickens, there is also a strong flavour of William Boyd, both in the sense of place and in the way heredity and brotherhood get their grippers into a man and shape the narrative of his life. . . . We can only stand back awestruck at [Verghese’s] energy. . . . In medicine, there are times when one can do nothing. The novelist can always do something. But in both cases, and seldom better exemplified than in Verghese’s lovely book, there is a heart to be uncovered.” —Michael Bywater, The Independent (UK)

“There are some novels in which everything seems larger than life–the plots are elaborate, there are many characters, each with their own story, the setting teems with activity. In recent years, two good examples of such BIG books are Khaled Hosseini’s The Kite Runner and Leon Uris’s Exodus. Charles Dickens and other 19th century writers are known for their BIG novels. . . . Cutting for Stone [is] an irresistibly readable epic novel that, I think, well qualifies for this group. [It] is a BIG novel, ranging across generations and continents, taking the reader through political upheavals, romantic entanglements, the complexity of being human, and many different surgeries. When I finished reading this, I wanted to take the next flight to Ethiopia because the author made it sound so interesting. Like Afghanistan (Hosseini) and Israel (Uris), Verghese brought the setting of Cutting for Stone to life as a dynamic and three-dimensional character in its own right.” —Nancy Pearl, KUOW NPR

“In Abraham Verghese’s hands, [medicine] becomes something grander: the nucleus of a lifelong, globe-spanning saga of personal discovery and tangled, multifaceted humanity. . . . Rich with metaphorical resonance . . . Vivid, moving, deeply engrossing and richly rewarding.” —K. Ross Hoffman, Philadelphia City Paper

“Riveting . . . [Verghese] begins this entrancing novel with an opening sentence that is so full of implication it’s practically Dickensian. . . . Try to stop reading after that. You probably can’t, which is good because if you did, you’d miss one of the best books to come along in the past year. . . . In Marion, Verghese creates one of the unique voices in recent fiction, someone who sees both the matter-of-fact nature of life and the equally important mystical implications of every event. . . . As Verghese builds his story front-to-back, he also builds his characters in sharply drawn, believable individuals. . . . Fascinating.” —Greg Langley, The Advocate (Baton Rouge)

“Breathtaking . . . A global story about medicine and family relationships that achieves the literary heights of A Thousand Splendid Suns by Khaled Hosseini. . . . A masterful read.” —Chris Stuckenschneider, The Missourian


“The admixture of the generally unfamiliar but colorful venues of northeastern Africa and a distinctly different yet subtly similar part of the Bronx; a cast of complex but thoroughly conceivable characters; an intriguing medical drama of the highest intensity without deviation from scientific truth–in sum–leads to the diagnosis of an exciting novel and the assured prognosis of a memorable read! I’d prescribe Cutting for Stone not just for every surgeon and surgeon-in-training, but for any reader in search of an awesome tale.” —Seymour I. Schwartz, Distinguished Alumni Professor of Surgery, University of Rochester Medical Center, editor-in-chief of Principles of Surgery, and author of Surgical Reflections and Gifted Hands

“[An] astonishing, breath-taking and heartrending human epic about two little boys who become enamored of medicine, but whose paths violently diverge . . . A perfectly pitched, endlessly rewarding symphony of a debut novel. If you have time to read only one novel this year, make it this one.” —Sheila Anne Feeney, Newark Star-Ledger

“Stupendous . . . The best novel to come along so far this year. [Cutting for Stone] doesn’t really belong to any familiar genre. Rather, it has invented its own: the epic medical romance, surgery meets history. [Verghese is] an original talent; a writing that can deliver with both pen and scalpel. . . . Verghese’s eye is acutely diagnostic. Like Tolstoy (the comparison is not completely far-fetched), he spots the symptomatic, involuntary tics and twitches of body language and nails something bigger: the rough force of politics with which the twins Shiva and Marion . . . have to deal as they grow to maturity in embattled Ethiopia. . . . In War and Peace, the field hospital was a place of last resort for Tolstoy’s antagonists to discover the point of the life from which they are about to exit. For Verghese, the hospital is the world itself, laid out in a state of extreme emotional exposure—for Cutting for Stone is also, at its core, a story of erotic upheavals and familial betrayals. Its action takes place within the arc of the two terrifying procedures that form its beginning and end, and in this sense it reaches for the ambitions of Greek tragedy. . . . Beautiful and deeply affecting.” —Simon Schama, Financial Times

“Some of the best passages in [all of Verghese’s books] are those in which he reads the language of the body—its colours and betraying odours, its telltale pulses–and the emotions that obscure and interrupt that language. . . . While I don’t know Verghese personally, I know the streets and shops he evokes, the hospitals; I know that his setting, seemingly so rich and strange, is real. . . . Verghese’s achievement is to make the reader feel there really is something at stake—birth, love, death, war, loyalty. . . . The mythic arises seamlessly from the quotidian. . . . You conserve pages because you don’t want [the book] to end.” —Aida Edemariam, The Guardian (UK)

Excerpt

The ComingAfter eight months spent in the obscurity of our mother’s womb, my brother, Shiva, and I came into the world in the late afternoon of the twentieth of September in the year of grace 1954. We took our first breaths at an elevation of eight thousand feet in the thin air of Addis Ababa, capital city of Ethiopia. The miracle of our birth took place in Missing Hospital’s Operating Theater 3, the very room where our mother, Sister Mary Joseph Praise, spent most of her working hours, and in which she had been most fulfilled.When our mother, a nun of the Diocesan Carmelite Order of Madras, unexpectedly went into labor that September morning, the big rain in Ethiopia had ended, its rattle on the corrugated tin roofs of Missing ceasing abruptly like a chatterbox cut off in midsentence. Over night, in that hushed silence, the meskel flowers bloomed, turning the hillsides of Addis Ababa into gold. In the meadows around Missing the sedge won its battle over mud, and a brilliant carpet now swept right up to the paved threshold of the hospital, holding forth the promise of something more substantial than cricket, croquet, or shuttlecock.Missing sat on a verdant rise, the irregular cluster of whitewashed one- and two-story buildings looking as if they were pushed up from the ground in the same geologic rumble that created the Entoto Mountains. Troughlike flower beds, fed by the runoff from the roof gutters, surrounded the squat buildings like a moat. Matron Hirst’s roses overtook the walls, the crimson blooms framing every window and reaching to the roof. So fertile was that loamy soil that Matron—Missing Hospital’s wise and sensible leader—cautioned us against stepping into it barefoot lest we sprout new toes.Five trails flanked by shoulder-high bushes ran away from the main hospital buildings like spokes of a wheel, leading to five thatched-roof bungalows that were all but hidden by copse, by hedgerows, by wild eucalyptus and pine. It was Matron’s intent that Missing resemble an arboretum, or a corner of Kensington Gardens (where, before she came to Africa, she used to walk as a young nun), or Eden before the Fall.Missing was really Mission Hospital, a word that on the Ethiopian tongue came out with a hiss so it sounded like “Missing.” A clerk in the Ministry of Health who was a fresh high-school graduate had typed out the missing hospital on the license, a phonetically correct spelling as far as he was concerned. A reporter for the Ethiopian Herald perpetuated this misspelling. When Matron Hirst had approached the clerk in the ministry to correct this, he pulled out his original typescript. “See for yourself, madam. Quod erat demonstrandum it is Missing,” he said, as if he’d proved Pythagoras’s theorem, the sun’s central position in the solar system, the roundness of the earth, and Missing’s precise location at its imagined corner. And so Missing it was. Not a cry or a groan escaped from Sister Mary Joseph Praise while in the throes of her cataclysmic labor. But just beyond the swinging door in the room adjoining Operating Theater 3, the oversize autoclave (donated by the Lutheran church in Zurich) bellowed and wept for my mother while its scalding steam sterilized the surgical instruments and towels that would be used on her. After all, it was in the corner of the autoclave room, right next to that stainless-steel behemoth, that my mother kept a sanctuary for herself during the seven years she spent at Missing before our rude arrival. Her one-piece desk-and-chair, rescued from a defunct mission school, and bearing the gouged frustration of many a pupil, faced the wall. Her white cardigan, which I am told she often slipped over her shoulders when she was between operations, lay over the back of the chair.On the plaster above the desk my mother had tacked up a calendar print of Bernini’s famous sculpture of St. Teresa of Avila. The figure of St. Teresa lies limp, as if in a faint, her lips parted in ecstasy, her eyes unfocused, lids half closed. On either side of her, a voyeuristic chorus peers down from the prie-dieux. With a faint smile and a body more muscular than befits his youthful face, a boy angel stands over the saintly, voluptuous sister. The fingertips of his left hand lift the edge of the cloth covering her bosom. In his right hand he holds an arrow as delicately as a violinist holds a bow.Why this picture? Why St. Teresa, Mother?As a little boy of four, I took myself away to this windowless room to study the image. Courage alone could not get me past that heavy door, but my sense that she was there, my obsession to know the nun who was my mother, gave me strength. I sat next to the autoclave which rumbled and hissed like a waking dragon, as if the hammering of my heart had roused the beast. Gradually, as I sat at my mother’s desk, a peace would come over me, a sense of communion with her. I learned later that no one had dared remove her cardigan from where it sat draped on the chair. It was a sacred object. But for a four-yearold, everything is sacred and ordinary. I pulled that Cuticura-scented garment around my shoulders. I rimmed the dried-out inkpot with my nail, tracing a path her fingers had taken. Gazing up at the calendar print just as she must have while sitting there in that windowless room, I was transfixed by that image. Years later, I learned that St. Teresa’s recurrent vision of the angel was called the transverberation, which the dictionary said was the soul “inflamed” by the love of God, and the heart “pierced” by divine love; the metaphors of her faith were also the metaphors of medicine. At four years of age, I didn’t need words like “transverberation” to feel reverence for that image. Without photographs of her to go by, I couldn’t help but imagine that the woman in the picture was my mother, threatened and about to be ravished by the spear-wielding boy-angel. “When are you coming, Mama?” I would ask, my small voice echoing off the cold tile. When are you coming?I would whisper my answer: “By God!” That was all I had to go by: Dr. Ghosh’s declaration the time I’d first wandered in there and he’d come looking for me and had stared at the picture of St. Teresa over my shoulders; he lifted me in his strong arms and said in that voice of his that was every bit a match for the autoclave: “She is CUM-MING, by God!”Forty-six and four years have passed since my birth, and miraculously I have the opportunity to return to that room. I find I am too large for that chair now, and the cardigan sits atop my shoulders like the lace amice of a priest. But chair, cardigan, and calendar print of transverberation are still there. I, Marion Stone, have changed, but little else has. Being in that unaltered room propels a thumbing back through time and memory. The unfading print of Bernini’s statue of St. Teresa (now framed and under glass to preserve what my mother tacked up) seems to demand this. I am forced to render some order to the events of my life, to say it began here, and then because of this, that happened, and this is how the end connects to the beginning, and so here I am.We come unbidden into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. My intent wasn’t to save the world as much as to heal myself.Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.I chose the specialty of surgery because of Matron, that steady presence during my boyhood and adolescence. “What is the hardest thing you can possibly do?” she said when I went to her for advice on the darkest day of the first half of my life. I squirmed. How easily Matron probed the gap between ambition and expediency. “Why must I do what is hardest?”“Because, Marion, you are an instrument of God. Don’t leave the instrument sitting in its case, my son. Play! Leave no part of your instrument unexplored. Why settle for ‘Three Blind Mice’ when you can play the ‘Gloria’?”How unfair of Matron to evoke that soaring chorale which always made me feel that I stood with every mortal creature looking up to the heavens in dumb wonder. She understood my unformed character. “But, Matron, I can’t dream of playing Bach, the ‘Gloria’ . . . ,” I said under my breath. I’d never played a string or wind instrument. I couldn’t read music.“No, Marion,” she said, her gaze soft, reaching for me, her gnarled hands rough on my cheeks. “No, not Bach’s ‘Gloria.’ Yours! Your ‘Gloria’ lives within you. The greatest sin is not finding it, ignoring what God made possible in you.”I was temperamentally better suited to a cognitive discipline, to an introspective field—internal medicine, or perhaps psychiatry. The sight of the operating theater made me sweat. The idea of holding a scalpel caused coils to form in my belly. (It still does.) Surgery was the most difficult thing I could imagine.And so I became a surgeon.Thirty years later, I am not known for speed, or daring, or technical genius. Call me steady, call me plodding; say I adopt the style and technique that suits the patient and the particular situation and I’ll consider that high praise. I take heart from my fellow physicians who come to me when they themselves must suffer the knife. They know that Marion Stone will be as involved after the surgery as before and during. They know I have no use for surgical aphorisms such as “When in doubt, cut it out” or “Why wait when you can operate” other than for how reliably they reveal the shallowest intellects in our field. My father, for whose skills as a surgeon I have the deepest respect, says, “The operation with the best outcome is the one you decide not to do.” Knowing when not to operate, knowing when I am in over my head, knowing when to call for the assistance of a surgeon of my father’s caliber—that kind of talent, that kind of “brilliance,” goes unheralded.On one occasion with a patient in grave peril, I begged my father to operate. He stood silent at the bedside, his fingers lingering on the patient’s pulse long after he had registered the heart rate, as if he needed the touch of skin, the thready signal in the radial artery to catalyze his decision. In his taut expression I saw complete concentration. I imagined I could see the cogs turning in his head; I imagined I saw the shimmer of tears in his eyes. With utmost care he weighed one option against another. At last, he shook his head, and turned away.I followed. “Dr. Stone,” I said, using his title though I longed to cry out, Father! “An operation is his only chance,” I said. In my heart I knew the chance was infinitesimally small, and the first whiff of anesthesia might end it all. My father put his hand on my shoulder. He spoke to me gently, as if to a junior colleague rather than his son. “Marion, remember the Eleventh Commandment,” he said. “Thou shall not operate on the day of a patient’s death.”I remember his words on full-moon nights in Addis Ababa when knives are flashing and rocks and bullets are flying, and when I feel as if I am standing in an abattoir and not in Operating Theater 3, my skin flecked with the grist and blood of strangers. I remember. But you don’t always know the answers before you operate. One operates in the now. Later, the retrospectoscope, that handy tool of the wags and pundits, the conveners of the farce we call M&M—morbidity and mortality conference—will pronounce your decision right or wrong. Life, too, is like that. You live it forward, but understand it backward. It is only when you stop and look to the rear that you see the corpse caught under your wheel.Now, in my fiftieth year, I venerate the sight of the abdomen or chest laid open. I’m ashamed of our human capacity to hurt and maim one another, to desecrate the body. Yet it allows me to see the cabalistic harmony of heart peeking out behind lung, of liver and spleen consulting each other under the dome of the diaphragm—these things leave me speechless. My fingers “run the bowel” looking for holes that a blade or bullet might have created, coil after glistening coil, twenty-three feet of it compacted into such a small space. The gut that has slithered past my fingers like this in the African night would by now reach the Cape of Good Hope, and I have yet to see the serpent’s head. But I do see the ordinary miracles under skin and rib and muscle, visions concealed from their owner. Is there a greater privilege on earth?At such moments I remember to thank my twin brother, Shiva—Dr. Shiva Praise Stone—to seek him out, to find his reflection in the glass panel that separates the two operating theaters, and to nod my thanks because he allows me to be what I am today. A surgeon. According to Shiva, life is in the end about fixing holes. Shiva didn’t speak in metaphors. Fixing holes is precisely what he did. Still, it’s an apt metaphor for our profession. But there’s another kind of hole, and that is the wound that divides family. Sometimes this wound occurs at the moment of birth, sometimes it happens later. We are all fixing what is broken. It is the task of a lifetime. We’ll leave much unfinished for the next generation.Born in Africa, living in exile in America, then returning at last to Africa, I am proof that geography is destiny. Destiny has brought me back to the precise coordinates of my birth, to the very same operating theater where I was born. My gloved hands share the space above the table in Operating Theater 3 that my mother and father’s hands once occupied.Some nights the crickets cry zaa-zee, zaa-zee, thousands of them drowning out the coughs and grunts of the hyenas in the hillsides. Suddenly, nature turns quiet. It is as if roll call is over and it is time now in the darkness to find your mate and retreat. In the ensuing vacuum of silence, I hear the high-pitched humming of the stars and I feel exultant, thankful for my insignificant place in the galaxy. It is at such times that I feel my indebtedness to Shiva.Twin brothers, we slept in the same bed till our teens, our heads touching, our legs and torsos angled away. We outgrew that intimacy, but I still long for it, for the proximity of his skull. When I wake to the gift of yet another sunrise, my first thought is to rouse him and say, I owe you the sight of morning.What I owe Shiva most is this: to tell the story. It is one my mother, Sister Mary Joseph Praise, did not reveal and my fearless father, Thomas Stone, ran from, and which I had to piece together. Only the telling can heal the rift that separates my brother and me. Yes, I have infinite faith in the craft of surgery, but no surgeon can heal the kind of wound that divides two brothers. Where silk and steel fail, story must succeed. To begin at the beginning . . .

Awards

  • FINALIST | 2010
    PEN New England/Hemingway Foundation Award

Author

© Joanne Chan
Abraham Verghese is Professor and Vice Chair for the Theory and Practice of Medicine at the Stanford University School of Medicine. The founding director of the Center for Medical Humanities & Ethics at the University of Texas Health Science Center, San Antonio, he is the author of My Own Country, a 1994 National Book Critics Circle Award Finalist and a Time Best Book of the Year; The Tennis Partner, a New York Times Notable Book; and, most recently, the critically acclaimed novel Cutting for Stone, which was a national bestseller. A graduate of the Iowa Writers’ Workshop, his essays and short stories have appeared in The New Yorker, The New York Times, The Atlantic Monthly, Esquire, Granta, The Wall Street Journal, and elsewhere. In 2016 Verghese received a National Humanities Medal from President Obama. He lives in Palo Alto, California. View titles by Abraham Verghese