Cutting For Stone
by Abraham Verghese
The Coming
After eight months spent in the obscurity of our mothers 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 Hospitals 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 Hirsts roses overtook the walls, the crimson blooms framing every
window and reaching to the roof. So fertile was that loamy soil that
MatronMissing Hospitals wise and sensible leadercautioned 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
Matrons 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 hed proved Pythagorass theorem, the suns central position in the
solar system, the roundness of the earth, and Missings 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
Berninis 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
mothers 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. Teresas 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 didnt need words like
transverberation to feel reverence for that image. Without photographs of her
to go by, I couldnt 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. Ghoshs
declaration the time Id first wandered in there and hed 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 Berninis
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
wasnt 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. Dont 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 cant dream of playing Bach, the Gloria ... , I said under
my breath. Id never played a string or wind instrument. I couldnt read music.
No, Marion, she said, her gaze soft, reaching for me, her gnarled hands rough
on my cheeks. No, not Bachs 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 fieldinternal 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 Ill 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 fathers caliberthat 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 patients 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 patients 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 dont 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&Mmorbidity and
mortality conferencewill 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. Im 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 diaphragmthese 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 serpents 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, ShivaDr. Shiva Praise
Stoneto 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 didnt speak in metaphors. Fixing holes is precisely what he did.
Still, its an apt metaphor for our profession. But theres 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. Well 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 fathers 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 ...
Excerpted from Cutting for Stone by Abraham Verghese Copyright © 2009 by Abraham Verghese. Excerpted by permission of Knopf, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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