Cutting for Stone

  ALSO BY ABRAHAM VERGHESE

  The Tennis Partner

  My Own Country

  For George and Mariam Verghese

  Scribere jussit amor

  And because I love this life

  I know I shall love death as well.

  The child cries out when

  From the right breast the mother

  Takes it away, in the very next moment

  To find in the left one

  Its consolation.

  —Rabindranath Tagore, from Gitanjali

  PROLOGUE

  The Coming

  AFTER 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 hed 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-year-old, 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. “Wh
at 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 …

  PART ONE

  … for the secret of the care of the patient

  is in caring for the patient.

  Francis W. Peabody, October 21, 1925

  CHAPTER 1

  The Typhoid State Revisited

  SISTER MARY JOSEPH PRAISE had come to Missing Hospital from India, seven years before our birth. She and Sister Anjali were the first novitiates of the Carmelite Order of Madras to also go through the arduous nursing diploma course at the Government General Hospital, Madras. On graduation day my mother and Anjali received their nursing pins and that evening took their final vows of poverty celibacy, and obedience. Instead of answering to “Probationer” (in the hospital) and “Novitiate” (in the convent), they could now be addressed in both places as “Sister.” Their aged and saintly abbess, Shessy Geevarughese, affectionately called Saintly Amma, had wasted no time in giving the two young nurse-nuns her blessing, and her surprising assignment: Africa.

  On the day they were to sail, all the novitiates rode from the convent in a caravan of cycle-rickshaws to the harbor to send off their two sisters. In my mind's eye I can see the novitiates lining the quay, chattering and trembling with exc
itement and emotion, their white habits flapping in the breeze, the seagulls hopping around their sandaled feet.

  I have so often wondered what went through my mother's mind as she and Sister Anjali, both just nineteen years old, took their last steps on Indian soil and boarded the Calangute. She would have heard stifled sobs and “God be with you” follow her up the gangway. Was she fearful? Did she have second thoughts? Once before, when she entered the convent, she'd torn herself away from her biological family in Cochin forever and moved to Madras, which was a day and a night's train ride from her home. As far as her parents were concerned, it might just as well have been halfway across the world, for they would never see her again. And now, after three years in Madras, she was tearing herself away from the family of her faith, this time to cross an ocean. Once again, there was no going back.

  A few years before sitting down to write this, I traveled to Madras in search of my mother's story. In the archived papers of the Carmelites, I found nothing of hers, but I did find Saintly Amma's diaries in which the abbess recorded the passing days. When the Calangute slipped its mooring, Saintly Amma raised her hand like a traffic policeman and, “using my sermon voice which I am told belies my age,” intoned the words, “Leave your land for my sake,” because Genesis was her favorite book. Saintly Amma had given this mission great thought: True, India had unfathomable needs. But that would never change and was no excuse; the two young nuns—her brightest and fairest—were to be the torch-bearers: Indians carrying Christ's love to darkest Africa—that was her grand ambition. In her papers, she reveals her thinking: Just as the English missionaries discovered when they came to India, there was no better way to carry Christ's love than through stupes and poultices, liniments and dressings, cleansing and comfort. What better ministry than the ministry of healing? Her two young nuns would cross the ocean, and then the Madras Discalced Carmelite Mission to Africa would begin.