Abraham Verghese's Epic "Cutting for Stone": The Best 2009 Book I Read

Abraham Verghese's first book, My Own Country, is a heartbreaking tale of falling into being the AIDS specialist in rural Tennessee at a time there was no efficacious treatment and young people (mostly but not only gay males) came "home" - to a place from which they had fled - to die. The book made very clear how little compassion these young, terminally ill people received from the "healthcare system," There were no dramatic technical remedies to deploy, but Verghese doggedly put some care into "healthcare."

His first novel, Cutting for Stone (a phrase form the Hippocratic oath that is a historical elaboration on "Do no harm") is also set within healthcare-in a mission hospital in Addis Ababa, Ethiopia, a field hospital in Eritrea, and in a New York slum hospital with no white physicians, nurses, or patients. The very long (560-page) book is a page turner with a great deal about family feelings and a lifelong heterosexual love. Most of the characters are surgeons, including the narrator, his twin brother, and three of their four parents (one of the two biological ones is a nurse).

The book begins and ends with very complicated surgeries, decades and continents apart, but with a considerable overlap of characters, including both the two surgeons and two (of the three) operated on back at "Missing" (the mispronunciation of "mission" by Ethiopians). In some ways both these set pieces yield both miraculous and fatal effects.

Certainly, Dr. Thomas Stone (born in India to English parents, schooled in Scotland, and a miracle-worker in Ethiopia) is haunted by the birth of Marion (the narrator) and his identical twin brother Shiva. From the start, we know that their mother was a nun, Sister Mary Joseph Praise, who was in love with the surgeon she assisted and who fled after failing to save her (so this is not plot spoiling). How the biological parents got to Missing along with the obstetrician, Hema, who returns from a visit to India midway through the delivery, and Ghosh, the other staff surgeon who was off drinking at the time and the chaotic childbirth takes more than a hundred pages. I found the cliffhanging chapter ends followed by switches to another character (leading to another cliffhanger) reminiscent of 19th-century novels that were serialized in daily newspapers.

Both the mammoth size of the novel and its compassion for multiple characters seems 19th century. Verghese says he was inspired to study medicine by the (old-fashioned and lengthy) Of Human Bondage, written by a physician turned novelist about a would-be artist turned physician: "The particular lines that stayed with me, that have haunted me, were: 'There was humanity there in the rough, the materials the artist worked on; and Philip felt a curious thrill when it occurred to him that he was in the position of the artist.' The phrase 'humanity there in the rough' spoke directly to my twelve-year-old mind."

Maugham was a great story-teller, and so is Verghese. There are many stories in Cutting for Stone, though I would not call the book "episodic." If anything, the stories of diverse characters scattered at different times from Addis Abada all being in New York City feels a bit contrived. There is a very elaborate plot in this novel with memorable characters and Dickensian suffering.

I don't know that the Mildred from Of Human Bondage was a conscious influence on Verghese's imagining of the femme fatale Genet. As Philip was obsessed with Mildred, who brought him great grief before dying of diseases of poverty, Genet nearly destroys Marion both when he is a lovestruck adolescent and when he is board-certified US surgeon. Mildred and Genet both seem to me descendants of Pandora (even though I suspect that like Proust's Albertine, the primary model for Mildred was probably male).

If I had read all of the novel before going to a local author appearance by Verghese (who has recently joined the Stanford Medical School), I'd have asked him about Mildred and Genet. Instead, I asked him "Did it have to be so long?" (when you say something like that, one smiles as genially as one can). Unlike trial lawyers, I don't usually ask questions to which I know the answer. I know (and knew) that the answer was yes, and I knew that Verghese would say no. He said that his editor had cut out a lot. I am confident that I could cut ten percent of the length without sacrificing anything of importance to the characterization or plot developments. I realize that how Marion learns the art of diagnosis from Ghosh needs extensive coverage, but there are more surgeries (under varying conditions) and technical details than there need to be. I will readily grant that my occasional irritations at these obstacles would have been less keen if I were not so caught up in the story of the twins and their four parents. And, perhaps, the dawn of desire and even a particularly traumatic first love have been done very often, so the middle seems to bulge (even though it sets up the amazing final set piece, I know having finished the novel, but other readers might bog down and quit, I fear).

I am not at all surprised that through Marion's perspective Marion has insightful things to say (and show) about patient care, and how that is subordinated and even forgotten in high-tech US medical practice. There is once was a widely known (but now not so) medical school riddle: "What is the emergency treatment delivered to the patient's ear?" The answer is "Words of comfort." That Verghese was a physician who knew and applied this was very clear in My Own Country. It is something that makes the physicians in Cutting for Stone stand out from modern medical practice. (Shiva communicates nonverbally, but is perhaps the most compassionate of all these compassionate medical practitioners. To an extent that appalls Verghese, as to Marion, "The patients' illness has been translated into binary signals stored in the computer... It is as if the patient in the bed is merely an icon for the real patient, who exists in the computer.")

Although the vocation of medicine is absolutely central to the book, it also provides windows into growing up in Ethiopia (as Verghese did, though he is not a twin and was raised by his biological parents, neither of whom are physicians), surviving civil war, and coming to the American system of second-class provision of healthcare (here in a hospital that interests the medical elite as a source of organs to harvest, Appalachia in My Own Story). There is a lot of humor in a novel filled with tragedies: not only M*A*S*H-like mishaps in surgery, but in finding authentic Ethiopian food (and the émigré community) in Boston, etc.