Thursday, January 26, 2012

Book Review: Cutting for Stone by Abraham Verghese






(Blogger Note: This review was published in the January, 2012 edition of LAMLight, the physician newsletter of the Lynchburg Academy of Medicine.)



This could be the very shortest book review which I have ever written.  It would read:  Buy, borrow or steal a copy of this book immediately and read it.  It is fantastic.  That brevity would not, however, do this book justice or fill up the page, so here goes:

Cutting for Stone is the first novel by author Abraham Verghese, an internist and infectious disease specialist.  He has written two previous non-fiction books.  The first, published in 1995 is titled My Own Country: A Doctor’s Story of a Town and Its People in the Age of AIDS.  He was practicing at the time in Johnson City, Tennessee.  The second, The Tennis Partner was published in 1999 and told of the author’s relationship with a colleague who had an unfortunate addiction problem.  At that time, Dr. Verghese was a Professor of Medicine and Chief of the Infectious Disease Division at the Texas Health Sciences Center in El Paso, Texas.  Dr. Verghese is now on the faculty at Stanford University as a Professor and Senior Associate Chair for the Theory and Practice of Medicine.  He also has received an MFA in Creative Writing from the prestigious Iowa Writers Workshop.

Cutting for Stone is a 657 page tour-de-force novel packed with history, unforgettable characters and descriptions of medicine practiced without any of the modern diagnostic tools.  The story starts in the early 1950s in Addis Ababa, the capital of Ethiopia. Ethiopia is located on the Horn of Africa and has Middle Eastern, Muslim, Christian and Jewish heritages.   Marion Stone and his twin brother Shiva are born in chaotic fashion.  They are delivered from a Carmelite nun by emergency C-section after attempts to deliver them vaginally by the mission hospital’s surgeon nearly killed them.  Sister Mary Joseph Praise was a dedicated surgical nurse and had kept the pregnancy a secret until she was found in the late stages of arrested labor in her room.  She had worked diligently for years in the operating theater with Dr. Thomas Stone who was presumed by all to be the babies’ father.  The secrets of the babies’ conception are hidden from the reader until nearly the entire book has transpired.  Sister Mary Joseph Praise dies on the operating table and Dr. Stone disappears.  The hospital is left in a state of turmoil, having lost their most talented physician and their most respected nurse in one day.   The twin boys are adopted by the hospital’s obstetrician and her husband, an internist who takes over surgical responsibilities in the absence of Dr. Stone.

The story then follows the childhood and early adulthood of both boys.  They are raised on the hospital grounds and attend local schools.  They are literally raised by a village, including servants, hospital workers and even some of the patients.  The author reveals the stories of Thomas Stone and Sister Mary Joseph Praise in flashback chapters.  They both were born and raised in India and each arrived at Missing Hospital in Addis Ababa for different reasons.  These stories are very compelling in their own rights.  Dr. Stone became an expert tropical surgeon and wrote an internationally recognized text book on the subject.  Marion and Shiva develop quite different personalities despite being identical twins.  Marion is the serious student and romantic, Shiva is rebellious and more irresponsible.  This inevitably causes friction and the boys become estranged after a fight over a local girl, a love interest for Marion and a conquest for Shiva. 

As a physician reading this novel, it was refreshing to read of doctors using history taking and basic physical diagnosis skills to solve medical puzzles and not only make correct diagnoses but prescribe the appropriate treatments.  They accomplish this without MRI or CT scans or reams of laboratory data.  They use their medical knowledge, their physical examination skills and their insights as diagnosticians to practice their art.

This author is able to weave the history of modern Ethiopia into the fabric of the novel, much like Khaled Hosseini did for Afghanistan in A Thousand Splendid Suns.  The author describes the impact of Italian occupation on the local culture and, in particular, the architecture.  He narrates the rise to power of the diminutive Emperor Haile Selassie and multiple attempts to dethrone him.  The hospital is geographically caught in the middle of several coup attempts and the twins’ adopted father is imprisoned at one point for operating emergently on one of the resistance leaders.  Political unrest eventually leads Marion to immigrate to America to complete surgical residency.

In another comparison to Hosseini, Abraham Verghese does a terrific job of describing the plight of women in third world countries.  The female characters in Cutting for Stone are subjected to unbelievable prejudices and sufferings.  There is one chapter which graphically describes a female circumcision and its horrible aftermath which is as riveting as it is revolting.  Even the crude health care system discriminates and women are often left with the natural consequences of their diseases.   Shiva uses his precocious fascination for repairing things and anatomical knowledge that he gleans by observing surgeries performed by his adopted mother gynecologist to devise a surgical repair for vaginal fistulae.  These are an all too common occurrence in Ethiopia because of early teen and multiple pregnancies combined with inadequate gynecological care.  Because of incontinence these women become outcasts, much like lepers in previous centuries.  Shiva's notoriety becomes yet another source of irritation for Marion who has worked tirelessly for years to become an accomplished surgeon, only to have his formally untrained twin receive notoriety for his surgical innovations.

The latter portion of the book details Marion’s life as a surgical house officer in a depressed hospital in New York City.   This hospital is in such a blighted area that it is completely staffed by foreign medical grads.  It is a virtual United Nations with Pakistani, Indian and Ethiopian physicians.  The combination and clash of cultures in the house staff living quarters is entertaining.   Marion inevitably comes into contact with his biological father who has by now reinvented himself as a renowned Boston academic transplant surgeon.  After expressing his great anger, Marion more or less makes amends with Thomas Stone.  Marion becomes seriously ill which precipitates a reunion of the brothers, their biological father and their adopted mother.  The book ends with the exposition of the many secrets and fears which all of the characters had held in their hearts for thirty years.

One of the more pleasant surprises in this book is the author’s description of the foods of his native land.  His descriptions almost make the aromas of lamb, lentils and chicken waft off of the page:

“Mustard seeds explode in the hot oil.  She holds a lid over the pan to fend off the missiles.  Rat-a-tat-tat! Like hail on a tin roof.  She adds the cumin seeds, which sizzle, darken, and crackle.  A dry, fragrant smoke chases out the mustard scent.  Only then are the onions added, handfuls of them, and now the sound is that of life being spawned in a primordial fire.”
  
 (Side note:  If you would like to try amazing and authentic Ethiopian food, try Zed’s Ethiopian Cuisine at 1201 28th Street, N.W, in the Georgetown section of Washington, D.C.  Their chicken doro watt is superb and they have great vegetarian entrees as well, such as Split Pea Kik Alicha.  We discovered this restaurant a few years ago when it was recommended to us by an Ethiopian cab driver.)  

This is a wonderful book which is extraordinarily well written.  The words flow and the paragraphs glide and the entire book is a mesmerizing and fantastic reading experience.  The characters are so vivid you feel like you have known them your whole life.  The emotions are conveyed in a sincere way and all of the melancholy, fear, desperation, hope and even happiness are felt deeply by the reader.  Cutting for Stone is also a novel of redemption, forgiveness, sacrifice and triumph over adversity.    As I said earlier, get a copy of this book, read it and savor it.  You will be glad that you did.


Thursday, January 19, 2012

The Edgar Awards and a Book Review: The Lock Artist by Steve Hamilton




     The Mystery Writers of America, founded in 1945, annually presents the Edgar Awards for mystery fiction, non-fiction, television, film and theater published or produced in the previous year.  The nominees are always announced on January 19, the birthday of Edgar Allan Poe.  Poe is generally recognized as the “father” of the mystery novel.    Today is the 203rd anniversary of the birth of Poe and the announcements of all of the Edgar nominees are included here: (2012 Edgar Nominations).   The Edgar nominees for the Best Mystery novel of 2011 are:

-          The Ranger by Ace Atkins
-          The Devotion of Suspect X by Keigo Higashino
-          1222 by Anne Holt
-          Gone by Mo Hayder
-          Field Gray by Philip Kerr

     To celebrate the announcement of this year’s nominees, here is a review of the 2011 winner: The Lock Artist by Steve Hamilton.  This review was previously published in “The LamLight”, the physician newsletter of the Lynchburg Academy of Medicine.




 The Lock Artist by Steve Hamilton

This novel is a truly unique and intriguing read.  The story is narrated in the first person by the main character, a young adult named Michael.  Michael suffers a major psychological trauma as an eight year old which leaves him literally speechless.  This trauma is alluded to early on and is revealed in detail at the conclusion of the story, a riveting chapter which ties up all of the plot’s loose ends.
We meet Mike as a struggling junior in a large high school in a town about forty miles from Detroit.  He has not spoken a word since age 8 and is seen as the class freak.  He is a very accomplished art student and can sketch in great detail.  He is living with an uncle who owns a liquor store.  Quite by chance, he learns that he is very good at picking locks.  He finds some old locks in an antique store and becomes fascinated by their mechanism, eventually teaching himself how to open any lock, including combination locks.  His skill is discovered by some of the more popular students in his school who recruit him to participate in a prank – breaking into the home of a rival school’s star football player and leaving a derogatory sign in the student’s bedroom.  Vandalism occurs, the police arrive, the perpetrators scatter and the only one apprehended is Michael.  He refuses to reveal the other students involved and a probation/restitution deal is worked out.  Michael has to work the entire summer for the well-to-do homeowner who was victimized by the vandalism.  He is a sadistic sort and has Michael dig a pool in his backyard using only a small shovel.  Michael becomes enamored with the man’s daughter who is also very artistic and a love affair ensues. 
The homeowner is in some economic difficulties, owes money to the mob and sees Michael as a possible solution to his problems.  He involves Michael with these criminals and the rest of Michael’s story is a series of break-ins where his safe-cracking abilities are well utilized.  The story of Michael’s criminal life is interwoven with the story of how he was introduced to this life in a very intricate but effective way.
The tragedy which caused Michael’s communication issues is revealed in a very innovative way at the end of the book.  Between assignments for the mob, Michael tracks down his former girlfriend who is now attending the University of Michigan.  They return to Michael’s childhood home which is now abandoned and together they draw a huge mural which depicts the events leading to Michael’s issues.
The Lock Artist is very entertaining.  It is told in the first person by the mute main character as a memoir which he is writing from jail.  The plot moves forward at a constant but not a rushed pace and switches back and forth between Michael’s life of crime as a young adult and his adolescence..  The writing is very engaging; the author even makes all of the details about the construction and design of different types of locks interesting.  I thoroughly enjoyed this book and recommend it highly.


Saturday, January 14, 2012

Rascal Flatts, Sara Evans and Hunter Hayes at the Roanoke Civic Center: Friday, January 13, 2012





Rascal Flatts, Sara Evans and Hunter Hayes at the Roanoke Civic Center
January 13, 2012

     I have to admit that we went to this concert knowing really very little about Rascal Flatts and nothing about Hunter Hayes.  We have seen Sara Evans a couple of times before with Brad Paisley, so we were confident that she would give a great performance.  Well, we left unabashed Rascal Flatts fanatics.  They were superb.  From their opening percussion assault they had the audience captivated.  Their stage set was awesome, highlighted by a giant high definition board back-drop.  Rascal Flatts consists of three very talented individuals, the combination of which somehow far exceeds their individual abilities.  Their vocal harmonies are impeccable, their command of multiple instruments impressive and their dominant stage presence was extraordinary.  They went through their  11 years of hits and one new single (“Banjo”), some in extended versions and some as part of medleys.  A funny thing happened in the middle of their amazing show.  They played a three song group, each of which highlighted one individual. Jay DeMarcus, who mainly plays bass, opened this mini-set playing Billy Joel’s “Piano Man” on a beautiful white grand piano.  Guitarist Joe Don Rooney then lit up his white Gibson Les Paul playing Stevie Ray Vaughan’s “The House is Rockin’”.   Vocal leader Gary LeVox’ thrilling rendition of Stevie Wonder’s “Signed, Sealed and Delivered” capped off this virtuoso set.   The interesting thing to me about Rascal Flatts is that even though each individual is extremely talented and could front a band on their own, they sublimate their individual egos to the band.  This may be a façade, but they have constructed their performance to showcase each individual here and there, but they seem to understand and relish the uniqueness and specialness of the group dynamic.   I had no idea these guys were this talented and versatile.  Gary LeVox, in particular, is a pro.  He had the entire arena following his every move. With the exception of Mick Jagger, I can’t remember when I have seen anyone completely capture an audience like he did.  He is completely absorbed in his performance, delivering his unique vocals to the accompaniment of the appropriate hand and facial expressions, dance moves and engaging interactions with the audience.   I think everyone left the Roanoke Civic Center in a sense of awe and appreciation for Rascal Flatts.  If you ever have the opportunity to see one of their live performances: DO IT!  You won’t be disappointed.




     Sara Evans played an hour long set consisting of many songs from her newest CD “Stronger” and sprinkled in some of her older hits (“Suds in the Bucket” and “Born to Fly” being particularly well received).  The song which brought the biggest reaction was “Stonger”, probably because most in the audience were well aware of her difficult domestic situations over the past several years.   Her band provided excellent instrumental back-up and they ended their portion of the show with a rousing rendition of Cheap Trick’s “I Want You to Want Me”.  It was, all in all, a very well done performance which, unfortunately, sort of got lost after the force of nature known as Rascal Flatts blasted onto the stage.




    
      Newcomer Hunter Hayes opened the show with a brief but entertaining set highlighted by his own compositions “Somebody’s Heartbreak” (which really is a very good song) and current top 15 hit “Storm Warning”. 



     All in all, this was an outstanding show, one which I am very glad we were able to attend and one I would highly recommend to anyone with an interest in pop music performance, not just country music.




 For more photos, visit:



Wednesday, January 11, 2012

Book Review: The Prisoner of Guantanamo by Dan Fesperman




The Prisoner of Guantanamo
By Dan Fesperman
  
(Blogger Note: This review was originally published in "The LAMLight", the physician newsletter of the Lynchburg Academy of Medicine.  It is posted here on the tenth anniversary of the establishment of the prison at Guantanamo Bay, Cuba.)

     Dan Fesperman is a reporter for the Baltimore Sun who has worked in Berlin and Afghanistan.  He used his first hand knowledge and reporter’s eye for detail to great advantage to craft this spine tingling and tremendously frightening novel. In “The Prisoner of Guantanamo” Dan Fesperman tells the story of Revere Falk, an Arabic speaking FBI special agent assigned to the prison at Guantanamo Bay.  He specializes in Yemeni dialects and interrogates a subset of the al-Queda prisoners. The story begins when the body of an Army reservist washes up on the shore in Cuban territory.  Did he drown during an after dark leisure swim or is there foul play involved?  Falk is enlisted to help with the investigation and at this point the plot becomes serpentine.  The victim was a banker in civilian life and had recently authorized several large cash tranfers through his home bank and two banks notorious for drug money laundering (one in the Caymans and one in South America.)  There may have been a witness who saw the victim with two other men in a small watercraft the night of his death.  Was he a “bad guy” or a pawn in a bigger game?  Another plot line involves a prisoner who discloses a name to Falk which may link Cuban agents with al-Queda.  These two plots intertwine and the frustrating lack of cooperation between the Defense Department intelligence operatives, the CIA and the FBI becomes central.  It also turns out that Falk had been compromised by Cuban agents during a previous stint at Guantanamo while serving in the Marine Corps and has acted as a double agent ever since.  The implication in all of this is that the United States government tries to manufacture evidence of Cuban support of al-Queda to justify a take-over of Cuba.  In light of revelations regarding the lack of evidence of connections between Saddam Hussein and al-Queda this plot becomes all too believable.  The plot of this novel is actually overly complex.  The various plots and sub-plots never really come to satisfying resolutions and the characters are fairly stereotypical government types.  The book is valuable, however, because of its insights into the inner workings at the Guantanamo facility and the handling of al-Queda prisoners.  It is disheartening to think that the various U.S. agencies could still be so fragmented and competitive years after the terrorist attacks of 9/11.  

Sunday, January 8, 2012

Book Review: Red Cat by Peter Spiegelman


Red Cat
By Peter Spiegelman

     The Huffington Post (www.thehuffingtonpost.com) recently posted an article listing mystery novels which transcend the genre and are actually quite literary.  This novel was included.  The skeleton of the plot of Red Cat is actually fairly pedestrian.  A wealthy banker hires his private investigator brother to find out who the woman is that he met on the internet.  Their casual affair took a wrong turn when the woman, who the banker knows only by her internet name, starts phoning his work and home in an effort to set up further trysts.  The brother, John March, follows a long and winding route through the art world of New York, finally identifying the mysterious Wren as a failed actress and writer.  This is where the story takes a particularly nasty and different angle.  “Wren” has created video art by secretly filming her liaisons.  During the final scenes of her videos, which she sells discreetly for large sums of money, she turns the tables on her paramours and berates them for their infidelity and stupidity.


     The plot takes another wicked turn when a “Jane Doe” is found in the water, the only identifying feature on the body being a red cat tattoo which is all too familiar to her film subjects, John March’s brother included. The cast of characters who may have been involved in “Wren’s” demise is large, including the video subjects, former boyfriends and co-workers.  The author leads us down several circuitous paths before revealing the culprit, one unsuspected by this reader, in the next to last chapter.

     This is a very well written mystery, but whether it rises to the level of literature is up to each reader to decide.  The author’s prose is very descriptive, the characters are all very well developed (even the elusive “Wren”) and the pacing is perfect.  The author leaves you hanging at the end of chapters and then changes gears with the opening paragraphs of the next chapter, making the reader want to race through the book.  New York in this book is reminiscent of the New York in the best of Ed McBain’s  57th  Precinct novels.  I enjoyed Red Cat very much and would recommend it highly.