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.

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