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A novel

Written by Abraham VergheseAuthor Alerts:  Random House will alert you to new works by Abraham Verghese


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On Sale: February 03, 2009
Pages: 560 | ISBN: 978-0-307-27134-1
Published by : Vintage Knopf

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A sweeping, emotionally riveting first novel–an enthralling family saga of Africa and America, doctors and patients, exile and home.

Marion and Shiva Stone are twin brothers born of a secret union between a beautiful Indian nun and a brash British surgeon at a mission hospital in Addis Ababa. Orphaned by their mother’s death in childbirth and their father’s disappearance, bound together by a preternatural connection and a shared fascination with medicine, the twins come of age as Ethiopia hovers on the brink of revolution. Yet it will be love, not politics–their passion for the same woman–that will tear them apart and force Marion, fresh out of medical school, to flee his homeland. He makes his way to America, finding refuge in his work as an intern at an underfunded, overcrowded New York City hospital. When the past catches up to him–nearly destroying him–Marion must entrust his life to the two men he thought he trusted least in the world: the surgeon father who abandoned him and the brother who betrayed him.

An unforgettable journey into one man’s remarkable life, and an epic story about the power, intimacy, and curious beauty of the work of healing others.

From the Compact Disc edition.


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 he’d 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-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. 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. “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. 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 . . .

From the Hardcover edition.
Abraham Verghese|Author Q&A

About Abraham Verghese

Abraham Verghese - Cutting for Stone

Photo © Joanne Chan

Abraham Verghese is Professor and Senior Associate Chair for the Theory and Practice of Medicine at the Stanford University School of Medicine. He was the founding director of the Center for Medical Humanities & Ethics at the University of Texas Health Science Center, San Antonio, where he is now an adjunct professor. He is the author of My Own Country, a 1994 NBCC Finalist and a Time Best Book of the Year, and The Tennis Partner, a New York Times Notable Book. A graduate of the Iowa Writers’ Workshop, he has published essays and short stories that have appeared in The New Yorker, The New York Times, The Atlantic Monthly, Esquire, Granta, The Wall Street Journal, and elsewhere. He lives in Palo Alto, California.

Abraham Verghese is represented by Random House Speakers Bureau (http://www.rhspeakers.com).

Author Q&A

Q: Your previous two books are non-fiction, but you’ve said that you have always thought of
yourself as a fiction writer first. How so?
Fiction is truly my first love. To paraphrase Dorothy Allison, fiction is the great lie that tells the
truth about how the world really lives. It is why in teaching medical students I use Tolstoy’s The
Death of Ivan Ilych
to teach about end-of-life, and Bastard out of Carolina to help students really understand child abuse. A textbook rarely gives them the kind of truth or understanding achieved in
the best fiction.
One of my first published short stories was “Lilacs,” in which the protagonist has HIV. Its
appearance in The New Yorker in 1991 was a part of what led to my contract to write My Own Country,
a memoir of my years of caring for persons with HIV in rural Tennessee. While writing that book
I found myself living through an intense personal story of friendship and loss that led to a second
non-fiction book, The Tennis Partner. But after that, I passed up on an offer to write a third non-fiction
book. I was keen to get back to fiction, to explore that kind of truth.

Q: In 1990, while practicing medicine, you decided to attend the Iowa Writers’ Workshop and obtain a degree in Fine Arts. What led you to go back to school—particularly for creative writing—while you were in the middle of a successful career as a doctor?
At the time I was living in Johnson City, Tennessee, working at a small medical school as an internist
and infectious diseases specialist. Between ‘85 and ‘90, we began to see many HIV-infected
persons at a time when the pundits said AIDS was a big-city disease, and we’d never see it in our
small communities. Soon we had close to 100 patients in a town of 50,000, a mystery I explained in
My Own Country. It was an intense, sad, heartbreaking period because we had no real therapy and
lots of prejudice and hatred, but also lots of courage and heroism. Not having anything by way of
medicine to offer my patients, I began to visit with them at times in their homes. That is when I
found that even when I had nothing to offer, I had everything to offer: It was the distinction between
healing and curing (and the cure was what all of us in Western medicine were obsessed with). I realized
that I could heal when I could not cure, meaning that my presence, my interest and support,
could help the patient and the family come to terms with the illness, come to terms with death.
But by the fifth year of this practice, with little in the way of help, I was getting burned out.
If I wanted to stay in the war against AIDS—and I did—I needed to pace myself, to take a break. I
had been writing short stories and essays as a way of keeping sane during those intense days. So I
decided I would apply to the Iowa Writers’ Workshop, send in my two stories, and if they took me,
I would go. If they didn’t take me, I was still determined to take a break and support my family by
working in emergency rooms.
Well, Iowa took me, and I wound up cashing in my 401K plan and giving up my tenured position to drive out there with my wife and two young children. As I look back, I think it was a very selfish thing to put my family through, but it was an act of self-preservation, too—I felt I would implode if I didn’t take a break.
In Iowa, I worked in the University HIV clinic once a week. Other than that and the workshop
that met weekly, my time was gloriously free to read and write. Given my background, this was precious
time—I didn’t think I would ever get time like that again (and I haven’t)—so I worked very hard
for the year and a half it took me to finish. The bills piled up, and when I was done, I needed to get a
regular job again, which is how I landed up in El Paso at Texas Tech’s teaching hospital there. I chose
a place well off the main academic trail because I thought that my nights and weekends would be
mine, no grants to write. That turned out to be true and my first two books were written there.

Q: Was there a single idea behind or genesis for Cutting for Stone?
My ambition as a writer was to tell a great story, an old-fashioned, truth-telling story. But beyond
that, my single goal was to portray an aspect of medicine that gets buried in the way television depicts the practice: I wanted the reader to see how entering medicine was a passionate quest, a romantic pursuit, a spiritual calling, a privileged yet hazardous undertaking. It’s a view of medicine I don’t think too many young people see in the West because, frankly, in the sterile hallways of modern medical-industrial complexes where physicians and nurses are hunkered down behind computer monitors, and patients are whisked off here and there for this and that test, that side of medicine gets lost.
So I began with the image of a mission hospital in Africa, redolent with Dettol, the antiseptic of choice of the tropics; I wanted to portray a place so basic, so unadorned, that nothing separates doctor and patient, no layers of paperwork, technology or specialists, no disguising of the nature of the patient’s experience or the raw physician experience. It’s a setting where the nature of the suffering, the fiduciary responsibility and moral obligation to the patient and society are no longer abstract terms. In that setting I wanted to put very human, fallible characters—people like Sister Mary Joseph Praise and Thomas Stone. I wanted the whole novel to be of medicine, populated by people in medicine, the way Zola’s novels are of Paris.

Q: Where does the title “Cutting for Stone” come from?
There is a line in the Hippocratic Oath that says: . . . I will not cut for stone, even for patients in whom
the disease is manifest . . .
It stems from the days when bladder stones were epidemic, a cause of great
suffering, probably from bad water and who knows what else. Adults and children suffered so much
with these—and died prematurely of infection and kidney failure. There were itinerant stone cutters—
lithologists—who could cut either into the bladder or the perineum and get the stone out, but
because they cleaned the knife by wiping it on their blood-stiffened surgical aprons, patients usually
died of infection the next day. Hence the proscription, “thou shall not cut for stone.”
It has always seemed to me a curious thing to say when we recite the oath in this day and age.
But I love the Hippocratic Oath (or oaths, because its origins and authorship are far from clear), and
always try to attend medical school commencement. When the new graduates stand and take the
oath, all the physicians in the room are invited to rise and retake the oath. You see many physician
parents and physician siblings standing as their son or daughter or brother or sister takes the oath. It
chokes me up every time. Not only am I renewing my faith, but I am bursting with pride in seeing my
students graduate—another part of the oath is “to teach them this art, if they desire to learn it; to give
a share of precepts and oral instruction and all the other learning to my children and to the children
of those who instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law.”
How does all this relate to my novel? It isn’t just that the main characters have the surname ‘Stone’; I was hoping the phrase would resonate for the reader just as it does for me, and that it would have several levels of meaning in the context of the narrative.

Q: Each of the characters in this novel is drawn to medicine in different ways and for different
personal reasons. What drew you to medicine?
I was the middle of three sons of Indian parents who taught college physics. My brothers had a precocious ability with numbers, while I had no head for math—or much else in the curriculum. For middle-class Indian parents only three professions exist: medicine, engineering, and law. My older brother announced he was going to be an engineer, which delighted my parents. I felt obliged to proclaim that I intended to be a doctor. I figured that my propensity to fall and bleed, my unseemly interest in witnessing chickens and sheep being slaughtered for the kitchen, and my fascination with watching animals give birth could now be viewed as a form of scholarship. This was my false call to medicine.
My true call to medicine came in the form of a book. By the time I picked up Of Human Bondage by Somerset Maugham I had already read Lolita and Lady Chatterley’s Lover. I was twelve, I think. Maugham’s protagonist, Philip, sets out for Paris to become an artist. Money is tight, and he lives on the brink of starvation, and finally finds he does not have the talent. He is crushed and disappointed but also relieved to have discovered what is not to be his calling. He returns to London and enters medical school. When after years of slogging away he enters the outpatient clinic for the first time, he realizes he has made the right choice. 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. I took it to mean that if one had no God-given talent to be an artist (or mathematician), one could aspire to be a doctor, perhaps even a good one. The beauty of medicine is that it is proletarian, and its prime prerequisite is that you have an interest in humanity in the rough.
Many of us also come to medicine because we are wounded in some way. Thomas Stone is
a great example, but so is Marion Stone.

Q: How has being a doctor influenced you as a writer and vice versa? Do you think practicing one has helped you practice the other?
I think sometimes we make too much of the doctor-writer business—it’s in danger of becoming a cliché. I’ve not put MD behind my name on any books, except one that was called “Infections in Nursing Home and Long Term Care Facilities.” Unless I’m writing a diet book or a textbook like the one above, the doctoring seems kind of irrelevant—the writing has to stand on its own, don’t you think? Or else every writer should put their AB, and JD, and MFA and whatnot after their name on the title.
That said, I confess that my love of medicine feeds this book and much of my other writing. There are lots of parallels between writing and medicine. I remember hearing the aphorism “God is in the details” both in medical school and also at the Writers’ Workshop. When we see a patient we take a ‘history’—the word “story” is in there. As a consultant, when I see a patient whom others have seen before me, if I can shed light on the problem it is often because the particular patient story resonates with my repertoire of stories and so I know where it is heading. I have given Ghosh—the internal medicine specialist at Cutting for Stone’s Missing hospital—some of these attributes.
Internal medicine, which is also my field, is so much about details, about tying together disparate
clues to come up with a unifying diagnosis and about close observation. Medicine is full of wonderful aphorisms which I love, like, “beware of the woman with the glass eye and the big liver” (which refers to the fact that melanoma of the eye, a common cause for an eye to be removed, can be followed many years later with liver metastases). And as for metaphors, to list just a few fruit metaphors, we have the strawberry tongue of scarlet fever (which becomes the raspberry tongue the next day), and the cherry red spot in the retina, the peau d’orange appearance of the breast, the melon seed body of TB, the currant jelly stools of intussusception . . . .(It is very revealing that modern medicine with so many new diseases—AIDS, SARS, Lyme—has not to my knowledge in the last fifty years come up with a metaphor as colorful as the mulberry molar or the cracked-pot skull or the saber-shinned tibia. It speaks of a disturbing atrophy of the imagination, an obsession with the science at the expense of the art. If I hear the word ‘evidence-based’ medicine any more, I think I’ll be sick.)
So, to answer your question, being in medicine is helpful, particularly for the novel I chose to write. But it provides no short cuts. Writing is still hard, and the real art is in the revision, the real talent is in having the stamina, in being able to delay gratification over the many years it takes to get it right.

Q: Though you confront serious issues in the novel, there is much humor in it, too. Was it a conscious choice to bring humor in, and if so, why? Levity finds its way into many of the medical
scenes (Ghosh performing a vasectomy, for example); was there an element of wanting to make
medicine less intimidating?
The humor surprised me. I didn’t set out to be funny or to inject comedy into the novel. And that’s probably a good thing, because it’s difficult to deliberately try to write humorous stuff.
That said, there are many occasions for side-splitting laughter in medicine, but one has to be careful that the patient never construes this as our being light-hearted about his or her suffering. I’ve drawn on some of my most memorable professors, the ones who told the bawdiest stories that were therefore unforgettable. I so much want to tell my students these stories, but common sense stops me. We’ve become so sensitive.
I once, in print, called the coronary artery bypass operation the great blow-job of American medicine: lucrative for one, satisfying for the other, but biologically a dead end. Many were not amused, let me tell you.

Q: The question “What treatment is administered in an emergency by ear?” is important to many of the characters in this novel. Perhaps you can tell us the correct answer, and also tell us how the answer informs the book.
The answer to this trick question that recurs in the book is of course, ‘words of comfort.’ It’s the sort of thing examiners like to ask in the British system, in the places that still have the viva voce—the terrifying oral exams—and that still test physicians on real patients, not make-believe patients. Alas, in America, we are getting so ‘virtual’ that board-certified internists become board-certified by taking a multiple-choice examination. No one really tests that they can feel an enlarged spleen, or diagnose and put together physical signs at the bedside.
‘Words of comfort’ relate to a sense I have that the patient in America is becoming invisible. The patient is unseen and unheard. The patient is presented to me by the intern and resident team in a conference room far away from where the patient lies. The patient’s illness has been translated into binary signals stored in the computer. When we do go to the bedside to make rounds, often physicians are no longer at ease. It is as if the patient in the bed is merely an icon for the real patient, who exists in the computer. But none of these tests done at a distance substitute for being with the patient, for the ‘words of comfort’ aspect of treatment.
When one knows how to look, the patient’s body reveals many things—it is an illuminated manuscript. I am no Luddite and have no illusions that the kind of exam I do is superior to a CAT scan or MRI. But a skilled exam can do two things: first, it can allow us to practice cost-effective medicine by generating a reasonable diagnosis at the bedside and ordering selective tests, rather than the shotgun approach, where we tick off everything that seems remotely interesting on the lab and radiology slips. Secondly, the skilled exam done with courtesy and done well conveys something important about caring and about professionalism to the patient; indeed it is a key component to building a good physician-patient relationship. Particularly in patients with chronic illness, where there are few dramatic interventions that one can prescribe, a good physician-patient relationship can support the patient through the ups and downs of an illness; the physician’s presence, the ‘words of comfort’ aspect, can be therapeutic in itself.
The fact that patients with chronic illness increasingly seek the attention of naturopaths, refelexologists, acupuncturists, and others has a lot to do with the fact that these individuals will spend time and put hands on the patient, where the physician does that infrequently or in a cursory fashion. When your head is wrapped around the latest gene-array test or ‘evidence-based medicine’ (as though what preceded it was witchcraft), then you might underestimate the importance of ‘words of comfort.’

Q: You bring Ethiopia to life so vividly—its contradictions of beauty and poverty. Addis Ababa
(and Missing Hospital) is so much a part of each character though some come to it from other places or leave it for other places. Why did you decide to set much of this novel there? And how do you think the atmosphere of the place affected your life?
Even in this era of the visual, I think a novel can bring the feel of a place out better than almost any vehicle. It’s another thing that Somerset Maugham did so well. The few images one sees of Ethiopia are uniformly negative, about war and poverty. I wanted to depict my love for that land and its people, for their incredible beauty and grace and their wonderful character.
I wanted also to convey the loss many felt when the old order gave way to the new. Ethiopia had the blight of being ruled by a man named Mengistu for too many years, a man propped up by Russia and Cuba. My medical school education was actually interrupted when Mengistu came to power and the emperor went to jail. As an expatriate, I had to leave. It was my moment of loss. Many of my medical schoolmates became guerilla fighters, trying to unseat the government. Some died in the struggle. One of them fought for over twenty years, and his forces finally toppled the dictator. Meles Zenaweis, now Prime Minister of Ethiopia, was a year behind me in medical school. I went through hard times because of the disruption, but I eventually finished my medical education in India. But what I went through was nothing compared to what others went through—they were willing to die for their cause.

Q: At the heart of this novel there is a love story—that of Sister Mary Joseph Praise and Dr.
Thomas Stone—which informs almost everything that happens to each character in the book,
and yet one of these characters is dead and one has not been seen by anyone for decades. How did you conceive of their relationship, and how do they exert such force on the novel even though neither is present for the majority of it?
Love to me has a quality to it like a trip wire—hence we ‘fall’ in love, instead of simply ‘arriving’
to love. Love comes down to a set of wills trying to match and sometimes mismatching in spectacular fashion; I think all love is unrequited unless we have a clone of ourselves and even then the love
is unrequited. In my day job I see all too often that people’s appreciation of the existence of love, of
the meaning of love, or of the idea that the meaning of life turns out to be love—all these are arrived
at too late, when the love is long lost, or arrived at just before the moment of death. Perhaps what
love seeks is not reciprocity but redemption, the sense that who you are is worthy and was always
worthy of love.
Thomas Stone and Sister Mary Joseph Praise’s love is hidden even from them by the strict boundaries of their chosen professions and then even more so by their professional relationships. It takes a miracle or a catastrophe or both for it to be revealed to them and to others. I suppose it makes for an unusual love story, one that never really happens in real time, one where possession is out of the question—and yet it is a love story that has the power to drive every event in the book directly or indirectly.

Q: What is next for you? Do you anticipate both practicing medicine and writing fiction and nonfiction in the future? Anything in the works right now?
As to what is next: I have a collection of short stories, most of them published in various magazines,
but a few that are yet to come. But after a little break, I’d love to embark on the next novel. I learned invaluable lessons about form, structure, stamina, and pacing in the course of writing this one—painful lessons that should not go to waste. I’ve also been steadily doing shorter things, op-ed pieces for the Wall Street Journal and the New York Times Magazine all through the years I wrote the novel. I’d like to do that more regularly.
I’d like to practice medicine till my last breath without actually collapsing on the patient—that would be bad form. I hope my mind and body will allow this. Being a physician is central to my life, truly my refuge, and so I don’t think I can give it up. If it’s a calling, then you can’t be a dilettante and wander off because you think something else calls. My writing emanates from a very personal stance which in my case is wrapped up in the privilege of practicing medicine. I recognize that I have a worldview colored by that fact. Still, what I think matters most is the words on the page, not the credentials or vocation of the writer.

From the Hardcover edition.

Praise | Awards


“A winner. . . . Filled with mystical scenes and deeply felt characters. . . . Verghese is something of a magician as a novelist.”
USA Today
“A masterpiece. . . . Not a word is wasted in this larger-than-life saga. . . . Verghese expertly weaves the threads of numerous story lines into one cohesive opus. The writing is graceful, the characters compassionate and the story full of nuggets of wisdom.”
San Francisco Chronicle
“Lush and exotic. . . . The kind [of novel] Richard Russo or Cormac McCarthy might write. . . . Shows how history and landscape and accidents of birth conspire to create the story of a single life. . . . Verghese creates this story so lovingly that it is actually possible to live within it for the brief time one spends with this book. You may never leave the chair.”
Los Angeles Times
“Vivid. . . . Cutting for Stone shines.”
The Washington Post Book World
“Absorbing, exhilarating. . . . If you’re hungry for an epic . . . open the covers of Cutting for Stone, [then] don’t expect to do much else.”
The Seattle Times
“Wildly imaginative. . . . Verghese has the rare gift of showing his characters in different lights as the story evolves, from tragedy to comedy to melodrama, with an ending that is part Dickens, part Grey’s Anatomy. The novel works as a family saga, but it is also something more, a lovely ode to the medical profession.”
Entertainment Weekly
“Engrossing. . . . Endearing. . . . A passionate, vivid, and informative novel.”
The Boston Globe
“Here is an extraordinary imagination, artfully shaped and forcefully developed, wholly given in service to a human story that is deeply moving, utterly gripping, and, indeed, unforgettable. . . . As noble and dramatic as that ancient practice—medicine—that lies at the heart of this magnificent novel.”
—John Burnham Schwartz
“Grand enough for the movies. . . . Fascinating.”
Dallas Morning News
“Stupendous. . . . An epic romance, surgery meets history. Beautiful and deeply affecting.”
—Simon Schama, Financial Times
“Verghese plays straight to the heart in his first novel, which will keep you in its thrall.”
“A marvel of a first novel. Verghese’s generosity of spirit is beautifully embodied in this gripping family saga that brings mid-century Ethiopia to vivid life. The practice of medicine is like a spiritual calling in this book, and the unforgettable people at its center bring passion and nobility—not to mention humor and humility—to the ancient art, while living an unforgettable story of love and betrayal and forgiveness. It’s wonderful.”
—Ann Packer
“Like Chekhov, Verghese is a doctor and is as authoritative about the workings of the human heart as he is of the human body. . . . If comparisons with another writer have to be made, its blend of intensely realized detail, adventure, myth, wit, drama and poetry reminded me of Shakespeare.”
—Richard Eyre, The Sunday Telegraph (UK)
“Compelling. . . . Readers will put this novel down at book’s end knowing that it will stick with them for a long time to come.”
St. Louis Post-Dispatch
“The novel is full of compassion and wise vision. . . . I feel I changed forever after reading this book, as if an entire universe had been illuminated for me. It’s an astonishing accomplishment to make such a foreign world familiar to a reader by the book’s end.”
—Sandra Cisneros, San Antonio Express-News
“Verghese’s first novel is a whopper, illuminating the magic and the tragedy of our lives, brimming with wisdom about the human condition. Such fun to read, too. . . . In Cutting for Stone, we get all we were promised and then some. . . . Like Rushdie, Verghese takes us wholly away to a foreign place, culture and history.”
“Tremendous. . . . Vivid and thrilling. . . . I feel lucky to have gotten to read it.”
—Atul Gawande
“The first novel from physician Verghese displays the virtues so evident in his bestselling and much-lauded memoirs. He has a knack for well-structured scenes, a passion for medicine and a gift for communicating that passion.”
Cleveland Plain-Dealer
“Fantastic. . . . Written with a lyrical flair, told through a compassionate first-person point of view, and rich with medical insight and information, [Cutting for Stone] makes for a memorable read.”
Houston Chronicle
“Vastly entertaining and enlightening.”
—Tracy Kidder
“Ambitious. . . . Sprawling. . . . A synthesis of the everyday and the extraordinary [written] in a style that could be called ecstatic realism.”
The Oregonian
“[An] astonishing, breath-taking and heartrending human epic. . . . A perfectly pitched, endlessly rewarding symphony of a debut novel. If you have time to read only one novel this year, make it this one.”
—Newark Star-Ledger
“Verghese’s achievement is to make the reader feel there really is something at stake—birth, love, death, war, loyalty. . . . You conserve pages because you don’t want [the book] to end.”
The Guardian (UK)
“Richly entertaining. . . . A narrative that ranges as skillfully through the emotional register as it does across time and space. . . . Cutting for Stone honors the extraordinary, complex work of surgeons and physicians, but it also allows us to see them as ordinary men and women.”
The Sunday Times (London)

“Absolutely fantastic! If Vikram Seth and Oliver Sacks were to collaborate on a four-hour episode of Grey’s Anatomy set in Africa, they could only hope to come up with something this moving and entertaining.”
—Mark Salzman

“Tremendous, compassionate, technically exuberant. . . . This is a big book and, along with Naipaul and Waugh and Dickens, there is also a strong flavour of William Boyd. . . . We can only stand back awestruck at [Verghese’s] energy.”
The Independent (UK)
“Breathtaking. . . . A global story about medicine and family relationships that achieves the literary heights of A Thousand Splendid Suns by Khaled Hosseini. . . . A masterful read.”
The Missourian
“Gripping. . . . What’s most memorable about Cutting for Stone is Verghese’s compassionate authorial generosity toward his characters, particularly in his medical scenes. Verghese’s doctors never forget that they are operating on human beings. . . . Refreshing.”
—Minneapolis Star Tribune
“Magical. . . . A big, sweeping family saga. . . . I don’t think I’ve read a novel with this kind of depth and sweep and character and sort of vividness for such a long time.”
—Tina Brown, The Daily Beast
“A saga about love, medicine, and exile, this debut reads like a modern Odyssey.”
Good Housekeeping
“To read the first page of Cutting for Stone is to fall hopelessly under the spell of a masterful storyteller; and to try to close the book thereafter is to tear oneself away from the most vivid of dreams. . . . Verghese has once again set the bar and re-defined great medical literature—great literature period—for the rest of us.”
—Pauline W. Chen, author of Final Exam


FINALIST 2010 PEN New England/Hemingway Foundation Award
Reader's Guide|About the Book|Author Biography|Discussion Questions|Suggestions

About the Book

“A winner. . . . Filled with mystical scenes and deeply felt characters. . . . Verghese is something of a magician as a novelist.” —USA Today

The introduction, questions, and suggestions for further reading that follow are designed to enhance your group's discussion of Abraham Verghese's acclaimed novel, Cutting for Stone.

About the Guide

An epic novel that spans continents and generations, Cutting for Stone is an unforgettable story of love and betrayal, compassion and redemption, exile and home that unfolds across five decades in India, Ethiopia, and America.

Narrated by Marion Stone, the story begins even before Marion and his twin brother, Shiva, are born in Addis Ababa's Missing Hospital (a mispronunciation of “Mission Hospital”), with the illicit, years-in-the-making romance between their parents, Sister Mary Joseph Praise, a beautiful Indian nun, and Thomas Stone, a brash, brilliant British surgeon. Mary and Thomas meet on a boat out of Madras in 1947; she follows him to Ethiopia and to Missing, where they work side by side for seven years as nurse and doctor. After Mary dies while giving birth to the twins—a harrowing, traumatic scene on the operating table—Thomas vanishes, and Marion and Shiva grow up with only a dim sense of who he was, and with a deep hostility toward him for what they see as an act of betrayal and cowardice.

The twins are raised by Hema and Ghosh, two Indian doctors who also work at Missing, and who shower Marion and Shiva with love and nurture their interest in medicine—part of the deep, almost preternatural connection the brothers share. They are so close that Marion, as a boy, thinks of them as a single entity: ShivaMarion.

Marion and Shiva come of age as Ethiopia hovers on the brink of revolution, and their lives become intertwined with the nation's politics. Addis Ababa is a colorful, cosmopolitan city: the Italians have left behind cappuccino machines, Campari umbrellas, and a vibrant expat community. But they've also left a nation crippled by poverty, hunger, and authoritarian rule: Ethiopia in the 1960s and 1970s is both bolstered and trapped by its notorious emperor, Haile Selassie, and rocked by violence and civil war.

Yet it is not politics but love that tears the brothers apart: Shiva sleeps with Genet—the daughter of their housekeeper and the girl Marion has always loved. This second betrayal, now by the two people this sensitive young man loves most, sends Marion into a deep depression. And when Genet joins a radical political group fighting for the independence of Eritrea, Marion's connection to her forces him into exile: he sneaks out of Ethiopia and makes his way to America.

Marion interns at a hospital in the Bronx, an underfunded, chaotic place where the patients are nearly as poor and desperate as those he had seen at Missing. It is here that Marion comes to maturity as a doctor and as a man. It is here, too, that he meets his father and takes his first steps toward reconciling with him. But when the past catches up to Marion—nearly destroying him—he must entrust his life to the two men he thought he trusted least in the world: the father who abandoned him and the brother who betrayed him. The surprising, stunning denouement both arises from and reenacts the major themes of Cutting for Stone: love and betrayal, forgiveness and self-sacrifice, and the inextricable union of life and death.

In Cutting for Stone, renowned physician Abraham Verghese has given us a remarkable reading experience that explores the lives of a memorable cast of characters, many of them doctors; the insight the novel offers into the world of medicine, along with its wealth of precise detail about how doctors work, is unparalleled in American fiction. Verghese is so attuned to the movements of the heart and of the mind, so adept at dramatizing the great themes of human existence, and he has filled this world with such richly drawn, fascinating characters, that Cutting for Stone becomes one of those rare books one wishes would never end, an alternate reality that both rivals and illuminates the real world readers must return to when the book is closed.

About the Author

Abraham Verghese is Professor and Senior Associate Chair for the Theory and Practice of Medicine at the Stanford University School of Medicine. He was the founding director of the Center for Medical Humanities & Ethics at the University of Texas Health Science Center, San Antonio, where he is now an adjunct professor. He is the author of My Own Country, a 1994 NBCC Finalist and a Time Best Book of the Year, and The Tennis Partner, a New York Times Notable Book. A graduate of the Iowa Writers’ Workshop, he has published essays and short stories that have appeared in The New Yorker, The New York Times, The Atlantic Monthly, Esquire, Granta, The Wall Street Journal, and elsewhere. He lives in Palo Alto, California.

Discussion Guides

1. Abraham Verghese has said that his ambition in writing Cutting for Stone was to “tell a great story, an old-fashioned, truth-telling story.” In what ways is Cutting for Stone an old-fashioned story—and what does it share with the great novels of the nineteenth century? What essential human truths does it convey?

2. What does Cutting for Stone reveal about the emotional lives of doctors? Contrast the attitudes of Hema, Ghosh, Marion, Shiva, and Thomas Stone toward their work. What draws each of them to the practice of medicine? How are they affected, emotionally and otherwise, by the work they do?

3. Marion observes that in Ethiopia, patients assume that all illnesses are fatal and that death is expected, but in America, news of having a fatal illness “always seemed to come as a surprise, as if we took it for granted that we were immortal” [p. 486]. What other important differences does Cutting for Stone reveal about the way illness is viewed and treated in Ethiopia and in the United States? To what extent are these differences reflected in the split between poor hospitals, like the one in the Bronx where Marion works, and rich hospitals like the one in Boston where his father works?

4. In the novel, Thomas Stone asks, “What treatment in an emergency is administered by ear?” The correct answer is “Words of comfort.” How does this moment encapsulate the book's surprising take on medicine? Have your experiences with doctors and hospitals held this to be true? Why or why not? What doesCutting for Stone tell us about the roles of compassion, faith, and hope in medicine?

5. There are a number of dramatic scenes on operating tables in Cutting for Stone: the twins' births, Thomas Stone amputating his own finger, Ghosh untwisting Colonel Mebratu's volvulus, the liver transplant, etc. How does Verghese use medical detail to create tension and surprise? What do his depictions of dramatic surgeries share with film and television hospital dramas—and yet how are they different?

6. Marion suffers a series of painful betrayals—by his father, by Shiva, and by Genet. To what degree is he able, by the end of the novel, to forgive them?

7. To what extent does the story of Thomas Stone's childhood soften Marion's judgment of him? How does Thomas's suffering as a child, the illness of his parents, and his own illness help to explain why he abandons Shiva and Marion at their birth? How should Thomas finally be judged?

8. In what important ways does Marion come to resemble his father, although he grows up without him? How does Marion grow and change over the course of the novel?

9. A passionate, unique love affair sets Cutting for Stone in motion, and yet this romance remains a mystery—even to the key players—until the very conclusion of the novel. How does the relationship between Sister Mary Joseph Praise and Thomas Stone affect the lives of Shiva and Marion, Hema and Ghosh, Matron and everyone else at Missing? What do you think Verghese is trying to say about the nature of love and loss?

10. What do Hema, Matron, Rosina, Sister Mary Joseph Praise, Genet, and Tsige—as well as the many women who come to Missing seeking medical treatment—reveal about what life is like for women in Ethiopia?

11. Addis Ababa is at once a cosmopolitan city thrumming with life and the center of a dictatorship rife with conflict. How do the influences of Ethiopia's various rulers—England, Italy, Emperor Selassie—reveal themselves in day-to-day life? How does growing up there affect Marion's and Shiva's worldviews?

12. As Ghosh nears death, Marion comments that the man who raised him had no worries or regrets, that “there was no restitution he needed to make, no moment he failed to seize” [p. 424]. What is the key to Ghosh's contentment? What makes him such a good father, doctor, and teacher? What wisdom does he impart to Marion?

13. Although it's also a play on the surname of the characters, the title Cutting for Stone comes from a line in the Hippocratic Oath: “I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.” Verghese has said that this line comes from ancient times, when bladder stones were epidemic and painful: “There were itinerant stone cutters—lithologists—who could cut into either the bladder or the perineum and get the stone out, but because they cleaned the knife by wiping their blood-stiffened surgical aprons, patients usually died of infection the next day.” How does this line resonate for the doctors in the novel?

14. Almost all of the characters in Cutting for Stone are living in some sort of exile, self-imposed or forced, from their home country—Hema and Ghosh from India, Marion from Ethiopia, Thomas from India and then Ethiopia. Verghese is of Indian descent but was born and raised in Ethiopia, went to medical school in India, and has lived and worked in the United States for many years. What do you think this novel says about exile and the immigrant experience? How does exile change these characters, and what do they find themselves missing the most about home?

(For a complete list of available reading group guides, and to sign up for the Reading Group Center enewsletter, visit www.readinggroupcenter.com)

Suggested Readings

Chinua Achebe, Girls at War; Andre Brink, A Dry White Season; Pauline Chen, Final Exam; Dave Eggers, What Is the What; Tracy Kidder, Old Friends; John Irving, The Cider House Rules; Ryszard Kapuscinski, The Emperor; Barbara Kingsolver, The Poisonwood Bible; Somerset Maugham, Of Human Bondage; Samuel Shem, The House of God; William Carlos Williams, The Doctor Stories.
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  • Cutting for Stone by Abraham Verghese
  • January 26, 2010
  • Fiction - Literary; Fiction
  • Vintage
  • $15.95
  • 9780375714368

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