For most laymen, medicine is a complex and opaque thing, a web of molecular biology, the workings of which are mystical, mysterious, unknowable.
For Abraham Verghese, a physician who teaches at Stanford University, it's simpler. The bricks and mortar of medicine, he writes in his new novel, "Cutting for Stone," can be broken down into simple words.
"There is something very proletarian about the study of medicine," Verghese says. "All it requires for the individual is to take words and descriptions and sort of begin to see an elaborate construct. ... (I) would look at a page in 'Gray's Anatomy' and, for me, there was an architecture there; there was a scaffold, and they were pointing out the names of the major pillars, the wires that led here and there, and I could sort of see it."
Verghese, whose previous books include the nonfiction "My Own Country" (a National Book Critics Circle nominee), starts his first novel in Ethiopia, where he grew up as the child of Indian parents who were teachers. In Addis Ababa, he trained as a physician before coming to the United States for his residency, and some of "Cutting for Stone" is culled from Verghese's experiences.
Most of the book, which spans four decades, centers upon Marion and Shiva Stone, born as conjoined twins. Their mother, Sister Mary Joseph Praise, dies in childbirth. Their father, Thomas Stone, a British surgeon, flees the hospital immediately after they are born. The twins are raised by a loosely knit family at Missing Hospital in Addis Ababa. (It should be Mission Hospital, but the natives mispronounce it, so the name sticks with the staff who tend to the needs of poor and indigent Ethiopians).
The idea of twins, Verghese says, allowed him to explore the ethical issue of separating conjoined babies.
"In our mind (conjoined twins) are not normal, they need to be two individuals," he says. "There's an ethical debate about the one-ness of Siamese twins and is it truly a one-ness, and who are we to make that into a two-ness. It's almost like saying if you have three arms, do you have to cut off the third arm because it's just not normal even if it's functional. Society is imposing its will on these babies and saying you really are two even if you are one. I liked playing with that."
That duality, at the end of the novel, becomes a redemption that cannot be revealed lest it ruin a major plot point. But the setting of the novel is fair game, and having spent much of his life in Ethiopia, Verghese was interested in how geography determines destiny -- even if it is often misinterpreted from afar.
"There's something very peculiar about that geography," he says of Ethiopia. "It's nothing like anybody imagines it to be, unless they go there or visit it by way of the book. In a sense, it's a very unique geography, a very unique people, a very ancient feudal system. It flies in the face of every preconceived notion that people have about Ethiopia, which tends to be about starvation and things like that. I wanted to use geography as a character, that the geography was so distinct that out of it emerged these distinct people."
In the novel there's Hema, a gynecologist, and Ghosh, an internist, who adopt the twins. There's Gebrew, the handyman and guard who is also a priest; Rosina and Almaz, caretakers who watch over the twins while their adoptive parents work; and Tsige, a bar girl who works near Missing and ultimately reinvents, and saves, herself. Genet, Rosina's daughter, eventually causes a friction between the twins that will divide them for most of their lives.
Marion narrates the story, occasionally as Marion/Shiva, such is the fraternity between the twins. But when Shiva betrays Marion, the gulf seems irreparable. It is not until he is in New York, working at an inner-city hospital, that they are reunited, and only by unfortunate circumstances.
While the passages set in Ethiopia account for two-thirds of the novel, the last section of "Cutting for Stone" describes how an inner-city hospital in the Bronx operates. The fictional hospital, Our Lady of Perpetual Succour, features a United Nations of residents, and when Marion first arrives, he thinks he has landed in medical Nirvana.
But Our Lady is only grand in comparison to Missing Hospital. Still, the care is better in a place like Our Lady than most of the rest of the world, and that is partially because of the foreign residents who flock to the United States because they are desperately needed. Most Americans studying medicine, according to Verghese, tend to shun residencies at hospitals where the majority of the clientele are poor.
"I think most Americans are aware there are a lot of foreign doctors," Verghese says. "But they don't necessarily know how that comes about. They're not aware of the need for the annual influx to manage these inner-city hospitals in places like the Bronx and Philly and Jersey and elsewhere."
Additional Information:Capsule review
Two twin boys enter the world in an Ethiopian hospital; the mother dies, the father flees. There would seem to be not much hope for Marion and Shiva Stone, conjoined twins, separated shortly after they are born. But in Abraham Verghese's 'Cutting for Stone,' the possibilities are endless. They are nurtured by a community, given substance and succor, grow into young men of great possibility. When a betrayal occurs, their lives start to unwind, and Verghese's greatest achievement is making the characters tangible and close at hand. One smells the food they eat, hears the conversations close at hand, walks with them through the Ethiopian night. A few of the medical passages may be off-putting for those with weak constitutions, but the sweep and grandeur of Verghese's narrative is inviting, beguiling.⢠Rege Behe
