Set in Addis Ababa, Ethiopia, and in the slums of New York City, Cutting for Stone is a richly layered novel that tells many stories. Abraham Verghese, who is a physician as well as an author, masterfully depicts Missing Hospital – the native Ethiopian tongue mispronounces the English word “mission,” causing it to come out as “missing” – in Addis Ababa; Our Lady of Perpetual Succor in the Bronx; the practice of medicine at both locales; and the complexity of human beings. Despite the depth and scope of the book, a major insight gives it unity. It is stated as an aphorism at the beginning of part I: “…for the secret of the care of the patient is in caring for the patient.”
The book’s central characters are identical twins, Marion and Shiva, born at Missing Hospital in 1954. Verghese chronicles their lives from the moment of their precarious delivery up to the present time. It is Marion who serves as the novel’s narrator. The boys’ natural parents are Thomas Stone, a Scottish surgeon, and his assistant, Sister Mary Joseph Praise, a Roman Catholic Carmelite nun from Madras, India. Stone’s celebrated skill in the operating theater fails to save Sister Mary’s life when she gives birth. Overwhelmed with sorrow and rage, he flees the hospital and Ethiopia. Thomas Stone’s rejection of his baby sons and his exile from Africa underpin the novel and drive its plot.
The infants, however, are not orphans. They are raised with affection and wisdom by one of current literature’s most appealing couples. Kalpana Hemlatha, known as Hema, and Abhi Ghosh are both immigrants to Africa from Madras. Hema is a gynecologist – generous, vivacious, and outspoken. Ghosh, who practiced internal medicine up to the time of Stone’s precipitous departure, becomes Missing’s chief surgeon. The twins, along with a nanny, are whisked away to Hema’s bungalow, and Ghosh and his cook soon join them. Every available pair of hands is needed to care round-the-clock for the premature babies. Consulting no one, Hema names one boy “Marion” after the father of obstetrics, Marion Sims, a practitioner in Alabama, U.S.A. She names the other baby “Shiva” after the Hindu god.
Hema and Ghosh have loved one another for more than a decade, since their days as classmates at Madras Medical College in India. Ghosh was besotted with Hema’s chubby cheeks and “the cupid’s bow of her upper lip.” Yet up until the time of the twins’ birth, when they were more or less forced to stay under one roof, they never dared to declare any affection, each thinking the other would laugh at the notion of them becoming a couple.
But, in fact, their union turns out to be ideal in every sense. Hema’s easy-going, sunny approach to living balances Ghosh’s more pragmatic and driven attitude. They agree to “marriage’ sometime during the boys’ first year, and perhaps more significantly, they decide to renew or not renew this commitment once a year.
Verghese makes use of the technique of back story in rendering the characters of Hema and Ghosh. The same is true for the characters of Sister Mary Praise and Thomas Stone. Indeed we don’t learn what makes Stone the man he is until near the end of the novel. Like Greek drama, much of the action in Cutting for Stone takes place offstage. Sister Mary, we learn, left India for Africa when she was only 19. “The floating packet of misery that called itself a ship,” notes Verghese, “steamed across the Indian Ocean toward Yeman.” On board was Dr. Thomas Stone, traveling to the mission hospital in Ethiopia. Gravely ill with typhoid, he would have died at sea had it not been for Sister Mary’s vigilance in nursing him. “… a face so lovely – lips so full – even a veil couldn’t block its sensuality,” writes Verghese in describing Sister Mary. Stone’s associates have learned not to read too much into his demeanor, “which a stranger might think was surly when in fact he was painfully shy.”
For seven years Stone and Sister Mary are an inseparable team in Missing’s operating theater. Standing across the table from him, scrubbed, gloved, gowned, and a “beacon of calm,” Sister is indispensible. And in the case of her partner, we read that:
“As a surgeon Stone was famous for his speed, his courage, his daring, his boldness, his inventiveness, the economy of his movements, and his calmness under duress. These were skills that he’d honed on a trusting and uncomplaining population, briefly in India, and then in Ethiopia.”
Midway in the novel Verghese depicts Ghosh extolling Stone’s surgical skills to a teen-aged Marion:
“You see, your father was a real surgeon. I don’t think I’ve seen anyone better…[He demonstrated] passion for his craft and skill and dexterity. His hands were always quiet. I mean he had no wasted movements, no dramatic gestures.”
A year after Marion and Shiva’s birth, their nanny, a native Ethiopian woman, gives birth to a daughter whom she names Genet. The three children grow up together in Hema and Ghosh’s household, and all attend Loomis Town and Country, a prestigious day school run by the British. Always acting older than her years, Genet is “argumentative” and “ready for combat.” Yet both boys are “in love” with her, and when Shiva and Genet’s relationship becomes sexual, the twins veer away from each other. Marion considers Shiva’s behavior a betrayal.
Marion’s unhappiness over Genet is matched by an inexplicable longing for the father he never knew. Though he loves Ghosh wholeheartedly, he broods over his invisible father. Often Marion loiters around Missings’s front gate hoping Thomas Stone will appear. He fantasizes that his father will smile at him with pride. More woe is in store for young Marion when Ghosh is sent to prison, falsely accused of collusion with rebel forces that had attempted to depose Ethiopia’s monarch, Emperor Haile Selassie.
With the resilience of youth, Marion rises above his trials, and after finishing the British School in the early 1970s, attends a medical school in Addis Ababa where Genet, too, enrolls. Meanwhile, Shiva, who for years has trained under Hema’s conscientious tutelage, eschews formal medical education and eventually becomes a gynecologic surgeon.
Genet’s actions once again have a devastating effect on Marion. In fact, some two years following Ghosh’s death, Marion is forced to flee from Ethiopia. Verghese explains:
“…Four Eritrean guerillas posing as passengers had commandeered an Ethiopian Airlines Boeing 707 and forced it to fly to Khartoum, Sudan. One of the four was Genet.”
During World War II the Allies had presented as a protectorate the Italian colony of Eritrea (located north of Ethiopia) to Emperor Selassie. Now, Eritrean rebels – the Eritrean Liberation Front – were fighting for autonomy. Because Genet’s father had been Eritrean, she considered herself one. Within an hour of the hijacking, Marion was unjustly implicated in the crime.
With help from Hema and the other longtime members of the Missing Hospital staff, Marion escapes first to Nairobi, Kenya and finally to New York City where he begins a surgery internship in the Bronx at Our Lady of Perpetual Succor Hospital. In a remarkably compelling conclusion to the novel, Thomas Stone, now a renowned Boston surgeon, re-enters his son’s life. Shiva and Hema, too, join Marion and Thomas for a dramatic yet bittersweet ending.
If precision is the hallmark of Thomas Stone’s surgical performance, it is also the most apparent characteristic of Verghese’s sentences. So clearly does he describe medical procedures, that readers will feel equipped to perform them themselves. This textbook style of writing is balanced with the vivid color of Verghese’s fictional world. In lyrical prose he conjures Ethiopia – its relentlessly beautiful sky, its ancient rock and desert, and its stultifying heat. Throughout he details the unfathomable needs and random, inexplicable brutality of the Ethiopian people.