Tadias Magazine

By Chloe Malle

Published: Tuesday, June 2, 2009

I. The Hippocratic Oath

The title of Abraham Verghese’s first novel, Cutting for Stone, is intriguing, perhaps unrewardingly so. In the book’s epilogue, Verghese, a surgeon and professor at Stanford Medical School, closes with the following explanation, “Medicine is a demanding mistress, yet she is faithful, generous, and true […] every year, at commencement, I renew my vows with her: I swear by Apollo and Hygieia and Panaceia to be true to her, for she is the source of all…I shall not cut for stone.”

In an interview he clarifies,

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. […] There were itinerant stonecutters—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 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.

The lyrical sound of the title and its poetic medical significance are certainly convincing, however, I am not sure to what extent this title pervades multiple layers of the narrative as Verghese intends it to. Certainly the title confirms the intrinsic, if not central, role of medicine in the novel. Stone is the shared name of the three main characters but ‘cutting for stone’ is the name Verghese bestows upon the equally important character that medicine and surgery personify in the novel. But beyond rhetoric the title does not resonate emotionally throughout different levels of meaning in the novel.

The novel is rich and warm like the womb that opens the central conflict of the story, or like quicksand, disabling you from exiting Verghese’s world until the last page of the text.

The essence of Cutting for Stone is divided between Marion’s coming of age and Ethiopia’s. It is also tinged with a desire for the magical to impart its warmth and weakness upon the real. One of the most attractive things about Verghese’s first novel is the emotion the book evokes, the womblike comfort within its pages.

The novel recounts the story of Marion and Shiva Stone, Siamese twins separated at birth by their surgeon father, Thomas Stone. In the realm of magical realism the twins are born attached at the skull and almost as soon as they are separated from each other they are separated from both parents as well. Their mother, Sister Mary Joseph Praise, a nun working at a mission hospital in Addis Ababa, dies in childbirth. No one in the hospital was aware of her pregnancy, not even the presumed father, Dr. Thomas Stone. Stone, Mission Hospital’s main surgeon, disappears grief-stricken immediately after Sister Mary’s death. The twins are orphaned before they leave the delivery room only to be swiftly rescued by the Indian Ob-Gyn, Hema, and her soon-to-be husband, Dr. Ghosh. The plot is a rambling coming of age story that tracks Marion and Shiva’s childhood and rise to adulthood set against the background of Ethiopia’s turbulent political climate. The novel crosses three continents, coming to a treacherous climax in New York City.

It is no coincidence that Verghese was born and raised in Addis Ababa to Indian parents around the same time as his protagonist. Verghese’s own biography closely reflects that of the protagonist twins in his novel.

Part II: The African Bildungsroman

Cutting for Stone, knowingly or not, follows the formula of the German literary genre, the bildungsroman. The German Enlightenment term, coined by German philologist, Johann Morgenstern, refers to a genre of novels that follow a similar plotline mapping the psychological, moral and social development of a, usually young, protagonist. Examples of this range from the revolutionary model, Goethe’s Wilhelm Meister’s Apprenticeship to Harper Lee’s contemporary interpretation in To Kill a Mockingbird. Verghese’s novel follows the bildungsroman formula almost exactly: the protagonist matures from child to adult, this maturation is long and arduous and rife with challenges and conflicts, eventually one or all of these conflicts forces the protagonist to flee their home and begin a personal Odyssey. The independence and demands of this journey are what eventually enable the protagonist to integrate comfortably and successfully into society. I will not map out Marion Stone’s corresponding steps in hope that you will map them yourself whilst reading the book.

In The Situation and the Story, writer Vivian Gornick explains, “there is the story and then there is the situation, the writer must be aware of both.” In Cutting for Stone the story is Marion’s coming of age, the situation is Ethiopia. But it is not that simple. The story is also Ethiopia’s coming of age and these two wide-eyed adolescents—no not the twins, Marion and Shiva—Marion and Ethiopia, must mature in their own individual ways.

Cutting for Stone is by all measures a novel about Africa, but it is more importantly a novel about daily life and about growing up. It just so happens that our protagonist experiences daily life and grows up in Africa. Like the British Romantics, Verghese emphasizes the importance of place as well as plot and character, acknowledging their inherent union. Ethiopia is a central driving force of the narrative. It is the ghost character, like Thomas Stone, omnipresent yet never quite defined. Like the twins who center the story, the setting of the narrative is divided; it is at once the coming of age of Marion and the coming of age of Ethiopia. With creative chronological license Verghese maps the crashing tides of Ethiopia’s political climate throughout the twenty-five years of Marion and Shiva’s youth.

Ethiopia is a character like a magical realist creation, her intrinsic parts are outlined and detailed, but they are detailed in emotion, not in reality. Verghese writes Ethiopia like the regal male peacock adorned with all his iridescent feathered glory, when in fact, she more closely resembles the unplumbed female by his side. As readers, we enter that magical reality, coming to understand a place most of us do not know as if it is our own. Early in the novel Verghese describes Ghosh’s introduction to Ethiopia, “Ghosh didn’t understand any of this till he came to Africa. He hadn’t realized that Menelik’s victory had inspired Marcus Garvey’s Back to Africa Movement, and that it had awakened Pan-African consciousness in Kenya, the Sudan, and the Congo. For such insights, one had to live in Africa.” For such insights one had to live in Africa or in Verghese’s epic novel.

While reading I wonder if there is a sense of guilt involved for Verghese, if this ode to Ethiopia is a tax or homage owed to a fatherland—I use the expression fatherland rather than native land, or birthplace, because of the ambiguity and driving force that very subject ignites throughout the novel. In an interview Verghese reveals,

Even in this era of the visual, I think a novel can bring out the feel of a place better than almost any vehicle. […] I also wanted 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 school classmates became guerilla fighters who tried to unseat the government. Some died in the struggle. One of them fought for more than twenty years, and his forces finally toppled the dictator. Meles Zenawi, now prime minister of Ethiopia, was a year behind me in medical school.

While it is the omnipresence of Ethiopia, coming of age, and personal conflict that drive the novel there is also a very poetic emphasis on what is not present. Absence is a prevalent motif throughout the novel. The theme of things missing from the story is prevalent throughout the novel, things happening offstage like in Greek tragedy, or not at all. Until the end of the novel there is never any confirmation of Marion and Shiva’s conception. Three chapter titles are dedicated to absence: Missing Fingers, Missing People, Missing Letters.

Part III: The Writer’s Writer

There is no doubt about it; Verghese is a lyricist whose way with words rivals his mastery of the scalpel—though I cannot attest to this as I have never had the opportunity to be operated on by him. Indeed, he is a prose poet whose manipulation of words makes every minutia an event of Biblical and lyrical proportions. It is the sanctity of his syntax, the deliberate and precise choice of words and their order in the sentences in which they appear that sets his novel apart, forcing even the least interested reader to continue turning pages, trancelike and mystified. Simple sentences such as the following are rendered at once wholesome and cavernous by the depth and simplicity of his language. Of Ghosh’s barber Verghese writes, “One never doubted for a moment that it was Ferraro’s destiny to be a barber; his instincts were perfect; his baldness was inconsequential.” Many writers are lauded for their attention to detail, Verghese is to be praised for his dedication to detail. To Verghese, life is indeed, in the details.

The Baton Rouge Advocate writes, “Clearly Verghese paid attention in English Lit 101. He begins this entrancing novel with an opening sentence that is so full of implication it’s practically Dickensian.” It is true that Cutting for Stone can be read as a rolodex of mastered literary techniques and signatures. The scent of scribes past is at once foetid and intoxicating across the pages. Their influences and identifying traits mark Verghese’s pages, just as the archive of great writers mark every work of fiction, to its benefit or detriment, depending on the skill of he or she who whittles these influences into something they can use to better illustrate their essence of their own novel.

Most reviews of Cutting for Stone, including this one, cite different authors Verghese has drawn influence from, some as a critique of his writing, some as an accolade. Different historical-literary genres shutter through the critics’ lens like a widening aperture. While I don’t disagree with these comparisons I do believe that they distract from Verghese’s own brand of writing, one that may in turn be imitated in its own right.

Many critics have accused Verghese of foraging unsuccessfully into the realm of magical realism and according to Mexican literary critic Luis Leal they may be correct. Leal argues, “Without thinking of the concept of magical realism, each writer gives expression to a reality he observes in the people. To me, magical realism is an attitude on the part of the characters in the novel toward the world […] If you can explain it, then it’s not magical realism.” But won’t any child’s reaction to the world will be magical tinged by the real or vice versa, otherwise, how would we absorb and understand it all? For me one of the most beautiful qualities about the novel is Verghese’s ability to recount fifty years through the eyes of a child, with wonder, whimsy and heartbreak. This being said, the epic, rambling pace of the novel would be better executed with Verghese giving in to the story’s demand for a magical realist telling. Instead, the novel’s all too realist tone is difficult to swallow alongside its magical and leaping storyline. Imagine Paul Farmer writing Love in the Time of Cholera and you can begin to imagine Verghese’s first foray into fiction.

While literary forefathers stalk like quill-tipped ghosts across Verghese’s pages the real muse is medicine herself. The danger in this is that it risks losing the mystical tone the novel has so successfully created. Verghese’s fault lies in him knowing too much, the over-realism of his medical descriptions blunt the magic of the rest of the novel.

Indeed, too much medicine takes the magical out of realism. During passages such as the following my rapture is dulled completely,

With the colon swollen to Hindenburg proportions it would be all to easy to nick the bowel and spill feces into the abdominal cavity. He made a midline incision, then deepened it carefully, like a sapper defusing a bomb. Just when panic was setting in because he was going nowhere, the glistening surface of the peritoneum—that delicate membrane that lined the abdominal cavity—came into view. When he opened the peritoneum, straw-colored fluid came into view. Inserting his finger into the hole and using it as a backstop, he cut the peritoneum along the length of the incision.

It is as if Verghese believes the only currency he can trade with is his knowledge of medicine. I only wish his confidence in the poetry and lyricism of his writing was enough for him to abandon his crutch of medical vernacular.

There are moments though, when his descriptions leave the kingdom of Gray’s Anatomy and help the non-medical understand medical problems, such as the enigmatic and complex problem of obstetric fistula. Verghese’s haunting and powerful description of the arrival of a young girl with fistula to the mission is one of the most powerful in the book.

An unspeakable scent of decay, putrefaction, and something else for which words remain to be invented reached our nostrils. I saw no point in holding my breath or pinching my nose because the foulness invaded instantly, coloring our insides like a drop of India ink in a cup of water. In a way that children understand their own, we knew her to be innocent of her terrible, overpowering odor. It was of her, but it wasn’t hers. Worse than the odor (since she must have lived with it for more than a few days) was to see her face in the knowledge of how it repulsed and revolted others.

Verghese’s surgical sword is double-edged and while it jars the melodic pace of the rest of the novel, it is for the most part an important addition to the story and soul of the book.

Part IV: The Dueling Careers

A journalist interviewing Verghese asks, “Was there a single idea behind or genesis for Cutting for Stone?”

Verghese’s complex answer was the following, “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.” Verghese cares for his characters in the same way an ideal surgeon would, he feels for them. The Economist critiques, “surgery is indeed a wonderful metaphor, but it should be wielded with precision.”

He continues, “I wanted the whole novel to be of medicine, populated by people in medicine, the way Zola’s novels are of Paris.”

Indeed, medicine is the medium through which the tale is propelled forward, the catalyst to characters’ coming of age and falling apart.

Not by coincidence, Verghese’s life parallels that of the twin protagonists in the story. He executes a balancing act between two careers, conjoined unknowingly like Siamese twins, but unlike Thomas Stone, while Verghese fathered these twins, he did not abandon them, he raised and nurtured them to grow into unique but also inherently linked careers.

Cutting for Stone deftly conveys the eerie and perhaps poetic similarity between the seemingly disparate vocations of surgery and writing. As Verghese writes of Ghosh in the novel, “he had a theory that bedroom Amharic and bedside Amharic were really the same thing: Please lie down. Take off your shirt. Open your mouth. Take a deep breath…The language of love was the same as the language of medicine.”

Like medicine, writing is in the details. Describing Thomas Stone during the birth of his Siamese twins, Verghese has the patience to describe, “His hair was parted on the right, a furrow that originated in boyhood with every tamed by the comb to know exactly which direction it was to tilt.” Like medicine, writing is about people, about being interested by people, by humanity. Interviewed Verghese concludes, “The beauty of medicine is that it is proletarian, and its prime prerequisite is that you have an interest in humanity in the rough.” Though Verghese counters,

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 Homes 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? […] I remember hearing the aphorism ‘God is in the details’ both in medical school and at the Writer’s Workshop. When we see a patient we take a ‘history’—the word ‘story’ is in there.

Part V: The Writer is I

In an interview Verghese explains, “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 issues […] A textbook rarely gives them the kind of truth or understanding achieved in the best fiction.”

As a child I owned a children’s book called, Lives of the Writers with 19th century Daumier-style caricature drawings of all the great writers in history and a brief but biting one-page biography of each author. Some quirky anecdote or sibling rivalry, information we, ostensibly, could not read from their books. Or could we? Is not every novel a life of the writer? Verghese’s certainly is.

By the end of the novel, the only thing lacking is a comprehensive biography of the man whom we cannot imagine having invented, nor even vicariously living the events detailed in these pages. The voice is too strong, the involvement too deep.

If it is, in fact, fiction then Verghese has achieved a feat indeed, he has made the living narrator out of the page. I don’t believe that is the case, I believe all of Marion Stone is Abraham Verghese, the question is, how much of Abraham Verghese is Marion Stone? Verghese includes a foreword and an afterword, but what I want is a during. I want a detailed autobiography of Verghese, to cross check the fraternal or identical twin-ness of the writer and the written. Though maybe that is too much to ask, similar perhaps to asking a doctor to betray the Hippocratic oath.
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About the Author:
Chloe Malle is a freelance journalist currently based in Addis Ababa, Ethiopia where she teaches English as a Second Language and assists an American physician at the local Mother Theresa Clinic. Chloe studied creative writing and comparative literature at Brown University.

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