Cutting for Stone

I will try to find the words to fully capture the love that I have for “Cutting for Stone.” I have kept Verghese on my list of clinical superheroes ever since I read his memoir, “In My Own Country;” however, I had been hesitant to read “Cutting for Stone” because, in my experience, physician penned memoirs lead only to disappointment. Verghese; however, is as much a master writer as he is a master clinician. Although “Cutting for Stone” is a medical story (highlights include attribution to his characters the first living donor liver transplant, the discovery of caffeine for apnea of prematurity and others), it is not foremost a story about medicine. Instead it is an semi-coming of age epic about how people form connections to each other, push others away in the pursuit of perfection and ultimately about self-actualization through realization of human bond.

Despite such lofty ambitions, Verghese never lets idealism or heavy-handedness overpower the fact that “Cutting for Stone” is indeed a novel. His characters shine - each individuals, each with amazing strengths - the cunning Ghosh, the brilliant, fierce Hema, the sharp, quick-witted Genet and the genius but alien Shiva and the loyal, logical Marion - his language is evocative and beautiful and his settings are picture-perfectly described.

A review of “Cutting for Stone” would be incomplete without at least a glancing mention of it's treatment of medical education. What struck me the most was Verghese's characterization of the martyrdom that residency entails as being a defense mechanism. His depiction of the selflessness with which residents treat patients as being a form of indulgence was a little uncomfortably honest. That being said, what “Cutting for Stone” will be exalted for in years to come is the decency with which it treats international medicine graduates. The treatment of such graduates by American medical students is borderline racist, with training programs being judged harshly on the number of such trainees enrolled. It is common for IMGs to be treated with disdain, and Verghese's candor in describing the differences that they experience when they train compared to the training environment faced by American graduates will not soon be forgotten.

“What treatment is offered by ear in an emergency?.... Words of comfort.”

This quote epitomizes the ideal of practicing the art of healing and the science of medicine with the person/patient at the center. It is the question posed by Dr. Thomas Stone to a group of interns on grand rounds, a question meant to stump the entire troop. Yet, it is also the question Dr. Marion Stone is able to answer because Dr. Thomas Stone is his father. However, the answered question is the first contact father and son have ever had.

This novel tells the story of an Indian nun and a British surgeon connecting when they land together in an Ethiopian mission hospital, working tirelessly in deplorable conditions to provide medical care to the poor and neglected of Addis Ababa during a time of civil unrest. A set of conjoined twins results from their union, but the mother dies in childbirth while the young surgeon and father, Thomas Stone, flees from the fear, stigma and responsibility the twins represent.

The twins, joined at the head, survive and are separated, yet remain joined in the special way twins seem to share. In their adopted family at the mission hospital, the brothers are guided towards medical healing paths, each one demonstrating special gifts for knowledge, empathy and compassion. Events in Ethiopia bring about separation, betrayal and grief, but the Stone family ties reach beyond and only strengthen as time and events pass.

This novel is one of the few books that I've finished and immediately wanted to turn right back to the first page and start reading again. So many layers of insight and meaning are woven into the characters and the narrative of their lives that one reading doesn't seem to be sufficient. I have a special fondness for detailed medical descriptions of illness, disease and treatments in the form of a well-written narrative and this story more than meets my curiosity and need to know .

I would suggest this book to readers who are comfortable with making the commitment to a long novel, who are fascinated by medicine in literature, and those who love family sagas that make you appreciate your own relatively uncomplicated life, but also want to read about individuals you want to admire and even emulate.

P.S. Don't skip the author's acknowledgments at the end. Abraham Verghese gives credit to the sources of many of his ideas, and I think this act demonstrates a level of character and integrity that just adds more weight to the praise of this beautiful novel. It also is a fascinating look at the way an author finds and works with ideas.