Verghese, Abraham: Cutting for Stone

cuttingforstoneI woke up suddenly.

Frankincense drifting in the air, mingling with the strains of Ethiopian music and the fragrance of Ethiopian coffee….where could I be?

Someone jabbed me in the ribs, said there was a blogger crisis, and told me to grab a pen…ah yes, I had nodded off. I knew that third bottle had been ambitious…

It was March at the Monthly Book Group, and the book was “Cutting for Stone” by Abraham Verghese (2009).

A nurse had recommended it to the proposer, who was himself in the medical profession. And the well-informed medical content of the book had appealed to him immensely. There was a very informative section on fistula medicine, and the character Shiva’s major work in this field. The proposer had heard Dr Catherine Hamlin, a pioneering fistula surgeon in Ethiopia, talk in Edinburgh, which made it very meaningful.

He, like others amongst us, had heard Ethiopia described as the most beautiful country in the world, which again added allure to the book. So did his familiarity with most of the book’s settings – in Kerala in India, the Bronx and Queens in New York, and of course with Stone’s training in Edinburgh.

He felt Verghese wrote with much compassion and empathy, maintaining tension and suspense as he wove the different story lines together. The twists and turns of the medical stories mirrored and illuminated the twists and turns of life as a whole. His observations both of people and of places were vivid, full of description and detail, and some of the best that he had come across. He enjoyed the wide variety of realistic characters. The book had captivated him from the opening paragraphs, when we hear of a nun giving birth.

Verghese had been born in Addis Ababa in 1955, to Indian parents recruited by the Emperor Haile Selassie to teach in Ethiopia. He grew up near the capital and began his medical training there. When the Emperor was deposed, Verghese briefly joined his parents who had moved to the United States because of the war. He worked as an orderly in a hospital before completing his medical education in India.

After graduation, he left India for a medical residency in the United States and initially found only the less popular hospitals and communities open to him. However, he progressed and became heavily involved in the stressful work of caring for AIDS patients. He then took a break, cashing in his retirement plan to study writing full time in Iowa. He now combined a Professorship at Stanford on the Theory and Practice of Medicine with a very successful writing career.

Amongst his wide range of influences were A.J. Cronin’s “The Citadel” (see discussion 28/3/13), Maugham’s “Of Human Bondage” and Conan Doyle. The lengthy acknowledgements at the end of the book revealed Verghese’s very wide and rich range of cultural reference, even if it were showboating a little to draw such explicit attention to it.

The lengthy and explicit passages on surgery featured strongly in our initial discussion. For some they were too long, too gruesome, or too boring, distracting attention from the main story. Others felt they marked the book out as exceptional, so clearly expressing his love and passion for medicine. For these readers he brilliantly depicted the bone and gristle and sinew of the operations. And yet others simply skipped the medical passages.

So not much agreement there, nor was there on the characters. Some felt that they were very well drawn. Others felt they were rather weak with little real feelings. Genet in particular was cited, who had the most interesting but tormented life, but about whose feelings we learned very little.

But was that because we only saw her through Marion’s eyes, and Marion idealized her but was frustrated by his inability to get close to her? And didn’t we learn a lot about Stone’s torment, and to a lesser extent Hema’s?

We felt Hema was the best drawn of the female characters. She had had to move from India to Ethiopia to progress in medicine. She had become a dominant person in Ethiopia, controlling the hospital and medical procedures.

The issue arose in discussion of whether Hema was an imagined character, or a projection of the Australian doctor Catherine Hamlin. This might account for the greater strength of writing about Hema than the other female characters. Or was rather Shiva modelled on Hamlin? However, we agreed that the historical genesis of a character or plot was not relevant to judging the quality of a book.

Another feature was that none of the characters achieved satisfactory relationships, with the exception, eventually, of Hema and Ghosh. This was sad, and perhaps linked to the pervasive sense in the book that sex was dangerous. Many characters were destroyed or seriously damaged by sex: Mary Praise, Genet, Marion and indirectly Shiva, Thomas Stone and so on. The genital mutilation of Genet was one of the most powerful and shocking of such scenes, and showed an unflinching willingness to confront unpleasant physical issues.

Thus was the danger of sex the moral – conscious or unconscious – of the book? The idea that sex leads to death was of powerful archetypal origin (see discussion of “Sir Gawain and the Green Knight” 25/7/07).

Marion’s sexual inhibition was not easy to comprehend at a literal level. He turned down the Probationer, and decided not to pursue Tsige when she put him on hold, but saved himself for years and years for what proved to be a nihilistic and destructive coupling with Genet. Given that Marion was obviously a largely autobiographical figure, there might be an autobiographical basis for this, but that did not constitute a convincing explanation.

Meanwhile Marion’s twin brother Shiva, from whom he had been sundered at birth, was unthinkingly promiscuous, and named after a god. This led us to wonder if the author had in mind some notion of dualism, of illustrating different aspects of humanity, through the trope of the divided twins. However, if so it was not too clear to us what the idea was. Nor was it clear if there were some intended notion of universality in giving a man, Marion, a female name. And was the choice of name of “Genet” for the woman he loved, echoing the writer Jean Genet, also meant to have significance?

Despite these hints that the writer might have high literary ambitions, there was some enjoyable humour in the novel, e.g. in the description of the cricket team. There were fine homilies, such as Stone’s question about what treatment was administered by ear (reassurance) or his injunction never to operate on a patient on the day of his death. More generally we liked the strong Indian influence in the book.

So, taking the book as a whole, what were its strengths and weaknesses? Most felt that the first section of the book in Missing Hospital, climaxing with Mary Praise’s dramatic delivery and death, was outstanding. One, for example, thought that the book showed fantastic imagination, especially the first 100 pages. It was rich in references to different cultures, and totally gripping in its depiction of the panic when they operated on the Sister. Generally the later American sections were less powerful than those set in Ethiopia.

The plot, and in particular the use of coincidence and the neatness of the ending, attracted criticism from some. Others liked the overall coming of age structure of the book, the way in which the twins and other characters influenced the lives of each others, and how external events affected them all. Perhaps you needed to cut the author a bit of slack on plotting given the type of novel he was writing.

And it was a pleasure to see another Indian author writing an expansive, compassionate, ebullient, self-confident novel, at a time when so many British writers were writing cramped and overly self-conscious works.

Yours truly felt he had done quite well to record all this high-flown stuff, and was just dropping off for another well-earned and well-sedated snooze, when rudely awakened by laughter.

 “Everybody says that the Ecstasy of St. Theresa is an orgasmic pose!”

 Run that by me again???!……

 And Ethiopian Airlines are the best, despite the odd hijacking!

 No, I must have been dreaming….