Doctoring the Story

Cutting for Stone by Abraham Verghese.  Vintage.  667 pp.  $15.95.

The one time I formally studied creative writing, in a class with Reynolds Price my freshman year at Duke University, he encouraged us to pay special attention to openings.  “It doesn’t have to be ‘Rape!’ screamed the Duchess’ every time,” he said, “but you want to begin with something that gets the reader’s attention and draws him in.”

Abraham Verghese got that memo.  Cutting for Stone opens with a beloved nun at a hospital in Ethiopia who is not well, and it turns out not only that she is pregnant—the nun is pregnant!—but it’s a problem pregnancy, her vital signs are fading fast.  She needs a Caesarian but the doctor who could do that—at this badly understaffed hospital—is away, so another doctor, unused to the procedure, has to try, but he has an emotional complication: he’s been extremely close to this woman, to the point where people suspect he’s the one who got her pregnant.  It turns out after he cuts this woman open that not only is she pregnant with twins, they’re conjoined.  They’re conjoined at the head!  Talk about your difficult first experiences.  Now what?

This birth scene, which took 100 pages of a 660 page novel, just about did me in.  The book was narrated by one of these twins, so we knew at least one of them survived (spoiler alert: they both did), and to be fair to our narrator, he was introducing a number of characters who would eventually be important to the overall plot.  But 100 pages devoted to the birth of our protagonist: we’re in Tristam Shandy territory here.

I think it’s fair to call that opening melodramatic.  In a way the book has an equally melodramatic end, as our narrator comes quite close to dying (again, we’re pretty sure he doesn’t, because he’s telling the story).  Without giving away too much, let me just say that the opening and the ending are connected in a remarkable way; without that beginning, we couldn’t have the ending.  In between we learn a great deal about immigrant life in Africa, medical care and medical staffing in other parts of the world; we read a remarkable story about foster parents who take care of children that more or less dropped into their lives out of the sky, and a fascinating story about the political situation in Ethiopia, and a man’s eventual exile to the United States.  There are melodramatic aspects to the plot, but they never bothered me until I sat back and thought about them.  While I was reading I was completely absorbed.


I read this novel because one of my friends on Death Row recommended it.[1]  The Death Row guys are great readers, always anxious to hear about new books.  There’s one whom I always ask about his reading.  His suggestions are quite reliable.

Cutting for Stone,” he said, shaking his head.  “Now there’s a novel.  You got to read that.”

People often talk about the difficulties of globalism, or multiculturalism, whatever it is that has me reading a book by a Stanford University doctor whose ancestry is Indian but who grew up in Ethiopia, did his medical training overseas, then came to work in this country, where he was shunted off for years to Johnson City, Tennessee, before he found his present position.

People don’t talk enough about the advantages of globalism, the miracle of it, the fact that I am reading such a book, which I would never have read, nor would it ever have been published, or probably even written, back in the Sixties when I fell in love with the novel for good.  The novel has changed in that time.  It’s become a different creature altogether.

So have the people writing it.  Abraham Verghese is one of those people of enormous talent and immense energy who seem to fit more into one lifetime than the rest of us could in two or three.  It was after he did his medical training, and was working in Johnson City, that he attended the Iowa Writers Workshop and got trained as a writer, the same way he trained to practice medicine.  He published two highly regarded books of non-fiction before he wrote his first novel.  It was on the New York Times bestseller list for two years.


Part of my absorption in this book came because it was written by a doctor.  There have certainly been medical subplots in books I’ve read, but the writer wasn’t speaking with firsthand knowledge; this is a person who can not only tell us what’s happening in the surgery, but can describe what it’s like to reach into a person’s body and move their organs around, try to stop gushes of blood, take desperate measures to get a heart started again.  I was fascinated by the medical details in this novel.  I had no idea I’d even be interested.

The twins who emerged from that opening scene were named Marion and Shiva.  They had that uncanny connection that twins often seem to have, and though they both eventually pursued careers in medicine, they were quite different as people, a difference which I can best express by saying that, when they were teenagers, Marion—our narrator—was determined to preserve his virginity for the girl he loved, while Shiva, on the occasion when he admitted to his brother he was no longer a virgin, had already slept with more than 20 women.  Shiva also had remarkable mental powers; he could recite from memory a page that he had seen just once.  He could duplicate it on another page.  In many ways he seemed the more interesting and mysterious twin, often the more likable one, but I agree with the decision to make Marion the narrator.  Shiva was so far out that he would have been hard to understand.

One of my favorite parts of the book was when Marion made his way—after an extremely complicated escape from Ethiopia—to the Bronx, where he did his training as an intern.  At the shoddy and understaffed hospital where he found work, all of the doctors were from India—to the point where they could field a cricket team—and all of them were dedicated and proficient.  None of them could have gotten a job at a better hospital because of prejudices against them and their training, but they dealt with extremely difficult cases because they were living in a place that was more or less a war zone.  The characters we meet at that hospital are among the most memorable and likable in the book.  It is also there that the final melodramatic coincidence happens, and plot strands from the whole novel come together.

I don’t mean to disparage the book by calling it a melodrama.  Many of our greatest novelists used such elements in their novels, and created marvelous stories.  Verghese writes with the skill of a born novelist, and his knowledge of medicine only enriches the story he tells.  I haven’t begun to suggest all the plotlines in this book, all the memorable and admirable characters, the richness of the places where the author has lived and worked.  I’m in awe of a person who has accomplished so much.  I envy him.  He’s crammed two rich careers into one lifetime.

[1] Along with three of my friends from the Chapel Hill Zen Center, I meditate with several men on Death Row in Raleigh’s Central Prison.