Verghese is a new author to me; he has, understandably, only two previous books, for besides being a writer, he is a physician who also holds two appointments at distinguished medical centers in Stanford and San Antonio. This book only just misses my 5-star superlative rating, but it was compelling, intelligent and intricate, reflective and shot through with symbolism and analogy. Cutting for Stone is set primarily in Ethiopia, with India as the background, and the US—New York and Boston--as a third setting. It takes place in a panoramic twenty-five years of Ethiopian life, rich with detailed understanding of the people and culture and its geopolitical history. It is an intensely sensual novel—the smells, tastes, flowers, seasons and skies of Ethiopia especially. The narrator Marion Stone, one of two identical boy twins, even begins his distinction in medicine by his sensitivity to the smells of different medical conditions, a talent he shares with his obstetrician mother Hema.
The story proper begins when four people from India come separately to a medical clinic in Addis Ababa at a key moment in history: "It was 1947, and the British were finally leaving India; the Quit India Movement had made the impossible come about. Saintly Amma slowly let the air out of her lungs. It was a new world, and bold action was called for, or so she believed. "
In 1954 at the clinic are born identical twin boys and their lives become inextricably interwoven with the politics and history of Ethiopia, including a tragic failed coup against Emperor Haile Selassie, the struggles of the Eritrean people, a successful but disastrous military uprising and dictatorship, and finally a more stable and humane revolution. The novel is well worth reading if only for the vivid realities of Ethiopian life conveyed through its intersection with an understaffed and underfunded medical clinic run by a Christian matron who sets her jaw against the endless donation of Bibles and religious material, believing that their patients need medicine, not missionary zeal.
The people of Ethiopia themselves figure not just as exotic or pitiful "natives" but as complex characters, their humanity more fully realized than in most stories set in Africa and written by non-Africans. Verghese shows Emperor Haile Selassie as a dictator responsible for the country's poverty. His caprice and paranoia and resplendent lifestyle (20 are Rolls Royces among his 26 cars) are set against the results of his rule: rickets, malnutrition, joblessness, prostitution, and untreated diseases. Nor does Verghese spare some of the country's customs like genital mutilation ("female circumcision"), and the too-frequent tragedy of girls in labor too young, resulting in sometimes immediate death of baby and mother, or sometimes a lingering hideous condition leading more slowly to the same conclusion: a condition called "fistula," where a baby's head being ground against an immature pelvis in impossible labor destroys vaginal tissue, leading to ulcerations where the bladder leaks constantly into the diseased remains of a stinking vagina.
This introduces the second unique beauty of the book, although the word "beauty" may seem a strange word to use after a description of "fistulas," but what distinguishes the book above all, I think, is something which online reader chat cites as obstacle. It is what definitively rescues the story from being romantic or exotic: the intense language of physiology, details of medical procedures, of colon surgery, liver transplants, disastrous labors, babies dying, twisted colons, "Version" clinic in which women from the country are taught how to reposition breech babies. In these scenes, the body glistens and throbs, or it dries and fades, it leaks, it smells, while human language and skills survey, senses alert, and then intervene, cutting, clamping, removing, replacing, resectioning. In a brief prologue the narrator, Dr. Marion Stone speaks from Ethiopia of his career at age fifty: "I venerate the sight of the abdomen and chest laid open. I'm ashamed of our human capacity to hurt and maim one another, to desecrate the body." His language is that of reverence:
My fingers "'run the bowel' looking for holes that a blade or bullet might have created, coil after glistening coil, twenty-three feet of it compacted into such a small space. The gut that has slithered past my fingers like this in the African night would by now reach the Cape of Good Hope, and I have yet to see the serpent's head. But I do see the ordinary miracles under skin and rib and muscle, visions concealed from their owner."
Intense scenes of medical engagement function almost as a counter-narrative. Although often suspenseful and dramatic, they are written in the language of a densely precise science, arcane and esoteric to the layperson. It is also a historical language, recording the conquests of human anatomical challenges like the marking of ascents of Everest, and also ignoring the Sherpas:
There is a Chvostek's sign, a Bos's sign, a Courvoisier's sign, a Quincke's sign— no limit it seems to white men naming things after themselves. Surely, the world is ready for an eponym honoring
a humble compounder [Adam, an untrained Ethiopian] who has seen more relapsing fever with
one eye than you or I will ever see with two.
So writes Ghosh, the male third doctor at the Addis clinic, in a struggle from Ethiopia to have an article published in the New England Journal of Medicine.
The third great beauty of Cutting for Stone is a deeply lodged poetic imagery, a resonance of sensuality and intelligence, of sympathy and anger. The title itself comes from the Hippocratic oath "I will not cut for stone," an enigmatic phrase, and "cutting for stone" continually unfolds new levels of resonance. One of the four expatriates of India is the Anglo-Indian surgeon Thomas Stone, a hidden character, self-withheld. The twin boys will be given his surname, and the middle name derived from their dead birthmother: they are thus named Marion Praise Stone and Shiva Praise Stone. One, Marion, will become a surgeon also, thus someone who lives "cutting," while the other is a savant who never completes schooling but nevertheless revolutionizes treatment of "fistulas," another kind of "cutting edge." The twins are physically linked in utero, but an instant decision to separate them—to cut them apart--in an emergency Caesarean section, has a long psychologically symbolic, and mortal, aftermath. They will search history for their antecedents, "cutting" to the bone.
The book is not short on humor, either: a panicked nursing attendant at the birth which sets the plot going cries out, "Japanese twins! Japanese twins!"—the hapless girl thus begins her role in the story getting things not quite right, always. But even she develops, grows, changes, plays her part. There are no caricatures here. Attitudes toward sexuality are consistent with the no-nonsense vision of the human body, its miracles, mysteries and its misfunctions, its dominant role in determining our lives.
It's a wildly adventurous story, but the adventures are never gratuitous. Ghosh is at one point arrested as an "acquaintance" of the first coup's leader, General Mebratu, who is based on a historical figure. Marion Stone has to flee Ethiopia through the underground of the Eritrean People's Liberation Front. After a wild near-disastrous flight in a cargo plane, Hema applies a coercive maneuver to the pilot's testicles. Her move is not a crude self-defensive reflex: "she was thinking of the Frenchman's balls, of rugaeform folds, of the median raphe that separated one bollock from the other, of the dartos muscle, the cells of Sertoli."
She succeeds in immobilizing and overpowering him (she is equally tall). "The Frenchman, his eyeballs sinking in their sockets, nodded mutely. France had colonized Djibouti and parts of Somalia, and they had even jockeyed with the English in India before settling for a foothold in Pondicherry. But on this steamy afternoon, one brown soul who would never be the same again, and who had Malayalis, Armenians, Greeks, and Yemenis backing her, showed that she was free."
There is not very much anti-colonial talk in the book; there doesn't have to be, for the very heart of the book is Post-Colonial in flavor, philosophy, realism and determination. It was a grand experience to be taken into this world in which the US is a strange and dispiriting place of great wealth and great inequality and injustice. In a particularly moving scene, the mission Matron explodes at a Houston church visitor who is concerned that the mission should "teach Christianity." She points out the window: "When you look around Addis and see children barefoot and shivering in the rain, when you see the lepers begging for their next morsel, does any of that [sectarian] nonsense matter the least bit?" "God will judge us, Mr. Harris, by—by what we did to relieve the suffering of our fellow human beings. I don't think God cares what doctrine we embrace." The book also takes that view: Hema's pantheism, Ghosh's pragmatism, the Christianity of Sister Mary Joseph Praise, the Ethiopian Christianity of Gebrew the watchman, cheerful atheism: there are no doctrines that matter besides dedication to relieve suffering.
So why not five stars in my opinion? I don't really know. I think it's because almost all the main characters, and especially the ones we get to know best, are men. I'm a woman; I don't like to live in a world where one of the women characters is a beautiful dead girl, and one (an Eritrean named Genet) is always incomprehensible, her motivations and emotions unexamined, and she acts throughout as a kind of doom for the main characters, a constant irritation and emptiness and erotic stimulant who almost kills Marion. Hema, the strongest woman character, is eventually swallowed up in mothering, and Matron is a minor character. Maybe that was the small disappointment that haunted my reading.
I still plan to reread it, however, and I do strongly recommend it.
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