Cutting for Stone

Cutting for Stone

Author: Abraham Verghese

By Mcjudy - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=14586909
By McjudyOwn work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=14586909

SYNOPSIS

This is a fascinating family saga written by a professor of Medicine whose Indian heritage and Ethiopian background permeate the book. He tells a tale which crosses the generations, and traverses several continents. Set in a missionary hospital in Addis Ababa, the story reaches back in time to colonial India, and accelerates to a dramatic finale in modern-day America. The fictional narrative is interspersed with rich factual historical accounts such as the intricate chronicling of the Malayali Christians of India (page 15), and the critical recounting of the Eritrean struggle for independence (page 35).

ethiopia-156237_1280

The story depicts the intrigues and tragedies surrounding the family of identical twins Marion and Shiva Stone. The gripping tale grabs the attention right from the beginning with the breathtaking depiction of their birth, and the lingering controversy surrounding their conception. The author meticulously defined the contrasting personalities of the twins, painstakingly characterising the conflicts that threatened them and their family. He also successfully interweaves the adventures, and misadventures, of the diverse characters that infuse the book, painting a canvas with their human failings and their heroic deeds.

By chaouki - Flickr: gemini, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=18265278
By chaoukiFlickr: gemini, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=18265278

A captivating feature of the book is the author’s brilliant and hypnotising prose which greatly enhanced the tales he spun. Take these illustrative examples:

  • I can see the novitiates lining the quay, chattering and trembling with excitement and emotion, their white habits flapping in the breeze, the seagulls hopping around their sandaled feet (page 13).
  • This is my life…I have excised the cancer from my past, cut it out; I have crossed the high plains, descended into the desert, traversed oceans, and planted my feet in new soil; I have been the apprentice, paid my dues, and have just become master of my ship… (page 478).
Journal Entry. Joel Montes de Oca on Flikr. https://www.flickr.com/photos/joelmontes/4762384399
Journal Entry. Joel Montes de Oca on Flikr. https://www.flickr.com/photos/joelmontes/4762384399

The author has a wonderful way with similes and metaphors, and he applied this with a shakespearean flair. Take these quotations for example:

  • The cardigan sits atop my shoulders like the lace amice of a priest (page5)
  • When she pinched up a skin fold at the back of his arm and let go, it stayed up like a tent, like the buckled deck (page 17)
  • His expression was that of a child whose reach had exceeded its grasp with disastrous results (page 263)

As a medical drama, the book will resonate with all doctors. Physicians, for example, will relate to the descriptions of coma vigil (page 21) and la belle indifference (page 92). Surgeons will appreciate the description of the Pringle maneuver in liver surgery (page 411), and everyone will be touched by the author’s tender portrayal of the dreadful vesico-vaginal fistula (VVF).

By Engraved by R. O'Brien - http://ihm.nlm.nih.gov/images/B23841, Public Domain, https://commons.wikimedia.org/w/index.php?curid=18968624
By Engraved by R. O’Brien – http://ihm.nlm.nih.gov/images/B23841, Public Domain, https://commons.wikimedia.org/w/index.php?curid=18968624

Although this is clearly a work of fiction, the book is peppered with references to real historical medical personalities. A key example is the author’s acknowledgement of Marion Sims, the father of modern gynaecology, who carried out the first VVF repair (page 347). He made many factual references to influential physicians in the field of transplant surgery such as C. Walton Lillehei (page 50), Peter Medawar (page 417), Thomas Starzl and Roy Calne (page 418).

The author’s medical background is most evident from his rich retelling of surgical maxims. These pearls of wisdom are often witty and pithy as seen in these examples:

  • The operation with the best outcome is the one you decide not to do
  • The 11th commandment is ‘thou shall not operate on the day of a patient’s death’ (page 7)
Safety. GotCredit on Flikr. https://www.flickr.com/photos/jakerust/16223630914
Safety. GotCredit on Flikr. https://www.flickr.com/photos/jakerust/16223630914

Of particular importance to healthcare is the author’s advocacy for patient safety practices. He did this in several places, and in diverse settings. Take his advise that ‘to be a good surgeon, you need to commit to being a good surgeon…you need to be meticulous in the small things, not just in the operating room, but outside’ (page 395). He also addressed non-technical patient safety skills, for example thinking aloud for your assistant during difficult surgical procedures; this practice, the protagonist says, clarifies the issue for the surgeon, and allows the assistant to point out any faulty reasoning (page 95). The book also referred to several medical heuristics such as ‘low platelets in a woman is lupus until proven otherwise’ (page 342).

The author speaking at a TED talk

OPINION

This book holds its own as a work of fiction. The prose is excellent and the tale enthralling. I found some scenes somewhat drawn out, for instance the caesarean delivery of the twin brothers in theatre number 3. The background of some supporting characters were at times unnecessarily detailed, and the occasional depictions of carnal knowledge did nothing to enhance the story. These criticisms aside, I found the story gripping, and the lessons up-lifting.

OVERALL ASSESSMENT

The book contains many medical aphorisms which hold lessons for all doctors. The recurrent exhortation to hard-work and to putting patients first is relevant today. The author’s writing is lucid- a lesson for doctors in composing their prose. The book contains sufficient lessons for healthcare and I recommend it to all doctors.

BOOK DETAILS

  • Publisher, Place, Year: Vintage Books London, 2010
  • Number of Chapters: 55
  • Number of Pages: 541
  • ISBN: 978-0-099-44363-6
  • Price: £6.29
  • Rating: 4 stars

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