By Abraham Verghese, M.D., M.A.C.P. New York, Vintage Books, 2009. ISBN-13: 978-0-375-71436-8, ISBN-10: 0375714367. Pages: 688. Price: $15.95.
Cutting for Stone is a novel written from the first-person perspective of Marion Stone, one of the identical twins born of a secret affair between a beautiful Indian nun and a British surgeon. A series of catastrophic events occur during their births, leading to their father's abandonment and life-altering changes to the staff of Missing Hospital. Set in Ethiopia beginning in the 1950s, the story chronicles the twins as they grow up amid the perils of a volatile country on the verge of revolution.
The “true” meaning behind the title Cutting for Stone is debatable. A simple explanation is that the main characters have the last name Stone and are practicing surgeons of varying degree. Looking deeper, Cutting for Stone is an excerpt from a passage of the Hippocratic Oath, which all physicians recite either directly or through modernized versions during their respective commencements. The direct passage mentioned in the novel, “I will not cut for stone, even for patients in whom the disease is manifested. I will leave this operation to be performed by practitioners, specialists in this art.” The original passage refers to the practice of lithotomy, or “cutting for the stone,” which appears in records from the ancient Greeks, Chinese, Persians, and Egyptians. Verghese, an internist and professor at Stanford University School of Medicine, has been quoted previously as saying he renews his vows to medicine every year at commencement, to “swear by Apollo and Hygieia and Panaceia to be true to her, for she is the source of all … I shall not cut for stone.”
Most of the story takes place at Missing Hospital in Addis Ababa, Ethiopia. Verghese finds the delicate balance between sufficiently describing medical procedures and terminology while offering ample explanations to foster the reading enjoyment of medical professionals and nonprofessionals. For a medical professional, it is both interesting and informative as the author describes the hospital's internist's (Ghosh) classic examination findings, such as “the head bobbing in tune with the pulse” of aortic regurgitation and “the high pitched notes, like water dripping on a zinc plate” of a volvulus. Ghosh even constructs for Marion a homemade Corrigan water hammer to illustrate the pulsatile findings of aortic regurgitation. (Ghosh resembles Verghese in this regard because the author is renowned for demonstrating the wealth of knowledge and information that can be gleaned from physical examination of a patient.)
Verghese's writing style throughout the book is graceful, detailed, and engrossing. He skillfully incorporates medicine into the novel without letting it overtake the narrative, instead making it a complementary part of the story and crucial to the development of each character. Each character's development is affected by events throughout the story. In addition, all the characters have personal flaws that make them more believable and lovable. For instance, Shiva, the other identical twin, is a one-dimensional character throughout the book—a savant in certain aspects, such as rote memorization, math, and dancing. However, he is socially awkward and inept, with an inability to understand the consequences of his actions toward other characters. Marion is the outgoing, outspoken twin, who is more in tune with others' thoughts, but his work-comes-first tendencies permit life's pleasures to pass him by. Despite their different personalities, the twins have in common a passion for medicine. Clearly, medical professionals aren't all alike.
Verghese draws on his own experiences to help the reader understand the Ethiopian culture and surroundings by eloquently describing the country's social unrest, class divisions, customs, traditions, and daily lifestyle. Historical figures, such as Emperor Haile Selassie, dictator Mengistu Haile Mariam, and coup leaders, were real figures actively involved in the Ethiopian revolution. Their actions weigh heavily on each character as the book progresses.
The story line moves at a steady pace, and characters are seamlessly transitioned into the story without interrupting the overall flow of the novel. Likewise, the author blends seemingly benign daily events, such as the twins and their family playing bridge with friends, into crucial turning points in the story.
This book is a must-read. It has all of the plot twists a reader expects in a well-written novel and will hold one's attention regardless of one's interest in medicine. The story flows naturally, a tribute to human nature's triumph over hardships. You will not want to put this book down.