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Thursday, 25 April 2013

Abraham Verghase - Cutting for Stone

 Review by Ro Bennett live on bookshfow 25th April 2013

This is a huge, chunky book - 560 pages, with small print which just about put me off reading it. However it was so good I persevered, although it took me ages and I read other lighter books in between because it’s such a meaty tome. 

The author, Abraham Verghese is  a surgeon, currently a professor at the Stanford University School of Medicine. He wrote Cutting for Stone over a seven year period, a little bit every day. 

The story revolves around Marion and Shiva Stone, twin boys born in 1954 in Addis Ababa, capital city of Ethiopia. Their mother — a beautiful nun, Sister Mary Joseph Praise — dies of complications which arose during her hidden pregnancy followed by an obstructed labour.  Dr Thomas Stone, despite being a surgeon and the father of the twins is unable to save her life.  Traumatised by the situation he disappears and the twins are raised by Hema and Ghosh,  a lovely and caring couple, recruited from India to be doctors at the missionary hospital. 

The growth and development of the twins unfolds in the Addis Ababa of the 1960s,'70s and '80s, a time of political instability and turmoil, when Mengistu, the Stalinist revolutionary deposed Emperor Haile Selassie and the Empire collapsed. This is the background, to a saga of love, loyalty, betrayal, family and political upheaval, taking the reader through complex, interwoven themes from India to Yemen to New York but mainly set in Addis Ababa. Ethiopia is vibrantly described and the reader is immersed in its culture and history, its poverty, struggles  and inequality and the dedication of a small group of people intent on helping, healing and caring for the sick, vulnerable and impoverished.The book has many detailed accounts of various operations and medical procedures which I found very illuminating, interesting and fascinating.

 Toward the end of the novel the mystery of Thomas Stone is revealed and we finally learn what made him the man he is, with all his strengths and deficits.

This is a well researched and informative book which also draws on personal experience.  Emperor Haile Selassie recruited teachers from the Kerala area of India after he visited there and saw children going to school. Like Hema and Ghosh in the story, Verghese’s parents, went to Ethiopia, met after arriving, and married. Their son Abraham Verghese was born in Ethiopia, and considered it his country, although he had to leave it during the revolution.  

The title, Cutting for Stone is interesting. The author wanted the title to be deep and mysterious.  It explains the surname of the narrator of the book, Marion Stone, along with his twin brother, Shiva, and their father, the almost entirely absent surgeon, Thomas Stone. I looked up the meaning and found that the deeper significance stems from Ancient Greece and the Hippocratic Oath which states "I will not cut for stone, even for patients in whom the disease is manifest: I will leave this operation to be performed by practitioners, specialists in this art”. This clarified that surgeons and doctors were not to share duties. A doctor was required to leave the "cutting" to the trained surgeons and take that promise as part of his oath.

In the olden days when people suffered from bladder, gallbladder or kidney stones that caused extreme pain and ultimately death, unqualified charlatans would travel around cutting the stones out. This would bring immediate relief but also usually death from botched procedures and infections. Even today new doctors still promise to not perform these operations.

The practice of "cutting for stone" was also employed at one time to root out mental illness with cranial trephination- that is drilling a hole in the skull. This aspect is also linked to the story as Marion and Shiva were born conjoined at the skull, yet separated at birth and Shiva has elements of Asperger’s syndrome. 

Then there were two instances in the book where the phrase cutting for stone was used. In the beginning, it seems that it is an Ethiopian term for surgery and then later in the book, women needing fistula surgery carried placards reading "cutting for Stone" to indicate that they were patients to be operated on by Shiva Stone. So even the title is involved and clever. 

This was an intelligent, gripping, well-written story. It is riveting and memorable,  I was loathe to finish it and wholeheartedly recommend it.

Finally -  Verghese tells his medical students, “If you aren’t reading novels, the imagination part of your brain will atrophy” - and he should know!

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