It is easy to be drawn to this novel’s suggestive title, Cutting for Stone, both a reference to the Hippocratic oath as well as a play upon the family name of the three main characters, all of whom are surgeons. Our attention is further arrested by the prophetic and momentous tone of the book’s opening lines: “After eight months spent in the obscurity of our mother’s womb, my brother, Shiva, and I came into the world in the late afternoon of the twentieth of September in the year of grace 1954. We took our first breaths at an elevation of eight thousand feet in the thin air of Addis Ababa, capital city of Ethiopia.” By its length (534 pages) as well as tone, this book asks to be taken seriously. And indeed, the author’s meticulous attention to detail and the insights drawn from his first-hand experience should not be discounted, as they help create a work that is highly evocative of place and time. However, in its plot structure and character development this novel struck me as essentially a male, medical bildungsroman. In spite of the breadth of detail it includes, in centering on Marion, Shiva and Thomas Stone’s search for meaning, the novel sometimes demotes supporting characters, especially women, to the status of developmental stepping stones instead of depicting them as fully rounded people.
Abraham Verghese, former director of the Center for Medical Humanities and Ethics at University of Texas, San Antonio, is currently a professor of internal medicine and “Senior Associate Chair for the Theory and Practice of Medicine” at Stanford University (http://bioethics.stanford.edu/people/resumes/AbrahamVerghese.html). In addition, he holds a Master of Fine Arts degree from the Iowa Writers Workshop. His current novel joins two previous award-winning books of nonfiction, including My Own Country: A Doctor’s Story, about his years working at Texas Tech Health Sciences Center, El Paso, and The Tennis Partner: A Story of Friendship and Loss, about his “friend and tennis partner’s struggle with addiction.” The former was chosen as one of Time magazine’s five Best Books of the Year; the latter was a New York Times Notable Book. In both his writing and medical practice, Professor Verghese seeks to reintroduce the sensory and linguistic engagement between doctor and patient so often lost in modern treatment settings. For example, in an admirable attempt to “resuscitate the vanishing art of the bedside exam,” Professor Verghese guides Stanford medical students to engage directly with patients rather than depending solely on a battery of tests for diagnosis (http://stanmed.stanford.edu/2010summer/article3.html).
Verghese says, “I see all my writing, whatever form it takes—fiction, nonfiction, reportage, obituary, op-ed—as being a function of the privilege and that stance of being a physician, which, to me, is everything” (http://med.stanford.edu/mcr/2009/5qs-novel-0204.html). It is not surprising, then, that some of the most memorable scenes in Cutting for Stone depict doctors listening to and touching patients’ bodies, drawing upon all their senses to arrive at diagnosis and treatment. Especially masterful at this process is Dr. Ghosh, adoptive father to the twin boys Marion and Shiva Stone. After their biological father Thomas Stone abandons them upon their mother’s death, fellow staff doctors Ghosh and Hema raise the boys at the Ethiopian hospital “Missing” (the local mispronunciation of Mission). The novel implies that doctors practicing in Ethiopia are in some ways better able to focus on the most relevant elements of patient illness without the high-tech diagnostic options provided by ‘first-world’ medicine. Listening to a patient’s obstructed bowl, Ghosh hears “a cascade of high-pitched notes, like water dripping onto a zinc plate” and in the background “the steady drum of the heartbeat.” He notes that “fluid-filled loops of bowel” often transmit heart sounds—“an observation he’d never seen in a textbook” (140).
At times, the novel’s main characters do not seem to put their hands and ears to each other in the same way they do to their patients, however. Shiva is hard-wired to miss the symbolism and subtext in human communication, inhabiting simultaneously the roles of prophet and prodigy. Marion has more emotional insight, but often sees only the superficial elements to personality, easily categorizing people and over-simplifying their emotions. This is especially the case with the main female characters he encounters. As reviewer Aida Edemariam comments, “it is difficult not to feel discomfited [with] the virgin/whore/mother/passive sufferer roles of the women” (http://www.guardian.co.uk/books/2009/may/09/abraham-verghese-cutting-for-stone).
Along these lines, I would like to briefly call attention to the characterization of nurses in the book. It is unfortunately common for female nurses to fill the role of passive and acted-upon characters in literature rather than to show individual agency, especially in narratives of male medical development. Cutting for Stone is not immune to this tendency. Here, nurses’ main choice seems to consist of accepting or inviting the sexual advances of their male superiors, whether in the case of Sister Mary Joseph Praise, the boys’ mother, or the nurse probationer, only ever named by the book “the probationer.” This woman, described as “a young, nervous Eritrean girl” who is studious but unable to apply her book learning in the operating theatre (32-5), performs poorly when assisting in the labor of Sister Mary Joseph Praise and feels guilty for her death. She stays at Missing and is eventually promoted to Staff Probationer. Years later, when he is sixteen, Marion sees the same nurse dancing alone in her bedroom and is surprised by this distinctive behavior. While previously he had thought “The only identity she had was that of being in the nursing profession”, now he sees “The uniform concealed a body full of curves” (305). In spite of the narrator’s status in this passage as a sixteen-year old boy, it is disquieting that the only real counterpoint to the Staff Probationer’s generic identity is the fact that she has a body. The feeling of disquiet intensifies when the nurse then lies spread-eagled on the bed, offering Marion sexual intercourse as reparation for her role in the death of his mother.
In both nonfictional and fictional medical narratives, nurses (most often depicted as female) are too often the background figures standing silently, noticeable only in their success or failure as a (most often male) doctor’s helpmate, or their status as his lover. Cutting for Stone reinscribes these gender stereotypes, even while it opens up the male, medical bildungsroman to include more awareness of the class and race politics affecting global health.