Cutting for Stone: A novel
by Abraham Verghese
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Book Summary Information
Author: Abraham VergheseEdition: Hardcover
Audio: English (Unknown); English (Original Language); English (Published)
Format: Deckle Edge
Published: 2009-02-03
ISBN: 0375414495
Number of pages: 560
Publisher: Knopf
Book Reviews of Cutting for Stone: A novel
Book Review: A surgeon's assessment
Summary: 5 Stars
Cutting for Stone: A novel
This is not yet one of those "modern" gimmicky novels whose authors try to show how virtuous they are, exercising acrobatics with their narrative. Instead, Abraham Verghese tells the story, and the numerous tales within it, in a "classical" calm, linear fashion--like the great Russian masters would do.
It is a book to savor slowly, word by word, enjoying the authors majestic and yet easy readable voice. Listen to this for example: "Her body slumped as if the starch had vanished not just from her clothes but from her bones." And in each page the author shows indirectly, and directly, his medical roots: "When he came of age, he dropped the e at the end of his name, because he though it redundant, like a skin tag."
The novel seems to borrow, to a large extent, from the author's own life story, taking us from India, to Eden, Ethiopia, and finally to the USA. It provides a rich historical perspective against which the story unfolds, taking the reader to diverse sites such as a mission hospital or even a whorehouse (!), and finally to a surgical residency program in the USA.
Overall, I think that the book is a great success; but it is an uneven piece of art: to me the novel resembles a layered pita sandwich - a falafel. The first layer tasty and promising-I enjoyed the colorful introduction of the main characters, followed by the drama surrounding the birth of the twins. And then, suddenly, after Thomas Stone disappears, the story line loses momentum...this part--the center of the falafel-reads more like the author's own memoir of Ethiopia would read. Of course this part is gracefully written (ala' Verghese) but the pace of narrative is slow -an anticlimax to the beginning and what comes later. Do we need so much Ethiopian court politics? I asked myself-do we need so many side characters, each with his own little past story? I had the feeling that the mid section could be shorter and that not a few readers may abort the book while plodding through it. However, the last part of the sandwich is a masterpiece --if one manages to swallow the center of the falafel--it the final reward!
More impressions:
--Drama interrupted. Repeatedly the stream of narrative is arrested, offering explanations, data, facts or side stories. It is fine to do so when explaining, for example, what is an atriocaval shunt for retrohepatic trauma--but at other places such digressions may be represent a tactical mistake. For example during the birth of twins, the drama is repeatedly halted. How could Hema waste so much time talking to Thomas Stone while the Sister was busy dying? What growing of coffee beans has to do within that episode? And the exhausting dwelling on the character of the probationer--could it not have awaited until the drama unfolds? It feels like interrupting the fun of a roller coaster ride--like interrupting the coitus to tell your girlfriend about what's up on Wall Street.
--Characters. I think that the best developed character--and the most likable--is Ghosh! We learn much about Marion, the narrator, but Shiva remains an enigma. Wasn't he an autistic child? We can picture to ourselves the image and personality of Hema and that of her house servants. But the adult Thomas Stone -I love his Indian childhood-is not portrayed as a complete human being. Many other characters come and go -mostly Indian, and Eritrean and Ethiopians--and most of them are "enjoyable" and "contributing." The Matron and Dr. Ross are perhaps the only "positive" white characters in the whole book. I did not appreciate Dr. Popsy's character: I thought that it is overly comical and grotesque!
Medicine & Surgery
I think that what makes this book special and original is its huge amount of medical and surgical contents. I do not recall any modern or "classic" literary novel which attempted--and succeeded-- in doing the same thing. This book has it all: pathology, anatomy, clinical medicine -in places it reads like an infectious diseases manual--preventive medicine, tropical medicine, gynecology, obstetrics, general surgery, trauma and transplant! And let's not forget critical care and neurosurgery! It is a love song to medicine, a hymn of the author's fascination with surgery, and his compassion to any form of living--not only human.
The book virtually smells of disease! It would have required a genius to weave all the above into a smooth and elegant narrative but the author did beautifully--like Solzenicyn did it in "Cancer Ward". I bet that it will encourage people to become doctors or surgeons; it will be enjoyed by generations of doctors or anyone interested in medicine and surgery. On the other hand, the vivid and detailed surgical scenarios may abhor others--like that British lady who'd reviewed this novel for the New York Times Book Review.
Only surgeon would notice:
I have to congratulate the author -it is almost impossible to find any factual inaccuracies with the way he describes surgeons and what they do. Rarely, however, he allows himself to twist the reality, bending it to what the novel dictates...Here and there he adds a touch of surrealism or magic realism, which I do not like, but many others probably do. Below is the list of "minor problems" which "only a surgeon would notice" but would not be perceived lay readers.
Ultra-rapid surgical training: that Ghosh manages to successfully "untwist" the sigmoid volvulus is plausible--but his almost overnight transformation to become Missing Hospital's leading surgeon is not. I would have sent him instead for a period of intensive training in Nairobi's university hospital--only then he would learn to do C/sections "in and out in 15 minutes." [I am performing a C/section almost once a week--it takes me at least 30 minutes.]
Deepak's Schrock's (atriocaval) shunt: His amazing success rate with this obsolete procedure is not realistic--a total fiction! And the long chat between Deepak and Thomas Stone, looking behind his shoulders, would make surgeons' eyes role. That the vena cava has been repaired is not the end of the saga...and only a psychopath could now relax for an easy, lengthy chat with a visiting professor.
The re-look operation for abdominal trauma (page 410): re-warming and correction of the disrupted clotting system cannot be accomplished within two hours plus, as suggested in the relevant scenario. No sane trauma surgeon would have rushed this patient back to the OR so soon.
Marion's visit to Mecca (starts in page 419): I did not understand this: Marion goes for a liver transplant meeting in Boston and on the "morning of the conference" decides to skip the meeting and see where his father is working. And suddenly he is one of the "interviewees in our dark suits." This sounds bizarre!
Lady Mercy Hospital, Bronx: the whole "picture" seems a little bizarre to me--sort of a caricature of a training program--even in Bronx, 1980's. As I said above, Popsi's image is lacking: laymen, non surgeons, people who did not work in such sort of run down departments would not understand that "character". Did Deepak and the others work in a total vacuum? Where were the other attendings? What about the hospital administrators? Yes, we get a glimpse of a third world training program in NY during the 1980's but it reads partially like a joke.
Shiva treated with "blood thinners" for thrombosis of a vein in his arm, eventually leading to a lethal intra-cranial hemorrhage. This too could rise a few eyebrows!` Unless a patient has a full blown axillary/subclavian vein thrombophlebitis anticoagulation is not indicated. For this to have developed the patient needed to have long term central line in place...which Shiva didn't. Anyway, I would have inflicted Shiva with postoperative DVT in his leg....this would justify treatment with heparin.
* * *
Browsing again through the book and looking at my footnotes, while I'm writing this, I realize what a huge accomplishment this book is. There are so many little masterpieces scattered everywhere. The death scenes of Ghosh and Shiva are Tolstoyan in quality! The way places and their smells are portrayed is superb. Even the few sex scenes are majestic and rough at the same time --urine, blood and even viruses are mixed with love.
There were many doctors throughout history who became famous authors, and not a few respected physician-writers exist today. Most, if not all, of the latter made their name in the fields of non-fiction or genre (non literary medical) writing. Few excelled as literary novelists. But with "Cutting for Stone" a great doctor novelist has been born. Perhaps one day we will add Abraham Verghese's name to the list that includes Chekhov, Schnitzler and Maugham.
Summary of Cutting for Stone: A novel
A sweeping, emotionally riveting first novel?an enthralling family saga of Africa and America, doctors and patients, exile and home.Marion and Shiva Stone are twin brothers born of a secret union between a beautiful Indian nun and a brash British surgeon at a mission hospital in Addis Ababa. Orphaned by their mother?s death in childbirth and their father?s disappearance, bound together by a preternatural connection and a shared fascination with medicine, the twins come of age as Ethiopia hovers on the brink of revolution. Yet it will be love, not politics?their passion for the same woman?that will tear them apart and force Marion, fresh out of medical school, to flee his homeland. He makes his way to America, finding refuge in his work as an intern at an underfunded, overcrowded New York City hospital. When the past catches up to him?nearly destroying him?Marion must entrust his life to the two men he thought he trusted least in the world: the surgeon father who abandoned him and the brother who betrayed him.
An unforgettable journey into one man?s remarkable life, and an epic story about the power, intimacy, and curious beauty of the work of healing others.
Amazon Exclusive: John Irving Reviews Cutting for Stone
John Irving has been nominated for a National Book Award three times--winning once, in 1980, for the novel The World According to Garp. In 1992, Irving was inducted into the National Wrestling Hall of Fame in Stillwater, Oklahoma. In 2000, he won the Oscar for Best Adapted Screenplay for The Cider House Rules--a film with seven Academy Award nominations. Read his exclusive Amazon guest review of Cutting for Stone:
That Abraham Verghese is a doctor and a writer is already established; the miracle of this novel is how organically the two are entwined. I?ve not read a novel wherein medicine, the practice of it, is made as germane to the storytelling process, to the overall narrative, as the author manages to make it happen here. The medical detail is stunning, but it never overwhelms the humane and narrative aspects of this moving and ambitious novel. This is a first-person narration where the first-person voice appears to disappear, but never entirely; only in the beginning are we aware that the voice addressing us is speaking from the womb! And what terrific characters--even the most minor players are given a full history. There is also a sense of great foreboding; by the midpoint of the story, one dreads what will further befall these characters. The foreshadowing is present in the chapter titles, too--?The School of Suffering? not least among them! Cutting for Stone is a remarkable achievement.--John Irving
(Photo © Maki Galimberti)
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