Cutting for Stone

by Abraham Verghese

  “May I know who is speaking—”

  “You see, we have had a death of one of our staff. It might be a couple of days before she calls you.” He started to say something, but Matron hung up abruptly. Then she took the receiver off the hook, glaring at it, daring it to ring.

  The Baptists of Houston were of late Missing's best and most consistent funders. Matron sent out handwritten letters every week to congregations in America and Europe. She asked that her letter be forwarded to others if they were unable to help. If a reply came expressing any interest, she immediately mailed them Thomas Stone's textbook, The Expedient Operator: A Short Practice of Tropical Medicine. Though expensive to mail, it was better than any prospectus. Donors, she found, always had a prurient interest in what could go wrong with the human body, and the photographs and illustrations (by Sister Mary Joseph Praise) in the book satisfied that desire. A picture of a strange creature with the face of a pig, the furriness of a dog, and with small, myopic eyes accompanied the chapter on appendicitis, and Matron always put her letter there as a bookmark. The legend read “The wombat is a burrowing, nocturnal marsupial found only in Australia, and the only reason to mention it is the dubious distinction it has in joining man and apes in ownership of an appendix.” The book, more than any exchange of letters, had won the Houston Baptists’ support.

  Ghosh arrived half an hour later, shaking his head. “I went to the British Embassy. I drove around the city. I went to his house again. Rosina's there and she hasn't seen him. I walked all over Missing's grounds—”

  “Let's take a ride,” Matron said.

  As they drove down to Missing's gate, they saw a taxi coming up the hill carrying a white man. “That must be Eli Harris,” Matron said, sliding down in the passenger seat with an alacrity that surprised Ghosh. She told him about Harris's call. “If I remember correctly, I got Harris to fund a project that was your idea: a citywide campaign against gonorrhea and syphilis. Harris has come to see how we are doing.”

  Ghosh almost steered them off the road. “But we have no such project, Matron!”

  “Of course not.” Matron sighed.

  Ghosh never looked his best in the morning, even after a bath and shave. He hadn't had time for either of these. Dark stubble swept up from his throat, detoured around his lips, and reached almost to his bloodshot eyes.

  “Where are we going?” he said.

  “To Gulele. We need to make funeral arrangements.”

  They rode in silence.

  THE GULELE CEMETERY was on the outskirts of town. The road cut through a forest where the dense overhanging canopy of trees made it feel like dusk. Suddenly the forbidding wrought-iron gates loomed before them, standing out against the limestone walls. Inside, a gravel road led up to a plateau thick with eucalyptus and pine. There were no taller trees in Addis than in Gulele.

  They trudged between the graves, their feet crunching and crackling on the carpet of leaves and twigs. No urban sounds or voices were to be heard here; only the stillness of a forest and the quiet of death. A fine drizzle wet the leaves and branches, then gathered into big drops that plopped on their heads and arms. Matron felt like a trespasser. She stopped at a grave no larger than an altar Bible. “An infant, Ghosh,” she said, wanting to hear a living voice, even if it was only hers. “Armenian, judging by the name. Lord, she died just last year.” The flowers by the headstone were fresh. Matron began a Hail Mary under her breath.

  Farther down were the graves of young Italian soldiers: NATO à ROMA, or NATO à NAPOLI, but no matter where they were born they were DECEDUTO AD ADDIS ABABA. Matron's vision turned misty as she thought of them having died so very far from home.

  John Melly's face appeared to her, and she could hear “Bunyan's Hymn.” It was the hymn they had played at his funeral. At times the tune found her; the words came to her lips unbidden.

  She turned to Ghosh, “You know I was in love once?”

  Ghosh who already looked troubled, froze where he stood.

  “You mean … with a man?” he said at last, when he could speak.

  “Of course with a man!” She sniffed.

  Ghosh was silent for a long time, then he said, “We imagine we know everything there is to know about our colleagues, but really how little we know.”

  “I don't think I knew I loved Melly until he was dying. I was so young. Easiest thing in the world is to love a dying man.”

  “Did he love you?”

  “He must have. You see he died trying to save me.” Her eyes welled up. “It was in 1935. I'd just arrived in the country, and I couldn't have picked a worse time. The Emperor fled the city as the Italians were about to march in. The looters went to town, pillaging, raping. John Melly commandeered a truck from the British Legation to come and get me. You see, I was volunteering at what is now Missing. He stopped to help a wounded person on the street, and a looter shot him. For absolutely no reason.” She shuddered. “I nursed him for ten days, and then he died. One day I'll tell you all about it.” Then, uncontrollably, she had to sit down, her head in her hands, weeping. “I'm all right, Ghosh. Just give me a minute.”

  She was mourning not Melly as much as the passage of the years. She'd come to Addis Ababa from England after getting restless teaching in a convent school and running the student infirmary; she'd accepted a post with Sudan Interior Mission to work in Harrar, Ethiopia. In Addis, she found her orders were canceled because the Italians had attacked, and so she had simply attached herself to a small hospital all but abandoned by the American Protestants. During that first year she'd watched as soldiers—some of the young men buried here—as well as Italian civilians poured in to populate the new colony: carpenters, masons, technicians. The peasant Florino became Don Florino when he crossed the Suez. The ambulance driver reinvented himself as a physician. She had carried on, just as the Indian shopkeepers, the Armenian merchants, the Greek hoteliers, the Levantine traders had carried on during the occu pation. Matron was still there in 1941, when the Axis's fortunes turned in North Africa and in Europe. From the Hotel Bella Napoli's balcony, Matron watched Wingate and his British troops parade into town, escorting Emperor Haile Selassie, who was returning after six years of exile. Matron had never set eyes on the diminutive Emperor. The little man seemed astonished by the transformation of his capital, his head swiveling this way and that to take in the cinemas, hotels, shops, neon lights, multistory apartment buildings, paved avenues lined with trees … Matron said to the Reuters correspondent standing beside her that perhaps the Emperor wished he'd stayed in exile a little longer. To her chagrin, she was quoted verbatim (but fortunately as an “anonymous observer”) in every foreign paper. She smiled at that memory.

  She rose, brushed away her tears. The two of them trudged on.

  They walked down the path between one row of graves, then back up another.

  “No,” Matron said abruptly. “This'll never do. I can't imagine leaving our cherished daughter in this place.”

  Only when they broke out into the sunlight did Matron feel she could breathe.

  “Ghosh, if you bury me in Gulele, I'll never forgive you,” she said. Ghosh decided silence was the best strategy. “We Christians believe that in the Lord's Second Coming the dead will be raised from the grave.”

  Ghosh was raised a Christian, a fact that Matron never seemed to remember.

  “Matron, do you sometimes doubt?”

  She noticed that his voice was hoarse. His eyelids sagged. She was reminded again that this was not her grief alone.

  “Doubt is a first cousin to faith, Ghosh. To have faith, you have to suspend your disbelief. Our beloved Sister believed … I worry that in a place as damp and disconsolate as Gulele, even Sister will find it hard to rise when the time comes.”

  “What then? Cremation?”

  One of the Indian barbers doubled as a pujari and arranged cremations for Hindus who died in Addis Ababa.

  “Of course not!” She wondered if Ghosh was being willfully dense. “Burial.
I think I might know just the place,” Matron said.

  THEY PARKED AT Ghosh's bungalow and walked to the rear of Missing, where the bottlebrush was so laden with flowers that it looked as if it had caught fire. The property edge was marked by the acacias, their flat tops forming a jagged line against the sky. Missing's far west corner was a promontory looking over a vast valley. That acreage as far as the eye could see belonged to a ras—a duke—who was a relative of His Majesty Haile Selassie.

  A brook, hidden by boulders, burbled; sheep grazed under the eye of a boy who sat polishing his teeth with a twig, his staff near by. He squinted at Matron and Ghosh and then waved. Just as in the days of David, he carried a slingshot. It was a goatherd like him, centuries before, who had noticed how frisky his animals became after chewing a particular red berry. From that serendipitous discovery, the coffee habit and trade spread to Yemen, Amsterdam, the Caribbean, South America, and the world, but it had all begun in Ethiopia, in a field like this.

  An unused bore well occupied this corner of Missing. Five years before, one of the Missing dogs had fallen into the well. Koochooloo's desperate yelps brought Gebrew. He fished her out by dangling a noose around her, almost lynching her in the process. The well needed to be sealed over. In supervising that task, Matron found used prophylactics and cigarette butts around the rock wall; she'd decided the area was in need of redemption. Coolies cleared the brush and planted native grass seedlings. In two months a beautiful green carpet surrounded the well. Gebrew tended to this lawn, squatting, crab walking, grabbing a fistful of grass with his left hand and sweeping under it with the sickle in his right hand.

  It was Sister Mary Joseph Praise who identified the wild coffee bush by the well. But for Gebrew's regularly nipping the top buds, it would have grown out of reach. With a few old outpatient benches brought to this lawn it became a place where even Thomas Stone temporarily abandoned his cares. Cigarette in hand, mind adrift, hed smoke and watch while Sister Mary Joseph Praise and Matron fussed with their plants. But before too long he would grind his cigarette into the grass (a practice which Matron thought vulgar) and march off as if to some urgent summons.

  Matron prayed silently. Dear God, only You know what will become of Missing now. Two of ours are gone. A child is a miracle, and we have two of those. But for Mr. Harris and his people, it wont be that. For them it would be shameful, scandalous, a reason to pull out. Missing had no income to speak of from patients. It relied on donations. Its modest expansion of the last few years came because of Harris and a few other donors. Matron had no rainy-day fund. It was against her conscience to hold back money when money allowed her to cure trachoma and to prevent blindness, or give penicillin and cure syphilis—the list was endless. What was she to do?

  Matron studied the view in every direction. She wasn't registering what she saw because her thoughts were turned inward. But gradually, the valley, the scent of laurel, the vivid green colors, the gentle breeze, the way light fell on the far slope, the gash left by the stream, and above all this the sweep of sky with clouds pushed to one side—it had its effect on her. For the first time since Sister Mary Joseph Praise's death, Matron felt a sense of peace, a sense of certainty where there had been none. She was certain that this was the spot—this was where the long voyage of Sister Mary Joseph Praise would end. She remembered, too, how in her first days in Addis, when things had looked so bleak, so terrifying, so tragic with Melly's death—it was at those moments that God's grace came, and that God's plan was revealed, though it was revealed in His time. “I can't see it Lord, but I know You can,” she said.

  CHAPTER 13

  Praise in the Arms of Jesus

  THE BAREFOOT COOLIES were jovial men. Told by Ghosh what their task would be, they made clucking sounds of condolence. The big fellow with the prognathic jaw shed his fraying coat; his shorter companion pulled off his tattered sweater. They spat on their palms, hefted the pickaxes, and set to it; happened-had-happened and be-will-be as far as they were concerned, and though it was a grave they were digging, it guaranteed the night's bottle of tej or talla and perhaps a bed and a willing woman. Sweat oiled their shoulders and foreheads and dampened their patchwork shirts.

  The sky had started off bluffing, convoys of gray clouds scurrying across like sheep to market. But by afternoon a perfect blue canopy stretched from horizon to horizon.

  GHOSH, SUMMONED to the casualty room by Matron, spotted a lean and very pale white man waiting by a pillar. Ghosh kept his head down, certain this was Eli Harris, and thankful that the man's back was to him.

  Inside, Adam pointed to a curtain. Ghosh heard regular grunting, coming with each breath and in the rhythm of a locomotive. He found four Ethiopian men standing there, three in sports coats and one in a burly jacket. They were gathered around the stretcher, as if in prayer. All four had spit-shined brown shoes. As they squeezed out to make room for Ghosh, he glimpsed a burgundy holster under a coat.

  “Doctor,” the man lying on the table said, offering his hand and trying to rise, but wincing with the effort. “Mebratu is my name. Thank you for seeing me.” He was in his thirties, his English excellent. A thin mustache arched over a strong mouth. Pain had given him a peaked expression, but it was nevertheless an extraordinary, handsome face, the broken nose adding to its character. He looked familiar, but Ghosh couldn't place him. Unlike his companions, he seemed stoic, not fearful, even though he was the one in pain.

  “I tell you, I have never hurt like this.” He grinned from ear to ear as if to say, A man is going along when out of the blue comes a banana peel, a cosmic joke that leaves you upended and clutching your belly. A wave of pain made him wince.

  I can't possibly see you today. Beloved Sister has died and any minute I expect someone to tell me they have found Dr. Thomas Stone's body. For God's sake go to the military hospital. That was what Ghosh wanted to say, but in the face of such suffering he waited.

  Ghosh took the proffered hand and while supporting it he felt for the radial artery. The pulse was bounding at one hundred and twelve per minute. Ghosh's equivalent of perfect pitch was to be able to tell the heart rate without a watch.

  “When did this start?” he heard himself say, taking in the swollen abdomen that was so incongruent on this lean, muscled man. “Begin at the beginning …”

  “Yesterday morning. I was trying to … move my bowels.” The patient looked embarrassed. “And suddenly I had pain here.” He pointed to his lower abdomen.

  “While you were still sitting on the toilet?”

  “Squatting, yes. Within seconds I could feel swelling … and tightening. It came on like a bolt of lightning.”

  The assonance caught Ghosh's ear. In his mind's eye he could see Sir Zachary Cope's little book, The Diagnosis of the Acute Abdomen in Rhyme. He'd found that treasure on the dusty shelf of a secondhand bookstore in Madras. The book was a revelation. Who knew that a medical text could be full of cartoon illustrations, be so playful, and yet provide serious instruction? Cope's lines regarding sudden blockage of the normal passage through the intestine came to him:

  … rapid onset of distention

  Will certainly attract your keen attention.

  He asked the next question, even though he knew the answer. There were times like this when the diagnosis was written on the patient's forehead. Or else they gave it away in their first sentence. Or it was announced by an odor before one even saw the patient.

  “Yesterday morning,” Mebratu replied. “Just before the pain began. Since then no stool, no gas, no nothing.”

  Sometimes a bowel-coil gets out of place

  By twisting round upon a narrow base …

  “And how many enemas did you try?”

  Mebratu let out a short sharp laugh. “You knew, huh? Two. But they did nothing.”

  He wasn't just constipated but obstipated—not even gas could pass. The bowel was completely obstructed.

  Outside the cubicle the men seemed to be arguing.

  Mebratu's tongue w
as dry, brown, and furred. He was dehydrated, but not anemic. Ghosh exposed the grotesquely distended abdomen. The belly didn't push out when Mebratu took a breath. In fact it moved hardly at all. This is my work, Ghosh thought to himself as he pulled out his stethoscope. This is my grave-digging equivalent. Day in and day out. Bellies, chests, flesh.

  In place of the normal gurgling bowel sounds, what he heard with his stethoscope was a cascade of high-pitched notes, like water dripping onto a zinc plate. In the background he heard the steady drum of the heartbeat. Astonishing how well fluid-filled loops of bowel transmitted heart sounds. It was an observation he'd never seen in a textbook.

  “You have a volvulus,” Ghosh said, pulling his stethoscope off his ears. His voice came from a distance, and it didn't sound like it belonged to him. “A loop of the large bowel, the colon, twists on itself like this—” He used the tubing of his stethoscope to demonstrate first the formation of a loop, then the twist forming at the base. “It's common here. Ethiopians have long and mobile colons. That and something about the diet predisposes to volvulus, we think.”

  Mebratu tried to reconcile his symptoms with Ghosh's explanation. His mouth turned up; he was laughing.

  “You knew what I had as soon as I told you, right, Doctor? Before you did all these … other things.”

  “I suppose I did.”

  “So … will this twist untwist by itself?”

  “No. It has to be untwisted. Surgically.”

  “It's common, you say. My countrymen who get this … what happens to them?”

  At that moment, Ghosh connected the face with a scene he wished he could forget.

  “Without surgery? They die. You see, the blood supply at the base of the loop of bowel is also twisted off. It's doubly dangerous. There's no blood going in or out. The bowel will turn gangrenous.”

  “Look, Doctor. This is a terrible time for this to happen.”