Cutting for Stone

by Abraham Verghese

  “Yes, it is a terrible time,” Ghosh burst out, startling Mebratu. “Why here, if I may ask? Why Missing? Why not the military hospital?”

  “What else have you understood about me?”

  “I know you're an officer.”

  “Those clowns,” he said, nodding his chin in the direction of his friends outside. “We don't do a good job of dressing as civilians,” Mebratu said, wryly. “If their shoes aren't spit polished they feel naked.”

  “It's more than that, actually. Years ago, shortly after I arrived here, I saw you conduct an execution. I'll never forget that.”

  “Eight years and two months ago. July the fifth. I remember it, too. You were there?”

  “Not intentionally.” A simple drive into the city had turned into something else when a large crowd on the road had forced him and Hema into being spectators.

  “Please understand, it was the most painful order I ever carried out,” Mebratu said. “Those were my friends.”

  “I sensed that,” Ghosh said, recalling the strange dignity of both the executioner and the condemned.

  Another wave of pain traveled over Mebratu's face and they both waited till it passed. “This is a different kind of pain,” he said, trying to smile.

  “You should know,” Ghosh said, “that earlier today the palace called. They asked Matron to inform them if a military person came here for treatment.”

  “What?” Mebratu swore and tried to sit up, but the movement made him yell in pain. His companions rushed in. “Did Matron tell the palace?” he managed to ask.

  “No. Matron told me she wouldn't turn you away knowing that you had nowhere else to go.”

  The patient relaxed now. His friends had a quick discussion, and then they remained in the room.

  “Thank you. Thank Matron for me. I am Colonel Mebratu, of the Imperial Bodyguard. You see we had plans, a few of us, to meet on this date in Addis. I came from Gondar. When I got here I found the meeting had to be called off. We feared we were … compromised. But I didn't get the message till I was already here. Before I left Gondar, yesterday, my pain began. I saw a physician there. Like you, he must have known what I had, but he told me nothing. He told me to come back and see him in the morning and that he wanted to check me again. He must have told the palace, or else why would they call the hospitals in Addis? Hanging will also be my fate if I am discovered in Addis. You must treat me. I can't be seen at the military hospital today.”

  “There is another problem,” Ghosh said. “Our surgeon has … he has left.”

  “We heard about your … loss. I am sorry. If Dr. Stone can't do it, then you have to.”

  “But I can't—”

  “Doctor, I have no other options. If you don't do it, I die.”

  One of the men stepped forward. With his light beard, he looked more like an academic than a military man. “What if your life depended on it? Could you do it?”

  Colonel Mebratu put his hand on Ghosh's sleeve. “Forgive my brother,” he said, then smiled at Ghosh as if to say, You see what I have to do to keep peace? Out loud he said: “If something should happen, you can say in good faith that you knew nothing about me, Dr. Ghosh. It's true. All you know about me are all the things you guessed.”

  GHOSH DIALED Hema's quarters. It occurred to him that Colonel Mebratu and his men must have been plotting some kind of a coup. What else could the secret meeting in Addis have been about? Ghosh was faced with a conundrum: How did one treat a soldier, an executioner, who now was engaged in treason against the Emperor? But of course, as a physician, his obligation was to the patient. He felt no dislike for the Colonel, though he could do without the brother. It was difficult to dislike a man who bravely suffered physical pain and managed to retain his manners.

  Over the hum of the receiver, Ghosh could hear the blood rushing into his ear with every heartbeat.

  Hema's brusque “Hello” told him she was scowling. “It's me,” he said. “Do you know who I have here tonight?” He told her the story. She interrupted before he could finish: “Why are you telling me this?”

  “Hema, did you hear what I just said? We have to operate. It's our duty.”

  She wasn't impressed.

  He added, “They're desperate. They have nowhere else to go. They have guns.”

  “If they are so desperate, they can open the belly themselves. I am an obstetrician-gynecologist. Tell them I just had twins and I'm in no condition to operate.”

  “Hema!” He was so mad that words would not come out. At least in the business of patient care, she was supposed to be on his side.

  “Are you minimizing what I have on my hands?” she said. “What I've gone through just yesterday? You weren't there, Ghosh. So now these children's every breath is my responsibility.”

  “Hema, I'm not saying …”

  “You operate, man. You've assisted him with volvulus, haven't you? I've never operated on volvulus.” By “him” she meant Stone.

  The silence was punctuated only by the sound of her breathing. Does she not care if I get shot? Why take this attitude with me? As if I'm the enemy. As if I caused the disaster she walked into when she returned. Did I invite the Colonel here?

  “What if I have to resect and anastomose large bowel, Hema? Or do a colostomy? …”

  “I'm postpartum. Indisposed. Out of station. Not here today!”

  “Hema, we have an obligation, to the patient … the Hippocratic oath—”

  She laughed, a bitter, cutting sound. “The Hippocratic oath is if you are sitting in London and drinking tea. No such oaths here in the jungle. I know my obligations. The patient is lucky to have you, that's all I can say. It's better than nothing.” She hung up.

  GHOSH WAS an internal medicine specialist through and through. Heart failure, pneumonia, bizarre neurological illness, strange fevers, rashes, unexplained symptoms—those were his métier. He could diagnose common surgical conditions, but he wasn't trained to fix them in the operating theater.

  In Missing's better days, whenever Ghosh popped his head into the theater, Stone would have him scrub and assist. It allowed Sister Mary Joseph Praise to relax, and for Ghosh, being the first assistant to Stone was a fun change from his routine. Ghosh's presence transformed the cathedral hush of Theater 3 to a carnival racket, and somehow Stone didn't seem to mind. Ghosh asked questions left and right, cajoling Stone into talking, instructing, even reminiscing. At night, Ghosh sometimes assisted Hema when she did an emergency C-section. Rarely, Hema sent for him when she performed an extensive resection for an ovarian or uterine cancer.

  But now he found himself alone, standing in Stone's place, on the patient's right, scalpel in hand. It was a spot he hadn't occupied for many years. The last time he stood on the right was during his internship when, as a reward for good service, they let him operate on a hydrocele while the staff surgeon stood across and took him through each step.

  On his instruction the circulating nurse passed a rectal tube into the anus, guiding it up as high as it would go.

  “We better start,” he said to the probationer who was scrubbed, gowned, and gloved on the other side of the table, ready to assist him. Her faint pockmarks were hidden by cap and gown. Even though her lids were puffy, she had beautiful eyes. “We can't finish if we don't start so we better start if we're to finish, yes?”

  A very large incision should be made

  —of small ones in such cases be afraid—

  The coil brought out, untwisted by a turn

  —a clockwise turn as you will quite soon learn—

  And then a rectal tube is upward passed—

  Thereon there issues forth a gaseous blast …

  With the colon swollen to Hindenburg proportions it would be all too easy to nick the bowel and spill feces into the abdominal cavity. He made a midline incision, then deepened it carefully, like a sapper defusing a bomb. Just when panic was setting in because he felt he was going nowhere, the glistening surface of the peritoneum—that delicate membra
ne that lined the abdominal cavity—came into view. When he opened the peritoneum, straw-colored fluid came out. Inserting his finger into the hole and using it as a backstop, he cut the peritoneum along the length of the incision.

  At once, the colon bullied its way out like a zeppelin escaping its hangar. He covered the sides of the wound with wet packs, inserted a large Balfour retractor to hold the edges open, and delivered the twisted loop completely out of the wound onto the packs. It was as wide across as the inner tube of a car tire, boggy, dark, and tense with fluid, quite unlike the flaccid pink coils of the rest of the bowel. He could see the spot where the twist had occurred, deep in the belly. Gently manipulating the two limbs of the loop, he untwisted, clockwise, just as Cope said. He heard a gurgle and at once the blue color began to wash out of the ballooned segment. It pinked up at the edges.

  He felt through the bowel wall for the rectal tube that Nurse Asqual had inserted. He fed it up like a curtain rod in a loop. When the tube reached the distended bowel, they were rewarded with a loud sigh and the rattle of fluid and gas hitting the bucket below. “And down the coil contracts and you will see, the parts arranged more as they ought to be,” Ghosh said, and the probationer, who had no idea what he was talking about, said, “Yes, Dr. Ghosh.”

  Ghosh flexed his gloved fingers. They looked competent and powerful—a surgeon's hands. You can't feel this way, he thought, unless you have the ultimate responsibility.

  AFTER HE CLOSED, as he was stripping off his gloves, he saw Hema's face in the glass of the swinging doors. It disappeared. He charged after her. She ran, but he soon caught up with her in the walkway. She stood panting against the pillar. “So?” she said when she could speak. “It went well?”

  They were both grinning. “Yes … I just untwisted the loop.” He couldn't hide the pride and excitement in his voice.

  “It could twist again.”

  “Well, his choice was either me or nothing, since the other doctor here would not help.”

  “True. Good for you. I've got to go. Almaz and Rosina are watching the babies.”

  “Hema?”

  “What?”

  “You would have helped if I got into trouble?”

  “No, I was just stretching my legs …” Despite herself, a twinkle showed in her eyes. “Silly. What did you think?”

  With Hema, even sarcasm felt like a gift. He fought the instinct to jump forward, the eager puppy too ready to forget the cuffing it had received minutes before.

  “Just yesterday,” Hema said, “I drove past the spot where we saw that first hanging, and I thought about it …” She seemed to study him meditatively “Have you eaten anything today?”

  That was when he noticed: His beloved, his Madras-returned, unmarried beauty, was more magnified than ever. There were succulent rolls visible between sari and blouse. The skin under her chin was gently swollen like a second mons.

  “I've not eaten since you left for India,” he said, which was almost true.

  “You've lost weight. It doesn't look good. Come by and eat. There's food, tons of it. Everybody keeps bringing food.”

  She walked off. He studied the way the flesh on her buttocks swung this way, and that, about to sail off her hips. She'd brought back from India more of herself to love. It was the worst time for this, but he was aroused.

  He dressed and found himself thinking about the operation again. Should I have tacked the sigmoid colon to the abdominal wall to prevent it twisting again? Didn't I see Stone do this? Colopexy I think he called it. Had Stone spoken to me about the danger of a colopexy and warned against it, or had he recommended it? I hope we took out all the sponges. Should have counted once more. I should've taken one more look. Checked for bleeders while I was at it. He recalled Stone saying, When the abdomen is open you control it. But once you close it, it controls you. “I understand just what you mean, Thomas,” Ghosh said, as he walked out of the theater.

  IT WAS LATE EVENING before the hospital staff gathered by the gaping cavity in the earth, now shored up with timber. There was no time to waste, because by Ethiopian tradition, no one eats till the body is interred. That meant the nurses and probationers were starving. The casket arrived on the shoulders of orderlies treading the same path down which Sister Mary Joseph Praise would come to sit in this grove. Hema trailed behind the pallbearers, walking with Stone's maid, Rosina, and with Ghosh's maid, Almaz, the three of them taking turns carrying the two infants who where bundled up in blankets.

  They laid the casket down by the edge of the grave, and removed the lid. There were sobs and strangled cries as those who had yet to see the body pressed closer.

  The nurses had dressed Sister Mary Joseph Praise in the clothes the young nun first donned when she pledged body and soul to Christ—her “bridal” dress. The arching, hooded veil was to show that her mind was not on earthly things but on the kingdom of heaven; it was the symbol of her being dead to the world, but in the gathering mist it was no longer a symbol. The starched guimpe around her neck hung down like a bib. Her habit was white, interrupted by a plaited white cord. Sister Mary Joseph Praise's hands emerged from the sleeves and met in the middle, the fingers resting on her Bible and a rosary. Discalced Carmelites originally shunned footwear—hence the term “discalced.” Sister Mary Joseph Praise's order had been practical enough to wear sandals. Matron had left her feet bare.

  Matron chose not to call Father de la Rosa of St. Joseph's Catholic Church, because he was a man who had a disapproving manner even when there was nothing to disapprove, and there was plenty here. She almost called Andy McGuire from the Anglican church; he would have been a comfort and most willing. But in the end Matron felt that Sister Mary Joseph Praise would have wanted no one but her Missing family to see her off. The same instinct led Matron to ask Gebrew earlier that day to prepare to say a short prayer. Sister was always respectful of Gebrew, even though his being a priest was incidental to his duties as watchman and gardener; she would have appreciated how much it honored and consoled Gebrew to be called on in this fashion.

  In the cool and very still air, Matron held up her hand. “Sister Mary Joseph Praise would have said, ‘Don't grieve for me. Christ is my salvation.’ That must be our consolation as well.” Matron lost her train of thought. What else was there? She nodded at Gebrew who was immaculately dressed in a white tunic extending to his knees, trousers underneath, and tightly coiled turban on his head. These were the ceremonial clothes he wore only on Timkat, the day of the Epiphany. Gebrew s liturgy was in ancient Biblical Geez, the official language of the Ethio pian Orthodox Church. With great effort, he kept his singsong recitation short. Then the nurses and probationers sang Sister Mary Joseph Praise's favorite hymn, one she had taught them and which they favored in morning chapel in the nurses’ hostel.

  Jesus lives! Thy terrors now

  Can no longer, death, appall us;

  Jesus lives! By this we know

  Thou, O grave, canst not enthrall us.

  Alleluia!

  They all pushed forward, straining for a last look before the lid was nailed in place. Gebrew would say later that Sister Mary Joseph Praise's face glowed, her expression was peaceful, knowing her ordeal on earth was over. Almaz insisted that a lilac scent emerged as the lid went down.

  Ghosh felt a message being conveyed to him. Sister seemed to be saying, Make good use of your time. Don't waste more years pursuing love that might never be reciprocated. Leave this land for my sake.

  Hema, standing close, vowed silently to Sister Mary Joseph Praise that shed look after us as if we were her own.

  With ropes under the casket, the coolies lowered Sister into her grave. The heavy stones required by Ethiopian tradition were handed down to the taller coolie whose feet were perched on either side of the coffin. The stones were to keep hyenas out.

  At last the two men pushed the earth back to fill in the grave, the service all but over. All but the ululations.

  Shiva and I, so new to life, were startled by that
unearthly sound. We opened our eyes to contemplate a world in which so much was already amiss.

  CHAPTER 14

  Knowledge of the Redeemer

  THE DAY AFTER THE FUNERAL, Ghosh rose early. For a change his waking thoughts were not about Hema but about Stone. As soon as he was dressed, he went straight to Stone's quarters, but he found no sign that the occupant had returned. Deflated, he went to Matron's office. She looked up expectantly. He shook his head.

  He was eager to see his postoperative patient and check his handiwork. He'd been a reluctant surgeon, but now the anticipation he felt was a revelation to him. It must have been a feeling Stone had regularly enjoyed. “This could be addictive,” he said to no one in particular.

  He found Colonel Mebratu sitting on the edge of the bed, his brother helping him dress. “Dr. Ghosh!” Mebratu said, smiling like a man without a care in the world, though he was clearly in pain. “My status report: I passed gas last night, stool today. Tomorrow I will pass gold!” He was a man used to charming others, and even in his weakened state, his charisma was undiminished. For someone fewer than twenty-four hours out of surgery, he looked great. Ghosh examined the wound, and it was clean and intact.

  “Doctor,” the Colonel said, “I must return to my regiment in Gondar today. I can't be gone for much longer. I know it's too soon, but I don't have a choice. If I don't show my face I will be under even deeper suspicion. You don't want to save my life only for me to be hanged. I can arrange for intravenous fluids at home, whatever you say.”

  Ghosh had opened his mouth to protest, but he realized he could not insist.

  “All right. But listen, there is a real hazard of the wound bursting if you strain. I'll give you morphine. You must travel lying flat. We'll arrange intravenous fluids, and tomorrow you can sip water and then clear liquids the next. I will write it all down. You will need the stitches removed in about ten days.” The Colonel nodded.

  The bearded brother clasped Ghosh's hand and bowed low, muttering his thanks.