Cutting for Stone

by Abraham Verghese

  I walked with Tsige to the gate. There she turned to me, her eyes full of pain. We held each other's gaze for what seemed like a long time. She bowed, then carried her bundle away. I felt so sad for her. Her baby's suffering had ended, but hers had just begun.

  DR. COOPER ARRIVED promptly at eight that evening in an embassy staff car, just as the patient, a Polish gentlemen, pulled up in his Kombi.

  Ghosh had learned the technique of vasectomy as an intern, and he'd learned directly from Jhaver in India, whom he spoke of as “the maestro of male nut clipping who is personally responsible for millions of people not being here.” The operation was a novelty in Ethiopia, and now expatriate men, particularly Catholics, came to Ghosh in increasing numbers for an operation that was uncommon or unavailable in their countries.

  “I have a proposition for you Dr. Cooper. I shall teach you the vasectomy, and once you are proficient, you can pay me back by doing a vasectomy on a VIP patient.”

  “Do I know him?” Cooper asked.

  “You are talking to him,” Ghosh said. “So you see I have a vested interest in seeing you are superbly trained. My assistant, Marion, will help me judge your skills. Marion, not a word to Hema—you either, Cooper—about my plans, please.”

  Cooper had a stiff brush cut and overlapping square teeth that looked like Chiclets. His American accent was sharp, jarring to the ear, but offset by the way he drawled out his words, by his relaxed, affable manner, as if he'd never had an unpleasant moment in his life and did not expect to.

  “See one, do one, teach one. Raaaiyt, old buddy?” Cooper said.

  “Indeed, yes,” Ghosh said. “It is easy to do, but harder than it looks. Some preliminaries, Dr. Cooper. I tell the patient to use an enema the night before, because nothing makes them more tense than being constipated. Warm milk and honey mixed together and put into an enema bag held shoulder high is what I recommend.”

  “Does it work?”

  “Does it work? Let me put it this way: if the patient happens to be drinking a whiskey and soda, it'll suck the glass right out of his hand.”

  “Gotcha,” said Cooper.

  “I also ask the patient to take a warm bath beforehand. It relaxes him.” He added sotto voce, “And it improves my olfactory experience, you know?”

  The patient hadn't said a word thus far. He was, Ghosh had told me, a consultant to the Economic Commission for Africa, an expert on population control who happened to be the father of five girls. He didn't mind all the attention.

  “We can't finish if we don't start, so we better start, yes? Marion, the heater please?” I'd already turned on the electric heater under the table. “Here is the first caveat. If you don't want the scrotum to shrivel up, and the balls to retract to the armpit, the room has to be really warm. Now, the second caveat is relaxation. Very important. A barbiturate or narcotic might help. I recommend an ounce of Johnny Walker Red or Black. I'm not particular. A wonderful relaxant. And yes, you might give one to the patient, too.”

  Cooper's laugh rolled leisurely out of his mouth, like the great banks of clouds that spilled over the Entoto Mountains.

  I hoped Cooper was paying attention. I'd seen it before: when the patient's private parts were first exposed, even when the room was warm, the scrotal skin—the dartos muscle—would wrinkle and shrink, and the cremaster muscle would tug the testis up. Then, after a good swallow of whiskey (by the patient), which was served only at this point and not before, the sac unfurled.

  Both surgeons were gloved, and Ghosh cleaned the area thoroughly and then draped sterile towels to frame the field. “Another tip, Dr. Cooper. Even though it's a simple operation, mustn't allow any bleeding. Do you know what a brinjal looks like, Dr. Cooper?”

  “I don't believe I do, no sir,” Cooper said.

  “Aubergine? … Melanzana?…Eggplant?”

  Cooper recognized the last word.

  “Well, if you don't meticulously control bleeding, you'll have an eggplant. Or two. And you know what we call that complication, Cooper. We call it the bloody-brinjal-and-bugger-all. Which is also what they fed us for five years in my medical-school hostel.”

  I served the patient his Johnny Walker, which he downed in one gulp.

  I loved assisting Ghosh. Ever since he treated me as if I were old enough to learn and understand, I took my role very seriously. I was thrilled to have Cooper there watching.

  Ghosh, on the patient's right, rooted with his thumb and index finger at the top right of the scrotum, just where it joined the body. “You feel all the wiry things—lymph vessels, arteries, nerves, and whatnot? Well, the vas deferens is in that lot, and with practice you can tell it apart from all the other wires. It has the largest wall-to-lumen ratio of any tubular structure in the body, believe it or not. Here it is. A whiplike structure. Put your finger behind mine.”

  Cooper rooted around, and said, “Got it. The vas. Yup.”

  “Now, push the vas forward from the back with the tip of your index finger, fix it like this against the pulp of your finger so that it doesn't slip away.”

  Ghosh's instructions to Cooper were similar to what he said to me when I assisted him. He loved to teach, and in Cooper, he had the kind of student he deserved. If he dazzled Cooper with his polished delivery, it was because he'd practiced it on me. Practicing medicine and teaching medicine were completely connected for Ghosh. When there was no one to instruct, he suffered. But that was rare. He would happily teach a probationer, or even a family member—whoever happened to be around.

  “I use Adrenalin with my local anesthetic to keep the bleeding minimal. And don't be stingy.” He emptied a five-cc syringe of local into the tissue that his index finger pushed forward. “Any less than that and he'll have pain and the balls will go to the armpit. You'll have to call a chest surgeon to bring them down. Now … see how my index finger still has the vas stretched over it? I make a tiny cut in the scrotal skin. I keep pushing on the vas, pushing it forward … and … there! When I can see it in the wound, I use an Allis to grab the vas.”

  He pulled out a short length of pale, white, wormlike tissue. “I put a mosquito clip here and here … and then I cut between the clips. I remove a two-centimeter segment. Ideally you'd send it to pathology. That way if his wife gets pregnant a year from now, you can show the patient the pathology report and he'll know it's not because you didn't do your job but because a third party did his job better. I don't send it to pathology for the simple reason that we don't have a pathologist. But for a while, there was a pathologist at the American Embassy clinic in Beirut. I'd do the vasectomies for the American staff and send him these little pieces I cut out. The man did the pathology for all the American embassies in East and West Africa. He kept sending back reports that my specimens were inadequate: though he thought he saw some uroepi -thelial tissue, he couldn't be certain it was the vas. ‘It's the vas,’ I wrote to him each time. ‘What other uroepithelial tissue could I have cut out? Call it the vas.’ But he kept complaining: ‘Cannot be certain. Not enough tissue.’ It was starting to annoy me, you know? So finally, I sent him a pair of sheep's balls. I put them in formalin and sent them off in the same diplomatic pouch. With a note: ‘Is this enough tissue?’ Never had a problem with him after that.”

  Cooper hee-hawed, his mask sucking in and out.

  “Now, I tie off the cut ends with catgut. And then I tell the patient, ‘No communication with wife allowed for the next ninety days.’ “

  Ghosh turned to face the patient, and repeated the sentence. The patient nodded. “Okay, you can communicate, say ‘Good morning, darling,’ and all that, but no sex for three months.” The patient grinned. “Okay, you can have sex, but you must wear a condom.”

  “I use interruptus,” the patient said, speaking for the first time in a heavy East European accent.

  “You use what? Interruptus? Pull and pray? Good God, man! No wonder you have five kids! It's noble of you to try to get off the train at an earlier station, but it's unreliable. No sir.
Interrupt the interruptus, man, unless you want to reach your half dozen this year.” The patient looked embarrassed. “You know what we call young men who use coitus interruptus?” Ghosh said.

  The population expert shook his head.

  “We call them Father! Daddy. Pater. Pappa. Père. No sir, I have done the interrupting for you. Give me three months and you can tell your missus that she is not to worry because you will be shooting blanks, and there will be no more interruptions and you will be staying for dessert, coffee, and cigars.”

  CHAPTER 31

  The Dominion of the Flesh

  WITH GENET AND ROSINA AWAY, our quarters felt empty. I missed Genet terribly. Hema and I both worried that wed never see her again. She'd promised to call, and write, but three weeks had gone by and wed yet to hear from her. That year, 1968, we had torrential rains; the Blue Nile and Awash had spilled their banks, causing flooding. The babbling brook behind Missing looked like a river. In Addis, the populace was bottled up indoors so that a lull in the rain released the scent of stifled humanity, dung fires, and clothes that refused to dry. The ivy raced up the drainpipes and found chinks in walls, while the tadpoles hurried into croaking frogs before their limbs were fully formed. No child I knew was ever tempted to turn its face to the sky and catch raindrops on the tongue, not when you lived and breathed water.

  Now that Shiva and I were teenagers, looking ahead to our fourteenth birthday, I kept expecting something to feel different. I tried to stay busy, but all I could think about was Genet and what she might be up to in Asmara. I hoped she was homebound, miserable, and missing me. Without Genet as a witness, nothing I did was meaningful.

  LATE ON A TUESDAY EVENING, I watched Ghosh in Operating Theater 3 as he removed a gallbladder. When he was done, we swung by the surgical ward to see Etien, a diplomat from Ivory Coast, a man we knew socially, who'd suddenly developed a bowel obstruction. In surgery, Ghosh had found an obstructing rectal cancer which he was forced to resect. It was a big and challenging operation, and I knew Ghosh was hopeful for a cure. But he was forced to create a colostomy on the belly wall. “Etien's very depressed,” Ghosh said. “Not about the cancer, but over his colostomy. He can't accept the idea of waste coming out from an opening in his abdomen.”

  Etien had the sheet over his head. When Ghosh examined him, and then said the colostomy looked beautiful, tears welled up in Etien's big eyes. He wouldn't look down there. All he said was “Who will marry me now?”

  Ghosh was surprisingly firm. “Etien, that's not the part of your body I cut off, the marrying part. You'll find a woman who loves you, and you'll explain it to her. If she loves you for yourself, you'll both be glad that you are alive.” Ghosh's facial expression brooked no argument, but then he softened. “Etien, imagine if all humans were born with their anus on the belly and that's where everyone's waste emerged. Then imagine if someone said they were going to operate on you and reroute your bowel so it opened behind you, between your buttock cheeks, somewhere where you couldn't see it except in a mirror, and where you could hardly reach it or easily keep it clean …” It took a few seconds, but then Etien smiled. He dabbed his eyes. He ventured a glance down at his colostomy. It was a small step in the right direction.

  Ghosh had one more patient to see. He told me to go on home so I wouldn't be late for dinner.

  The rain began to come down hard and I had no umbrella. I walked under the sheltered walkways connecting the theater to Casualty and Casualty to the male ward. Where the walkway ended, I dashed across a short gap, leaping over a puddle to arrive at the nurses’ quarters. I rarely explored this female warren. It looked deserted. If I went up the long outer balcony and down the stairs at the other end … well, I'd still get soaked, but I'd be fifty yards closer to home before I had to dash out into the rain. I hoped Adam's wife, the keeper of the virgins, with that big cross around her neck, didn't see me, because she would chase me out.

  Upstairs, the doors of the individual nurses’ rooms opened onto the shared veranda. They must have all been in the dining room, otherwise they would have been lined up against the veranda railing, teasing out their hair, painting their nails, sewing, and chatting.

  I heard music from the corner room that had once been my mother's. I'd been up here a few times, but just like her grave, this wasn't a place where I felt her presence. The strangeness of the music, the beat, were what pulled me closer. Guitars and drums in a driving rhythm repeated a musical refrain first in one register, then another. Of late some Ethiopian music adopted a Western sound, with horns, snare drums, and a repeating electric guitar riff that took the place of the muffled strings of the krar and the hand clapping. But this wasn't Ethiopian music, and not just because the words were English (albeit an English I couldn't quite understand). This was radically different, like a new color in the rainbow.

  The door was open a crack.

  She stood barefoot in the center of the room, her back to me. A white slip exposed her shoulders and ended at the back of her knees. Her head went from side to side, and her long, straight hair, conked with chemicals, followed as if welded to her skull. Her hips were driven by the bass line, while her upraised right hand kept the melody. Her left hand must have been pressed to her belly, because the elbow jutted out like the handle of a teacup. The music had entered her; it lubricated her joints, softened her bones and flesh to produce this gyrating, fluid, and sensual movement.

  She turned. Her eyes were closed and her face was tilted up. The lower lip was twisted, as if it had been split and had healed out of alignment.

  I knew that lip, that faintly pockmarked face, though now the pocks textured the skin and exaggerated her cheekbones. It was the body I didn't recognize. She'd been a student probationer forever, until Matron, taking pity on her, gave her a new title, Staff Probationer, which transformed her. From being on the long-term plan, a perpetual student, she became an instructor for incoming probationers. In the classroom, with textbooks that she knew by heart, she could both drive facts into the probationers’ heads and demonstrate that it was possible to keep them there, by the manner in which she regurgitated her material, never looking at the text.

  Normally she wore her hair pulled off her forehead and neck and gathered into a top bun so tight that it arched her eyebrows. When she crowned this with the winged nurse's cap, it looked as if she'd inverted an ice-cream cone on her head.

  Other than her precarious hairdo, I'd always thought of the Staff Probationer as plain. At school, I knew girls who were neither ugly nor beautiful but who saw themselves one way or the other, and that conviction made it come true. Heidi Enqvist was gorgeous, but alas not in her own eyes, and so she lacked the mystery and allure of Rita Vartanian, who despite her overbite and prominent nose managed to make Heidi envious.

  The probationer was of the Heidi mold. I think that's why she made herself a willing prisoner of a stiff, starched uniform and adopted an unsmiling expression to go with it. The only identity she had was that of being in the nursing profession; in her own eyes, and in the light of the world, she thought she was nobody. Id always felt the probationer's discomfort around us. But then she was shy around everybody.

  But I could see now that there was more to her than nursing. The uniform concealed a body full of curves, like the figures Shiva used to draw, and the body moved in ways that would have made a harem dancer jealous.

  Her eyes were closed. Were she to see me she'd be startled, embarrassed, and probably furious. I was about to step back when, to my surprise, she stepped forward and pulled me in by my hand, as if a phrase in the song was my cue. She kicked the door shut. The music was louder and more intense inside the room.

  She had me taking little steps in time to the beat, moving my body this way and that. I was embarrassed at first. I wanted to laugh or say something clever, the way an adult would. But her expression and the throbbing beat made me feel anything but dancing would have been like talking in church. My steps became effortless. I imitated her, my shoulders movin
g in the opposite direction from my hips. My hands drew figures in the air. The trick was not to think. My body felt segmented, and each segment answered the call of a particular instrument. The pattern of our steps felt inevitable.

  Just when I mastered that, she pulled me to her, my cheek against her neck, my chest against her breasts, separated from them by the thinnest of materials. I'd never danced before, certainly not like this. I breathed in her perfume and her sweat. She squeezed, taking my breath away, as if to make our two bodies one. She guided my arm so that it was around her, my hand over her sacrum, and I held her close. We never stopped moving. She led.

  I anticipated her every step, clueless as to where that knowledge came from. We spun, then surged this way, then that, like one organism. I thought of Genet. Emboldened, I led and she followed. I pressed against the soft flesh where her legs came together only because she pressed, too, grinding her hips into me. Blood surged to my face, to my arms, into my stomach, my groin. The world had fallen away. I was in an elaborate dialogue with her.

  The music wouldn't stop, and I never wanted it to stop, and just when I thought that, it faded. The American announcer's lazy drawl was so unlike the crisp formal tones of the BBC. “Well, well,” he said. “My, my. Umm, hmmm,” as if hed seen us carrying on. “Have you ever heard anything quite like that? This is the Rock of East Africa. East Africa's Big 14. Armed Forces Radio Service, Asmara.” It wasn't a station that I knew existed. I knew of a huge American military presence, a listening post, I'd heard it called, just outside of Asmara in Kagnew. Who knew they had something we could listen to?

  We were still pressed together, holding the world at bay. She gazed into my eyes, I didn't know if she was about to cry or laugh. All I knew was that I'd have cried with her, or laughed or got down on all fours and pretended to be Koochooloo if she asked.

  “You're so beautiful,” I said, surprising myself.