Cutting for Stone

by Abraham Verghese

  I don't remember anything about that day in school. Ghosh and Hema had no idea what had transpired, but they knew something had happened. The door and window to Rosina's quarters were closed, and they could hear Rosina carrying on in there in a loud voice.

  That evening Hema said there were three of Rosina's relatives— a woman and two men—visiting her. Hema pressed me as to what was going on. I couldn't believe that she didn't know or that Rosina didn't tell her. It appeared that no one was talking about what happened the previous night. I was sure Rosina would go to Hema and accuse me and I couldn't understand why so far she had not. Had Hema talked to Shiva, I suspect she would have found out everything. But no one thought to ask him.

  Shiva returned just as we were finishing dinner, pleased with his excursion to Akaki. Neither Genet nor Rosina was at the table. Almaz said that mother and daughter were having a big fight and that Rosina's relatives had come to mediate.

  Hema rose to go see what was happening, but Ghosh held her back. “Whatever it is, if you get in the middle it's only going to get more complicated.” Shiva said nothing, eating his food.

  I wasn't being noble by keeping quiet. I didn't think anyone would believe my side of the story. It was up to my brother or Genet to save me if they wanted to. I studied Shiva's face at the dining table. There was no sign that he was aware of the calamity he'd caused. No indication at all.

  That night I told Shiva I was moving to a room in Ghosh's old quarters. I was going to sleep and study there. I wanted to be alone there, I announced, not looking at him.

  He said nothing. It would be the first time in our lives that we did not occupy the same bed. If there were filaments and cords of yolk or flesh that kept our divided egg sticking together, I was taking a scalpel to them.

  Saturday morning, when I came over for breakfast, it seemed to me that Shiva hadn't slept any better than I had. After breakfast, he left for Farinachi's.

  I was about to go back to my room to study when Almaz burst into the dining room. “I think you better come, madam,” she said, addressing Hema.

  She led the charge to the servant's quarters; Hema, Ghosh, and I followed.

  Rosina sat in a corner of the darkened room, looking sullen, defensive yet anxious. Genet lay on her bed, her face pale, sweat beading on her forehead, her eyes open, but unfocused and dull. The room held a raw, sour odor of fever.

  “What happened here?” Hema asked, but Rosina wouldn't answer or meet Hema's gaze. Almaz turned on the light, and she moved to block my view, then lifted the blanket to show Hema.

  Ghosh said, “Open the window, Marion,” and he moved closer to look.

  “My God,” Hema said. Genet moaned in pain. Hema grabbed Rosina's shoulders. “Did you? Did you just … this poor girl?” Choking with fury, Hema shook her. But Rosina wouldn't look up. “You stupid woman!” Hema said. “Oh, God, God. Why?” Hema's eyes were those of a madwoman, uncomprehending, dangerous. I thought she might strangle Rosina. Instead, she pushed her away. “You've probably killed her, Rosina, do you know that?” There were tears coming down Rosina's chin, but her expression remained surly.

  Ghosh scooped Genet in his arms, and she let out an unearthly moan as he lifted her off the bed. “The car,” Ghosh said, and Almaz ran ahead to get the door. Hema followed. I lingered for a second in the doorway on the threshold of Genet's home. My nanny sat just the way she had when we came in. I thought of the day she'd taken a razor to scarify Genet's face and how her expression had been defiant, proud. But now, I saw shame and fear.

  As I ran to join them in the car, Hema spun on her heel and thrust her face in mine. “I think you had something to do with this, Marion. I'm not a fool!”

  She got in the car and slammed the door. They pulled away with Almaz cradling Genet in the back, Ghosh driving. I ran down our drive, cut behind the toolshed and across the field, and caught up with them as they took her into Casualty.

  They poured fluids and antibiotics into Genet's veins. Then Hema took her to Operating Theater 3 for a more careful examination. When Hema came out, she was shaken but more composed, and quietly furious. She didn't seem to care if I heard her report to Ghosh and Matron. “Can you imagine Rosina paid to slice off the child's clitoris? Not just clitoris but also the labia minora and then sew the edges together with sewing thread! Good God, can you imagine the pain? I cut the sutures out. It is hugely infected. Now it's up to God.”

  Genet was wheeled to the single room reserved for VIPs. I remembered Ghosh telling me it was the room that General Mebratu had occupied after emergency surgery, shortly after we were born.

  I sat on a chair by her bed. At one point, Genet squeezed my hand, whether consciously or reflexively I couldn't be sure. I held it.

  Hema sat across from me in an armchair, her elbows on her knees, head in her hands. We had nothing to say to each other. I was as angry with Hema as she was with me.

  At one point, Hema lifted her head up and said, “The people who did this should all go to jail.” It wasn't the first time she'd had to rescue a woman in Genet's situation. She was probably one of the world's experts in treating botched and infected female circumcisions. But now her face was clamped down in a bitterness I'd never seen before.

  It was evening when Genet opened her eyes. She saw me, and she tried to say something. I asked her if she wanted water, and she nodded. I guided a straw to her mouth. She looked around to see if there was anyone else in the room.

  “I'm sorry, Marion,” she whispered, her eyes swimming with tears.

  “Don't talk,” I said. “It's all right.” It wasn't, but that's what came to my mouth.

  “I … should have waited,” she said.

  Why didn't you, I wanted to say. I didn't get any of the pleasure, the honor of being your first lover, but I'm getting all the blame.

  She moaned when she tried to move, licking her lips. I gave her more water.

  “My mother thinks it was you.” Her voice was weak.

  I nodded, but said nothing.

  “When I told her it was Shiva,” Genet said, “she slapped me. She kicked me and called me a liar. She didn't believe me. She thinks Shiva is a virgin.” She tried to laugh, but grimaced and then coughed. When she could speak, she said, “Listen, I made my mother promise not to tell Hema.”

  I couldn't resist a sarcastic snicker. “Well, don't worry. She will tell Hema. She's probably telling her right now.”

  “No. She won't,” Genet said. “That was our deal.”

  “What do you mean?”

  “I agreed to let her do this to me, if she wouldn't … say anything. She's to keep quiet. Not a word to Hema. Not one word. And no more shouting at you.”

  I slumped back on hearing this. Genet allowed a strange woman to cut her privates with an unsterilized blade, and it was all to protect me? So now I was to blame for the circumcision? It was so absurd that I wanted to laugh, but I found I couldn't: the guilt had settled on me as if it knew that was its home and it would be welcome.

  Shiva came in the evening, his face pale and drawn. “Here, sit here,” I said before he could open his mouth. I didn't trust myself near him and I needed a break. “Stay with her till I come back. Hold her hand. She gets restless when I let go.” There was nothing else I could say to him, now. I was beyond anger, and he was beyond sorrow.

  GENET'S FEVER RAGED for three days. I sat by her bed day and night. Hema, Ghosh, and Matron were in and out all the time.

  On the third day, Genet stopped making any urine. Ghosh was very worried, drawing blood himself, then Shiva or I would run to the lab, help W.W. line up our reagents and tubes and measure the blood urea nitrogen level: high, and getting higher.

  Genet was never completely unconscious, just sleepy, confused at times, often moaning, and at one point horribly thirsty. She called for her mother once, but Rosina wasn't there. Almaz told me Rosina wouldn't leave her room, which was probably a good thing. The atmo sphere in the hospital room was tense enough without the prospect of Hem
a attacking Rosina.

  On the sixth day, Genet's kidneys began to produce urine, and then they produced it in huge amounts, filling up the catheter bag. Ghosh doubled and tripled her intravenous fluid rates, and encouraged her to drink to keep up with the loss. “Hopefully this means her kidneys are recovering,” Ghosh said. “They just aren't able to concentrate the urine too well.”

  One morning, when I woke up in the chair and saw her face, the texture of the skin, the relaxation around the brow, I knew she was going to make it. She was skinny to begin with, and now the illness had consumed her, burned her down to just bones. Her color was returning; the sword that hung over her had lifted away. My shoulders began to unknot.

  That afternoon I went to my room in Ghosh's quarters, and I fell into a black sleep. It was only when I woke up that I turned my attention to Shiva. Did he understand how he shattered my dreams? Did he see how he hurt Genet, hurt us all? I wanted to get through to him. The trouble was that I couldn't think of any other way than to pummel him with my fists until he felt the same degree of pain he had caused in me. I hated my brother. No one could stop me.

  No one but Genet.

  When she told me about her deal with Rosina, how she had agreed to be circumcised if Rosina said nothing to Hema, Genet hadn't finished what she had to say. Later that first night, she struggled to consciousness to ask something of me. She had made me swear to it. “Marion,” she said, “punish me, but not Shiva. Attack me and cast me away, but leave Shiva alone.”

  “Why? I can't do that. Why spare him? “

  “Marion, I made Shiva do what he did with me that night. I asked him.” Her words were like kidney punches. “You know how Shiva is different … how he thinks in another way? Believe me, if I hadn't asked him, he would have read his book and I wouldn't be here.”

  Reluctantly, on that first night, I had given Genet my word that I wouldn't confront Shiva. I did so mainly because that night had looked as if it might well have been her last.

  I never told Hema what had really happened, leaving her to imagine whatever it was she thought I had done.

  Why, you might ask, did I keep my word? Why did I not change my mind when I saw that Genet would survive? Why didn't I tell Hema the truth? You see, I'd learned something about myself and about Genet during her battle to stay alive. I'd come so close to losing her, and it helped me understand that despite everything, I didn't want her to die. I might never forgive her. But I still loved her.

  WHEN SHE WAS DISCHARGED from the hospital, I carried Genet from the car to the house. No one objected, and if they had I would have stood my ground. My unceasing vigil at Genet's bedside had earned a grudging acknowledgment from Hema; she didn't dare deny me.

  As I carried her daughter into our house through the kitchen, Rosina watched from her doorway. Genet never looked in that direction. It was as if her mother and the room in which she had lived her life no longer existed. Rosina stood there, beseeching with her eyes, pleading for forgiveness. But a child's ability for reprisal is infinite, and can last a lifetime.

  I carried Genet to our old room, Shiva's room, which would now be hers.

  The plan was that Shiva and I would sleep in Ghosh's old quarters, but separately, he in the living room.

  Half an hour later, when I went to get Genet's clothes from Rosina's quarters, she had locked herself in and wouldn't answer despite my knocking. I pushed on the wood in anger, and I could tell from the resistance that she'd barricaded the door or else she was leaning against it. A peculiar silence blanketed the atmosphere. I went to the window. The shutters were bolted, but now, with Almaz helping, I pulled on the flimsy slats till they snapped off. The wardrobe had been used to block the window. I scrambled onto the ledge and tried to shove the wardrobe aside with my hands, but I couldn't. I craned my neck to peer above it. What I saw made me set my back to the window frame, put both feet on the wardrobe, and topple it without a thought to its contents. It hit the ground with a terrific crash, the wood splintering, the mirror shattering, plates smashing. It brought everyone running.

  I could see clearly now. We all could see. Hema, Ghosh, Shiva were behind me, and even Genet, hearing the commotion, had dragged herself there.

  There is a mathematical precision to that scene as I remember it, but there are no angles in Carr's Geometry or any other text that quite describe the slant of that neck. And no pill in the pharmacopoeia that might erase the memory. Hanging from a rafter, her head tilted on her spine, her mouth open and the tongue looking as if it had been yanked out of her throat, was Rosina.

  CHAPTER 35

  One Fever from Another

  THE MOSSY STONE WALLS and the massive gate of Empress Menen School gave it the look of an ancient fortress. In her white socks, light blue blouse, dark blue skirt, and with no headbands, clips, or earrings, Genet was just one of the girls, blending in. Her only adornment was the St. Bridget's cross hanging from her neck. She didn't want to stand out. Her old vivacious self had died along with the corpse we took down from the rafter and buried in Gulele Cemetery.

  My new ritual was to come on Saturday evenings to see Genet. She was just up the hill from the palace where General Mebratu (with Zemui at his side) took hostages and tried to bring about a new order.

  Genet could have come home on weekends, but she said Missing evoked painful memories. She insisted she was happy at Empress Menen. The Indian teachers were strict but very good. Sheltered from society and from us, she worked very hard.

  We entered university together for our premedical course, and the following year we entered medical school. Now out of uniform and in regular clothes, her dress and manner remained reserved and subdued. Each time I went to visit Genet in the Mekane Yesus Hostel opposite the university, I'd pray that this would be the day when the locked door to her heart opened and I might see traces of the old Genet. She was appreciative for the tiffin carrier of food Almaz and Hema sent for her, but the barrier she put up around herself remained.

  I still loved her.

  I wished I didn't.

  We entered the Haile Selassie the First School of Medicine in 1974— only the third class to be admitted. Genet and I were paired as dissection partners on a cadaver, which was fortunate for her. Anyone else would have taken offense at her frequent absences and her failing to carry her load. I didn't think she was lazy. There was no good reason for this; something was brewing, and for once I had no clue.

  OUR BASIC SCIENCE TEACHERS were very good, a mix of British and Swiss professors and a few Ethiopian physicians who graduated from the American University of Beirut and then took postgraduate training in England or America. There was one Indian: our own Ghosh. Ghosh had a title: not Assistant Professor, or Associate Professor, or Clinical Associate Professor (implying an honorary, unpaid designation), but Professor of Medicine and Adjunct Professor of Surgery.

  I don't think any of us, not even Hema, realized the extent of Ghosh's scholarship during his twenty-eight years in Ethiopia. But Sir Ian Hill, dean of the new medical school, certainly did. Ghosh had forty-one published papers and a textbook chapter to his name. An initial interest in sexually transmitted illness had given way to major scholarship on relapsing fever, for which he was the world's expert, because the louse-borne variety of this disease was endemic to Ethiopia, and because no living person had observed the disease as closely.

  I learned about relapsing fever as a schoolboy when Ali of the souk opposite Missing brought his brother, Saleem, to the hospital and asked me to intercede. Saleem burned with fever and was delirious. Ghosh said later that Saleem's story was typical: He'd arrived in Addis Ababa from his village with his life's belongings in a cloth strung over his shoulder. Ali found his brother a toehold in the seething, swarming docks of the Merkato, where, monsoon or not, he hauled sacks off the trucks and into the godowns. At night he slept cheek by jowl with ten others in a flophouse. In the rainy season, there was little opportunity to wash clothes because they would take days to dry. Saleem's living conditio
ns were unfit for humans, but ideal for lice. While scratching his skin he must have crushed a louse, its blood entering his body through the scratch. Coming from the village, he had no immunity to this urban disease.

  In Casualty, Saleem lay on the ground too weak to sit or stand, semiconscious. Adam, our one-eyed compounder, bent over the patient, and with one swift move made the diagnosis.

  Years later Ghosh showed me the correspondence he had with the editor of the New England Journal of Medicine, who was about to publish Ghosh's seminal series of cases of relapsing fever. The editor felt “Adam's sign” was pretentious. Ghosh defended the honor of his uneducated compounder at the risk of not being published in that prestigious journal.

  Dear Dr. Giles,

  … in Ethiopia we classify hernias as “below the knee” and “above the knee,” not “direct” or “indirect.” It's another order of magnitude, sir. Our casualty room often has as many as five patients prostrate on the floor with fever. The clinician asks: Is this malaria? Is it typhoid? Or is it relapsing fever? There is no rash to help sort this out (the “rose spots” of typhoid are invisible in our population), though I will grant you that typhoid causes a bronchitis and a slow pulse, and people with malaria often have giant spleens. I would be remiss in publishing a paper on relapsing fever without providing the clinician a practical way to make the diagnosis, particularly in settings where blood and serum tests are hard to come by. The clinician has only to grab the patient's thigh, squeeze the quadriceps muscle, squeeze it hard: Patients with relapsing fever will jump up because of the otherwise silent muscle inflammation and tenderness that is part of this disease. Not only is this a good diagnostic sign, but it can raise Lazarus. This sign was first noted by Adam, and is deserving of the eponym “Adam's sign.”

  I could testify to Adam's sign—Saleem yelled and leaped to his feet when Adam mashed. The editor wrote back. He was pleased with all the other revisions but Adam's sign remained a sticking point. Ghosh held his ground.