Cutting for Stone

by Abraham Verghese

  On the back of the bookmark was written:

  My mother had penned this note a day before our birth and her death. Her clear writing, the even letters, retained a schoolgirl's innocence. How long had Shiva posessed the book and bookmark? Why give it to me? Was it so that I'd have something from my mother?

  To get in shape, I'd pace around the house, hauling the bag with books on my shoulder. I read Stone's textbook during those two weeks. At first I resisted it, telling myself it was dated. But he had a way of conveying his surgical experience in the context of scientific principles that made it quite readable. I studied the bookmark often, rereading my mother's words. What was in the letter she had left for Stone? What would she have been saying to him just one day before we, her identical twin boys, would arrive? I copied her writing, imitating the loops.

  One day when Luke brought my food, he said we'd leave that night. I packed one last time. The two books had to go with me; I couldn't abandon either one, though my Air India bag was still very heavy.

  We set out after curfew. “That's why we waited,” Luke said, pointing skyward. “When there's no moon it is safer.”

  He led me down narrow paths between houses, and then along irrigation ditches, and soon we were away from the residential areas. We crossed fields in the pitch-dark. I sensed hills in the distance. Within an hour, my shoulder hurt from the bag, even though I positioned it in different ways. Luke insisted on transferring some items from my bag to his knapsack. He looked shocked at the sight of the books, but said nothing. He took the Gray's.

  We walked for hours, stopping only once. At last, we were in the foothills, climbing. At four-thirty in the morning, we heard a soft whistle. We met up with a troop of eleven fighters. They greeted us in their trademark fashion: shaking hands while bumping shoulders back and forth, saying, “Kamela-hai” or “Salaam.” There were four women, sporting Afros just like the men. I was shocked to recognize one of the fighters: it was the firebrand, the student with the bovine eyes whom I had encountered in Genet's hostel room. On that occasion hed stormed out contemptuously. Now, recognizing me, he sported a lopsided grin. He shook my hand with both his. His name was Tsahai.

  The fighters were exhausted, but uncomplaining, their legs white with dust. They carried a heavy gun which they had dismantled into several large pieces.

  Tsahai brought something over to me. “High-protein field bread,” he said. It was a ration which was of the fighters’ own invention, but it tasted like cardboard. He rubbed his right knee as he spoke, and it looked to me as if it was swollen with fluid. If it was sore, he said nothing about it.

  We avoided the topic of Genet. Instead he described how earlier that night they'd ambushed an Ethiopian army convoy as it tried a rare night patrol. “Their soldiers are scared of the dark. They don't want to fight and they don't want to be here. Morale is terrible. When we shot the lead vehicle, the soldiers jumped out, forgetting to shoot, just running for cover. We had the high ground on both sides. Right away they screamed that they were surrendering, even though their officer was ordering them to keep fighting. We took their uniforms and sent them on foot back to the garrison.”

  Tsahai and his comrades had siphoned gas from the trucks, then hid the one working vehicle in the bush, stuffed with uniforms, ammunition, and weapons to be retrieved at another time. The real prize was the heavy gun and shells which they brought with them, everything carried on foot.

  WE SET OFF after fifteen minutes. Before daybreak we reached a well-hidden, tiny bunker carved out of the side of a hill. I didn't think I was capable of walking as far as I had. It helped that my fellow walkers carried five times my load without complaint.

  Luke and I stayed in the bunker. The others hurried on to a forward position, risking daylight and being spotted by the roaming MiG fighters because there was some urgency to reassemble the gun.

  I slept until Luke woke me. My legs felt as if a wall had collapsed on them. “Take this,” he said, giving me two pills and a tin mug of tea. “It's our own painkiller, paracetamol, manufactured in our pharmacy.”

  I was too tired to do anything but swallow. He made me eat some more of the bread, and I slept again. I awoke with less pain, but so stiff I could hardly get off the floor. I took two more of the paracetamol pills.

  Five fighters arrived to escort us onward when it turned dark. One of them had a partially withered leg: polio, I knew. Seeing his swinging, awkward gait, his gun serving as a counterbalance, made it impossible for me to think of my own discomfort.

  The second march was half as long as the first, and gradually my legs loosened. We arrived long before dawn at some scruffy hills. A narrow trail led to a cave, its entrance completely hidden by brush and by natural rock. Wooden logs framed the opening. A steep wooden ramp went down to more rooms, deep within. The trail on the outside led to other caves up and down the hill, all the openings cleverly concealed.

  I was taken inside to a stall. I removed my shoes, and fell asleep on a straw pallet. It felt luxurious. I slept till late afternoon. Luke walked me around. I was stiff again, but he seemed fine. The base was empty of fighters because of a major operation going on elsewhere.

  I suppose I should have admired these fighters, who could flit through the dust like sandflies. I should've admired their resourcefulness, their ability to manufacture their own intravenous fluid, their own sulfa, penicillin, and paracetamol tablets stamped out by a handpress. Hidden in these caves and invisible from the air or ground was an operating theater, a prosthetic limb center, hospital wards, and a school. The degree of sophistication in those surroundings was even more impressive for being so spartan. The quiet discipline, the recognition that the tasks of cooking, caring for children, sweeping the floors were as important as any other, convinced me that they would one day prevail and have their freedom.

  I watched a fighter relaxing outside the bunker. The sun filtering through the acacia tree formed a changing mosaic of light on her face and on the rifle across her lap. She hummed to herself as she scanned the skies with binoculars, looking for MiGs, which were flown by the Rus sian or Cuban “advisers” to Ethiopia. America had long supported the Emperor, but it withdrew its support of Sergeant-President Mengistu's regime, halting weapons and parts sales. The Eastern Bloc stepped in to fill the void.

  The fighter, who was about our age, reminded me of Genet in the way she arranged her limbs, in the ease with which she occupied her body. Despite the lethal weapon in her hand, her movements were delicate. She wore no makeup, and her feet were dusty and callous. Seeing her I was grateful for one thing: my Genet dream was gone forever and good riddance. Id been so stupid to sustain a one-sided fantasy for so long. The honeymoon in Udaipur, our own little bungalow at Missing, raising our babies, setting off to the hospital in the morning, doctors working side by side … It would never happen. I never wanted to see her again. And I probably never would. She was surely in Khartoum, still basking in the glory of her daring operation. There was no going back to Addis for her either. Soon she would join these fighters, live in these bunkers, and fight alongside them. I hoped I would be long gone by then. I resented having to be in their camp at all, even more having to turn to her comrades for help.

  That night I woke to the sounds of MiGs overhead and bombs dropping far away, but close enough for us to hear the rumble. Also the fainter thuds of artillery. No lights were allowed anywhere near the mouth of the cave.

  Luke said that a massive raid had just been completed on a weapons and fuel depot. It had included Tsahai and the group of fighters we met on the first night. They had penetrated using a stolen army truck. Once inside, they set charges, but their comrades outside had been surprised by a reinforcement convoy that attacked them from the rear. It had not gone exactly as planned. Nine guerrillas including Tsahai were dead and many more wounded. The Ethiopians’ losses were much larger and the fuel depot partially destroyed. Our casualties would arrive at the cave by early morning.

  I woke to voices, the
activity and urgency unmistakable. I heard moans and sharp cries of pain. Luke took me to the surgical ward.

  “Hello, Marion,” a voice said. I turned to see Solomon, whod been my senior in medical school. Hed gone underground as soon as he finished his internship. I remembered him as a chubby, well-fed intern. The man before me had hollow cheeks and was as lean as a stick.

  I followed Solomon, stooping down in a low-ceilinged tunnel where stretchers were arranged in pairs on the floor, triaged so that those most in need of surgery were closest to the operating theater at the end of the tunnel. The entrance to the theater was a cloth curtain.

  The wounds were ghastly. One barely conscious man whispered last instructions into the ear of a friend, who hovered over him, writing furiously. Intravenous fluid and blood bottles dangled from hooks embedded in the cave walls. The attendants worked squatting next to the stretchers.

  Solomon said hed gone close to the battlefront for this mission. “Usually I stay here. We resuscitate at the battlefield. Intravenous fluid, control bleeding, antibiotics, even some field surgery. We can prevent shock just like the Americans in Vietnam. Only we don't have their heli copters.” He slapped his thighs. “These are our helicopters. We carry our wounded by stretcher.” He scanned the room. “That man over there needs a chest tube,” he said, indicating with his head. “Please do it. Tumsghi will help you. I'll go ahead to the theater. That comrade cannot wait.” He pointed to a pale soldier lying near the curtain with a bloody pad over his abdomen. He was conscious, but barely, breathing rapidly.

  The fighter who needed the chest tube whispered “Salaam” when I squatted by him. The bullet had entered his triceps, then his chest, and miraculously missed the great vessels, the heart, and the spine. When I tapped with my bunched fingers above his right nipple it was dull, quite unlike the boxy, resonant note on the left. Blood had collected around the lung in the pleural space, compressing the right lung against the left lung and the heart in the confined cavity of the chest. Working just behind his right armpit, I injected lidocaine and anesthetized the skin, then the edge of the rib and deeper into the pleura, before making an inch-long cut with a scalpel. I pushed a closed hemostat into my incision till I felt it pop through the resistance of the pleura. I put my gloved finger into the hole, sweeping around to ensure space for the chest tube—a rubber hose with openings at side and tip—which I fed into the hole. Tumsghi connected the other end to a drainage bottle with water in it, so that the tube emerged under the water level. This crude underwater seal prevented air going back into the chest. Already dark blood was emerging, and the soldier's breathing improved. He said something in Tigrinya and pulled off his oxygen. Tumsghi said, “He wants you to give his oxygen to someone else.”

  I joined Solomon in the operating theater in time to see his patient come off the table. The man's chest didn't move. There was about a five-second silence. One of the women, fighting back tears, knelt and covered his face.

  “Some things are beyond us,” Solomon said quietly. “He had a laceration to the liver. I tried mattress sutures. But he also had a tear to the inferior vena cava where it goes behind the liver. It kept oozing. I couldn't stop it unless I clamped the inferior vena cava, which would kill him. You remember Professor Asrat used to say that injuries to the vena cava behind the liver are when the surgeon sees God? He used to say things like that that I didn't understand. I understand now.”

  The next patient had a belly wound. Solomon systematically sorted out what to me looked like an impossible and dirty mess. He pulled out the small bowel, identified several perforations which he oversewed. The spleen was ruptured and so this was removed. The sigmoid colon had a ragged tear. He cut out the segment, and then brought the two open ends to the skin in a double-barrel colostomy We irrigated the abdomen vigorously, left drains in place, and did a sponge count. The field looked so neat compared with its condition when we started. Solomon must have read my mind. He held up his hands to show me his stubby fingers and his hammer thumbs: “I wanted to be a psychiatrist.” Over the eight hours, that was the only time I saw him smile behind the mask.

  We amputated five limbs. The last two procedures we performed were burr holes in the skulls of two comatose patients. We used a modified carpenter's drill. In the first we were rewarded by blood welling out from just under the dura where it had collected, pressing on the brain. The other patient was agonal, his pupils fixed and dilated. The burr hole produced nothing. The bleeding was deep inside the brain.

  Two days later, I took leave of Solomon. There were dark rings under his eyes and he looked ready to fall over. There was no questioning his purpose or dedication. Solomon said, “Go and good luck to you. This isn't your fight. I'd go if I were in your shoes. Tell the world about us.”

  This isn't your fight. I thought about that as I trekked to the border with two escorts. What did Solomon mean? Did he see me as being on the Ethiopian side, on the side of the occupiers? No, I think he saw me as an expatriate, someone without a stake in this war. Despite being born in the same compound as Genet, despite speaking Amharic like a native, and going to medical school with him, to Solomon I was a ferengi— a foreigner. Perhaps he was right, even though I was loath to admit it. If I were a patriotic Ethiopian, would I not have gone underground and joined the royalists, or others who were trying to topple Sergeant Men-g istu? If I cared about my country, shouldn't I have been willing to die for it?

  We crossed the Sudan border by early evening. I took a bus to Port Sudan, and then Sudan Airways to Khartoum. In Khartoum I was able to call a number Adid had provided to let Hema know I was safe. Two days in sweltering Khartoum felt like two years, but at last I flew to Kenya.

  IN NAIROBI, Mr. Eli Harris, whose Houston church had been the pillar of Missing's support for years, had arranged room for me at a mission clinic. Matron and Harris had made these arrangements by cable. I found the work in the small outpatient clinic difficult, as I was certain that many things were getting lost in translation. In my free time, I studied for the exams that I had to take to begin postgraduate training in America.

  Nairobi was lush and green like Addis Ababa, the grass pushing up between pavement tiles as if the jungle seethed underneath the city ready to take over. Nairobi's infrastructure and sophistication dwarfed that of Addis. One could thank the years of British rule for that, and, though Kenya was independent, many Brits lived on there. And Indians: in some parts of Nairobi you could imagine you were in Baroda or Ahmedabad with sari emporiums ten to a street, chat shops everywhere, the pungent scent of masala in the air, and Gujarati the only language spoken.

  At first I spent my evenings in the bars, drowning my sorrows and listening to benga music and soukous. The jazzy Congolese and Brazilian rhythms were uplifting, full of optimism, but when I retired to my room, afloat in beer, my melancholia was always worse. Other than the music, Kenyan culture made no impact on me. The fault was mine. I resisted the place. Thomas Stone had come to Nairobi when he fled Ethiopia with his demons chasing him. It was another reason I was disinclined to stay.

  I called Hema on a schedule, dialing different friends’ houses every Tuesday night. Things were no better, she said. Were I to come back, I'd still be in danger.

  So I stayed in my room and studied every waking minute. I passed the American medical equivalency exams two months later, and immediately presented myself to the American Embassy for my visa. Again, Harris had eased my way.

  I was righteous: if my country was willing to torture me on suspicion, if it didn't want my services as a physician, then I disowned my country. But the truth is that by this time I knew that I wouldn't return to Ethiopia, even if things were suddenly rosy again.

  I wanted out of Africa.

  I began to think that Genet had done me a favor after all.

  PART FOUR

  The intellect of man is forced to choose perfection of the life, or of the work, And if it take the second must refuse A heavenly mansion, raging in the dark.

 
William Yeats, “The Choice”

  CHAPTER 38

  Welcome Wagon

  CAPTAIN GETACHEW SELASSIE—no relation to the Emperor— piloted the East African Airways 707 that flew me out of Nai robi. I heard his calm voice twice during the abbreviated night. I had a new respect for his line of work, which brought him closer to God than any cleric. He was the first of three pilots who carried me through nine time zones.

  Rome.

  London.

  New York.

  THE RITUAL OF IMMIGRATION and baggage claim at Kennedy Airport went by so quickly that I wondered if I'd missed it. Where were the armed soldiers? The dogs? The long lines? The body searches? Where were the tables where your luggage was laid open and a knife taken to the lining? I passed into marbled hallways, up and then down escalators and into a cavernous receiving area which, even with two planes disgorging passengers, looked half empty. There was no one to herd us from one spot to the next.

  Before I knew it, I was out of the sterile, hushed incubator of Customs. The automatic doors swished shut behind me as if to seal out the contamination of the cacophonous crowd outside, held back by a metal barrier.

  A Ghanaian woman, whose flowered gown and headcloth had made her look so regal when she boarded in Nairobi, walked out from Customs beside me. We were both exhausted, dazed, unprepared for the sea of faces scrutinizing us. We stood there, manila X-ray folders (a requirement for immigration which no one checked) clutched awkwardly, baggage straps crisscrossing our chests, wide-eyed like animals coming off the Ark.

  What struck me first was that the locals were of all colors and shapes, not the sea of white faces I had expected. Their lewd, inquisitive gazes traveled over us. In the cross fire of bewildering new scents, I picked up the Ghanaian woman's fear. She pressed close to me. Men in black suits held up signs on which they had printed names. Their gazes were flat, like overseers taking the measure of the Ghanaian woman's pelvis, noting the gap between her first and second toe which everyone knows is the only reliable gauge of fecundity. I had a vision of the Middle Passage, of blacks shuffling down the gangplank, shackles clinking while a hundred pairs of eyes probed their flanks, their biceps, and studied the exposed flesh for yaws, which was the Old World syphilis. As for me, I was nobody, her eunuch. She dropped her bag, she was so rattled.