Cutting for Stone

by Abraham Verghese

  “It's quite simple, Grogan,” Braithwaite said. “All you have to do is know your anatomy inside out, never leave the hospital, and prefer surgery over sleep, women, and grog.” Grogan became a pathologist, famous as a teacher in his own right, and famous for his extraordinary girth.

  During the war, Thomas was commissioned. He traveled with Braith waite to a field hospital in Europe. In 1946, he returned to Scotland, became a junior registrar, then a senior registrar. He'd skipped a real childhood and gone directly to doctorhood.

  Ross came to Scotland on a rare visit. He told Thomas how proud he was of him. “You're my consolation for never having married. That wasn't by choice, by the way—not being married. ‘Perfection of the life or of the work’—I could only do the one. I hope you don't make that mistake.”

  Ross planned to retire near the sanatorium, to play rummy at the Ooty Club every night, to catch up on a lifetime of reading, and to learn to play golf with the retired officers who lived there. But just as he did, a cancer made itself known in Ross's good lung. Thomas returned to India at once. He stayed with Ross for the next six months, during which time the cancer spread to his brain. Ross died peacefully, Thomas at his side, the faithful Muthu, old and gray, on the other side, with the many nurses and attenders who had worked with Ross holding vigil.

  The funeral brought Europeans and Indians from as far away as Bombay and Calcutta to pay tribute. Ross was buried in the same cemetery where many of his patients rested. “They are heroes, one and all, all those who sleep in this cemetery,” said the Reverend Duncan at the graveside service. “But no greater hero, and no humbler a man, and no better servant of God is buried here than George Edwin Ross.”

  THOMAS TOOK AN APPOINTMENT as a consultant surgeon in the Government General Hospital, Madras. But after independence in 1947, things were not the same. Indians now ran the Indian Medical Service, and they were not excited by Englishmen who wanted to stay on, though many did. Thomas knew he had to leave; if it had ever been his land, it no longer was. And that was how, in response to a notice from Matron in the Lancet, he made his voyage on the Calangute to Aden. It was on that ship that Sister Mary Joseph Praise literally fell into his arms and entered his life.

  Thomas Stone believed there existed within him the seeds for harshness, for betrayal, for selfishness, and for violence—after all, he was his father's son. He believed the only virtues passed down to him were the virtues of his profession, and they came through books and by apprenticeship. The only suffering that interested him was that of the flesh. For the heartache and the grief of his own loss, he had found the cure and he'd found it by himself. Ross had it wrong, or so Thomas thought: perfection of the life came from perfection of the work. Thomas stumbled on an address by Sir William Osler to graduating medical students in which the man articulated this very thesis:

  The master-word is Work, a little one, as I have said, but fraught with momentous sequences if you can but write it on the tablets of your hearts, and bind it upon your foreheads.

  “The master-word is Work.” Stone bound it to his forehead. He wrote it on the tablet of his heart. He woke to it and fought sleep for it. Work was his meat, his drink, his wife, his child, his politics, his religion. He thought work was his salvation, until the day he found himself seated in Our Lady of Perpetual Succour, in the room of a child he had abandoned; only then did he admit to his son how completely work had failed him.

  CHAPTER 46

  Room with a View

  HE STOPPED TALKING at this point. In the silence that followed, it seemed to me he was debating what to tell me next. When he resumed, I thought at first that he had leapfrogged over his years at Missing, dismissed the existence of my mother, and I nearly said something rude to interrupt him, but I'm glad I didn't, because what followed was all about her …

  THE OAKS AND MAPLES outside the window of his room are wild men with their heads on fire. He shuts his eyes, but the view inside his eyelids is the same nightmare. His nerves are lancinating cables under his skin that send jolts of electricity to his muscles. He is so tremulous that when he brings a glass of water to his lips, he has spilled most of it before he can take a sip. He pukes his insides out, till he imagines the lining of his stomach is smooth and shiny like a copper pot. But the impulse to run is gone. He has put one or perhaps two oceans between him and the place he flees.

  Eli Harris and another man, a doctor perhaps, judging by his detachment, leave him tincture of paregoric in a tiny bottle by the bedside. Thomas fails to see it at first, imagining that the peculiar scent of aniseed and camphor is a hallucination. But once he spies the bottle he drinks it as if it holds redemption. The antiseptic odor fills the room, and then it comes off his breath. It is the tiny amount of opium in paregoric that gives him some ease, or so he tells himself. Surely it isn't the alcohol base of the tincture. He is done with alcohol.

  The only two women he has ever loved have died, and though one death occurred years before the other, they became superimposed in his brain. It made him lose his mind. He fled. He ran without knowing where to or what from. He has now run far enough. He has no memory of how he arrived in New Jersey from Kenya, except that he has a benefactor, Eli Harris.

  A week passes, measured not in days, but in cold sweats and night terrors. It is two weeks before the agitation and the shakes ease, and before the ugly little invertebrates begin a retreat. For so long they have been on his skin and on the edge of his sheets, scurrying to the periphery of his vision when he turns to look at them. Now they retreat to the chitinous underworld from where they came.

  There is bread and cheese by his bed, sitting on a newspaper that is two days old. The paregoric bottle is empty. A pitcher of water has been refilled. When at last he feels it safe to take his chair to the window, the leaves have gone from carrot to brick to crimson and every hue in between, a palette beyond the imagination of any painter. He sits there like a statue, grateful for being able to sit, to see things for what they are. Leaves spiral down, each descent unique and never to be repeated. A million voyagers leave their invisible trails in the air.

  One morning he is steady enough to go downstairs. A sparrow hops on the warped wood of the porch, the varnish flaking under its feet. Stone sees the ginger kitten inching forward from the wisteria, its shoulder blades gliding like pistons under its fur. He wonders if he is hallucinating. The kitten's unblinking eyes are locked on its prey. The bird tilts its head like a coquettish woman to regard man and beast.

  Just when Thomas thinks the tension is unbearable, the kitten pounces, but the sparrow hops easily to the railing and out of reach. Thomas feels something crack inside, releasing him from the torpor that stifled his movements and slowed his thoughts. He has emerged to a world where a sparrow's fate and that of a man can be decided in the blink of a cat's eye, such is the true measure of time.

  HE KNOWS THE CEILING in his bedroom better than he knows his body. He has studied the molding. The decorative grooves are even in depth and width. He sees the handiwork of a craftsman. A clumsy amateur later subdivided the house with plywood partitions and with prefabricated doors. But the master's imprint is there to see.

  At first he credits the paregoric for the curious phenomenon, but it continues after the paregoric is long gone: like a cinema projectionist he watches his life play out on the screen of the blank ceiling, or sometimes in the light playing on his window. He cannot control the content or order of the reels. What he can do is observe dispassionately, separate emotions from event, and judge the actor who plays him.

  AN EARLY WINTER STORM comes over Ocean City and reaches inland by afternoon, first with freezing rain, crackling on the window, and then snow so heavy that when he stands outside it weighs down his eyelashes. It blankets northern New Jersey, five to six inches in as many hours. It shuts down interstates, airports, schools, and all commerce, but he knows nothing of this as he retreats to his room. Ice forms around the edges of his window, leaving a narrow prism through which to look on
to a still and ghostly world. It is on this evening that he witnesses a scene from his life which makes him want to end it. He is seated on his bed, staring through that narrow breach in the frosted window. His mind is motionless and hushed like the landscape outside. The only thing that stirs is the ebb and flow of his breath, but even that seems to cease.

  Then suddenly, he feels a quickening, as if the wearing away of brain cells has unroofed a lacuna of memory.

  What spews out that winter's night is a vivid, colorful, and specific memory of Sister Mary Joseph Praise.

  He is simply the observer, a man watching a bird, unaware of the feral cat lurking in the wisteria. This is what he sees, what he remembers:

  Addis Ababa.

  Missing Hospital.

  Work.

  He sees himself in the rhythm of operating, of clinics, of writing, forcing himself to sleep, his days full and satisfying. The weeks and months roll by. The master word. Work. And suddenly the machinery seizes …

  (He thinks of this as his “Missing Period.” He prefers that to “breakdown.”)

  It always begins the same way. He wakes from sleep in his quarters at Missing, wakes in terror, unable to breathe, as if he is about to die, as if the next breath will trigger the explosion. Though he is awake, the tentacles of dream and nightmare won't let go. A terrifying spatial distortion is the hallmark of this state. His bedroom in his quarters begins to shrink. His pen, the doorknob, his pillow—ordinary objects that normally do not merit a second glance—balloon in size. They become colossal and threaten to impale him, to suffocate him. He has no control over this state. He cannot turn it off by sitting up or moving around. He becomes neither child nor man, does not know where he is, or what scene he is reliving, but he is terrified.

  Alcohol is not the antidote. It does not break the spell, yet it dulls the terror. It comes with a price: instead of straddling the line between wakefulness and nightmare, he crosses over. He roams in a world of familiar objects turned into symbols; he traipses through scenes of his childhood and through hell's portals. He hears a nonstop dialogue, like cricket commentary on the radio. That is the backdrop to these night terrors in Ethiopia. The commentator's voice is indistinct—sometimes it sounds like his own voice. As he drinks, he loses his fear but not his sorrow. He who has no tears in his waking now weeps like a child. He sees Ghosh—probably the real Ghosh, not a dream figure—standing before him, concerned, the Ghosh lips moving but the words drowned out by the commentator.

  Then she is there. He cannot hear her words, but her presence is reassuring, and ultimately, only she stays, only she keeps vigil. She must have been asleep when she was summoned, because she wears a head scarf and a dressing gown. She holds him to her when a new wave of tears appears, and she cries with him, trying to rescue him from his nightmare but, in the process, she gets sucked in. (Every time he recalls this, there is a stirring in him.) In their work together, they share an intimacy that involves the body of another who lays between them, unconscious, naked, and exposed. But this weeping in her arms is shockingly different from their gowned forearms brushing or heads bumping during surgery. Separated as they are by an operating table for so many hours a day, when she holds him, the absence of the table, or of the mask, or the gloves, is startling. He feels like a newborn placed against its mother's naked belly. She whispers in his ear. What does she say? How he wishes he could remember. It sounds improvised, not a formal prayer. It succeeds in blunting the commentator's voice.

  He remembers her blouse, damp with his tears—no, both their tears.

  He remembers clinging to her, pressing his face to her bosom, sleeping, waking, clinging, weeping, sleeping again. She asks again and again, What is it? What is it that has come over you? For hours, days, who knows how long, she stays with him as he holds on for dear life, the storm raging, battering him, trying to pry him out of her grasp.

  He remembers a lull, a startling silence which is a change in the pattern. Her blouse has opened.

  Like a surgeon working to develop a tissue plane under the incision, he wills the blouse to open farther, and perhaps his nose, his cheeks, help it along. Her nipples stir from the coins on which they lie, and now her breasts escape her blouse to meet his lips. Her face must be a mirror of his because what he sees in it is fear coupled with desire.

  She hovers over him, naked, her breasts full and reassuring, tears of relief on both their faces, their kisses devouring each other to make up for time lost. Then he is above her, and she looks up at him as if he is the Savior. When he enters her, he is anchoring himself to her goodness, a goodness and innocence he lost so young, from which he has drifted away, and which he vows never to let go …

  Sitting on his bed in his New Jersey exile, the world outside muted in a canopy of snow, his heart is racing, a dangerous tachycardia, his shirt soaked with sweat despite the cold. There is a dull ache under his breastbone. How he wishes that he could recall the exact feel of her lips, of her breasts.

  But he recalls this (and he prays it is a true image):

  He recalls how he loses himself in her, pulling her like a soft lamb coat over him. She settles on him, smothers him like nightfall over a meadow. In their coming together they thwart the demons, his and hers, and when his cry of release comes it punctuates her soft exclamations. Order is restored. Proportion returns. Sleep comes as a blessing.

  HIS CURSE IS THIS (and he weeps in New Jersey at the recollection, he beats his head with his hand): when he wakes from his Missing Period, he senses only a perturbation in space, a gap in time, a deep embarrassment and shame, the reason for which he cannot recall, but which he can only heal by throwing himself into his work anew. He has blocked out what came before.

  How cruel it is that this memory should surface in a winter storm so long after she is dead. How cruel to have this fleeting, fragmented vision, seen through an ice-crusted window, then to wonder if it is real, or if it is the perturbation of a brain undone by alcohol. He has reassembled the memory like a shattered relic, and it is finally whole; and still he has doubts. He will never see her more clearly than that night at 529 Maple. When he recalls it in later years, he will wonder if he is distorting it, embellishing it, because each time he consciously recalls her, thatforms a new memory, a new imprint to be stacked on top of the previous one. He fears that too much handling will make it crumble.

  “You saved my life,” he says aloud to Sister Mary Joseph Praise, seated on his small bed in New Jersey “And my stupidity, my indecision, my panic, caused you to lose yours.” Though it is much too late to say it to her, he knows it must be said, and though he is a nonbeliever, he hopes that somehow she is listening. “I cannot love any human being more than I love you.” What he cannot bring himself to mention is the children; he feels he can do even less for them than he can do for Sister Mary Joseph Praise; they exist, two boys, twins, he knows, he remembers, in a universe even more removed than the one in which Sister resides.

  But it is too late to say all this to Sister Mary Joseph Praise. Even this memory of her, beautiful and erotic, cannot arouse him or fill him with joy. Instead, when he sees her nakedness, his engorgement, the miscibil-ity of their parts, what he feels is a violent jealousy, as if another person occupies his naked body and straddles the woman he loves, an illusion des soises—That is me, but it is not me. His thrusting body, the dark triangles of his shoulder blades, the hollows and dimples of the low back, only foretell death and destruction. They are an augury to a terrible end because this carnal pleasure will doom Mary, though she does not know it as yet, but he, watching the scene, does. His punishment is even worse: he must live.

  CHAPTER 47

  Missing Letters

  THOMAS STONE STAYED IN MY ROOM past midnight. At some point he became one with the dark shadows, his voice filling my space as if no other words had ever been spoken there. I didn't interrupt him. I forgot he was there. I was inhabiting his story, lighting a candle in St. Mary's Church in Fort St. George, Madras, holding my ow
n in an English boarding school, seeing how an unroofing of memory might lead to a vision of Mary. And if visions could happen in Fatima and Lourdes and Guadalupe, who was I to doubt that a secular vision of my mother had not appeared to him in a frost-rimmed rooming house window, just as I had seen and felt her in the autoclave room as a young boy? His voice walked me into a past that preceded my birth, but it was still mine as much as the color of my eyes or the length of my index finger.

  I became conscious of Thomas Stone only when he was done; I saw a man under the spell of his own tale, a snake charmer whose serpent has become his turban. The silence afterward was terrible.

  THOMAS STONE SAVED our surgery program.

  He did it by making Our Lady of Perpetual Succour an affiliate of Mecca in Boston. All it took was his affixing his signature to a letter saying it was so. But Our Lady of Perpetual Succour was no mere paper affiliate of Mecca. Each month, four medical students and two surgical residents came down from Mecca to do a rotation with us. “A safari to see the natives killing each other, and to catch a few Broadway shows,” is how B. C. Gandhi put it when he heard about the plan. But each of us also had opportunities to do specialty rotations up in Boston.

  I finished my internship and began my second year of residency. The most important result of our affiliation with Mecca was that it allowed Deepak, the Wandering Jew of surgery (as B.C. referred to him), to finish. He was now a board-certified surgeon and could have gone anywhere to set up practice. Instead, he stayed on at Our Lady with the title of Director of Surgical Training; he was also appointed Clinical Assistant Professor at Mecca. I had never seen Deepak happier. Thomas Stone, true to his word, paved the way for publication of Deepak's study on in juries to the vena cava. That paper in the American Journal of Surgery became a classic, one that everyone quoted when discussing liver injuries. Though Deepak was getting a consultant's salary, he continued to live in the house-staff quarters. Courtesy of the Mecca surgical residents who came down to the Bronx for rotations, we had more manpower and Deepak got more sleep. In an unused basement space, Deepak researched the effects of different interruptions to the blood supply of pig and cow livers.