Cutting for Stone

by Abraham Verghese

  I had reported to Hema my first sighting of Thomas Stone. Shed listened without comment, and she must have smiled when she heard of her son breaking and entering Thomas Stone's apartment. I didn't censor information for her benefit; surely, Thomas Stone was no longer the threat he'd once been to her when we were minors. When I had told her about placing the bookmark on Stone's desk as my calling card, I had read from Hema's silence that she'd known nothing about Shiva's having The Expedient Operator: A Short Practice of Tropical Surgery. I surmised from that and later confirmed from Matron that Hema had made every attempt to banish the book from Missing; she'd never wanted me or Shiva to see his work, much less a picture of him.

  “I had dinner with Thomas Stone, Ma,” I said when she came on the line. “I ate injera for the first time in well over a year.” She was miffed to learn that Ghosh had a message for Stone—I read that in the fact that she said nothing. When I told her just what Ghosh had wanted me to say to Stone, I heard a vigorous honk on her kerchief. The message said more about Ghosh and his selflessness than it did about Thomas Stone. I asked if she knew about the bookmark or a letter that accompanied it. She didn't.

  “Maybe Shiva knows,” I said. “Can I speak to him?”

  She called out his name, a summons I had heard so many times since I was a child. I heard Shiva's reply, and could judge from its echo that it had come from our childhood room. While I waited, I heard Hema asking Matron about the bookmark; her “No!” told me it was news to her.

  THE TELEPHONE WAS NEVER a comfortable instrument in Shiva's hands. He was fine, the fistula work was going very well, and no, he knew nothing about any missing letter.

  “Do you remember the bookmark, Shiva, and the reference to a letter?” I asked.

  “Yes.”

  “But you're saying there was no letter in the book?”

  “No letter.”

  “How did you get the book, Shiva?”

  “Ghosh gave it to me.”

  “When?”

  “When he was dying. He wanted to talk with me about many things. This was one. He said he'd taken the book from Thomas Stone's quarters on the day we were born. He had kept it. He wanted me to have it.”

  “Was that the first time you'd seen the textbook or seen a picture of Thomas Stone?”

  “Yes.”

  “Did Ghosh mention a letter from Sister Mary—our mother—to Stone?”

  “No, he didn't.”

  “Did he say why he wanted you to have the book?”

  “No.”

  “When you saw the bookmark and the reference to the letter, did you go back and ask him?”

  “No.”

  I sighed. I could have stopped there, but I had come this far. “Why not?” I asked.

  “If he wanted me to have the letter, he would have given it to me.”

  “Why did you give me the book, Shiva?”

  “I wanted you to have it.”

  There was no annoyance in Shiva's voice; his tone was no different than when we began—I wondered if he'd picked up the irritation in mine. Shiva was right: there either was no letter, or Ghosh had the letter and had his reasons for destroying it.

  I was about to say good-bye. I knew better than to expect my brother to ask about my health or my welfare. But he took me aback by saying, “How are your operating theaters?” He wanted to know about the layout, how far away the autoclave and the locker rooms were, and was there a sink outside each room, or one common scrubbing area. I gave him a detailed picture. When I was done, I waited. Once again, he surprised me: “When are you coming home, Marion?”

  “Well, Shiva … I have four more years of residency.”

  Was this his way of saying he was sorry for everything that had happened? That he missed me? Did I want that from him? I wasn't sure, so all I added was, “I don't know if it is safe for me to come, but if it is, I'd love to come a year or so from now … Why don't you come visit here?”

  “Will I be able to see your operating theaters?”

  “Sure. We call them operating rooms here, not theaters. But I can arrange for you to see them.”

  “Okay. I'll be there.”

  Hema came back on the line. She was in a chatty mood, reluctant to let me go. Listening to her lilting voice, I was transported back to Missing Mean Time, as if I were sitting by the phone under Nehru's photograph and looking across the room at the portrait of Ghosh which consecrated the spot where he spent so many hours listening to the Grundig.

  When I hung up I felt despair: I was back in the Bronx, my walls bare but for the framed Ecstasy of St. Teresa. My beeper, silent till then, went off. In answering its summons, I slipped the yoke back around my neck; indeed, I welcomed my slavish existence as a surgical resident, the never-ending work, the crises that kept me in the present, the immersion in blood, pus, and tears—the fluids in which one dissolved all traces of self In working myself ragged, I felt integrated, I felt American, and I rarely had time to think of home. Then in four weeks, it was time to dial Missing again. Were these phone calls just as difficult for Hema? I wondered.

  In a letter after our call, Hema said that shed checked with Bachelli, Almaz, and even W. W. Gonad to see if they had heard of Ghosh or Sister leaving a letter behind, but no one had. She told me that Shiva's application for an exit visa to come visit me was held up by the government; he was asked to provide affidavits to show he had no debts in Ethiopia, and moreover that I had no debts for which he might be responsible. She said she would remind Shiva to work on the visa. Reading between the lines, I knew and she knew that Shiva had lost interest.

  I wrote to Thomas Stone to let him know that the whereabouts of Sister Mary Joseph Praise's letter remained a mystery. He never wrote back to me thanking me for my troubles.

  OVER THE NEXT FOUR YEARS, I saw Thomas Stone now and then when he came to conduct conferences or bedside teaching rounds; he was impressive, as I knew he would be, masterful, serious, and in command of his subject. He had the kind of perspective that could only come from careful study of the literature of surgery and from living it for many years. I much preferred being around him in that fashion than having a dinner with him. Perhaps he felt the same way, because he didn't call or visit again.

  I went up to Boston for three separate, month-long rotations: plastic surgery, urology, and transplant, and the work was engrossing, challenging, so that each time my anxieties about being there and near him were forgotten. I worked with him in that last rotation, which was busier than I'd ever imagined. He suggested once during that time that we have a meal, but I begged off because my work in the transplant intensive care unit simply did not allow me to get away before nine in the evening, even on my nights off. I think he was relieved.

  By 1986 I had finished my year as Chief Resident, which was also my fifth year of training, and I stayed on as an assistant to Deepak as I prepared to take my board exam. Grudgingly, Id come to admire the long, arduous American system of surgical training; it was easier to admire when you were about done with it. I felt technically competent to do all the major operations of general surgery, and I knew my limits. There wasn't much I hadn't seen at Our Lady. More important, I was confident about caring for patients before and after surgery, and in the intensive care settings.

  ALSO IN 1986, my brother became famous; it was Deepak who showed me the feature article in the New York Times. What a shock it was to see Shiva's picture, to see in it my reflection, but with shorter hair, almost a crew cut, and without the gray that had completely taken over my sideburns and temples. The image brought immediate bitterness, the recollection of the pain of betrayal. And yes, envy. Shiva had taken the first and only girl I loved and spoiled her for me. Now, he was making headlines in my backyard, in my newspaper. I'd followed all the rules, and tried to do the right thing while he ignored all the rules, and here we were. Could an equitable God have allowed such a thing? I confess, it was a while before I could read the article.

  According to the Times, Shiva was the world'
s expert and the leading advocate for women with vaginal fistula. He was the genius behind a WHO fistula-prevention campaign that was a “far cry from the usual Western approach to these issues.” The Times reproduced the colorful “Five Failings That Lead to Fistula” poster: it showed a hand, the fingers splayed out. Peering at the photograph, I could see that it was Shiva's hand. In the palm was a seated woman in a posture of dejection—was the model the Staff Probationer?

  The poster was distributed all over Africa and Asia and printed in forty languages. Village midwives were taught to count off on one hand the Five Failings. The first was being married off too young, child brides; the second was nonexistent prenatal care; the third was waiting too long to admit that labor had stalled (by which time the baby's head was jammed halfway down the birth passage and doing its damage) and a Cesarean section was needed; the fourth failing was too few and too distant health centers where a C-section could be done. Presuming the mother lived (the baby never did), the final failing was that of the husband and in-laws who cast out the woman because of the dribbling, odiferous fistula from bladder to vagina, or from rectum to vagina, or both. Suicide was a common ending to such a story.

  “Somehow women with fistula find their way to Shiva Praise Stone,” the article said. “They come by bus, as far as they can before the other passengers kick them off. They come on foot, or by donkey. They come often with a piece of paper in their hand that simply says in Amharic, ‘MISSING’ or ‘FISTULA HOSPITAL’ or ‘CUTTING FOR STONE.’”

  Shiva Stone was not a physician, “but a skilled layperson, initiated into this field by his gynecologist mother.”

  When I next spoke to Hema, I asked her to congratulate Shiva for me. “Ma,” I said, “you should have gotten more recognition in that story. Without you, Shiva couldn't be doing what he does.”

  “No, Marion. This is really all his doing. Fistula surgery wasn't something I relished. It suits someone as single-minded as Shiva. It needs constant attention, before, during, and after surgery. You should see the hours he spends thinking over each case, anticipating every problem. He can see the fistula in three dimensions.” Shiva had fashioned new instruments in his workshop and invented new techniques. The article had mentioned Matron's fund-raising efforts and the desperate needs, and the article brought donations pouring in. Matron had in mind a new Missing building devoted to women with fistula. “Shiva has had the plans drawn out for years. It will be in the shape of a V with the wings converging on Operating Theater 3.” Theater 3 was to be overhauled and remodeled, making two operating rooms with a shared scrub area in the middle.

  I reread the Times article late that night. I felt a hollow sensation in my belly this time as I went through it again. The writer's unabashed admiration for Shiva came through, and one sensed she had abandoned her reserve, her usual dispassionate tone, because the man more than the subject so moved her. She ended with a quote from my brother: “What I do is simple. I repair holes,” said Shiva Praise Stone.

  Yes, but you make them, too, Shiva.

  I HAD MY OWN SUCCESS, albeit a quieter one: I passed the written exam of the American Board of Surgery. A few months after that, I was assigned to take my oral exams in Boston at the Copley Plaza Hotel. After a grueling hour and a half in front of two examiners, I was done. I knew I did well.

  Outside, the day was glorious. The monolith of gray stone that was the Church of Christian Scientists stood serene at the end of a long reflecting pool and framed against a blue sky. For five years I had spent my nights and days in the hospital, not seeing the sky, not feeling the sun on my face. I felt the urge to wade through the water fully clothed, or to let out a victory whoop. I contented myself instead with an ice-cream cone, which I enjoyed while sitting by the reflecting pool.

  I planned to head to the airport, take the shuttle back to New York. But seeing that my driver was so obviously Ethiopian, and having greeted him in our language, I had another idea. Yes, of course he knew the Queen of Sheba's in Roxbury, and it would be an honor for him to take me there.

  “My name is Mesfin,” he said, grinning at me in the rearview mirror. “Who are you? What do you do?”

  “My name is Stone,” I said, putting my seat belt on, although I wasn't worried; nothing bad could happen to me on this day. “I'm a surgeon.”

  CHAPTER 49

  Queen's Move

  THE STREET HAD A JUNKYARD at the corner with high walls and barbed wire so reminiscent of Kerchele Prison. A massive dog, chained and asleep, was visible through the gate. Then came a string of vacant lots where ashes and soot outlined whatever had stood there. Mesfin seemed to be pointing the cab to the sole house at the end of the street that survived the blight that had felled the others. Its driveway began in the middle of the road, as if the paving machine had run out of asphalt when it got this far and so the owner took things into her own hands. The split-level house had yellow shingles. The steps, the railings, the pillars, the doors, the decks, and even the drains were painted the same canary yellow. A column of (unpainted) wheel hubs shored up a corner of the sagging front veranda. There were four taxis parked outside, all yellow.

  The smell of fermenting honey elicited a Pavlovian response from my taste buds. A dour Somali met us at the door and led us to a dining room six steps down from the front landing. We found a half-dozen men eating at the picnic tables and benches, with room for a dozen more. The wooden floor was strewn with freshly cut grass, just as it would have been if this were a home or restaurant in Addis.

  We washed our hands and took our seats, and at once a buxom woman arrived, bowing, wishing us good health, and placing water and two small flasks of golden yellow tej before us. The cornea of her left eye was milky white. Mesfin said her name was Tayitu. Behind her, a younger woman brought a tray of injera, on which were generous servings of lamb, lentils, and chicken.

  “You see?” Mesfin said, looking at his watch. “I can eat here quicker than I can pump gas in my car. It's cheaper, too.” I ate as if I had lived through a famine. The waitress in New York who first told me about the Queen of Sheba's had been right. This was the real thing.

  Later, through a side window that looked out onto a sloping yard, I saw a white Corvette slide up. A shapely leg in heels emerged, the skin a café au lait color, with a shade of nail polish that B. C. Gandhi called “fuck-me red.” A baby goat appeared from nowhere and danced around those elegant feet.

  Soon a lovely Ethiopian lady came cautiously down the stairs, careful not to snag her heels. She said over her shoulder to the Somali, “Why is that silly boy letting the baby goat out at this hour? One of these days I'll run over it.” Her golden-brown hair had red streaks, and it was cut in a perky, asymmetrical style that revealed her neck. She wore a maroon pinstriped blazer over a white blouse and skirt.

  The Queen, for there was little doubt that this was she, bowed in our direction while continuing on to an office next to the kitchen. She stopped abruptly. She turned as if she had seen a vision and she stared. I was in my suit, my tie loosened—did I look that out of place? Within the confines of Our Lady of Perpetual Succour, all the tribes of Abraham were represented and I felt no more foreign than my patients or the staff. Now, as I attracted her attention, and that of the others there, I felt like a ferengi again.

  “Praise God, praise His Son,” the Queen said, her hands on her cheeks. She shifted her tinted glasses to her forehead, revealing eyes that were wide open in astonishment. I looked behind me; could she be talking to someone else? Her expression, at first quizzical, now turned joyous, showing brilliant white and perfect teeth. “Child, do you not know me?” she said, coming close, her rose-scented attar preceding her.

  I came to my feet, still puzzled.

  “I pray for you every day,” she said in Amharic. “Don't tell me that I have changed that much?”

  I towered over her. I was tongue-tied. She had been a mother and I a boy when I first met her.

  “Tsige?” I said at last.

  She
lunged toward me, kissed my cheeks, held me at arm's length to better examine me, then pulled me to her to bump cheeks again and again. “My God, Blessed Mary and all the saints, how are you? Is it you? Endemenneh? Dehna ne woy? How are you? Can this be you? Praise God that you are here …”

  After six years in America, it was only at that moment, standing in that yellow house, in her arms, cut grass under my feet, that I felt at ease in this land, felt my guard come down and the muscles in my belly and neck relax. Here was someone from my past, from my very street, someone whom I liked and with whom I had always felt a bond. I kissed her cheeks as vigorously as she kissed mine: Who would stop first? Not I.

  Tayitu peered in from the kitchen. Two other women looked over the upstairs rail. Our fellow diners stopped to watch. They were displaced people, just like us, and they understood all too well these kinds of reunions, these moments when a piece of your old house comes floating by in the river.

  “What are you doing here?” Tsige said. “You mean you didn't come to see me?”

  “I came to eat. I had no idea! I've been living in New York for six years. I'm here just for the day. I'm a doctor now. A surgeon.”

  “A surgeon!” She gasped, falling back, clasping her hands to her heart. Then she kissed the back of my wrists, first one, then the other. “A surgeon. You brave, brave child.” She turned to our audience and in the tones of a cantor she continued, still in Amharic, “Listen, all you unbelievers, when he was a little boy, and when my baby was dying, who took me to the right place in the hospital? It was he. Who called the doctor, who was his father, to see my child? He did. Then who was it who stayed with me as my baby fought for life? No one but him. He was the only one by my side when my little baby died. No one else was there for me, if only you knew …” The tears streamed down her face, and in an instant the mood in the room went from the joy of reunion to profound sadness, as if those two emotions were invariably linked. I heard sympathetic clucks and tsks from the men, and Tayitu blew her nose and dabbed at her good eye, while the other two women wept freely. Tsige was unable to speak, head bowed—she was overcome for a moment. At last she straightened her shoulders, raised her head, the lips parted to smile bravely, and she declared, “I never ever forgot his kindness. Even today, when I go to sleep, I pray for my baby's soul, then I pray for this boy. I lived across the street. I watched him grow up, become a man, go to medical school. Now he is a surgeon. Tayitu, give everyone their money back, for today is a feast day. Our brother has come home. Tell me, ye of little faith, does any one of you need some other proof that there is a God?” Her eyes glittered like diamonds; her hands, palms up, reached for the ceiling.