Cutting for Stone

by Abraham Verghese

  Sitting in my library that night, having done more damage to a bottle of Pinch in four hours than I had in the year since I bought it, I replayed our last exchange. She'd been curled up in the chair I now sat in, wearing my dressing gown, the gown that I now wore. I came to her with tea— that signature move of fools, one of the stigmata by which you shall know us.

  “Marion,” she said, for she had been gazing at my library, my eclectic little collection. “Your father's apartment in Boston, the way you described it … it sounds so much like this.”

  “Don't be ridiculous,” I said. “I built these bookcases myself. Half the books here have nothing to do with surgery. Surgery isn't my life.”

  She didn't argue. We sat quietly. At one point I saw her gaze flit to the rug on the floor between us—there was an intruder sitting naked on those synthetic fibers, a dark silent man with razor cuts to his body. His presence put a damper on our conversation.

  When I announced I was going to go to bed, she said she'd be right along. She smiled. I didn't believe her. I thought I'd never see her again. But I was wrong. She joined me under the covers. We made love. It was tender and slow. It was the very moment when I thought, At last, she is going to stay, but in fact it was her good-bye.

  TWO WEEKS AFTER SHE LEFT, I felt at odds with my house. I found my library oppressive. In the kitchen, I took out my dinner, which was a foil packet labeled FRIDAY in my handwriting; it was the last of what I had cooked, frozen, and packed in aliquots many weekends ago. Now I saw this categorizing of my freezer food as a sign of the true chaos inside my head.

  Thank God for my good neighbor, Sonny Holmes. He heard me raging, he heard me bang my head against the fridge. Sonny Holmes had an inherent curiosity an honest, all-American nosiness that came with crossing one's seventieth year and that did not try to conceal itself. Hed been aware of the coming of my guest—such a rare event—and he'd heard the headboard music and then the long silence.

  “You need to hire a security firm,” he said, coming to a quick diagnosis before I had even finished my story. Sonny believed in the ennea-gram, that Jesuit-invented classification of people into personality types. He was a One, willful and confident and certain. He had me pegged as a Three or a Four, or was it a Two? Whatever it was, it was a number that did not argue with Ones.

  “I need a what?” I said.

  “A private detective.”

  “Sonny, for what? I don't want to see her again.”

  “Perhaps so. But you need closure. What if she's in jail or in a hospital? What if she's trying desperately to get back to you, but can't?”

  A noble motive, that was all a Two needed to continue an obsession. I latched on to that.

  East Coast Investigations of Flushing turned out to be an earnest, blond youth by the name of Appleby, son of Holmes's late sister-in-law. Appleby quickly established that Genet had not returned to her halfway house. She hadn't gone to Nathan's restaurant, where she washed dishes. She had not checked in with her probation officer and she had not called Tsige. He learned these facts in no time. He even knew that Genet had been diagnosed with tuberculosis while in prison. She began medications, but then failed to report for her DOT—Directly Observed Therapy—after she was released. The cough, the fever, in all likelihood were her tuberculosis coming back. The disconcerting news was that if she ever materialized, I'd be third in line after the state health department and her probation officer. She would be headed back to jail. Apple by s source in jail could get his hand on her complete medical records if we wished, and Appleby said he'd taken the liberty of telling the man to proceed. I was concerned about violating her confidentiality. “Knowledge is power in these kinds of situations,” Appleby added, and with that he won me over; any man who would use a quote that Ghosh loved was a man to trust. “You are paying to know,” he added, “and I think we're obliged to know more.”

  “So what now?” I asked Appleby. I wasn't asking him about exposure to tuberculosis. I could handle that.

  Appleby avoided my eyes. His cheeks and the tip of his nose were covered with twitchy blood vessels, ready to flush at the least provocation. His condition was acne rosacea, not to be confused with the pedestrian acne vulgaris, the bane of many teenagers. Appleby's nose would one day be burgundy and bulbous, the cheeks a meaty red. Already shy, his problems would get worse because strangers would assume incorrectly that his appearance was a result of drink. Here I knew about his future while paying him to tell me mine.

  “Well, Dr. Stone,” Appleby said, clearing his throat, his nose starting to redden, a sure indication that I would not like what he had to say, “Respectfully, I would say to check your silverware. Inventory your belongings. Make sure nothing is missing.”

  I looked at him for a long while. “But, Mr. Appleby, the only thing that matters to me is precisely the one thing that is missing.”

  “Yes, of course,” he said.

  The compassion in his voice told me he had known my kind of pain. There are legions of us.

  AS FAR AS THE EVENTS of the next few weeks, I recall one night waking to the shrill ring of the telephone. Receiver in hand, I was lost, uncertain whether I was at Our Lady or back at Missing. I was the backup trauma consultant. But I couldn't decipher what the resident at the other end wanted. This isn't uncommon for the first ten seconds of a middle-of-the-night conversation. The caller understands. But, as we kept talking, the fog in my brain refused to lift. I hung up. I pulled the phone from its moorings. The next morning, my mind felt clear, but my body wouldn't rise off the bed. I was weak. The thought of food turned my stomach. I rolled over and went back to sleep.

  Perhaps that same day, perhaps a few days later, a man was on the edge of my bed. He took my pulse, called my name. It was my former Chief Resident and now my colleague at Our Lady, Deepak Jesudass. I desperately held his hand and asked him not to leave—I must have recognized the danger of my situation.

  “I'm not leaving,” he said. “Just pulling back the curtain.” My memory is that I told him everything that had transpired. He examined me as I spoke. He pulled down my eyelids, interrupting me only to ask that I look down at my feet, or say “Ah!” At one point he inquired if I had a stethoscope in the house. I said, “Are you kidding? I'm a surgeon,” and we laughed together, a strange sound that had been missing from my home. I said “Ouch” when he probed just under my ribs on the right. I found this funny. I heard him murmuring on the telephone. All the while, I did not let go of his hand.

  Three men whose faces I knew arrived with a stretcher. They wrapped me in a flannel cocoon, carried me out to the curb, and lifted me up into their ambulance. I remember wanting to say something about the beauty of their motion, the inherent grace, and how incredible it was, this baby-kangaroo-in-pouch feeling. I apologized for not having appreciated their skill all these years.

  Deepak rode with me. At Our Lady, he walked alongside my gurney past the shocked faces of the staff we encountered in the halls and elevator. He wheeled me into the Intensive Care Unit of Our Lady of Perpetual Succour. My eyes glowed yellow under the harsh fluorescent lights, but I didn't know it. My skin, too. I bled wildly from every needle stick. Too late, the nurses tried to hide the ominous tea-colored urine in my catheter bag from me, but I saw. For the first time, I was very, very scared.

  The increasing swelling in my brain made me desperately sleepy. I held on to consciousness long enough to ask Deepak to come near. “Whatever happens,” I whispered, “don't take me from Our Lady. If I must die and can't die at Missing, I want to die here.”

  At some point I was aware that Thomas Stone came to my bedside and was studying me, but not with the concern of a clinician. It was the petrified look I knew so well, the look of a parent whose child had suffered some misfortune. It was at about this time that I lost consciousness.

  AS I LEARNED LATER, the cable to Hema read: COME AT ONCE STOP MARION CRITICALLY ILL STOP THOMAS STONE STOP P.S. DO NOT DELAY STOP—and she did not. Hema called in her favor with the
Comrade President-for-Life's wife, who understood all too well Hema's need to be at her son's sickbed. The American Embassy readily provided visas, and by day's end, Hema and Shiva were on their way to Frankfurt via Cairo. Then, still on Lufthansa, they crossed the Atlantic. Hema pulled out the telegram more than once, studying the letters, looking for a hopeful anagram. Over Greenland, she said to Shiva, “Perhaps this means Thomas Stone is near death, not Marion.”

  Shiva said with absolute certainty, “No, Ma. It's Marion. I can feel it.”

  At ten in the night New York time, they floated into the Intensive Care Unit, a graying woman in a maroon sari, the face striking despite the raccoon rings around her eyes. With her was a tall youthful man who was so obviously her son and my identical twin.

  They slowed outside my glass cubicle, weary Old World travelers peering into the glow of a New World hospital room. There I was, the son who went to the States for higher studies, who became a practitioner of the artful, lavish, disposable-everything, lucrative, and incredibly effective American brand of medicine, with no prices on the menu, so different in style and substance from what they did at Missing; only now it must have appeared to them as if the American medicine had turned on me, like the tiger turning on its trainer, so that I lay moored to a blue-gray ventilator, chained to moni tors on the consoles behind my bed, comatose and invaded by plastic tubing, by catheters and wires. There was even a stiff wire like a nail poking up from my skull.

  They saw Thomas Stone seated on the side of my room closest to the window, his head resting awkwardly against the bed's safety rail, his eyes closed as if in sleep. In the seventy-two hours since he sent the telegram, my condition had worsened. Thomas Stone opened his eyes, suddenly aware of them. He stood up, bedraggled, stiff, and somewhat shrunken in his borrowed scrubs, relieved but apprehensive. Worry lines ran into his eyes, and his face was drawn and pale under his shock of white hair.

  The two old colleagues and combatants had last seen each other in a delivery room, moments after my birth and our mother's death. That was also when Stone had last seen Shiva: in Operating Theater 3, held tight in Hema's arms.

  The bedside table and the ventilator blocked Hema's approach to the near side of the bed. She circled to where Stone stood, her eyes on me.

  “He is ‘critically ill’ from what, Thomas?” Hema said, referring to the two words in the telegram that had most frustrated her. Her tone was professional, as if she were asking a colleague about a patient; it allowed her the pretense of being calm when inside she was quaking.

  “It's hepatic coma,” Thomas said, responding in the same manner, grateful that she'd elected to converse in the language of disease, a fallback which allowed even their son to be reduced to a diagnosis. “He has a fulminant hepatitis. The ammonia level is very high and the liver hardly functioning.”

  “What from?”

  “Viral hepatitis. Hepatitis B.”

  Stone let down the bed rail and the two of them stood over me. Hema's hand reached behind her for the tail end of her sari, the part that went over her shoulder. She brought it to her mouth.

  “He looks anemic, not just icteric,” she managed to say at last, clinging to the idiom of medicine to describe my pallor and jaundice. “What's his hemoglobin?”

  “Nine, after four units of blood. He's bleeding from his gut. His platelets are down and he isn't making clotting factors. The biliru-bin is twelve, and his creatinine just today is four, rising from three yesterday …”

  “What's this, please?” Shiva said, pointing at my skull. He stood across from Thomas Stone, the bed between them.

  “An intracranial pressure monitor. Goes into the ventricle. He has cerebral edema. They're giving him mannitol and adjusting the ventilator settings to keep the pressure down.”

  Shiva looked skeptical. “It goes through his skull, through brain into the ventricle just to measure? It does not treat?”

  Thomas Stone nodded.

  “How did this begin?” Hema asked.

  As Thomas Stone recounted the sequence of events, Shiva freed the bedside table and found slack between the bed and ventilator. He let down the bed rail on his side. Moving with the slow efficiency of a contortionist, he slid under the tubes and wires. Deepak entered in time to see Shiva lying on his side next to me, his head touching mine. His being there looked both precarious and entirely natural. All Deepak could do was stare, noting, however, that my intracranial pressure tracing, which had done nothing but go up for three days, went down.

  No sooner had Deepak introduced himself than Vinu Mehta, the gastroenterologist, filled the doorway, panting from taking the stairs. Vinu had been an internal medicine resident at Our Lady when I was a surgery resident. After specializing in gastroenterology he'd joined a lucrative practice in Westchester but wasn't happy and had returned to the salaried staff of Our Lady.

  “Vinu Mehta, Dr. Madam,” he said, putting his palms together in a ñamaste before grasping Hema's hand with both of his. “And this must be Shiva,” he said, unfazed at seeing Shiva in my bed. “I know this only because I am certain the other gentleman is Marion.” He turned back to Hema. “What a shock this must be, madam. For everyone here, too. Our whole world is upside down! Marion is one of us.” This sudden switch to the vernacular of feelings made Hema's lips tremble.

  One look at Vinu and you knew the stories about him buying groceries for patients he discharged were probably true. Id seen him extend a patient's stay to insulate her from some madness at home. He was the best friend to everyone on the staff and regularly baked cakes and cookies for me. I always sent him a card on Mother's Day, which pleased him no end.

  “I was called the minute that Marion was brought here, Dr. Madam,” Vinu went on. “Hepatology, the liver, that is my field. Hepatitis B swims around here. Lots of carriers, intravenous drug addicts and people who acquire it from their mothers at birth—very common in immigrants from the Far East. Madam, we see no end of silent cirrhosis and even liver cancer from this virus. But acute fulminant hepatitis B? In my career I have seen only two other patients quite this severe.”

  “Vinu, tell me the truth,” Hema said, taking on a no-nonsense, Mother India tone with this young doctor who was all too ready to play the role of nephew. “Is my son a drinker?”

  I suppose it was a fair question. I hadn't seen her in more than seven years. She knew it was in my genes. What did she really know of who or what I had become?

  “Madam, categorically no!” Vinu responded. “No, no. A gem of a son you have.”

  Hema's stern expression softened.

  “Although, madam,” Vinu continued, “in the past few weeks, madam—don't take this wrongly—by the report of his neighbor, Marion had been troubled and drinking.”

  Deepak had found a new prescription in my house for isoniazid, a drug used to prevent tuberculosis. Isoniazid was also famous for causing severe liver inflammation. It was routine to check liver enzymes two weeks after starting treatment so the drug could be discontinued if there was any sign of liver damage.

  “My hypothesis, madam, is that Marion-bhaiya started isoniazid on his own. The prescription is a month old. He probably didn't get his blood drawn to check liver functions the way he was supposed to. He is a surgeon after all, poor fellow. What does he know about these fine matters? If he'd only consulted me! I would have been honored to take care of him. After all, Marion-bhaiya took care of my hernia so lovingly.

  “In any case, madam, I personally went to Manhattan, to Mount Sinai, and I chauffeured over the world's best liver man, the man who trained me in this specialty. I said, ‘Professor, this is a not a case of hepatitis, but a case of my own brother.’ He is in agreement that the alcohol and the isoniazid might be contributory, but there is no doubt that what we are dealing with here first and foremost is hepatitis B.”

  “What is the prognosis?” Hema said. “Will someone tell me that?” It was the most basic thing a mother wanted to know. “Will he get better?”

  Vinu looke
d to Deepak and Thomas Stone, but neither man was willing to speak. The disease was, after all, Vinu's area of expertise.

  “Just tell me. Will he live?” Hema spat out.

  “It is undoubtedly very grave,” Vinu said, and the fact that he was fighting back tears told her everything.

  “Come on!” Hema said, annoyed by this and turning to Thomas Stone, and then to Deepak. “It's hepatitis. I understand hepatitis. We see the damage it does in Africa. But … here, America! In this wealthy place, this rich hospital”—she swept her hands at all the machinery— “surely here in America you can do more for hepatitis than to wring your hands and say it is very grave.“

  They must have winced when she said “rich.” Compared with the state-of-the-art ICUs in the money hospitals, such as Thomas Stone's institution in Boston, ours was bare-bones.

  “We tried everything, madam,” Deepak said now in a more subdued tone. “Plasma exchange. Whatever anyone in the world can do for this disease, we are doing that here.”

  Hema looked skeptical.

  “And praying, madam,” Vinu added. “The sisters have a prayer chain going around the clock for two days now. Honestly, we need that kind of a miracle.”

  Shiva had quietly followed every word from where he lay.

  Hema stood looking down at my unconscious form, stroking my hand and shaking her head.

  Vinu convinced the two of them to retire to a room readied for them in the house-staff building; he'd even arranged for a light dinner of cha-patti and dal. Hema was too tired to argue.

  THE NEXT MORNING, Hema appeared in an orange sari, looking rested, yet as if she had aged a few years in the course of the night.

  Thomas Stone was exactly where she had left him. He looked past her in the doorway, as if expecting Shiva, but Shiva wasn't there.

  She stood by my bed again, anxious to see me in daylight. The previous night she'd found it all too unreal, as if it were not me on the bed but some extension of all the noisy machinery which had taken the form of flesh. But now she could see me, see the rise and fall of my chest, the puffiness of my eyes, my lips contorted by the breathing tube. It was real. She couldn't help herself, and began to weep silently, forgetting Thomas Stone was there, or not caring one way or the other. She was only conscious of him when he tentatively offered a handkerchief. She snatched it from him, as if he'd been slow to offer it.