Cutting for Stone

by Abraham Verghese

  Little did I know that Shiva's recovery had been complicated by a bile infection requiring antibiotics. Or that he had developed a blood clot in the vein in his right arm through which he'd been getting fluids. He was on a blood thinner, and the clot was resolving.

  I held his hand for a long time, content to look at him, to thank him with my fingers, but he kept shrugging off my thanks. I reached for my pen, and Hema pushed the pad in front of me and I wrote, Greater love hath no man—

  He didn't let me finish. He held my pen. He said, You would have done the same. I had my doubts, but he nodded. Yes, you would.

  That evening, Deepak drained fluid from around my right lung, and my breath expanded in that direction. Then he took the wretched tube out of my throat. My first words were “Thank you,” and when that ugly blue machine left my room, I fell into a deep sleep.

  The next morning was full of small miracles: being able to turn and gaze at the window and see sky, being able to say “Ouch” when the movement pulled on my incision. Hema wasn't around. The ICU was quiet. My nurse, Amelia, was unnaturally cheery. I assumed it was still early morning. “We have an X-ray to do downstairs,” she said, unhooking me from the tethers, and readying my bed to roll.

  In Radiology I was lifted into the doughnut for a CAT scan, but oddly, it was of my head and not my belly. Surely it was a mistake. But no, the order was from Deepak, and it read, “CAT scan of the head with and without contrast.”

  Back in my room and by noon, still no sign of Hema, or Stone, or Shiva. Amelia said they would be along presently.

  The physical therapist helped me stand beside my bed for a few seconds. My legs felt like Jell-O sticks. I took a few steps with assistance, then sat in the chair, exhausted, woozy, as if I had run a marathon. I dozed there, ate what little I could. After lunch, I took a few more steps, and even peed upright. The nurses helped me back to bed. In retrospect, they seemed pleased to get out of my room.

  IT WAS 2:00 P.M. when Thomas Stone appeared at my door. There were dark circles around his eyes. He sat self-consciously on the edge of the bed. He touched my hand. His lips parted.

  “Wait,” I said. “Don't say anything yet.” I looked out of the window at the clouds, at distant smokestacks. The world was intact now, but I knew once he spoke it wouldn't be so.

  “Okay,” I said. “What happened to Shiva?”

  “He had a massive bleed in his brain,” he said, his voice hoarse. “It happened last night, about an hour after we left your room. Hema was with him. He suddenly clutched his head in pain … Then, in a matter of seconds, he was … unconscious.”

  “Is he gone?”

  Thomas Stone shook his head. “He bled from an arteriovenous malformation, a cavernous tangle of blood vessels in the cortex. He has probably had it all along … He was on anticoagulants for the blood clot in his arm … In a week we would have stopped.”

  “Where is he?”

  “Here. In the ICU. On a ventilator. Two neurosurgeons have seen him.” He shook his head. “It isn't feasible to evacuate the bleed. They think it's too late. And that he's brain-dead.”

  I didn't register much of what he said after that. I remember he said that my CAT scan showed a similar but smaller spider knot of vessels, but mine wasn't bleeding, a miracle of sorts, I suppose, since I'd bled from everywhere till I got Shiva's liver.

  A few minutes later, Hema, Deepak, and Vinu came into the room. I understood now that Stone had been delegated to break the news.

  Poor Hema. I should have tried to comfort her, but I was too full of grief and guilt. I felt so very tired. They sat around my bed, Hema weeping, bent over, resting her head on my thigh. I wanted them to leave. I closed my eyes for a moment. I woke up when a nurse came in to silence one of the intravenous pumps. There was no one else in the room. I had her walk me to the bathroom and then I sat in the armchair. I wanted my strength back.

  WHEN I AWOKE, Thomas Stone was by my chair. “He can't breathe on his own, and there are no pupillary or other reflexes,” he said in response to my silent query. “He's brain-dead now.”

  I said I wanted to see him.

  My father wheeled me down the hall where Shiva lay. Hema was with him, her eyes puffy and red, and when she turned to me, I felt ashamed to be alive, ashamed to be the cause of her sorrow.

  Shiva looked asleep. It was his turn to sport the spike coming out of his skull—the intracranial pressure monitor. The endotracheal tube skewed his lips, angling his chin up unnaturally. The rise and fall of his chest from the ventilator offered a spot on which to rest my eyes, and my ifs were coming in that rhythm: If I hadn't come to America. If I hadn't seen Tsige. If I hadn't opened the door for Genet …

  HEMA WHEELED ME BACK to my room, helped me back in bed.

  I said to her, “It would have been better if you and Shiva had buried me. Youd be on your way to Missing now with your favorite son.”

  It was a stupid, churlish thing to say, a primitive and subconscious urge to wound her so as to assuage my pain and guilt. But if I expected her to strike back, she didn't. There is a point when grief exceeds the human capacity to emote, and as a result one is strangely composed—she had reached that point.

  “Marion, I know you think I favored Shiva … And maybe I did. What can I say but that I'm sorry. A mother loves her children equally … but sometimes one child needs more help, more attention, to get by in the world. Shiva needed that.

  “Marion, I have to apologize to you for more than that. I thought you were responsible for Genet being mutilated, circumcised, and all that followed. I held that against you. When we came here, Shiva told me everything. My son, I hope you can forgive me. I'm a stupid mother.”

  I was speechless at this news. What else had gone on when I was unconscious?

  Outside a siren drew closer and closer, an ambulance coming to Our Lady.

  “They want to discontinue the ventilator on Shiva,” Hema said. “I can't bear for them to do that. As long as he is breathing, even if it is the ventilator breathing for him, he's alive for me.”

  The next morning, after the nurse seated me in the shower and helped me with my first bath, I put on a fresh gown and I asked to be wheeled to Shiva's room.

  “Stop here,” I said, well before his room, because I saw through the half-open door that Thomas Stone was seated by Shiva's bed, just as I was told he had sat by mine. His fingers rested on Shiva's wrist, feeling the pulse. His hand lingered there long after he had registered the heart rate. I wondered what he was thinking. I watched him for a full ten minutes before he stood up and came out, his eyes haunted and red. He didn't see me as he walked off in the other direction.

  I rolled my chair after him. “Dr. Stone,” I said. Every fiber of my being wanted to cry out, Father!

  He came to me. “Dr. Stone,” I said. “Surely an operation … is his only chance. Can't the neurosurgeons go in, tie off the tangled vessels, and evacuate the clot in his brain? So what if it's a long shot? It's his only shot.”

  He considered this for a while.

  “Son, they say the tissue in there is—sorry to say this—the consistency of wet toilet paper. Blood mixed with brain. The pressure's so high, if they so much as touch him, they tell me it'll only make him bleed further.”

  I didn't want to accept that. “Can't you do it? You and Deepak? You've done burr holes. I've done burr holes. What's there to lose? Please? Let's give him that chance.”

  He waited so long that even I could hear the fallacy of what I was suggesting. My father put his hand on my shoulder. He spoke to me gently, as to a junior colleague, not to his son. “Marion, remember the Eleventh Commandment,” he said. “Thou shall not operate on the day of a patient's death.”

  When I was back in my room, Thomas Stone brought up Shiva's CAT scan. I was shocked to see the huge white splotch—which is how blood looks on a CAT scan—involving both hemispheres and spilling into the ventricles. It compressed the brain within the rigid confines of the skull. I knew then that it
was hopeless.

  BECAUSE OF THE ANEURYSM or tangled vessel malformation in his brain, Shiva was not a potential donor for heart or kidneys, for fear there might be similar changes in those organs.

  Hema didn't want to be there when the ventilator was discontinued. I said I'd be with him. I asked to be alone with Shiva when he passed.

  Hema said her good-bye first.

  I was outside the room when Vinu escorted her out. It was a heartbreaking sight to see my mother, the tail end of her sari draped over her head, her shoulders slumped, leave her still-breathing child. It must have felt to her as if she were abandoning him. Every eye in the unit was on her, and not one was dry, as her shimmering, sari-clad form floated down the hall on her way to the Quiet Room.

  With Deepak's assistance I climbed onto Shiva's bed. It was eight in the evening. I settled myself next to him. Everything but his breathing tube and an intravenous line had been removed. Deepak peeled away the tape that held the tracheal tube to Shiva's cheeks. Then, with a nod from me, he injected morphine through Shiva's intravenous tubing. If any part of Shiva's brain was alive, we didn't want it to sense pain, or fear, or suffocation. Deepak turned off the ventilator, silenced its immediate shrill protest, slid the endotracheal tube from Shiva's mouth, and then he left the room.

  I LAY THERE, my head against Shiva's, a finger resting on his carotid pulse. His body was warm. He never took a breath after the tube came out. His facial expression never changed. His pulse stayed regular for almost a minute, then it paused, as if it had just realized its lifelong partner—the lungs—had quit. His heart sped up, became faint, and then, with a final throb under my fingers, it was gone. I thought of Ghosh. Of all the pulse types, this was both the rarest and the most common, a Janus quality that every pulse possesses: the potential to be absent.

  I closed my eyes and clung to Shiva. I cradled him, his skull buttressed against mine and now wet with my tears. I felt physically vulnerable in a way I'd never felt when we were a continent apart, as if with his death my own biology was now altered. The heat was rapidly leaving his body.

  I rocked Shiva, wedging my head against his, remembering how for so long I was unable to sleep except like this. I felt despair. I didn't want to leave this bed. Chang and Eng had died within hours of each other, because when the healthy one was offered the opportunity to be freed from the dead one, he declined. I understood so well. Let Deepak give me a lethal dose of morphine and let my life end this way, let my respiration cease, my pulse fade and then disappear. Let my brother and me leave the world in the same embrace with which we began in the womb.

  I PICTURED SHIVA getting the telegram, his coming to me, then putting himself at risk to save me. Would I have done the same for him? Perhaps when he saw me, he'd felt the way I did now: that it didn't matter what might have transpired between us, but life would not be worth living and would end soon if something happened to the other.

  His body continued to lose heat in my arms as if I were drawing it away, siphoning it over. I remembered the two of us running up the hill in a relay, carrying a lifeless and cold child to Casualty, the parents trailing behind us. He was now that lifeless child.

  The minutes passed.

  Ultimately it was the rude coldness of Shiva's skin, the terrible separation it delineated of the living and the dead, the disarticulation of our bound flesh, that forced me to a new understanding, a new way of seeing us in the face of such rapid attrition, and this is what I came to:

  Shiva and I were one being—ShivaMarion.

  Even when an ocean separated us, even when we thought we were two, we were ShivaMarion.

  He was the rake and I the erstwhile virgin, he the genius who acquired knowledge effortlessly while I toiled into the night for the same mastery; he the famous fistula surgeon and I just another trauma surgeon. Had we switched roles, it wouldn't have mattered one bit to the universe.

  Fate and Genet had conspired to kill my liver, but Shiva had a role in Genet's fate, and hence my fate. Every action of ours turned out to be dependent on the other. But now by a brilliant and daring rearrangement of organs, ShivaMarion had readjusted. Four legs, four arms, four kidneys, and so on, but instead of two livers, we had downsized to one. Then karma and bad luck took us even further, forced further concessions: we lost ground on his side, a few organs died. Okay—just about everything on his side died, but we retained half his liver, and it was thriving. What we had to do now was economize further, go halves again, tough measures for tough times: two legs sufficed, so also with eyes, kidneys. We'd go with half a liver, one heart, one pancreas, two arms … but we were still ShivaMarion.

  Shiva lives in me.

  Call it a far-fetched scheme that I conjured up to allow me to go on … Well then, it allowed me to go on. It gave me comfort. It dried my tears, helped me untwine my arms and legs from the body that we were discarding. In the eerie quiet of that room, so primed for machines but with the machines all silent, the blinds closed, and with an icy corpse next to me, I felt Shiva was instructing me. He had rowed over from the sinking ship and he was telling me to think this way, and it was just Shiva's kind of logic. One being at birth, rudely separated, we are one again.

  THEY WERE ASSEMBLED outside, a ghoulish receiving line was what I thought at first. But they couldn't know what had just transpired, and so I didn't blame them. Their hearts were in the right place. Thomas Stone, Deepak, Vinu, and so many of my nurses and nursing assistants— my friends, my Our Lady family before they became my caregivers. I shook each hand, and thanked them for the two of us. I believe they will tell you my manner was composed, far different from what they expected. I left Thomas Stone for last. After I shook his hand, I followed an irrational instinct—Shiva's, I believe, certainly not mine—which told me to hug him, not to get but to give. To let him know that as a father it turns out hed done what he was meant to do; he lived on in us and we lived because of his skills. The way he clung to me, held me as if he were drowning, told me Id made the right choice, or Shiva had, awkward as it was.

  I walked slowly down the hall to our Quiet Room, a euphemism for the place we chose to give bad news, a place with chairs, a table, a sofa, a big picture window, a cross on the wall, but no TV, no magazines, only a solid and soundproof door. How many times had I made this walk as a trauma surgeon? So often I had lingered outside the door, conscious of the devastation my news would be bringing. Had I honored the feelings and the dignity of those who waited in that room, the parents, siblings, spouses, and children, even if what I had to say dashed all their prayers? I could remember every such encounter; I could recall each face as it turned in hope and apprehension when the door opened.

  I FOUND HEMA, hands crossed in front of her, gazing out of the window at the lights of the Battleship housing project that abutted our house-staff quarters, and the distant outline of the bridge beyond. Her back was to me. She saw my reflection in the glass before she saw me, but unlike every single person I had ever come to see in this room, she did not spin around. Instead, she stood like a statue, staring at my reflection in the window. I stopped where I was, holding the door open. I saw in that glass her eyes widen, the eyebrows rise. She held my gaze for the longest time. Her face showed surprise … as if who she saw wasn't the person she had expected to see.

  “Here we are, Ma,” I said.

  She cocked her head at my voice. She brought one hand up to her chin, her fingers aligned and locked together and resting contemplatively along her cheek, her movements exaggerated. She studied my face, my reflection, just like a village girl who is surprised in the act of drawing water at the well, and who must now read the intentions of the tall, smiling avatar whom she sees standing behind her.

  Then, in slow motion, as if this were a dance, and both of us dancers, she turned and faced me.

  I moved to her. “Here we are,” I said again, my arms extending toward her. “We can go home now, Ma.”

  It must have seemed to her a very strange thing, even the wrong thing, t
o say. To live purely in the here and now, to look forward but never to the past—that was vintage Shiva. “Here we are,” I said.

  She came into my arms.

  We held her tight.

  CHAPTER 53

  She Is Coming

  ON A BEAUTIFUL MORNING, just three weeks after Shiva's transference, Hema and I took leave of Our Lady of Perpetual Succour. Thomas Stone insisted on being our escort. We stepped outside into air so crisp I felt a cough or a sneeze would shatter it like glass. The brick façade of Our Lady of Perpetual Succour glistened with dew as we said our good-byes. The hospital's recent turn in the limelight had brought in special city funds and sparked emergency repairs; as a result, the monsignor in the fountain was no longer tilting, his swizzle stick was gone, as was his crusting of bird droppings. Polished and sanguine, he looked emasculated and alien to the place where I had spent the last seven years of my life.

  Our yellow cab sped across the Whitestone Bridge to Kennedy Airport. The sun had barely come up, and yet the freeway was thick with cars, the solitary drivers insulated from one another in wafer-thin metal, which at these speeds offered only the illusion of protection. We merged like wingmen rejoining the formation. Hema looked out meditatively just as I had when I arrived seven years before. I wondered if she could hear the hum of the überconsciousness, the superorganism who kept this from descending into chaos.

  The year 1986 was a disaster for our family. Hema believed that it had something to do with the number, because it had birth in the 1 and destiny in the 8. Nineteen eighty-six had started off terribly with the Challenger spacecraft exploding on January 28 (which was month 1, and there was the number 8 again). Then the Chernobyl tragedy was exactly eighty-eight days after the Challenger disaster. On that scale, the death of one twin—on the eighteenth of the month—hardly registered.

  There was yet another death eight days later that had bearing on us: my neighbor Holmes came with Appleby of the detective agency to let me know that Genet had passed away in a prison hospital in Galveston just as I was regaining my strength. Genet's son had been adopted by a family in Texas, and she had gone in search of him. Shed been living hand-to-mouth in a cardboard lean-to a few blocks from the seawall when she was picked up. She was a mere skeleton and survived just two days in the prison infirmary. She had supposedly died of adrenal failure caused by tuberculosis. I knew better. She had died chasing greatness and never saw it each time it was in her hand, so she kept seeking it elsewhere, but never understood the work required to get it or to keep it. I'm ashamed to say I felt relief when the word came; only her death could ensure that we didn't keep tearing each other apart for what remained of our lives.