Author | Abraham Verghese |
---|---|
Cover artist | John Gall |
Language | English |
Publisher | Alfred A. Knopf |
Publication date | February 2009 |
Publication place | United States |
Pages | 658 pp |
ISBN | 978-0-375-71436-8 |
LC Class | PS3622 E744 C87 2009 |
Cutting for Stone (2009) is a novel written by Ethiopian-born Indian-American medical doctor and author Abraham Verghese. It is a saga of twin brothers, orphaned by their mother's death at their births and forsaken by their father. [1] The book includes both a deep description of medical procedures and an exploration of the human side of medical practices.
When first published, the novel was on The New York Times Best Seller list for two years and generally received well by critics. With its positive reception, former United States president Barack Obama put it on his summer reading list and the book was optioned for adaptations.
The story is told by the protagonist, Marion Stone. He and his conjoined twin Shiva are born at Mission Hospital (called "Missing" in accordance with the local pronunciation), Addis Ababa, in September 1954. Their mother, Sister Mary Joseph Praise, an Indian Carmelite nun, dies during childbirth. Their father, Thomas Stone, the English surgeon of Missing, abandons them and disappears. Orphaned at birth, the pair grow up in the household of two physicians of Missing, both from Madras, the obstetrician Kalpana Hemlatha (Hema) and Abhi Ghosh, who fall in love while caring for the infants. Hema names them Marion (after J. Marion Sims) and Shiva (after the Hindu deity). Ghosh teaches himself surgery to replace Stone. The tissue link between the twins has been separated at birth and the two grow up together being very close initially.
Both twins are exposed to the changing political environment in Ethiopia. There is an unsuccessful rebellion by Haile Selassie's bodyguard, General Mebratu. Ghosh is imprisoned, then released, in the aftermath of the coup, due to his friendship with Mebratu. Through their parents, both boys are exposed to medicine and taught at the hospital.
Over time, though, individual differences begin to become pronounced. When entering puberty their relationship to Genet, the daughter of Rosina, a domestic help, finally tears them apart. Marion is in love with Genet and intends to marry her, but it is Shiva who, interested in sexual pursuits, becomes her first lover. Marion feels betrayed. Rosina forces Genet to submit to female genital mutilation and commits suicide shortly thereafter. Genet will later join the Eritrean liberation movement. While Marion goes to medical school, his brother stays at Missing. Focused on the repair of birth-related fistulas, he takes up his surgical training with Hema eschewing a formal medical education. On his death bed, Ghosh has three wishes for Marion – to get the best medical education, to find Stone, and to forgive his brother.
When Genet and her comrades hijack an Ethiopian Airlines airplane in 1979, Marion is on a list of her connections. To avoid arrest he flees the country overnight to Kenya. He goes to New York City where he finds a position at Our Lady of Perpetual Succour, a hospital in the Bronx. There, he enters a surgical residency. One day, assisting his senior in a complicated trauma operation, an unknown surgeon enters looking them over the shoulder. It is Thomas Stone, by now a well-renowned liver surgeon from Boston. Marion's encounter with his biological father redirects his life leading to a painful reconciliation and reunion with his estranged brother.
The book contains descriptions of many medical diseases and interventions. The title relates to the oath of Hippocrates that calls his acolytes not to cut for (bladder) stones. Marion's mother dies during a complicated delivery (conjoined twins) from a uterine rupture. The babies are born premature. Shiva becomes an expert in the repair of vesico-vaginal and recto-vaginal fistulas. A vasectomy is described in detail "so charming and surgically precise, it could serve, in a pinch, as a how-to-manual." [2]
The surgery of an intestinal volvulus establishes a relationship between Ghosh and Mebratu, but leads to his later imprisonment. Ghosh later dies from leukemia possibly related to his handling of outdated x-ray equipment. Genet undergoes female genital mutilation (female circumcision) and suffers from its complications. The book describes conditions in a tuberculosis sanatorium where Stone's mother dies from a ruptured aneurysm, the underlying condition acquired from her husband who has syphilis, or more specifically, tabes dorsalis. Marion's participation in the setting of an atriocaval shunt (a "Shrock") during trauma surgery in New York sets the scene when he encounters his biological father. The reader is further confronted with typhoid fever and hepatitis with liver failure. Other topics covered are depression, appendicitis, amputation, rickets, intestinal cancer, phlebitis, and intracranial hemorrhage.
Culture Critic gave it an aggregated critic score of 78 percent based on an accumulation of British and American press reviews. [3] In Bookmarks May/June 2009 issue, a magazine that aggregates critic reviews of books, the book received a (4.00 out of 5) based on critic reviews with the critical summary saying, "Verghese’s first novel is an expansive story well told". [4]
By February 2012 the book had been on the bestseller list of The New York Times for more than two years, and over one million copies had been sold. [5] Paula Bock praises the book finding the epic "absorbing, exhilarating, and exhausting." [2] Aida Edemariam notes that Verghese "interweaves (the characters') story with that of Ethiopia's past half century" and likes "the variety and colour of Verghese's world, its earthiness and drama, its concreteness and unselfconscious swing." [6] She criticizes "a certain brutality ... in the gender politics" of the novel and that in real life things do not work out so neatly as narrated. [6] Erica Wagner gives a mixed review finding "the novel to be capacious, not to say baggy" and "tinged, albeit lightly, with a sense of magic". [7] While she admires the vivid descriptions of surgery, she suggests that the medical details sometimes interfere with the flow of the story. She criticizes that Verghese attempts "to cram in every last fact about (his characters)." [7] However, John Irving wrote that "I've not read a novel wherein medicine, the practice of it, is made as germane to the storytelling process, to the overall narrative, as the author manages to make it happen here." [8]
In 2011, President Barack Obama said he had chosen Cutting for Stone as one of the five books on his summer vacation reading list. [9]
In February 2012 it was announced that Susanne Bier has signed on to direct a movie version of Cutting for Stone. Scott Teems will write the screen adaption. [10]
Gynaecology or gynecology is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined area of obstetrics and gynaecology (OB-GYN).
Charles Everett Koop was an American pediatric surgeon and public health administrator who served as the 13th surgeon general of the United States under President Ronald Reagan from 1982 to 1989. According to the Associated Press, "Koop was the only surgeon general to become a household name" due to his frequent public presence around the HIV/AIDS crisis of the 1980s.
Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may include depression, infertility, and social isolation.
Abraham Colles was Professor of Anatomy, Surgery and Physiology at the Royal College of Surgeons in Ireland (RCSI) and the President of RCSI in 1802 and 1830. A prestigious Colles Medal & Travelling Fellowship in Surgery is awarded competitively annually to an Irish surgical trainee embarking on higher specialist training abroad before returning to establish practice in Ireland.
A surgical instrument is a medical device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in all sorts of surgeries, while others are designed for only certain specialties or specific procedures.
Pediatric surgery is a subspecialty of surgery involving the surgery of fetuses, infants, children, adolescents, and young adults.
James Marion Sims was an American physician in the field of surgery. His most famous work was the development of a surgical technique for the repair of vesicovaginal fistula, a severe complication of obstructed childbirth. He is also remembered for inventing the Sims speculum, Sims sigmoid catheter, and the Sims position. Against significant opposition, he established, in New York, the first hospital specifically for women. He was forced out of the hospital he founded because he insisted on treating cancer patients; he played a small role in the creation of the nation's first cancer hospital, which opened after his death.
The Royal College of Surgeons in Ireland (RCSI) is a not-for-profit medical professional and educational institution, which is also known as RCSI University of Medicine and Health Sciences. It was established in 1784 as the national body for the surgical branch of medicine in Ireland, with a role in supervision of training, and as of 2021 provides a broad range of medical education in multiple countries.
John of Arderne (1307–1392) was an English surgeon, and one of the first of his time to devise some workable cures. He is considered one of the fathers of surgery, described by some as England's first surgeon and by others as the country's first "of note". Many of his treatments are still in use today. Arderne's help was given to both the rich and the poor. His view on fees was that rich men should be charged as much as possible, but poor men should be remedied free of charge. His remedies for illness are considered substantial for his time. Arderne recommended opium as a soporific and as an external anesthetic that the patient "shal sleep so that he shal feel no cutting". In his document about Fistula in ano, John of Arderne sets out not only his operative procedures but also his code of conduct for the ideal medical practitioner.
Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF).
Anal fistula is a chronic abnormal communication between the anal canal and the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. Anal fistulae commonly occur in people with a history of anal abscesses. They can form when anal abscesses do not heal properly.
Elinor Catherine Hamlin, AC, FRCS, FRANZCOG, FRCOG was an Australian obstetrician and gynaecologist who, with her husband, New Zealander Reginald Hamlin, co-founded the Addis Ababa Fistula Hospital, the world's only medical centre dedicated exclusively to providing free obstetric fistula repair surgery to poor women with childbirth injuries. They also co-founded an associated non-profit organisation, Hamlin Fistula Ethiopia.
Abraham Verghese is an American physician and author. He is the Linda R. Meier and Joan F. Lane Provostial Professor of Medicine, Vice Chair for the Theory & Practice of Medicine, and Internal Medicine Clerkship Director at Stanford University Medical School. In addition, he is the author of four best-selling books: two memoirs and two novels. He is the co-host with Eric Topol of the Medscape podcast Medicine and the Machine.
Fistula Foundation is a nonprofit 501(c)(3) organization focused on treatment of obstetric fistula, funding more repair surgeries than any other organization, public or private. As of September 2022, they support hospitals and doctors in over 20 countries across Africa and Asia. The foundation is dedicated to treating obstetric fistula by covering the full cost of fistula repair surgery for poor women who would otherwise not be able to access treatment. They also provide fistula surgeon training, equipment and facility upgrades that make fistula treatment as safe as possible, post-surgery counseling and support for healed patients. The foundation has been recognized by several organizations for its transparency, effectiveness and efficiency, earning a top "A" rating from CharityWatch and a four star rating from Charity Navigator for 16 years in a row, placing it in the top 1% of charities reviewed on the site. In 2023, the foundation received a $15 million gift from philanthropist MacKenzie Scott, announced alongside a new five-year strategic plan that will advance the foundation's In It to End It vision. The foundation has also been selected as one of 22 charities recommended by Princeton Professor Peter Singer's organization, The Life You Can Save. The organization's cost-effectiveness was also noted by GiveWell in 2019.
Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.
Addis Ababa Fistula Hospital, also known as AAFH and Hamlin's Addis Ababa Fistula Hospital, is a women's health care hospital based in Addis Ababa, Ethiopia. The hospital was founded by Australian physicians Catherine Hamlin and Reginald Hamlin, to care for women with childbirth injuries. It is the only hospital of its kind dedicated exclusively to treating women with obstetric fistula, a condition in the developing world where maternal health provisions are poor. All patients are treated free of charge.
Pradeep Kumar Chowbey is an Indian surgeon, known for laparoscopic and bariatric surgeries. He is the incumbent Executive vice chairman of the Max Healthcare, Chairman of the Minimal Access, Metabolic & Bariatric Surgery and Allied Surgical Specialities of the Max Healthcare Institute, New Delhi. He is the founder of the Minimal Access, Metabolic & Bariatric Surgery Centre at the Sir Ganga Ram Hospital, New Delhi and has served as the Honorary Surgeon to the President of India, Dalai Lama and the Indian Armed Forces (AFMS). The Government of India awarded him the fourth highest civilian honour of the Padma Shri in 2002.
Willis John Potts was an American pediatric surgeon and one of the earliest physicians to focus on the surgical treatment of heart problems in children. Potts set up one of the country's first pediatric surgery programs at Children's Memorial Hospital in Chicago.
Ian Aird was a Scottish surgeon who became Professor of Surgery at the Royal Postgraduate Medical School in London. There he built up a large and productive research department which made particular contributions in cardiac surgery, renal transplantation and the association of blood groups with stomach cancer. He came to national and international prominence in 1953 when he led the teams which performed an operation to separate conjoined twins. His book A Companion in Surgical Studies was among the best selling surgical textbooks of its day. He died suddenly in 1962 at the age of 57.
The Covenant of Water is a 2023 novel by physician and author Abraham Verghese. The book tells the story of a Malayali family living in southwest India, in the Kerala state, with the narrative spanning three generations, from 1900 to 1977. In each generation, some members of the family die by drowning because of an affliction they refer to as "The Condition.” This inherited disorder, which is characterized by fear of water and deafness, is revealed to be von Recklinghausen's disease.