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Cutting for Stone: An Ethiopian Myth

March 10, 2012

Cuttng for Stone
Abraham Verghese
Vintage Canada Edition © 2010

Rating 4 Stars Excellent: a first class read

Unexpectedly I found his novel about Ethiopia and surgery entertaining and authentic.  It is not history but like many myths it presents larger truths. The characters are representatives of people you could meet in Africa.The story is largely set in a hospital known as Missing. Missing is a mispronunciation of mission but also is describes the situation  for  the surgeon Thomas Stone who buries himself in work to hide from his neglected childhood and Sister Mary Praise the beautiful Indian Nun who never recovers from the trauma of her 6 months transit through Aden.
Stone is credited with writing a book similar to the most famous surgical texts every published and like Hamilton Bailey the actual author has only 9 digits). Stone is a skilled mission surgeon and later a pioneer of liver transplantation. The Hippocratic oath is the source for the books title and the family name. Sister Mary Praise dies from a ruptured uterus after interventions with surgical instruments some of them as barbaric as the spears that martyred her hero St.Theresa.

The narrative starts with Stone and Mary leaving Missing for ever. Sister Mary Praise dies, Dr Thomas Stone absconds leaving premature conjoined twins who survive their surgical separation to form the nidus of a family. The Indian Gynecologist and the internist who has always loved her marry on a one year renewable contract and raise the twins as their own. This assembled family also includes two Ethiopian maids one of them Rosina who has a daughter Genet. So this is also just the simple story of a couple and their adopted children. Like many children living in Africa Marion (who is named after the founder of Gynecology, Shiva who is named after the Indian god of destruction and Genet meaning heaven, experience and witness events like murder, execution, arrest of family members and violent revolution. Events that children should not experience.

The coup staged by brothers in the Imperial Guard, who in this book are friends of the Missing Hospital staff, did occur, but at dates earlier than represented. Ghosh, the twins step father, is arrested for being friends with one of the coup leaders. Genet;s biological father is executed and her mother Rosina, commits suicide. Later Genet who is Eritrean, hijacks a plane and Marion has to flee Ethiopia. Guilt by association is all to common in Africa to this day. The human side of this book is accurate. The operating rooms in the caves of Eritrea described by Marion did exist but how good they were is something that has yet to be verified.

he author uses as a source the book the last days of the empire an allegorical account of Halie Selassie again literature but not actually historical. The surgical accounts are authentic including the description of the glistening peritoneum and the surgeons pride in the appearance of the colostomy in contrast to the patients abhorrence. The deception of Operating room number 3 being the only operating room is not quite believable. But the idea that donors don’t understand what may be the best use of their money is a reality.

The coming of age of the twins and Genet is another theme. The conflicts of the twin brothers are reminiscent of the old testament twins Jacob and Esau. Jacob takes the birth rite of Esau just as Shiva was always taking from Marion. Shiva becomes a fistula surgeon trained by his mother, and Marion goes to America where he ends up studying within the system where his father excels. Shiva and Marion are only reconciled at the end when Shiva donates part of his liver to save his Marion’s life from the hepatitis he contracted sexually from Genet.

Like a Shakespearean tragedy all is neatly worked out in the final act. Thomas Stone leads the team where a liver is transplanted from Shiva to Marion. Marion’s life is saved but Shiva dies of a brain hemorrhage which was caused by anticoagulants given for an upper limb phlebitis. It is possible that his last event could occur but I would not have anti coagulated an upper limb phlebitis. They don’t give pulmonary emboli. Marion returned to Ethiopia to witness the military overthrow of the bloody Mengistu regime.The change is described with optimism but this requires more critical assessment.

The book is excellent, I do recommend it as a surgeon who lives in Ethiopia and I would like to thank Mary Ellen Gillan for giving me a copy thus obliging me to read it.

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