Review: Cutting For Stone, Abraham Verghese

Verghese is a physician, and I’ve read and admired his work on the doctor-patient relationship, so I thought I would try his first novel (Knopf, 2009), which was a NYT bestseller (for 52 weeks), a book club favorite, and widely praised. Here’s the blurb:

The story is a riveting saga of twin brothers, Marion and Shiva Stone, born of a tragic union between a beautiful Indian nun and a brash British surgeon at a mission hospital in Addis Ababa. Orphaned by their mother’s death in childbirth and their father’s disappearance, and bound together by a preternatural connection and a shared fascination with medicine, the twins come of age as Ethiopia hovers on the brink of revolution.But it’s love, not politics — their passion for the same woman — that will tear them apart and force Marion to flee his homeland and make his way to America, finding refuge in his work at an underfunded, overcrowded New York City hospital. When the past catches up to him, wreaking havoc and destruction, Marion has to entrust his life to the two men he has trusted least in the world: the surgeon father who abandoned him and the brother who betrayed him.

It would be hard to overstate the love for this book. Looking at Amazon.com, Cutting For Stone has over 1000 reviews which average 4.5 stars. Over at Goodreads, it’s got a 4.2 out of 5 after 43,000 ratings. As seems typical of my response to book club fiction, I thought it was just ok. Click here for an excerpt and purchase links. This review contains spoilers.

The novel is set mainly in Addis Ababa, at Mission Hospital, known as “Missing Hospital” thanks to the way the locals pronounced it. The hospital is run by Matron, a sensible, wise, unflappable leader, dedicated to her missionary work with Ethiopia’s poor, who is not above bending the truth to get donations from American congregations who insist on sending Bibles instead of badly needed medical supplies. There are two immigrants from Madras, Dr. Kalpana Hemlatha, known as Hema, and Dr. Abhi Ghosh, who raise twins Marion and Shiva Stone when their birth mother, Sister Mary Joseph Praise, also Indian, dies in labor, and their father, brilliant English surgeon Thomas Stone, runs away.

The novel is written from the point of view of one of the twins, Marion, beginning with a prologue set in 2004 that refers to the momentous events of his life so far: “the miracle of our birth” in 1954, his relationship with his brilliant but tortured father, his estrangement from his twin, and his journey from Ethiopia to America and back. Although I was intrigued, I worried immediately that so many bits in this prologue were highlighted by my fellow Kindle readers, never a good sign. The abundance of Passages of Wisdom such as “Life, too, is like that. You live it forward, but understand it backward” and “We are all fixing what is broken. It is the task of a lifetime” had my fingers shaking as I pressed the forward buttons, but on I read. Unfortunately, these bon mots don’t ever end, later coming out of the minds of different characters, like the strong as a bull, typically unreflective Hema, who wonders, “Wasn’t that the definition of home? Not where you are from, but where you are wanted?” And, every time, they felt more to me like the author speaking than any character.

The novel begins with Dr. Stone’s and Sister Mary Joseph Praise’s perilous sea journey from India to Africa, then spends a couple of hundred pages on the day of the twins’ birth. Then we follow the twins as they grow up in the hospital. The blurb promises a great love affair that wrenches them apart, but it’s really just a young teenage crush gone awry, one more thing that happens in a novel in which a great many things happen. I never felt connected to any of the large cast of characters, which made this book feel much, much longer than its 667 pages. Despite having a nearly omniscient narrator (indeed, who was able to narrate how he felt being born, which confirmed for me that this guy was a ponderous wet mop literally from birth), and despite the burden of tremendous detail, a lot of it backstory, about each major character, I felt as attached to them as I would watching them through a plate glass window.

Although set in Ethiopia, against the backdrop of some major events like the overthrow of Haile Selassie in 1979 (I think the author takes some liberty with dates here, not a problem for this reader at all), I didn’t get a good sense of place outside of the actual hospital. I felt very much as if I were looking at it from a foreigner’s eyes, and perhaps that was the author’s intention. Or it may have been because none of the major characters were Ethiopians. The Ethiopians in the novel came in a few basic flavors: the emperor and his henchman, the prostitutes, the loyal servants, and the pitifully ill.

My biggest objection to the novel comes with its portrayal of women. Sister Mary Joseph is not only a nun, but a nurse, believing that “her job was to make her life something beautiful for God.” After a brief pit stop in Yemen, where she is raped (her habit is dramatically blood stained at the juncture of her thighs when she stumbles into Mission), she serves as Stone’s punctual, loyal, quiet assistant at the hospital, and is completely subordinate to him in both work and life, as when she becomes pregnant during his drunken nocturnal visit to her bed. She refused to tell anyone about her pregnancy until it was too late, and “Not a cry escaped from Sister Mary Joseph Praise while in the throes of her cataclysmic labor.” To make him more sympathetic, Stone is described as painfully shy and a “social retard”, and his silent rapport with Sister in the OR is, I think, supposed to convey a sense of mutual respect, but explanatory revelations about Stone’s character are too weak to support five hundred pages of anticipation, and Sister comes off as a paragon of virtuous womanhood who suffered gladly for her love of two men, Jesus and Dr. Stone, and not a real person at all.

The female who comes between the twins is Genet, the illegitimate daughter of Stone’s maid and another minor character. She is another stock type, familiar to anyone who has seen the film Forrest Gump and remembers Jenny. Marion falls in love with her, and wants to wait to have sex with her until they marry, but she’s not on board. She becomes a rebel, first with sex – for which she is punished by her mother with a bloody genital mutilation — then with politics, actually joining a terrorist group, the Eritrean People’s Liberation Front. Disgusted, Marion leaves Ethiopia for New York, but they meet up again, after she’s had and lost her child, burning up with fever from what we later learn is a sexy cocktail of TB and hepatitis B. Marion has sex with her, without her active consent, twice. Genet is so ill she bleeds and passes urine all over him, and all he can think is “It’s because you fucked my life up. You could have counted on me. Money in the bank, as they say here. And what did you do? You turned it all into shit.” Let’s review. Genet’s great unforgivable crimes were failing to love our uptight supercilious narrator in return, letting an upbringing which included illegitimacy and genital mutilation affect her emotional health, and gaining a political conscience. Dear reader, I know this will shock you, but Genet eventually dies.

Let’s see, who else do we have? Well, there’s Hema, a character I really liked at first. She’s a big woman, a determined and accomplished obstetrician with a take no prisoners attitude. But she takes one look at those parentless twin babies and it’s all over. Sure, she still works, but its the mothering that matters. Despite the fact that she herself bucked her parents’ gendered expectations of her, this is her attitude towards pregnant women:

Whether it is India or here, the ladies are all the same,” Hema said, gazing at the women milling around. No one had left. They waited for the tea, bread, and vitamin pill that would follow the clinic. They grinned back at Hema with sisterly affection — no, with adoration. “Look at them! All happy and radiant. In a few weeks, when labor starts, they’ll be yelling, screaming, cursing their husbands. They’ll turn into she-devils. You won’t recognize them. But now they’re like angels. She sighed. “A woman is never more a woman than in this state.

The title phase “Cutting for stone” is taken from the Hippocratic oath: “I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.” Cutting refers to surgery and stone to kidney or gallbladder stones (and is also, of course the name of the absent father), and, the prohibition in the Oath aside, the book is at its best when it is in the operating theater. I really enjoyed the take it provided on practicing medicine in diverse settings, from Ethiopia in the fifties to the seventies, to an underfunded city hospital in New York.

I can understand why so many loved this book. It’s a unique and ambitious story, with memorable characters, and it clearly wants to pass on a lot of wisdom about a lot of things — how to be a good doctor, a good parent, a friend, a patriot. I felt too much was crammed in, and despite an abundance of plot, it felt slow and bloated. Too many times a character would stop to tell a long story with a tidy moral, or the narrator would interpose an info-dumping historical lesson, or a character’s mind would drift off on some long sensation-packed memory irrelevant to the present action. I’ve enjoyed this author’s memoirs, and I think Ill stick to his nonfiction from now on.

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