Medicine is a demanding mistress, yet she is faithful, generous and true. She gives me the privilege of seeing patients and of teaching students at the bedside, and thereby she gives meaning to everything I do,” writes Abraham Verghese, professor for the Theory & Practice of Medicine at Stanford University,in the acknowledgement section of his debut novel Cutting For Stone (Random House India. It is a novel “steeped in medicine with every character being connected to that world”.
With a sweeping canvas that moves from 1940s to the present day, it tells the story of a mysterious and mystic union of Sister Mary Joseph Praise, a Malyali nurse, Thomas Stone, a British surgeon – who work at the Missing Hospital in Addis Ababa – and Marion and Shiva who are born from their unexpected union.
Says Verghese: “It is a world that I know well superficially, but therein lies the trap – all novels really have to be about individuals or families who are in dis- tress in some way, and in the case of my characters,they were in as much distress as those outside of medicine. So, a novelist prides himself or herself on being able to invent and imagine, and I have certainly done that but have chosen a backdrop that though different for the reader is one that I am very familiar with, namely the world of Missing Hospital and the world of medicine.”
Verghese, who was born in Ethiopia to Indian parents, says that the narrator’s voice is “close to my own”. He adds: But then since all the characters are my invention, you might find traces of my beliefs or my pleasures in one or other aspect of medicine being manifest in other characters.”
As for Dr Stone’s character, he “embodies the dedicated physician who in seeking
‘perfection of the work’ to use Yeats’ term, gives up on ‘perfection of the life.’ In that sense Thomas Stone is presented as a counter to Ghosh for whom perfection of the life takes precedence and despite that, Ghosh is no less of a doctor. The young narrator, Marion, gets to observe these and other physician characters, and he begins to see the allure and seduction of work, and the dangers when that is used as a substitute for relationships.”
Marion, who is the narrator, and his brother Shiva “represent the dichotomy of an
individual, the dichotomy or duality in all of us, except in their case the dichoto- my has a physical quality – they truly are one, and yet they are separate.”
Verghese is the author of two memoirs – My Own Country: A Doctor’s Story and The
Tennis Partner. While the former delved into the “medical and spiritual emergency” that AIDS unravelled in a largely conservative community of Tennessee in the US, the latter explored Verghese’s association with David Smith, a young medical resident at El Paso,Texas, and their “tennis ritual” that allows them to “shed their inhibitions and find security in the sport they love and in each other” Does Verghese notice any change in the overall approach of medical training in the West? “The overabundance of new ways of imaging the body, the marvellous new therapies and procedures we can perform to relieve suffering, have paradoxically resulted in a great fragmentation of healthcare and a retreat from the bedside. Patients complain that no one seems to be in charge, and they perceive that the cursory exam of the body at the bedside suggests that doctors are being inattentive. My sense is that a lot of this has to do with decline in our skilled examination of the patient at the bedside.
So we train brilliant doctors who know a lot of facts and are up on the ‘evidence base’ for the effectiveness of this treatment or that, and yet they may miss the more obvious things at the bedside. I often joke that if you come to a modern medical centre missing a finger, no one will believe you till you do an MRI and a CAT scan and draw blood.”
As for AIDS, the author says that awareness had really helped diminish to a degree the stigma of HIV. “That is true here in the United States. The disease has been around for over a quarter of a century. My medical students now have been aware of HIV from the time they were in grade school. It does not terrify as it once did, and we don’t see the kind of uncharitable responses to these patients as we once did. That said, it is still a stigmatising disease in the patient’s mind at the very least, if nowhere else. Education and awareness are the key to overcoming that; having very visible people like Magic Johnson speak about their illness has done a lot to make people more accepting.”
Verghese sees the roles of a writer and a physician as “one”. He says: “No twins here in my being. My identity, beyond that of being of Indian origin, being a father, husband and so on is completely wedded to that of being a physician, of having the privilege, the honour, the calling to serve, and to serve not only patients, but to serve the profession, to honour its ideals, to celebrate its grand history, to profess my belief in the ‘Samaritan’ function of being a physician (to use Robert Loeb’s term). So I see all my writing,whatever form it takes as being a function of that privilege and that stance of being a physician, which, to me, is everything. So you understand why I resist the definition of the writer as somehow separate and divorced from my day job, as if it were akin to leaving work and performing burlesque after hours.”
He holds that his writing “has to stand on its own, to work by the standards of the
discerning literate reader for whom I write”. He says: “Ultimately, I think my reader wants to feel that I have respected their investment of time in reading me, and that I have created a believable world in which truths emerge and in which they have a great need to turn the page to see what happens next.”
The author says fiction is truly his first love. “To paraphrase Dorothy Allison, fiction is the great lie that tells the truth about how the world really lives. It is why I use Tolstoy’s The Death of Ivan Ilych to teach about end-of-life issues, and Bastard Out of Carolina to help students really understand child abuse. A textbook rarely gives them the kind of truth or understanding achieved in the best fiction. And I love fiction and got sidetracked to non-fiction.”
One of Verghese’s first published short stories, he says, was Lilacs, which appeared in the New Yorker in 1991. “It led to my getting a contract to write My Own Country, a memoir of my years of caring for persons with HIV in rural Tennessee. While writing that book I found myself living through an intense personal story of friendship and loss, which led to the second book, The Tennis Partner. I passed up on an offer to write a third non-fiction book. I was keen to get back to fiction, to explore that kind of truth. I do think it is easier in the grand sweep of a novel,” says the author.