Editor ’ s Corner
Recommendations from My Bookshelf : Cutting for Stone by Abraham Verghese
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AVE YOU EVER BEEN a stranger in a strange land ?
I thought I was when I moved from New England to Cleveland , where I had to learn to talk a little slower , and that unfamiliar people who smiled and said “ hi ” as they passed me in the hallways were not mentally unstable – as I had been raised to believe in the Northeast – but were , in fact , just being friendly . In reality , it wasn ’ t until I traveled to other countries on faraway continents and tried to immerse myself in foreign cultures , however briefly , that I learned what it felt like to be an outsider .
The primary locale for much of the novel Cutting for Stone , by Abraham Verghese , MD , is a small hospital in Addis Ababa in Ethiopia . Mission Hospital goes by the misnomer Missing Hospital for the entire book , setting the tone for the doctors , nurses , and patients who justify its existence . Sister Mary Joseph Praise arrives from Madras , India , after a harrowing journey by sea during which her fellow novitiate and best friend from nursing school dies of typhoid fever , and she meets the English surgeon who will alter her course to this hard-to-find hospital , Thomas Stone . The path of our lives , it turns out , can veer quickly – prey to the randomness of fate , love , and disease .
At Missing , they are joined by two other foreign physicians , Kalpana Hemlatha ( Hema ), the hospital ’ s obstetrician and gynecologist , and Abhi Ghosh , an internist cum surgeon , both also from Madras . We meet the foursome in medias res , in the mid-1950s , after they have been working together for years , as Sister Praise is trying to give birth to the twins who will be the novel ’ s focus , Shiva and Marion ( named for Marion Sims , the 19th-century surgeon from Alabama ). Sister Praise … giving birth ? Yes and – spoiler alert – Stone is the father , though genetically only , as he flees the hospital soon after Shiva and Marion arrive . Fate intervenes yet again as the delivery does not go smoothly . Sister Praise develops disseminated intravascular coagulopathy , exsanguinates , and dies , leaving the parenting of the orphaned twins to Hema and Ghosh .
Oh , my fellow nerdy hematologists , I knew I ’ d draw you in with the DIC reference . In truth , this book is rife with hematology references , from the anemia many of the patients develop due to malnutrition and / or parasitic infections , to the myeloid metaplasia ( confirmed by none other than Maxwell Wintrobe !) and secondary acute myeloid leukemia that leads to Ghosh ’ s death .
And while I would love to be able to report that the hematologic aspects of the novel carry it from beginning to end , in truth they are but bit players in a broader story of tropical medicine , the cobbling together of health care with limited resources , and this notion of being an outsider .
The twins come of age recognizing their “ otherness ” against this backdrop . That Hema and Ghosh are not their biologic parents is frequently acknowledged , as is their societal position relative to their Ethiopian patients , and their relationship with the government amidst a failed coup . The twins start this story literally inseparable – they are conjoined , and seem to communicate without even speaking – but over time even view the other as being foreign . After Ghosh ’ s death , this time it is Marion who flees , following Stone ’ s path to America , as Shiva remains behind to assist Hema with gynecologic surgery , and to become internationally recognized for fistula repair , despite his lack of a medical degree .
Marion applies to and secures a surgical residency at a fictitious hospital in the Bronx in New York , Our Lady of Perpetual Succour . It is made clear from the outset that this hospital is staffed by international medical graduates and that , according to a co-resident , while “ rich ” hospitals take care of the poor in a way that is considered “ noble ,” at Our Lady , their care is “ shameful . The work of untouchables .” Ouch . They refer to Our Lady as an “ Ellis Island ” hospital , and contrast it to the “ Mayflower ” hospitals – the teaching hospitals for big medical schools . Their hospital cares for underrepresented minority populations
Mikkael A . Sekeres , MD , MS , is director of the Leukemia Program at the Cleveland Clinic in Cleveland , OH .
and represents “ the worst nightmare ” of residency for graduating American medical students . The Mayflower hospitals care for the rest of the population and use patients at Our Lady only as sources for organ donation . The prototypical Mayflower hospital cited in the novel is the one where I trained . Double ouch . A few years ago , I was at a conference with two colleagues from U . S . institutions , both wildly successful academically by any metric , and both having been raised and educated in Europe prior to completing their post-graduate training in America . As the three of us chatted , the conversation turned to the obstacles each of them had to overcome to attain his current position . They commented that I really had no idea how much harder they had to work than me , as physician immigrants , to “ make it ” in America .
They ’ re right . But thanks to Dr . Verghese , I ’ m a little closer to getting it .
Dr . Verghese writes with such insight , and passion , about community hospitals in underserved areas , it is clear he has more than just a passing knowledge of the international medical graduate experience in America . He is a gifted storyteller , and I am not ashamed to admit I ’ m jealous of his skills .
Those of us who are doctor- or nurse-writers ( please allow me the brief fantasy of including myself , if only for this book review , in that group ) tend toward a lean , chronological , and linear narrative akin to the H and Ps and progress notes we write in patients ’ charts . We are often guilty of eschewing extraneous descriptors , character development , or our own emotions in favor of patient-problem-solution pieces . Dr . Verghese crafts people and places with such talent , and injects so much feeling into his stories , that as I was reading Cutting for Stone , my own mood would rise and fall with those of the people he invented , and I regarded my colleagues who had come from other countries in an altogether different light .
Cutting for Stone is a terrific read , if only as a reminder of the medical technology we take for granted , and to treat those outsiders ( however they are defined ) with more respect , and more care .
Mikkael Sekeres , MD , MS Editor-in-Chief
6 ASH Clinical News June 2016