Stony silence

Saaz Aggarwal interviews Abraham Verghese the author of the book Cutting the Stone

Is there a story behind the title Cutting for Stone?
It's from a line in the Hippocratic Oath,u00a0. . .u00a0I will not cut for stone, even for patients in whom the disease is manifestu00a0. . .u00a0In the days when bladder stones were epidemic, there were itinerant stone cutters who would cut and get the stone out, but because they wiped the bloody knife on their aprons, patients usually died of infection the next day.

In my novel, several of the characters have the surname 'Stone' and they are surgeons, and I hoped the phrase would resonate for the reader at several levels.

Cutting for Stone is about a pair of identical twins. How much of the descriptions are influenced by your personal experience?
Actually the twins sort of emerged.u00a0 I don't think they had to do with my sons who are close in age, or my older brother and me. It's always been a tempting device for writers to explore two polar extremes in 'one' person, and it became an important redemptive theme in the book. I think we are all fascinated to some degree by twins (and nuns) and hence their initial appearance.

Of all your lifelike characters, Ghosh in Cutting for Stone is so real that the reader can even predict his reactions in the situations you describe before you have him make them. How much of him is drawn from a real person?u00a0
He embodies qualities I have most admired in people I know, both physicians, but also men who are comfortable with their maleness and vulnerability, and who have a practical and simple philosophy of life. His approach to medicine and to teaching is something I closely relate to, and his role as a father is one I think we would all aspire to hard to do, especially for kids that are not yours biologically, but he shows how irrelevant that is.

Cutting for Stone is based in your childhood home, Ethiopia, and your love and nostalgia for the country are quite palpable.
Ethiopia is my birthplace, the place of my earliest memories. I have only been back twice since I left. It was emotional and also left me with a sense of finality that you can't actually go back, or rather 'you can't step into the same river twice.'u00a0 I knew the geography well and it is a land of such incredible beauty that it seemed a natural location for my story.

India is the land of my heritage and I have a strong bond to Madras, where I attended Madras Christian College and later Madras Medical College. I have a dense web of friends and family in India it is a lively and vibrant place and my connections are strong.u00a0 I have lived in the United States for a good part of my life. My children were all born here. My writing is influenced by all these places and cultures and the people I have known in each of them.

How much of what you've written about liver transplants in Cutting for Stone is based on the reality?
The pioneering operation that Stone does in the book is real in the sense that the operation when it was first done that way became a breakthrough in surgery.

I met Thomas Starzl when I was a Chief Resident in East Tennessee and have kept up with him. He is truly a surgeon's surgeon and did much pioneering work in the liver transplant field. I also had help from Francisco Cigarroa who was president of the Health Science Center in San Antonio when I worked there.u00a0 He let me watch as he performed a liver transplant on a child. San Antonio has an extraordinary team led by Glenn Halff.

They make liver transplants appear almost routine.

Your previous two mainstream books My Own Country and The Tennis Partner are also steeped in the world and intricacies of medical practice. But Cutting for Stone shows how doctors are drawn into their vocation, and gives some glimpses into the passion doctors have for medicine and healing and the inherent nobility of the profession far more than in the other books.
I hope the reader will enjoy the technical passages, much as I enjoy learning about other occupations in the course of a novel. I do think the human body is inherently interesting and we are all drawn to it. An aim of the novel was to show just how medicine and the magic word, 'work,' can both heal and cripple. In the book, there are characters who exemplify both ends of that spectrum. Dr. Stone was very skilled, he focused on the moment and had great knowledge and wisdom, but it was not enough to save him.u00a0 I think that my love for medicine, my sense of it being a calling inevitably comes through in much of what I write.

While My Own Country told the story of how AIDS made an appearance in the US and began to be recognised as an epidemic, and The Tennis Partner deals with substance abuse as its central theme, would you say that Cutting for Stone is a book about the political issues in women's medicine?
No, not really. I did not set out to advance a certain agenda, but I think some of my biases come out: one of my pet peeves, which is over-reliance on science and technology at the expense of a caring doctor-patient relationship. One of the things I hope this book does is to portray that very well. I worry patients are starting to assume, 'I guess that's how medicine is: you show up and somebody sees you here and orders 17 tests and sends you somewhere else, sends you to someone else, and pretty soon you've seen all these people and you have no idea who you really belong to as a patient.' To me, this profession is a ministry of healing, it is a calling, and that sense has become greatly threatened. If I have to claim a theme that would be it: medicine unchanged through antiquity.

Your books are strewn with aphorisms, none more than Cutting for Stone. What do you attribute this to?
Medicine is so rich with aphorism and metaphor always trying to get the student to remember and feel what the patient is experiencing. The people teachers, leaders, friends I have known, the many patients I have worked with, all of whom have helped me know myself better and learn about life were proofs of these aphorisms.

In The Tennis Partner you mention your habit of keeping diaries, and making detailed notes to explore your thoughts, as a tool to getting insights and making progress in various areas of your life.
Diaries and journal-keeping are a very important habit for my writing. Even jotting a note, describing a face, or a road, or a situation keep it fresh for me a long time after it has happened. Sometimes, I feel that I understand what I am thinking only when I have written it down. It makes everything monumentally clearer and sharper.

Why was there such a long gap between your second and third books?
I've been writing this novel on and off for close to a decade. Since I love medicine and being a full time physician, that is just the way it had to be slow. I burned the midnight oil a lot and weekends were often writing time, which took away, of course, from my family time. Along the way I had a hard time saying no when I had a chance to submit an essay or article to the New York Times and the New York Times Magazine, The Wall Street Journal or elsewhere.u00a0 At Stanford, for the first time ever, I have fewer administrative responsibilities and protected time to write. The writing is considered my research-equivalent.

How did your time at the Iowa Writers' Workshop shape your writing?
The Workshop was so much less structured than the life in medicine I had been used to.u00a0 You met once a week to discuss two stories and then your time was deliberately free to immerse yourself in reading voraciously and to develop your writing voice.u00a0 I remember feeling very intimidated by my fellow students because they were very smart, younger than meu00e2u0080u0094I was in my mid-thirties, and they were mostly straight out of college English programs. Having your peers look at your work was very energizing.

It was at the Iowa Writers' Workshop that my agent, Mary Evans, came across one of my short stories,
"Lilacs," that I planned to have critiqued and she immediately showed the story and asked to represent me.u00a0 It was a wonderful break.

How do you now fit your writing into your very busy life as a doctor and teacher?
My identity is very much that of being a physician, of having the privilege, the honor, the calling to serve, and to serve not only patients, but to serve the profession,u00a0 to honor its ideals, to celebrate its grand history and to support what I think of as the priestly or Samaritan function of being a physician. So I see all the writing, whatever form it takes u00e2u0080u0093 fiction, non-fiction, op-ed, obituary, reviews, essay as being a function of that grand privilege and that stance of being a physician, which, in my case is everything.

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