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«Cutting for Stone By Abraham Verghese  Paperback: 667 pages  Publisher: Vintage Books; 1st edition (January 26, 2010)  Language: English  ...»

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Cutting for Stone

By Abraham Verghese

 Paperback: 667 pages

 Publisher: Vintage Books; 1st edition (January 26, 2010)

 Language: English

 ISBN-10: 0375714367

 ISBN-13: 978-0375714368

ABOUT THIS BOOK

A sweeping, emotionally riveting first novel—an enthralling family saga of Africa and America, doctors and

patients, exile and home.

Marion and Shiva Stone are twin brothers born of a secret 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, 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.

Yet it will be love, not politics—their passion for the same woman—that will tear them apart and force Marion, fresh out of medical school, to flee his homeland. He makes his way to America, finding refuge in his work as an intern at an underfunded, overcrowded New York City hospital. When the past catches up to him—nearly destroying him—Marion must entrust his life to the two men he thought he trusted least in the world: the surgeon father who abandoned him and the brother who betrayed him.

An unforgettable journey into one man’s remarkable life, and an epic story about the power, intimacy, and curious beauty of the work of healing others. (From the publisher.)

DISCUSSION QUESTIONS

1. Abraham Verghese has said that his ambition in writing Cutting for Stone was to “tell a great story, an oldfashioned, truth-telling story.” In what ways is Cutting for Stone an old-fashioned story-and what does it share with the great novels of the nineteenth century? What essential human truths does it convey?

2. What does Cutting for Stone reveal about the emotional lives of doctors? Contrast the attitudes of Hema, Ghosh, Marion, Shiva, and Thomas Stone toward their work. What draws each of them to the practice of medicine? How are they affected, emotionally and otherwise, by the work they do?

3. Marion observes that in Ethiopia, patients assume that all illnesses are fatal and that death is expected, but in America, news of having a fatal illness “always seemed to come as a surprise, as if we took it for granted that we were immortal” (p. 396). What other important differences does Cutting for Stone reveal about the way illness is viewed and treated in Ethiopia and in the United States? To what extent are these differences reflected in the split between poor hospitals, like the one in the Bronx where Marion works, and rich hospitals like the one in Boston where his father works?

4. In thenovel, Thomas Stone asks, “What treatment in an emergency is administered by ear?” The correct answer is “Words of comfort.” How does this moment encapsulate the book's surprising take on medicine? Have your experiences with doctors and hospitals held this to be true? Why or why not? What does Cutting for Stone tell us about the roles of compassion, faith, and hope in medicine?

5. There are a number of dramatic scenes on operating tables in Cutting for Stone: the twins' births, Thomas Stone amputating his own finger, Ghosh untwisting Colonel Mebratu's volvulus, the liver transplant, etc. How does Verghese use medical detail to create tension and surprise? What do his depictions of dramatic surgeries share with film and television hospital dramas—and yet how are they different?

6. Marion suffers a series of painful betrayals—by his father, by Shiva, and by Genet. To what degree is he able, by the end of the novel, to forgive them?

7. To what extent does the story of Thomas Stone's childhood soften Marion's judgment of him? How does Thomas's suffering as a child, the illness of his parents, and his own illness help to explain why he abandons Shiva and Marion at their birth? How should Thomas finally be judged?

8. In what important ways does Marion come to resemble his father, although he grows up without him? How does Marion grow and change over the course of the novel?

9. A passionate, unique love affair sets Cutting for Stone in motion, and yet this romance remains a mystery— even to the key players—until the very conclusion of the novel. How does the relationship between Sister Mary Joseph Praise and Thomas Stone affect the lives of Shiva and Marion, Hema and Ghosh, Matron and everyone else at Missing? What do you think Verghese is trying to say about the nature of love and loss?

10. What do Hema, Matron, Rosina, Sister Mary Joseph Praise, Genet, and Tsige—as well as the many women who come to Missing seeking medical treatment—reveal about what life is like for women in Ethiopia?

11. Addis Ababa is at once a cosmopolitan city thrumming with life and the center of a dictatorship rife with conflict. How do the influences of Ethiopia's various rulers-England, Italy, Emperor Selassie-reveal themselves in day-to-day life? How does growing up there affect Marion's and Shiva's worldviews?

12. As Ghosh nears death, Marion comments that the man who raised him had no worries or regrets, that “there was no restitution he needed to make, no moment he failed to seize” (p. 346). What is the key to Ghosh's contentment? What makes him such a good father, doctor, and teacher? What wisdom does he impart to Marion?





13. Although it's also a play on the surname of the characters, the title Cutting for Stone comes from a line in 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.” Verghese has said that this line comes from ancient times, when bladder stones were epidemic and painful: “There were itinerant stone cutters—lithologists— who could cut into either the bladder or the perineum and get the stone out, but because they cleaned the knife by wiping their blood-stiffened surgical aprons, patients usually died of infection the next day.” How does this line resonate for the doctors in the novel?

14. Almost all of the characters in Cutting for Stone are living in some sort of exile, self-imposed or forced, from their home country—Hema and Ghosh from India, Marion from Ethiopia, Thomas from India and then Ethiopia.

Verghese is of Indian descent but was born and raised in Ethiopia, went to medical school in India, and has lived and worked in the United States for many years. What do you think this novel says about exile and the immigrant experience? How does exile change these characters, and what do they find themselves missing the most about home? (Questions issued by publisher.) An interview with Abraham Verghese An interview with Abraham Verghese about his life and writing and in particular about his 2009 novel Cutting for Stone | taken from bookbrowse.com Your previous two books are non-fiction, but you've said that you have always thought of yourself as a fiction writer first. How so?

Fiction is truly my first love. To paraphrase Dorothy Allison, fiction is the great lie that tells the truth about how the world really lives. It is why in teaching medical students I use Tolstoy's The Death of Ivan Ilych to teach about end-of-life, 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.

One of my first published short stories was "Lilacs," in which the protagonist has HIV. Its appearance in The New Yorker in 1991 was a part of what led to my 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 that led to a second non-fiction book, The Tennis Partner. But after that, 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.

In 1990, while practicing medicine, you decided to attend the Iowa Writers' Workshop and obtain a degree in Fine Arts. What led you to go back to school—particularly for creative writing—while you were in the middle of a successful career as a doctor?

At the time I was living in Johnson City, Tennessee, working at a small medical school as an internist and infectious diseases specialist. Between '85 and '90, we began to see many HIV-infected persons at a time when the pundits said AIDS was a big-city disease, and we'd never see it in our small communities. Soon we had close to 100 patients in a town of 50,000, a mystery I explained in My Own Country. It was an intense, sad, heartbreaking period because we had no real therapy and lots of prejudice and hatred, but also lots of courage and heroism. Not having anything by way of medicine to offer my patients, I began to visit with them at times in their homes. That is when I found that even when I had nothing to offer, I had everything to offer: It was the distinction between healing and curing (and the cure was what all of us in Western medicine were obsessed with).

I realized that I could heal when I could not cure, meaning that my presence, my interest and support, could help the patient and the family come to terms with the illness, come to terms with death. But by the fifth year of this practice, with little in the way of help, I was getting burned out.

If I wanted to stay in the war against AIDS—and I did—I needed to pace myself, to take a break. I had been writing short stories and essays as a way of keeping sane during those intense days. So I decided I would apply to the Iowa Writers' Workshop, send in my two stories, and if they took me, I would go. If they didn't take me, I was still determined to take a break and support my family by working in emergency rooms. Well, Iowa took me, and I wound up cashing in my 401K plan and giving up my tenured position to drive out there with my wife and two young children. As I look back, I think it was a very selfish thing to put my family through, but it was an act of self-preservation, too—I felt I would implode if I didn't take a break.

In Iowa, I worked in the University HIV clinic once a week. Other than that and the workshop that met weekly, my time was gloriously free to read and write. Given my background, this was precious time—I didn't think I would ever get time like that again (and I haven't)—so I worked very hard for the year and a half it took me to finish. The bills piled up, and when I was done, I needed to get a regular job again, which is how I landed up in El Paso at Texas Tech's teaching hospital there. I chose a place well off the main academic trail because I thought that my nights and weekends would be mine, no grants to write. That turned out to be true and my first two books were written there.

Was there a single idea behind or genesis for Cutting for Stone?

My ambition as a writer was to tell a great story, an old-fashioned, truth-telling story. But beyond that, my single goal was to portray an aspect of medicine that gets buried in the way television depicts the practice: I wanted the reader to see how entering medicine was a passionate quest, a romantic pursuit, a spiritual calling, a privileged yet hazardous undertaking. It's a view of medicine I don't think too many young people see in the West because, frankly, in the sterile hallways of modern medical-industrial complexes where physicians and nurses are hunkered down behind computer monitors, and patients are whisked off here and there for this and that test, that side of medicine gets lost.

So I began with the image of a mission hospital in Africa, redolent with Dettol, the antiseptic of choice of the tropics; I wanted to portray a place so basic, so unadorned, that nothing separates doctor and patient, no layers of paperwork, technology or specialists, no disguising of the nature of the patient's experience or the raw physician experience. It's a setting where the nature of the suffering, the fiduciary responsibility and moral obligation to the patient and society are no longer

Abstract

terms. In that setting I wanted to put very human, fallible characters— people like Sister Mary Joseph Praise and Thomas Stone. I wanted the whole novel to be of medicine, populated by people in medicine, the way Zola's novels are of Paris.

Where does the title "Cutting for Stone" come from?

There is a line in the Hippocratic Oath that says:... I will not cut for stone, even for patients in whom the disease is manifest... It stems from the days when bladder stones were epidemic, a cause of great suffering, probably from bad water and who knows what else. Adults and children suffered so much with these—and died prematurely of infection and kidney failure. There were itinerant stone cutters— lithologists—who could cut either into the bladder or the perineum and get the stone out, but because they cleaned the knife by wiping it on their blood-stiffened surgical aprons, patients usually died of infection the next day. Hence the proscription, "thou shall not cut for stone." It has always seemed to me a curious thing to say when we recite the oath in this day and age.

But I love the Hippocratic Oath (or oaths, because its origins and authorship are far from clear), and always try to attend medical school commencement. When the new graduates stand and take the oath, all the physicians in the room are invited to rise and retake the oath. You see many physician parents and physician siblings standing as their son or daughter or brother or sister takes the oath. It chokes me up every time. Not only am I renewing my faith, but I am bursting with pride in seeing my students graduate—another part of the oath is "to teach them this art, if they desire to learn it; to give a share of precepts and oral instruction and all the other learning to my children and to the children of those who instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law."

How does all this relate to my novel? It isn't just that the main characters have the surname 'Stone'; I was hoping the phrase would resonate for the reader just as it does for me, and that it would have several levels of meaning in the context of the narrative.

Each of the characters in this novel is drawn to medicine in different ways and for different personal reasons. What drew you to medicine?



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