‘Cutting for Stone‘ by Abraham Verghese (Vintage Books, 2009)
Abraham Verghese’s 2009 novel, Cutting for Stone, is a compelling story of a surgeon in Ethiopia who, during his childhood, medical training and early career, tries to reconcile his ideals about medical practice with the tumultuous historical moment in which he lives. It is set entirely in under-funded and ill-equipped hospitals, with a cast of characters that are all medical practitioners of one kind or another. It is replete with vivid descriptions of surgical procedures and it offers a distinctive, clinical poetics of illness and medicine. But its engagement with medicine is more than just aesthetic: the novel further examines the social, political and economic pressures that act upon biomedical practice as the representation of medicine in the novel is imbricated with the political reality of a postcolonial Ethiopia and the economic network of global capitalism. This is particularly true of the way the novel represents expatriation. The first of the four parts follows the life of the protagonist Marion’s mother, a nurse, and a nun from the Carmelite Order of Madras, who travels abroad on a mission and finds herself working in Addis Ababa. The second follows the childhood of Marion and his twin brother, Shiva, as they are raised by their foster parents, two Indian surgeons working in the same hospital, after their mother dies and their father abandons them. In the third part, the family lives through a series of military coups and uprisings in Ethiopia, with their lives hanging precariously in the balance in the tense political climate. Finally, Marion is forced to leave the country because of the political situation, and he emigrates to America, where he works in a Medicaid-funded hospital in the Bronx.
What is most striking about the characters is that they are all expatriates, mostly from India. Marion’s biological father, his mother, and his adoptive mother, had all at some point worked in the Government General Hospital, Madras. This shared past led to a strong sense of kinship between them when they lived in Addis Ababa. Marion was always part of a diaspora community, either that of the Indian diaspora that he was born into or both the Indian and Ethiopian diasporas in New York with whom he shared racial and cultural affiliation.
Avtah Brah suggests that in order to fully understand this concept of diaspora, it is important to historicise the patterns of migration and to understand the socio-economic, political and cultural conditions that lead to these kinds of journeys (Brah 2005: 443). Verghese’s novel is sensitive to these nuances. The novel explores diverse material conditions – ranging from the dynamics of the international labour market to a national movement towards decolonisation – that led to these doctors migrating. It also explores the profound existential impact these journeys had on the characters’ sense of self.
Because the lives of the surgeons are determined by these overarching political and economic conditions, it is clear that medicine itself is subject to numerous ideological pressures that act upon it from outside. The title of the novel is a reference to the Hippocratic Oath, particularly the tenet that physicians must leave lithotomy (‘cutting for stone’) to surgeons alone. While on one level this allows for a pun in the names of the main characters, who have the last name Stone, this allusion to the Oath evokes an ethical idealisation of the practice of healing. This is rendered ironic by the novel’s representation of the grim political and economic realities that constrain medical practice in developing economies and in the American insurance-based healthcare model. The Ethiopian hospital’s funding depends on the favour it has with the existing government. The demographic of the medical staff they hire is the product of a labour market in which the shortage of doctors in a certain community attracts foreign migrants who are otherwise unemployed in their own countries. The act of treating a patient becomes further politicised when doctors begin serving members of the Emperor’s family or high-ranking officials in the government. Because medical practice is fraught with these kinds of pressures, the practice of healing or the ethical decisions associated therein are often skewed by these extra-medical concerns. The novel allows for the critique of the way these ideologies impinge upon medical practice.
Stylistically, the novel has a number of similarities with Salman Rushdie’s Midnight’s Children: both novels are framed as stories written by their protagonists about not just their own lives, but the history of their family and of their respective nations from a time before they were born. The narrator/author figures often intervene in the narrative through subtle changes in voice or the occasional re-emergence of the first-person pronoun. Verghese’s novel is mostly about Marion’s quest for reconciliation with his uprooted past as he tries to give meaning to his life and the lives of his brother, father and deceased mother by telling his story. Like in Rushdie’s comparative, there are also elements of the magical, such as moments of telepathy, intuition or Marion’s highly-developed sense of smell, which are counterpoised with the steely scientism of the surgeons’ training and practice. There is also a sense of fatalism as the plot is driven either by fortuitous coincidences or sudden, terminal illnesses. This blending of the scientific, fantastic and fatalistic reflects the indeterminacy of Marion’s existential condition, as his life and career are driven by political and economic forces beyond his control. This poses complex questions about the extent to which the medical practice has autonomy and agency against the sway of the social and political conditions that otherwise shape it.
Verghese’s novel has several layers of meaning. It is the story of surgeons struggling to come to terms their personal traumas through their duties within medical practice. It is also an astute observation of the political and economic conditions that drive medicine as an industry, such as the global labour market of doctors and surgeons, the systemic socioeconomic disparities entrenched within American healthcare and the dependency of the medical practice on the favour of the incumbent political regime. Medical practice in the novel is inflected by discourses of diaspora, nationalism, postcolonial identity and capitalism. This opens up further avenues of commentary on the extent to which medicine is not the idealised complicit in the political and economic ideologies of governments.
Reviewed by Vivek Santayana, who is a postgraduate student at the University of Edinburgh. Within the medical humanities, he is mainly interested in narrative ethics, literary representations of medicine, literature and psychotherapy and medical-ethical debates. He has recently reviewed J.M. Coetzee and Arabella Kurtz’s The Good Story: Exchanges on Truth, Fiction and Psychotherapy and the new Pixar film Inside Out for the BMJ Medical Humanities blog. He is also one of the organisers of the Medicine in Literature Reading Group at the University of Edinburgh. Besides the medical humanities, his research interests include postcolonialism, postmodernism, ecocriticism, literature and science, continental philosophy and the history and philosophy of science.
Correspondence to Vivek Santayana.
Brah, Avtah. 2005. Thinking through the concept of diaspora. B. Ashcroft, G. Griffiths and H. Tiffin (eds), The Postcolonial Studies Reader. Oxford: Routledge, pp. 443-447.
Rushdie, Salman. 1981. Midnight’s Children. London: Jonathan Cape.