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Cutting for Stone
  1. Ailsa E Gebbie
  1. Director of Family Planning and Well Woman Services, NHS Lothian, Family Planning, Edinburgh, UK

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Cutting for Stone Abraham Verghese. London, UK: Vintage (Random House), 2009. ISBN-13: 978-0-099-44363-6. Price: £8.99. Pages: 560 (paperback)

The Horn of Africa holds a rather enigmatic and glamorous image from another age and Abyssinia, now Ethiopia, is a country of outstanding natural beauty. This novel is a captivating tale of love, betrayal and destiny amidst the medical community in a mission hospital in Ethiopia. Emperor Haile Selassie is the revered but ageing politician feted by the international community (he was Time Magazine's Man of the Year in 1936) but latterly facing military coups, leading to the familiar heavy African burden of bloodshed and famine. The strands of the narrative come together against this backdrop of political turmoil but yet in a country of people who are immeasurably dignified and hospitable.

Thomas Stone is the hospital surgeon, an Edinburgh graduate, who is technically brilliant but lacking interpersonal skills. A young Indian nun who is his devoted theatre nurse dies unexpectedly while in the throes of labour with conjoined twins following a concealed pregnancy. The identity of the father is never doubted and Stone flees the hospital, leaving immigrant Indian medical colleagues to bring up the babies as their own. The boy twins live with this legacy of a saintly young mother and an arrogant, absentee father. They are named Shiva and Marion by their adoptive mother who delivered them and separated their heads at birth (Shiva in the way of thanks to the Indian god and Marion in tribute to gynaecologist J Marion Sims, a 19th century practitioner who had revolutionised women's surgery). The twins known collectively as ‘ShivaMarion’ are the main characters in the book, which describes their childhood, coming of age and ultimate search for meaningful lives, as narrated by Marion.

The author, Abraham Verghese, is currently Professor for the Theory and Practice of Medicine at Stanford University School of Medicine in California and Cutting for Stone is his first novel. A medical student in Addis Ababa at the time of Haile Selassie's downfall, he was forced to complete his studies in Madras before becoming a foreign medical graduate working in the USA. His earlier writing and published work explore the importance of the physical examination in the era of advanced technology, where the patient in the bed is often ignored in favour of the patient data in the computer. The book is full of medical adages and a gentle approach to medicine despite the diseases and poverty of the indigent population. Stone recounts a medical teacher from Edinburgh who muses on what first aid treatment is administered by the ear – “words of comfort”.

The slightly puzzling title Cutting for Stone, while reflecting the surname of the main characters, is also part of 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”. A statue of J Marion Sims, of the eponymous speculum, can be seen on the wall of Central Park, opposite the New York Academy of Medicine (although the legacy of Sim's pioneering work on vesico-vaginal fistulae was marred by operating on unanaesthetised enslaved women as experimental subjects). As the story unfolds and moves to the USA, Verghese's final denouement rounds up all the loose ends and inextricably draws the main characters into the ultimate act of altruism and atonement. The reader is left with a deep longing to visit the countries of the Horn of Africa, Ethiopia and neighbouring Eritrea, and also a hankering for the practice of old-fashioned clinical medicine where careful history taking and meticulous examination are as much an art as a science. This highly recommended book has an absorbing storyline, an evocative geographical setting, and much to keep up the interest for a medical reader.