''Cutting for Stone'' (2009) is a novel written by Ethiopian-born Indian-American medical doctor and author
Abraham Verghese
Abraham Verghese (born May 30, 1955) is a Malayali-American physician and author, who was born in Ethiopia. He is the Linda R. Meier and Joan F. Lane Provostial Professor of Medicine, Vice Chair for the Theory & Practice of Medicine, and Intern ...
. It is a saga of twin brothers, orphaned by their mother's death at their births and forsaken by their father. The book includes both a deep description of medical procedures and an exploration of the human side of medical practices.
When first published, the novel was on
''The New York Times'' Best Seller list for two years and generally received well by critics. With its positive reception, former
United States
The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
president
Barack Obama
Barack Hussein Obama II (born August 4, 1961) is an American politician who was the 44th president of the United States from 2009 to 2017. A member of the Democratic Party, he was the first African American president in American history. O ...
put it on his summer reading list and the book was optioned for adaptations.
Plot summary
The story is told by the protagonist, Marion Stone. He and his
conjoined twin
Conjoined twins, popularly referred to as Siamese twins, are twins joined ''Uterus, in utero''. It is a very rare phenomenon, estimated to occur in anywhere between one in 50,000 births to one in 200,000 births, with a somewhat higher incidence i ...
Shiva are born at Mission Hospital (called "Missing" in accordance with the local pronunciation),
Addis Ababa
Addis Ababa (; ,) is the capital city of Ethiopia, as well as the regional state of Oromia. With an estimated population of 2,739,551 inhabitants as of the 2007 census, it is the largest city in the country and the List of cities in Africa b ...
, in September 1954. Their mother, Sister Mary Joseph Praise, an Indian
Carmelite
The Order of the Brothers of the Blessed Virgin Mary of Mount Carmel (; abbreviated OCarm), known as the Carmelites or sometimes by synecdoche known simply as Carmel, is a mendicant order in the Catholic Church for both men and women. Histo ...
nun, dies during childbirth. Their father, Thomas Stone, the English surgeon of Missing, abandons them and disappears. Orphaned at birth, the pair grow up in the household of two physicians of Missing, both from
Madras
Chennai, also known as Madras ( its official name until 1996), is the capital and largest city of Tamil Nadu, the southernmost state of India. It is located on the Coromandel Coast of the Bay of Bengal. According to the 2011 Indian ce ...
, the
obstetrician
Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...
Kalpana Hemlatha (Hema) and Abhi Ghosh, who fall in love while caring for the infants. Hema names them Marion (after
J. Marion Sims
James Marion Sims (January 25, 1813November 13, 1883) was an American physician in the field of surgery. His most famous work was the development of a Surgery, surgical technique for the repair of vesicovaginal fistula, a severe Complication (me ...
) and Shiva (after the
Hindu deity
Hindu deities are the gods and goddesses in Hinduism. Deities in Hinduism are as diverse as its traditions, and a Hindu can choose to be polytheistic, pantheistic, monotheistic, monistic, even agnostic, atheistic, or humanist.Julius J. Lipne ...
). Ghosh teaches himself surgery to replace Stone. The tissue link between the twins has been separated at birth and the two grow up together being very close initially.
Both twins are exposed to the changing political environment in
Ethiopia
Ethiopia, officially the Federal Democratic Republic of Ethiopia, is a landlocked country located in the Horn of Africa region of East Africa. It shares borders with Eritrea to the north, Djibouti to the northeast, Somalia to the east, Ken ...
. There is an unsuccessful rebellion by
Haile Selassie
Haile Selassie I (born Tafari Makonnen or ''Ethiopian aristocratic and court titles#Lij, Lij'' Tafari; 23 July 189227 August 1975) was Emperor of Ethiopia from 1930 to 1974. He rose to power as the Ethiopian aristocratic and court titles, Rege ...
's bodyguard, General Mebratu. Ghosh is imprisoned, then released, in the aftermath of the coup, due to his friendship with Mebratu. Through their parents, both boys are exposed to medical knowledge and taught medical procedures at the hospital.
Over time, though, individual differences begin to become pronounced. When entering puberty their relationship to Genet, the daughter of Rosina, a domestic help, finally tears them apart. Marion is in love with Genet and intends to marry her, but it is Shiva who, interested in sexual pursuits, becomes her first lover. Marion feels betrayed. Rosina forces Genet to submit to
female genital mutilation
Female genital mutilation (FGM) (also known as female genital cutting, female genital mutilation/cutting (FGM/C) and female circumcision) is the cutting or removal of some or all of the vulva for non-medical reasons. Prevalence of female ge ...
, and Rosina commits suicide shortly thereafter. Genet later joins the
Eritrean liberation movement
Eritrean may refer to:
* Something of, from, or related to the country of Eritrea
* A person from Eritrea, or of Eritrean descent. For information about the Eritrean people, see Demographics of Eritrea and Culture of Eritrea. For specific persons, ...
. While Marion goes to medical school, his brother stays at Missing. Focused on the repair of birth-related fistulas, he takes up his surgical training with Hema, eschewing a formal medical education. On his deathbed, Ghosh has three wishes for Marion – to get the best medical education, to find Stone, and to forgive his brother.
When Genet and her comrades
hijack
Hijack, Highjack, or High Jack may refer to:
Film and television
* ''Hijack'' (1973 film), an American television action film
* ''Hijack!'' (1975 film), a British children's drama film
* ''Hijack'' (2008 film), an Indian Hindi-language action f ...
an
Ethiopian Airlines
Ethiopian Airlines (), formerly ''Ethiopian Air Lines'' (EAL), is the flag carrier of Ethiopia, and is wholly owned by the country's government. EAL was founded on 21 December 1945 and commenced operations on 8 April 1946, expanding to intern ...
airplane in 1979, Marion's name is found in a list of her connections. To avoid arrest, he flees the country overnight to Kenya. He goes to
New York City
New York, often called New York City (NYC), is the most populous city in the United States, located at the southern tip of New York State on one of the world's largest natural harbors. The city comprises five boroughs, each coextensive w ...
where he finds a position at Our Lady of Perpetual Succour, a hospital in
the Bronx
The Bronx ( ) is the northernmost of the five Boroughs of New York City, boroughs of New York City, coextensive with Bronx County, in the U.S. state of New York (state), New York. It shares a land border with Westchester County, New York, West ...
. There, he enters a surgical
residency
Residency may refer to:
* Artist-in-residence, a program to sponsor the residence and work of visual artists, writers, musicians, etc.
* Concert residency, a series of concerts performed at one venue
* Domicile (law), the act of establishing or m ...
. One day, while assisting his senior in a complicated trauma operation, an unknown surgeon enters and looks over their shoulders. It is Thomas Stone, by now a renowned liver surgeon from
Boston
Boston is the capital and most populous city in the Commonwealth (U.S. state), Commonwealth of Massachusetts in the United States. The city serves as the cultural and Financial centre, financial center of New England, a region of the Northeas ...
. Marion's encounter with his biological father redirects his life, leading to a painful reconciliation and reunion with his estranged brother.
Medical topics
The book contains descriptions of many medical diseases and interventions. The title relates to the
oath of Hippocrates that calls his acolytes not to cut for (
bladder
The bladder () is a hollow organ in humans and other vertebrates that stores urine from the kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the bladder is a distens ...
) stones. Marion's mother dies during a complicated delivery (
conjoined twins
Conjoined twins, popularly referred to as Siamese twins, are twins joined '' in utero''. It is a very rare phenomenon, estimated to occur in anywhere between one in 50,000 births to one in 200,000 births, with a somewhat higher incidence in south ...
) from a
uterine rupture
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth. Symptoms, while classically including increased pain, vaginal bleeding, or a change in contractions, are not always present. Disability or death of the ...
. The babies are born
premature
Premature may refer to:
* ''Premature'' (2014 film), an American comedy film
* ''Premature'' (2019 film), an American romantic drama film
* '' PREMature'', a 2015 British television drama miniseries
See also
* Premature aging, of an organism
* ...
. Shiva becomes an expert in the repair of
vesico-vaginal and
recto-vaginal fistulas. A
vasectomy
Vasectomy is an elective surgical procedure that results in male sterilization, often as a means of permanent contraception. During the procedure, the male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into ...
is described in detail "so charming and surgically precise, it could serve, in a pinch, as a how-to-manual."
The surgery of an
intestinal volvulus establishes a relationship between Ghosh and Mebratu, but leads to his later imprisonment. Ghosh later dies from
leukemia
Leukemia ( also spelled leukaemia; pronounced ) is a group of blood cancers that usually begin in the bone marrow and produce high numbers of abnormal blood cells. These blood cells are not fully developed and are called ''blasts'' or '' ...
possibly related to his handling of outdated
x-ray
An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...
equipment. Genet undergoes female genital mutilation (
female circumcision
Female genital mutilation (FGM) (also known as female genital cutting, female genital mutilation/cutting (FGM/C) and female circumcision) is the cutting or removal of some or all of the vulva for non-medical reasons. FGM prevalence varies ...
) and suffers from its complications. The book describes conditions in a
tuberculosis
Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can al ...
sanatorium where Stone's mother dies from a ruptured
aneurysm
An aneurysm is an outward :wikt:bulge, bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also b ...
, the underlying condition acquired from her husband who has
syphilis
Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms depend on the stage it presents: primary, secondary, latent syphilis, latent or tertiary. The prim ...
, or more specifically,
tabes dorsalis
Tabes dorsalis is a late consequence of neurosyphilis, characterized by the slow degeneration (specifically, demyelination) of the neural tracts primarily in the Dorsal root ganglion, dorsal root ganglia of the spinal cord (nerve root). These pati ...
. Marion's participation in the setting of an
atriocaval shunt An atriocaval shunt (ACS) is an intraoperative surgical shunt between the atrium of the heart and the inferior vena cava. It is used during the repair of larger juxtahepatic (next to the liver) vascular injuries such as an injury to the local vena ...
(a "Shrock") during trauma surgery in New York sets the scene when he encounters his biological father. The reader is further confronted with
typhoid fever
Typhoid fever, also known simply as typhoid, is a disease caused by '' Salmonella enterica'' serotype Typhi bacteria, also called ''Salmonella'' Typhi. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often th ...
and
hepatitis
Hepatitis is inflammation of the liver parenchyma, liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), Anorexia (symptom), poor appetite ...
with
liver failure
Liver failure is the inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology. Two forms are recognised, acute and chronic (cirrhosis). Recently, a third form of liver failure known as acute- ...
. Other topics covered are
depression,
appendicitis
Appendicitis is inflammation of the Appendix (anatomy), appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, fever and anorexia (symptom), decreased appetite. However, approximately 40% of people do not have these t ...
,
amputation
Amputation is the removal of a Limb (anatomy), limb or other body part by Physical trauma, trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as cancer, malign ...
,
rickets
Rickets, scientific nomenclature: rachitis (from Greek , meaning 'in or of the spine'), is a condition that results in weak or soft bones in children and may have either dietary deficiency or genetic causes. Symptoms include bowed legs, stun ...
,
intestinal cancer
Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel ...
,
phlebitis
Phlebitis (or venitis) is inflammation of a vein, usually in the legs. It most commonly occurs in superficial veins. Phlebitis often occurs in conjunction with thrombosis (clotting inside blood vessels) and is then called thrombophlebitis or ...
, and
intracranial hemorrhage
Intracranial hemorrhage (ICH) refers to any form of Hemorrhage, bleeding Internal bleeding, within the Human skull, skull. It can result from trauma, vascular abnormalities, hypertension, or other medical conditions. ICH is broadly categorized ...
.
Reception
By February 2012 the book had been on the
bestseller
A bestseller is a book or other media noted for its top selling status, with bestseller lists published by newspapers, magazines, and book store chains. Some lists are broken down into classifications and specialties (novel, nonfiction book, cookb ...
list of ''
The New York Times
''The New York Times'' (''NYT'') is an American daily newspaper based in New York City. ''The New York Times'' covers domestic, national, and international news, and publishes opinion pieces, investigative reports, and reviews. As one of ...
'' for more than two years, and over one million copies had been sold. Paula Bock praises the book finding the epic "absorbing, exhilarating, and exhausting."
[ ]Aida Edemariam
Aida Edemariam is an Ethiopian-Canadian journalist based in the UK, who has worked in New York, Toronto and London. She was formerly deputy review and books editor of the Canadian ''National Post'', and is now a senior feature writer and editor ...
notes that Verghese "interweaves (the characters') story with that of Ethiopia's past half century" and likes "the variety and colour of Verghese's world, its earthiness and drama, its concreteness and unselfconscious swing." She criticizes "a certain brutality ... in the gender politics" of the novel and that in real life things do not work out so neatly as narrated.[ ]Erica Wagner
Erica Wagner is an American author and critic, living in London, England. She is former literary editor of ''The Times''.
Biography
Erica Wagner was born in New York City in 1967. She grew up on the Upper West Side and went to the Brearley Sc ...
gives a mixed review finding "the novel to be capacious, not to say baggy" and "tinged, albeit lightly, with a sense of magic". While she admires the vivid descriptions of surgery, she suggests that the medical details sometimes interfere with the flow of the story. She criticizes that Verghese attempts "to cram in every last fact about (his characters)."[ However, ]John Irving
John Winslow Irving (born John Wallace Blunt Jr.; March 2, 1942) is an American and Canadian novelist, short story writer, and screenwriter.
Irving achieved critical and popular acclaim after the international success of his fourth novel '' Th ...
wrote that "I've not read a novel wherein medicine, the practice of it, is made as germane to the storytelling process, to the overall narrative, as the author manages to make it happen here."
In 2011, President Barack Obama
Barack Hussein Obama II (born August 4, 1961) is an American politician who was the 44th president of the United States from 2009 to 2017. A member of the Democratic Party, he was the first African American president in American history. O ...
said he had chosen ''Cutting for Stone'' as one of the five books on his summer vacation reading list.
In February 2012 it was announced that Susanne Bier
Susanne Bier (; born 15 April 1960) is a Danish filmmaker. Bier is the first female director to collectively receive an Academy Award (Academy Award for Best International Feature Film, Foreign Film), a Golden Globe Award, a European Film Award ...
has signed on to direct a movie version of ''Cutting for Stone.'' Scott Teems
Scott Teems is an American film director, screenwriter, and producer best known for his work on '' That Evening Sun'' (2009), '' The Quarry'' (2020), '' Halloween Kills'' (2021), '' Firestarter'' (2022) and '' Insidious: The Red Door'' (2023).
...
will write the screen adaption.
Listings and awards
* Amazon's Best Books of the Year: 2009 (#16)
* Publishers Weekly's Best Books: 2009 (Fiction)
* Indies Choice Book Award
The Indies Choice Book Award (formerly known as Book Sense Book of the Year 2000-2008) is an American literary award that was inaugurated at BookExpo America 2000. The American Booksellers Association (ABA) rededicated the award (previously known ...
(Adult Fiction, 2010)
* Wellcome Trust Book Prize
Wellcome Book Prize (2009–2019 — paused) is an annual British literary award sponsored by Wellcome Trust
The Wellcome Trust is a charitable foundation focused on health research based in London, United Kingdom. It was established in 1936 ...
shortlist (2009)
* International Dublin Literary Award
The International Dublin Literary Award (), established as the International IMPAC Dublin Literary Award in 1996, is presented each year for a novel written or translated into English. It promotes excellence in world literature and is solely ...
Longlist (2011)
* ''New York Times'' bestseller
References
{{Reflist, 30em
2009 debut novels
2009 novels
English-language novels
Medical novels
Novels about orphans
Novels about physicians
Novels set in Ethiopia