Abraham Verghese - Cutting for Stone

That night I woke to the sounds of MiGs overhead and bombs dropping far away, but close enough for us to hear the rumble. Also the fainter thuds of artillery. No lights were allowed anywhere near the mouth of the cave.

Luke said that a massive raid had just been completed on a weapons and fuel depot. It had included Tsahai and the group of fighters we met on the first night. They had penetrated using a stolen army truck. Once inside, they set charges, but their comrades outside had been surprised by a reinforcement convoy that attacked them from the rear. It had not gone exactly as planned. Nine guerrillas including Tsahai were dead and many more wounded. The Ethiopians’ losses were much larger and the fuel depot partially destroyed. Our casualties would arrive at the cave by early morning.

I woke to voices, the activity and urgency unmistakable. I heard moans and sharp cries of pain. Luke took me to the surgical ward.

“Hello, Marion,” a voice said. I turned to see Solomon, whod been my senior in medical school. Hed gone underground as soon as he finished his internship. I remembered him as a chubby, well-fed intern. The man before me had hollow cheeks and was as lean as a stick.

I followed Solomon, stooping down in a low-ceilinged tunnel where stretchers were arranged in pairs on the floor, triaged so that those most in need of surgery were closest to the operating theater at the end of the tunnel. The entrance to the theater was a cloth curtain.

The wounds were ghastly. One barely conscious man whispered last instructions into the ear of a friend, who hovered over him, writing furiously. Intravenous fluid and blood bottles dangled from hooks embedded in the cave walls. The attendants worked squatting next to the stretchers.

Solomon said hed gone close to the battlefront for this mission. “Usually I stay here. We resuscitate at the battlefield. Intravenous fluid, control bleeding, antibiotics, even some field surgery. We can prevent shock just like the Americans in Vietnam. Only we don't have their heli copters.” He slapped his thighs. “These are our helicopters. We carry our wounded by stretcher.” He scanned the room. “That man over there needs a chest tube,” he said, indicating with his head. “Please do it. Tumsghi will help you. I'll go ahead to the theater. That comrade cannot wait.” He pointed to a pale soldier lying near the curtain with a bloody pad over his abdomen. He was conscious, but barely, breathing rapidly.

The fighter who needed the chest tube whispered “Salaam” when I squatted by him. The bullet had entered his triceps, then his chest, and miraculously missed the great vessels, the heart, and the spine. When I tapped with my bunched fingers above his right nipple it was dull, quite unlike the boxy, resonant note on the left. Blood had collected around the lung in the pleural space, compressing the right lung against the left lung and the heart in the confined cavity of the chest. Working just behind his right armpit, I injected lidocaine and anesthetized the skin, then the edge of the rib and deeper into the pleura, before making an inch-long cut with a scalpel. I pushed a closed hemostat into my incision till I felt it pop through the resistance of the pleura. I put my gloved finger into the hole, sweeping around to ensure space for the chest tube—a rubber hose with openings at side and tip—which I fed into the hole. Tumsghi connected the other end to a drainage bottle with water in it, so that the tube emerged under the water level. This crude underwater seal prevented air going back into the chest. Already dark blood was emerging, and the soldier's breathing improved. He said something in Tigrinya and pulled off his oxygen. Tumsghi said, “He wants you to give his oxygen to someone else.”

I joined Solomon in the operating theater in time to see his patient come off the table. The man's chest didn't move. There was about a five-second silence. One of the women, fighting back tears, knelt and covered his face.

“Some things are beyond us,” Solomon said quietly. “He had a laceration to the liver. I tried mattress sutures. But he also had a tear to the inferior vena cava where it goes behind the liver. It kept oozing. I couldn't stop it unless I clamped the inferior vena cava, which would kill him. You remember Professor Asrat used to say that injuries to the vena cava behind the liver are when the surgeon sees God? He used to say things like that that I didn't understand. I understand now.”

The next patient had a belly wound. Solomon systematically sorted out what to me looked like an impossible and dirty mess. He pulled out the small bowel, identified several perforations which he oversewed. The spleen was ruptured and so this was removed. The sigmoid colon had a ragged tear. He cut out the segment, and then brought the two open ends to the skin in a double-barrel colostomy We irrigated the abdomen vigorously, left drains in place, and did a sponge count. The field looked so neat compared with its condition when we started. Solomon must have read my mind. He held up his hands to show me his stubby fingers and his hammer thumbs: “I wanted to be a psychiatrist.” Over the eight hours, that was the only time I saw him smile behind the mask.

We amputated five limbs. The last two procedures we performed were burr holes in the skulls of two comatose patients. We used a modified carpenter's drill. In the first we were rewarded by blood welling out from just under the dura where it had collected, pressing on the brain. The other patient was agonal, his pupils fixed and dilated. The burr hole produced nothing. The bleeding was deep inside the brain.

Two days later, I took leave of Solomon. There were dark rings under his eyes and he looked ready to fall over. There was no questioning his purpose or dedication. Solomon said, “Go and good luck to you. This isn't your fight. I'd go if I were in your shoes. Tell the world about us.”

This isn't your fight. I thought about that as I trekked to the border with two escorts. What did Solomon mean? Did he see me as being on the Ethiopian side, on the side of the occupiers? No, I think he saw me as an expatriate, someone without a stake in this war. Despite being born in the same compound as Genet, despite speaking Amharic like a native, and going to medical school with him, to Solomon I was a ferengi — a foreigner. Perhaps he was right, even though I was loath to admit it. If I were a patriotic Ethiopian, would I not have gone underground and joined the royalists, or others who were trying to topple Sergeant Men-g istu? If I cared about my country, shouldn't I have been willing to die for it?

We crossed the Sudan border by early evening. I took a bus to Port Sudan, and then Sudan Airways to Khartoum. In Khartoum I was able to call a number Adid had provided to let Hema know I was safe. Two days in sweltering Khartoum felt like two years, but at last I flew to Kenya.

IN NAIROBI, Mr. Eli Harris, whose Houston church had been the pillar of Missing's support for years, had arranged room for me at a mission clinic. Matron and Harris had made these arrangements by cable. I found the work in the small outpatient clinic difficult, as I was certain that many things were getting lost in translation. In my free time, I studied for the exams that I had to take to begin postgraduate training in America.

Nairobi was lush and green like Addis Ababa, the grass pushing up between pavement tiles as if the jungle seethed underneath the city ready to take over. Nairobi's infrastructure and sophistication dwarfed that of Addis. One could thank the years of British rule for that, and, though Kenya was independent, many Brits lived on there. And Indians: in some parts of Nairobi you could imagine you were in Baroda or Ahmedabad with sari emporiums ten to a street, chat shops everywhere, the pungent scent of masala in the air, and Gujarati the only language spoken.