Abraham Verghese - Cutting for Stone

“And our kind of taking care?”

“Shameful. The work of untouchables. Those rich hospitals up and down the East Coast got together and paid for our helipad so they can fly here. Why? Ischemia time! You see, what we have here in our neighborhood is an abundance of guns, ABMs, and ALMs—Angry Black Males, Angry Latin Males, and actually angry males of all stripes, not to mention jealous females. The man on the street is more likely to carry a gun than a pen. Bang! Bang! Chitty! Chitty! And so we wind up with too many GPO patients—Good for Parts Only. Young, otherwise healthy, but brain-dead. Pristine hearts, livers, and whatnot. Under warranty to keep going long after your pecker droops. Great organs. Great for transplant. Transplants which we can't do. But we can keep them alive till the vultures get here. They get the organ and run. Next time you hear the whup-whup-whup, don't think helicopter blades. Think paysa, moola, dinero! Heart transplant costs, what, half a million dollars? Kidneys a hundred thousand or more?”

“That's how much they pay us?”

“ Us? They don't pay us a fucking cent! That's how much they make. They come, cut, and take, show us the middle finger, and ride off in their whirlybird leaving us on our camels. Next time you hear the helicopter, come see what masters of medicine, the sahibs, look like.”

I had seen them more than once, their white coats emblazoned with vivid university logos on breast and shoulder, and the same icons on ice chests, on the igloos on wheels, and even on the helicopter. I saw in their faces the same variety of fatigue that I experienced, but theirs somehow seemed more noble.

DR. RONALDO CROSSED and uncrossed his arms, looking at the clock, then the door, for any sign of Popsy. I draped the sterile towels to outline a perfect rectangle, the portal to Hugh Walters Jr.'s abdomen.

Mr. Walters, a graying gentleman, showed up in our emergency room the week before. That particular night, stretchers spilled out of the ER's trauma bays into hallways. Alcohol had leached out of the lungs, out of skin pores, out of the secretions of enough men and women to make the place smell like a cocktail lounge. There were two inebriated men vomiting blood, competing to see who could be louder. When Mr. Walters arrived, also vomiting blood, I unfairly assumed he was one of their kin, related through alcohol and cirrhosis. I assumed that his bleeding came from wormlike varicose veins blooming in his stomach from the scarring in the liver. Over the course of the next twenty-four hours, I slipped a gastroscope down each bleeder's throat and peered into the stomach. Unlike the other two, Mr. Walters had none of the angry redness of alcoholic gastritis, and no bleeding varicose veins to suggest cirrhosis. What he did have was a large oozing gastric ulcer. I took biopsies through the scope.

A few hours after the endoscopy Mr. Walters, in a quiet dignified voice, again assured me that alcohol had never crossed his lips, and this time I believed him. He was a man of the cloth. He taught junior high school for a living. I chastised myself for lumping him in with the other two stomach bleeders. We started intense therapy to heal his ulcer.

Mr. Walters, I found, knew about my birth land. “When Kennedy died, I watched that funeral on TV. Your Emperor Haile Selassie came all the way. He was the shortest man there. But also the biggest man there. The only Emperor. The only Emperor. He was in the first row of dignitaries walking behind that coffin. He made me proud to be bl-ack.” When Mr. Walters said the word, he gave it a weight and a heft.

Mr. Walters read the New York Times every day. That and a Bible were a constant at his bedside. “I could never afford college. Just Bible school. I tell my students, ‘If you read this newspaper every day for a year, you'll have the vocabulary of a Ph.D. and you will know more than any college graduate. I guarantee you.’ “

“Do they listen?”

He held up a finger. “Every year one does,” he said, grinning. “But that one makes it worthwhile. Even Jesus only did twelve. I try to get one a year.”

Despite antacids and H2 blockers, Mr. Walters s ulcer was still bleeding. His stools remained the consistency and color of tar, a sure sign of blood being acted on by stomach acid. Five days after his admission, our troop had gathered at his bed during evening sign-out rounds.

Deepak Jesudass, our Chief Resident, sat on the edge of Mr. Walters s bed. “Mr. Walters, we have to operate tomorrow. Your ulcer is still bleeding. It isn't showing signs of stopping.” He sketched out on a piece of paper what a partial gastrectomy would look like—removal of the acid-producing area of his stomach. I admired Deepak's quiet careful manner, his way of being with patients that made them feel they were the focus of all his attention and that there was nowhere else he had to be. Most of all I admired his wonderful, very British accent, which seemed doubly exotic in that it came from a South Asian man. It was the result of his having lived in Britain for years. Deepak inspired confidence in patients.

As Deepak spoke, B. C. Gandhi looked at me and rolled his eyes. He was reminding me of something hed told me just the previous night. “You can be a cretin, but if you have the Queen's accent, next thing you know you are on Johnny Carson and he'll laugh at anything you say.”

B.C. was being facetious, but on the sitcoms I caught while going in and out of patients’ rooms, I had so far seen a black but very British butler serving a black American family; an eccentric Englishman who was the neighbor to a rich black family on the Upper East Side of Manhattan; and a rich British widower with a pretty Brooklyn nanny.

Mr. Walters had hung on Deepak's every word. At last he'd said, “I have faith in you. But for you-all, there wouldn't be any doctors here. I have faith in someone else, too,” he said, pointing to the ceiling.

The day of surgery, I rose at four-thirty to review the steps of the operation in my Zollinger's Surgical Atlas. Deepak had let me know that it was my case, and I would stand on the right while he assisted me. I was thrilled and nervous. It would be my first time to work directly with the Chief Resident.

But Popsy had ruined our plans. I stood on the patient's left, awaiting the legendary Dr. Abramovitz. I had yet to meet him. There was no sign of Deepak.

AND SUDDENLY POPSY WAS THERE, his head perilously close to the operative lights. He had a deeply furrowed face, kind blue eyes, the pupils rimmed with gray but retaining a curious, little-boy quality. His mask hung just under his nose, wire-brush hairs poking out from his nostrils. He held out his gloved hand for the knife. Sister Ruth hesitated, glancing at me before putting it in his palm.

Popsy made a sound in his throat. The scalpel quivered in his fingers. Sister Ruth nudged me. Before I could do anything, Popsy made his incision. It was bold. Very bold. I dabbed and I clamped tiny bleeding vessels, and when Popsy didn't move to tie them off, I did. Popsy handled the forceps to pick up the peritoneum. He couldn't get purchase on the tissue.

For good reason. In one spot his skin incision had cut through fascia and peritoneum. Liquid matter, looking suspiciously like bowel content, welled into the wound. Ronaldo peered over the anesthesia screen and his eyebrows disappeared under his surgical cap.

Popsy tried again with the forceps, but the instrument slipped from his fingers and clattered to the floor. He brought his hand up, minus the forceps. “I touched the side of the table …” He was looking at me, as if I might dispute his account. “I've contaminated myself.”

“I think you did,” Sister Ruth said hastily when she saw that I was tongue-tied.