Abraham Verghese - Cutting for Stone

I left him smiling at me, as if I had given him the greatest gift one man could ever give another.

AFTER LEAVING MR. WALTERS'S ROOM, I sat on the park bench by the house staff quarters. How unfair to Mr. Walters that his darkest day should be so impossibly beautiful. The trees of Our Lady turned colors I had never seen in Africa. And then they blessed the ground below with a fiery red, orange, and yellow carpet, which crunched underfoot and released a dry but sweet fragrance.

The laughter and shrieks coming from inside our building, from the patio, felt sacrilegious. B. C. Gandhi had christened our quarters “Our Mistress of Perpetual Fornication.” There were days when I felt I lived in Sodom.

When it turned chilly, I went inside. I caught a glimpse of the roaring wood fire in the cast-iron pot on the patio, and the scent of tobacco and something more pungent. Nestor, our Carribean fast bowler and my fellow intern, had a herb garden at the back of our building. The summer we arrived he grew a bumper crop of curry leaves, tomatoes, sage—and cannabis.

Beyond the herb garden the meadow sloped down to a brick fence topped with razor wire. It separated us from a housing project named Friendship by the city authorities twenty years ago. It was now called Battleship by one and all. At night we heard the pop of handguns from Battleship and saw comet streaks, messages from earth to sky.

On Mondays we gathered at the nurses’ quarters for a communal dinner at their invitation. But on this day it was their turn to visit us. I joined the crowd.

“How did it go?” B.C. said, coming over, putting his arm around my shoulders. I told him about my conversation with Mr. Walters.

B.C. listened quietly, and then said, “What a good man he is! What courage. You know, we've been lucky with Mr. Walters, particularly since he's a zero-to-one dirtballer. What's a dirt ball? The hard, stinky concretion that forms in the belly button. A patient with four dirt balls is often an alcoholic. He's had one or two heart attacks. Beats his wife. He's been shot a couple of times. He has diabetes. Kidney function is borderline. You try a BFO for a Triple A, guess what happens?”

“BFO” was Big Fucking Operation, and “Triple A” was Abdominal Aortic Aneurysm. B.C. loved acronyms and claimed to have invented a good many of them. A patient near death was CTD—Circling The Drain.

“A four dirtballer? … I guess he does terribly with a big operation?” I offered.

“No! Just the opposite. You see, he's already demonstrated his capacity to survive. Heart attacks, strokes, stabbings, falls off buildings—his protoplasm is resilient. Lots of collateral vessels, backup mechanisms. He waltzes out of the recovery room, farts the first night, pees on the floor trying to get to the bathroom, and does great despite the bourbon the family sneaks in to add flavor to the ice chips, which are all he's supposed to eat.

“The zero-to-one dirtballers are the ones to watch out for. They are your preachers or doctors. Men like Walters. They live good clean lives, stay married to the same woman, raise their kids, go to church on Sundays, watch their blood pressure, don't eat ice cream. You try a BFO for a Triple A and you will be CDSCWP.”

Canoeing Down Shit Creek Without a Paddle.

“As soon as the anesthesiologist brings the mask near their face, your zero dirtballer has a heart attack on the goddamn table. If you manage to operate, the kidneys conk out or the wound breaks down. Or they get confused, and before you can call the Freud Squad they've jumped out of the window. So you see, your Mr. Walters was lucky.”

Deepak took a drag on a cigar-size joint that Nestor passed to him. He handed it to me. “Here,” he said, holding the smoke in, and speaking in a clipped voice. “The point is … clean living will kill you, my friend.”

The cannabis did nothing for my fatigue. Soon I felt my face and body turn to wax. I stared into the sky above Battleship. The sounds— good-natured yelling, screams, the throb of a boom box, the clang of a basketball rattling the metal rim, the squeal of tires—were a symphony. They matched the chiaroscuro designs on the brick wall. I felt I could see into Battleship and that I was watching the lives of the hundreds of Americans living there, families who got their medical care from us. I felt like a visionary.

“Doesn't it seem strange,” I said, after a long while, struggling to frame my question so it wouldn't sound silly, “doesn't it seem strange that … here we all are, foreign doctors—”

“You mean Indian doctors,” Gandhi said. “You're half Indian, but luckily for you it's the pretty half. Even Nestor here has an Indian father, he just doesn't know it.”

Nestor threw a bottle cap at Gandhi.

“Yes, well, doesn't it seem strange,” I went on, “that here we are, a hospital full of Indian doctors and on the other side of that wall are the patients we are taking care of. American patients, but not representative of—”

“You mean black patients, mon,” Nestor said in his lilting accent. “And you mean Puerto Ricans.”

“Yes … but what I am getting at is where are the other American patients? Where are the other American doctors for that matter?”

“You mean where are the white patients? Where are the white doctors, mon?”

“Yes!” I said. “Precisely!”

“Look here, Marion,” Gandhi said. “You mean to say you hadn't noticed this fact till just this moment?”

“No … I mean, yes, I have. Don't be silly. But my question is, are all hospitals in America like this?”

“My goodness, Marion, you do understand why you are here and not at the Mass General?”

“Because … I didn't apply there.”

I was unprepared for the laughter that greeted me. Just when I thought I was on to something profound.

Nestor got up and jogged in place. He chanted, “Heenot not apply there! Heenot not apply there!” The cannabis seemed to facilitate their hysterical giggles, but it was doing nothing for me. I was getting angry. I rose to leave.

Gandhi grabbed my arm. “Marion, sit down. Wait. Of course you didn't apply,” he said soothingly. “You didn't want to waste your time on the Massachusetts General Hospital.”

I still didn't get it.

“See here,” he said, taking a saltshaker and pepper shaker and putting them side by side. “This pepper shaker is our kind of hospital. Call it a—”

“Call it a shit hole, mon,” said Nestor.

“No, no. Let's call it an Ellis Island hospital. Such hospitals are always in places where the poor live. The neighborhood is dangerous. Typically such hospitals are not part of a medical school. Got it? Now take this saltshaker. That is a Mayflower hospital, a flagship hospital, the teaching hospital for a big medical school. All the medical students and interns are in super white coats with badges that say SUPER MAYFLOWER DOCTOR. Even if they take care of the poor, it's honorable, like being in the Peace Corps, you know? Every American medical student dreams of an internship in a Mayflower hospital. Their worst nightmare is coming to an Ellis Island hospital. Here's the problem—who is going to work in hospitals like ours when there is a bad neighborhood, no medical school, no prestige? No matter how much the hospital or even the government is willing to pay, they won't find full-time doctors to work here.

“So Medicare decided to pay hospitals like ours for internship and residency training programs, get it? It's a win-win, as they say—the hospital gets patients cared for by interns and residents around the clock, people like us who live on site, and whose stipend is a bloody fraction of what the hospital would pay full-time physicians. And Medicare delivers health care to the poor.