Abraham Verghese - Cutting for Stone

“But when Medicare came up with this scheme, it created a new problem. Where do you get your interns to fill all these new positions? There are many more internship positions available than there are gradua ting American medical students. American students have their pick, and let me tell you, they don't want to come and be interns here. Not when they can go to a Mayflower hospital. So every year, Our Lady and all the Ellis Island hospitals look for foreign interns. You are one of hundreds who came as part of this annual migration that keeps hospitals like ours going.”

B.C. sat back in his chair. “Whatever America needs, the world will supply. Cocaine? Colombia steps to the plate. Shortage of farmworkers, corn detasselers? Thank God for Mexico. Baseball players? Viva Dom i n ica. Need more interns? India, Philippines zindabad !”

I felt stupid for not having seen this before. “So the hospitals where I was going to interview,” I said. “In Coney Island, Queens—”

“All Ellis Island hospitals. Just like us. All the house staff are foreigners and so are many of the attending physicians. Some are all Indian. Some have more of a Persian flavor. Others are all Pakistani or all Fili pino. That's the power of word of mouth. You bring your cousin who brings his classmate and so on. And when we finish training here, where do we go, Marion?”

I shook my head. I didn't know.

“ Anywhere. That's the answer. We go to the small towns that need us. Like Toejam, Texas, or Armpit, Alaska. The kinds of places American doctors won't go and practice.”

“Why not?”

“Because, salah, in those villages there's no symphony! No culture! No pro-ball team! How is an American doctor supposed to live there?”

“Is that where you will go, B.C.? To a small town?” I said.

“Are you kidding? You expect me to live without a symphony? Without the Mets or the Yankees? No, sir. Gandhi is staying in New York. I am Bombay born and Bombay bred, and what is New York but Mumbai Lite? I'll have my office on Park Avenue. You see, there is a crisis in health care on Park Avenue. The citizens are suffering because their breasts are too small or their nose is too big, or they have a roll around the belly. Who will be there for them?”

“You will?”

“Fucking right, boys and girls. Hold on, ladies, hold on! Gandhi is coming. B.C. will make it smaller, bigger, softer, cuter, whatever you want, but always better.”

He held his beer aloft. “A toast! Ladies and gentlemen. May no Ameri can venture out of this world without a foreign physician at his or her side, just as I am sure there are none who venture in.”

ONE AFTERNOON, in my ninth month at Our Lady of Perpetual Succour, as we were on our way to the operating room, a bailiff served Deepak Jesudass with papers. My Chief Resident took them without comment, and we went on with our work. Well after midnight, as we sat in the locker room outside the theater and smoked, he smiled at me and said, “Anyone else would have asked me what the papers were about.”

“You'll tell me if it concerns me,” I said.

Deepak was perhaps thirty-seven when I met him. He had a youthful face and boyish shoulders that belied the bags under his eyes and the gray streaks in his hair. Had you seen us all in the cafeteria, you would have guessed B. C. Gandhi was the Chief Resident, because B.C. looked the part. But when I reflect back on my surgical training, I'm indebted to a small, dark man, a self-effacing surgeon whom the world might never celebrate. In the operating room, Deepak was patient, forceful, brilliant, creative, painstaking, and decisive—a true artisan.

“Don't stutter with that needle holder.” “Self-discipline with those hands, Marion. Do each step just once, no wasted motion.” When I learned to cross my hands the way he suggested to get equal tension on both limbs of the knot, a new problem arose: “Keep your elbows in, unless you're trying to fly.” I redid more knots than I tied when I was with him. I took down entire suture lines and started again till he was satisfied. I gave new thought to light and exposure. “Working in the dark is for moles. We are surgeons.” His advice was sometimes counter intuitive: “When you are driving, you look to see where you are going, but when you are making an incision, you look to see where you have been.”

Deepak was from Mysore in southern India. That night in the locker room, he told me what I don't think he had told anyone else at Our Lady. When he graduated from medical school, his parents hastily arranged a marriage to a British-born Indian girl living in Birmingham; shed been a reluctant bride, bullied into marriage by her parents who didn't like the crowd she was hanging around with. She flew down with her family a few days before the wedding and left the day after, because she was attending college. It took six months for Deepak to get his visa and join her at her parents’ home. He found that if he opened his mouth he embarrassed her. She didn't want him near her in public or private. He left the house after a few weeks and found a house-officer position (equivalent to the internship in America) in Scotland. After a year he advanced to registrar, then to senior registrar. He passed the difficult exams to become a Fellow of the Royal College of Surgeons, the magic letters FRCS behind his name.

“I could have gone back to Mysore. With my FRCS up on a board, I would have done very well. But I pictured all the people who'd come to my wedding. I didn't want to face them … I just couldn't.”

The next step for him in England would have been to be a surgical consultant appointed to a hospital. “There aren't many consultant jobs. Someone has to die for an opening to come up.” After six years of working as a senior registrar, a consultant's understudy, doing all the emergency cases, Deepak decided to come to America.

“It meant starting all over again, because here you don't get credit for postgraduate training anywhere else. At my age, and after all the years of training, I wondered if I had it in me.”

The American system of surgical training was different: after a year of internship and then four years as a surgical resident with ever increasing responsibilities (the last year as Chief Resident), one was allowed to sit for the exam to become a board-certified surgeon, a consultant.

“I did my internship in a prestigious place in Philadelphia. I worked hard for them …” He closed his eyes and shook his head at the memory. “When my father died, I didn't even tell them. I didn't even try to take one day off for that. I was promoted to second year, even though I was performing at a much higher level, and they actually used me almost like a Chief Resident. But they bumped me after the third year. One of my attending physicians who went to bat for me wound up resigning over this. He was so incensed.

“I could have gone into urology or plastic. That's what people often do if they're bumped at that stage. Many foreign graduates give up and wind up in psychiatry or something. But I love general surgery The same guy who went to bat for me got me into another hospital, this time in Chicago, with the promise that I'd be promoted if I repeated my third year. I worked even harder—and got bumped again.” He laughed at my expression of incredulity. “It helps to be me, I suppose. To not expect too much. To love surgery for its own sake. But I was lucky. One of the attending physicians in Chicago went out on a limb for me. He called Popsy, and he arranged for me to come here as a fourth-year resident. That's the funny thing about America—the blessed thing. As many people as there are to hold you back, there are angels whose humanity makes up for all the others. I've had my share of angels. Popsy was one of those.”