Abraham Verghese - Cutting for Stone

At some point, just as were nearing completion, I sensed someone at my shoulder. Deepak glanced up but did not say anything.

“Is that a Shrock shunt, son?” a voice behind me said. It was a male voice, polite enough, conscious that it was a delicate moment to intrude, but with the authority of one who is entitled to ask.

Deepak looked up again, then back to his work. “Yes, sir,” he said.

“How big was the tear?”

Deepak pulled up the liver and adjusted the overhead light so the visitor could see. “It was three-quarters of the way around the cava.” The tube hed pushed down from the heart made a lovely internal splint for the vein, and running across it like a crease was the first part of Deepak's neat repair. It was a beautiful sight, order restored from chaos.

“Very impressive,” the voice said. There was no sarcasm, just genuine admiration. I stepped back so the visitor could have a better look, and when I did, he leaned in. “Very, very nice. Id put some gel foam around the raw area of the liver. Were you planning to leave some drains?”

“Yes, sir.”

“I'm assuming you are the attending physician?” the voice said.

“No, I'm the Chief Resident. My name is Deepak.”

“Where is your attending?”

Deepak met the speaker's eyes, and said nothing.

“I see. Not one to get out bed for this sort of thing. Do you ever see him?”

As if in reply, Ronaldo snorted and turned to his dials, feigning disinterest. The visitor looked to Ronaldo and seemed about to bite his head off, but then remembering this wasn't his theater, he didn't.

“And how many Shrock shunts have you done before, Deepak?”

“This is my sixth.”

“Really? In what period of time.”

“In two years here … Unfortunately we see a lot of trauma.”

“Unfortunate, yes. But fortunate for us. We are not ungrateful … Still, six Shrocks, did you say? Remarkable. How have they done?”

“One died, but a week after the surgery. He was walking, eating. Probably a pulmonary embolus.”

“Did you get an autopsy?”

“Partial. The family allowed us to reopen the belly. The repair to the cava looked good. We took photographs.”

“And the others?”

“Second, third, and fifth are alive and well, six months after the operation. Fourth died on the table before I got this far. I had just opened the heart.”

“Do you count that one?”

“I should. ‘Intention to treat’ … that counts.”

“Good man. You should count it. Most surgeons wouldn't. And your sixth?”

“This is him,” Deepak said.

“Right. Well, that's better than my experience. I've done four. That's over six years. They all died. Two on the table, two so close after surgery that it was as good as dying on the table. They weren't all trauma like this. Two were tears from someone trying to remove an adherent cancerous mass. You ought to write up your experience.”

Deepak cleared his throat. “With all due respect, sir. I have. No one will publish a report from Our Lady—”

“Nonsense. What is your full name?”

“Deepak Jesudass, sir. This is my intern—”

“I tell you what, write up this case and add him to your series, and then let me take a look at your paper. If it's good, I'll see that it gets published. I'll send it to the editor of the American Journal of Surgery. I'll check with you to see how this patient does. Good luck. By the way, my name is—”

“I know who you are, sir. Thank you.”

The visitor must have been walking away when Deepak said, “Sir? … If you were to … never mind.”

“What is it, man? I have a cadaver organ that I should have in the air by now. I just stopped to admire your work.”

“If you were to show us how to harvest the liver … we could start it for you, save you time.”

I tried to turn around to look, but because I was holding a retractor, I couldn't.

“I don't trust anyone else to do it,” the voice said. “That's why I do it myself. My chief residents don't have the skill … Smart boys, but they don't get the volume you have in a place like this.”

“We get the volume. And they are shutting us down.”

“What? I had heard some such rumor. I heard Popsy … True?”

Deepak just nodded.

“This is your fifth year?” the voice said.

“Seventh. Eighth. Tenth. Depends how you count, sir.” He didn't mention his training in England.

He didn't need to, because the visitor said, “I hear a Scotch inflection. Were you in Scotland? Took your FRCS?”

“Yes.”

“Glasgow?”

“Edinburgh. I worked in Fife. All over there,” Deepak said.

There was a profound silence. The man behind me hadn't moved. He seemed to be considering this.

“What will you do if they shut down?”

Deepak dropped his eyes. “I'll just keep working. Probably here. I love surgery …”

After an eternity the voice said, “Deepak Jesudass, with a J ?” And then he spelled it out. “Did I get that right? Come see me in Boston, Dr. Jesudass. We'll pay your fare. I'll arrange for you to come up to my dog lab. We'll get you going. If anyone can harvest for me, you probably can. When you come up we'll visit at length. Have to run now. Good work, Deepak.”

We heard the door swing behind him.

We worked in silence. At last, Deepak said, “He heard my name just once … and he was able to repeat it.” Deepak's repair was done. He was closing up now, as carefully and efficiently as he had opened. He asked for gel foam from the scrub nurse. “In all my years here, no one's been able to remember my name when I'm introduced. No one has bothered. They usually see us as types, not as individuals.”

His shoulders were straighter, his eyes bright and glowing. I'd never seen my Chief Resident like this. I was happy for him, and proud.

“Who was that?” I said, at last unable to contain my curiosity.

“Call me old-fashioned,” Deepak said, “but I've always believed that hard work pays off. My version of the Beatitudes. Do the right thing, put up with unfairness, selfishness, stay true to yourself … one day it all works out. Of course, I don't know that people who wronged you suffer or get their just deserts. I don't think it works that way. But I do think one day you get your reward.”

“Did you know him?” I said again.

Deepak sidestepped my question and turned to the circulating nurse.

“Did that particular team come for liver or heart?”

“Liver. Another team took the heart and ran.”

Deepak smiled and turned to me. “Marion, I'm not a hundred percent sure, because of his mask; had I seen his fingers I could have been certain. But I have a pretty good idea. You just met one of the foremost liver surgeons in the world, a pioneer of liver transplants.

“What's his name?”

“Thomas Stone.”

IBELIEVE IN BLACK HOLES. I believe that as the universe empties into nothingness, past and future will smack together in the last swirl around the drain. I believe this is how Thomas Stone materialized in my life. If that's not the explanation, then I must invoke a disinterested God who leaves us to our own devices, neither causing nor preventing tornadoes or pestilence, but a God who will now and then stick his thumb on the spinning wheel so that a father who put a continent between himself and his sons should find himself in the same room as one of them.

As a child Id longed for Thomas Stone or at least the idea of him. So many mornings I waited for him at the gates of Missing. I saw that vigil now as necessary, a prerequisite for my insides to harden and cure just like the willow of a cricket bat must cure to be ready for a lifetime of knocks. That was the lesson at Missing's gates: the world does not owe you and neither does your father.