Abraham Verghese - Cutting for Stone

The morning of the conference I could no longer lie to myself. I skipped the transplant meeting and walked the six blocks to the hospital in which Thomas Stone had worked all these years. After wearing scrubs for almost a year, my suit and tie felt strange, as if I were in fancy dress.

“Send them to Mecca” was an expression we used when we dispatched patients to places that offered what Our Lady of Perpetual Succour could not. It was a common medical expression in hospitals all over America, when sending patients to any of the top referral places in the country—Id even seen it in letters to the editor in the medical journals. Now I was going to Mecca.

“MECCA” CONSISTED OF a spanking-new hospital tower, weirdly shaped and shining as if it were made of platinum. It was the kind of structure architects compete to build. From a patient's perspective, it didn't look welcoming. The tower hid the older brick sections of the hospital, whose architecture felt authentic and aligned with the neighborhood.

“Good morning, sir,” a young man in a purple jacket said to me. I glared at him, thinking he was being sarcastic. Then I realized that he and two others stood there ready to park cars and assist patients into wheelchairs.

The revolving doors led to a glass-walled atrium, the ceiling extending up at least three stories and accommodating a real tree. A grand piano played itself by some mysterious mechanism. Around it were plush leather chairs, lamps. Beyond this was a waterfall trickling gently over a slab of granite. Then a reception desk where a concierge, one of three, looked up, smiling, eager to help. I followed the blue line on the floor to the elevators of Tower A, which took me to the Department of Surgery on the eighteenth floor, just as she said it would, but I made no promise about having a nice day. I found it difficult to believe I was in a hospital.

When I emerged from the elevators I was met by five men and one woman of my age, all dressed in dark suits, chests labeled with visitor tags exactly like mine. “We're supposed to wait here,” the woman said to me, helpfully.

Just then a young man, a white coat covering his blue scrubs, approached. “Sorry I'm late,” he said, not sounding sorry at all. “Welcome to the Department of Surgery. My name's Matthew.” He grinned at us. “God, a year ago I was in your shoes, interviewing for my internship. Time flies! Love the suits! Okay, we have about twenty minutes before morbidity and mortality conference. I'll give you a quick tour of the Department of Surgery. After M&M you'll have lunch with the house staff, then your individual interviews begin, and then the grand tour of the hospital. When I get you to the conference room, I'll break off. One of my patients is being presented at M&M. I have to go strap on the body armor.”

In the year I'd been at Our Lady of Perpetual Succour, I had yet to take any potential intern recruits around. Indeed, I'd never seen anyone come to be interviewed. At Mecca this was a weekly event. I tagged along.

The individual on-call rooms had a television on the wall, a fridge, a nice desk, and an attached bathroom; it was a far cry from Our Lady's solitary on-call room crammed with bunk beds, with just one phone and interns from all the specialties expected to bed there; I never used it. Next, Matthew showed us the “small” conference room where the Mecca surgical team held their morning report. It looked like a corporate boardroom with high-backed leather chairs around a long table. Oil portraits of the past chairmen of surgery stared down from the walls, a who's who of surgery.

“Check this out,” Matthew said, pushing a button. Screens came down behind the curtains to black out the room, and a projector rose out of what I took to be a coffee table. Constance, the woman in our group, rolled her eyes as if she thought this was so gauche.

When we arrived at the auditorium where morbidity and mortality conference was to be held, Matthew excused himself. “I have to change out of scrubs. Dr. Stone is a stickler for that. He doesn't even like scrubs on rounds.”

The auditorium was a small version of the Cinema Adowa in Addis, only with better seats, upholstered in a nubby beige fabric that felt smooth to the touch. A steep incline made the view from the back excellent, and this is where we prospective interns sat. A bank of motorized X-ray viewing panels was built into one side of the wall behind the podium. A resident stood loading films, stepping on a pedal to advance panels.

Constance sat next to me. A gaggle of medical students in short white coats filed in and joined us in the back. I'd forgotten about the existence of medical students. How nice it would be at Our Lady of Perpetual Succour to have someone below me on the food chain. The residents wore longer coats, and their expressions were not as carefree as the students’. The attending physicians wore the longest coats and were the last to come in. We interviewees in our dark suits stood out like penguins at a polar bear convention. In all my time at Our Lady, we never had this kind of an assembly. Deepak got us together regularly for coaching sessions, but one sensed a tradition in this room, a way of doing things that had not changed for decades.

“So what school are you from?” Constance asked. Id overheard her say she trained in Boston, but it wasn't at this institution.

“I went to school in Ethiopia,” I said. If she could have moved one seat over, she probably would have.

Thomas Stone didn't look at the crowd when he walked in; he assumed their presence. He was taller than I'd realized from seeing him in the theater, almost as tall as Shiva or me. The room turned quiet. His hands were in the pockets of his white coat. The way he slid into his seat, the ease and fluidity of that motion, reminded me of Shiva. He was alone in the front row. I was well behind him but off to one side, so I could see his profile. This was my first good look at my father. I felt my body grow warm; it wasn't possible to study him dispassionately, clinically. My mind was racing, my heart pounding—I worried that I was giving away my presence. I looked away to try and calm down. When I looked back, Stone was studying a paper in his hand—it was hard to tell he was missing a finger. His hair was quite gray at the temples, but still dark brown on top. His masseter muscles stood out, outlining his jaw, as if he habitually clenched his teeth. The one eye socket that I could see was a recessed dark hollow on his face. I noticed that he kept his head exceptionally still.

I CAN'T TELL YOU MUCH about the case being discussed or exactly what transpired. While I looked at Thomas Stone and sat next to the supercilious Constance, a slow fuse burned inside me and it was about to ignite. I was ready to hurl furniture, activate the ceiling sprinklers, scream obscenities, and disrupt this orderly meeting. I felt an impending loss of control. At one point I had to grab the arms of my chair as my rage peaked, and then gradually subsided.

“It was my fault,” Thomas Stone said, turning to face me. For a moment, I thought he was clairvoyant. He had heard me. Earlier, Matthew, our escort and the presenter of the case, came under harsh criticism from different quarters of the room. Matthew was only the messenger, but since his attending physician and the Chief Resident didn't come to his defense, he took the brunt of the attack. The snapping jaws were silenced when Thomas Stone stood up.

“Yes, it was my fault. Without a doubt we can do better surgically. I am installing a video camera in the two trauma bays. I want us to review the video after every major trauma that comes in. Were we standing in the right place? Did we take three steps to reach for an endotracheal tube when it should have been at hand? Did someone have to ask for something that should have been there? Did we distract each other with what we said? Who didn't need to be there? Is there a better way? That is always the challenge.” He pulled out a piece of paper from his pocket and unfolded it.