Abraham Verghese - Cutting for Stone

In a life that was merely a prelude to death, Thomas found he looked forward to Ross's visit, to the short man's daily rituals. And yet he held back his affection for the doctor, because that was a recipe for loss. “I'm not going away, lad,” Ross said one day. “And since you are staying, why don't you join us on rounds.” Ross turned and left, not waiting for an answer.

WHEN ROSS PRONOUNCED him healed, Thomas had been at the sanatorium for a year and a half. During that time he never saw his father. Fothergill came twice, saying Justifus Stone was too ill to travel. Thomas asked Ross about the illness from which his father suffered. Ross said, “It's not tuberculosis, but something else.”

“To do with his legs?”

Ross tousled Thomas's hair. “Something punky, lad. Unfortunate, it is. He is bedridden. You'll learn in medical school,” he said.

It was the first time Ross had ever uttered the words “medical school” to Thomas. Thomas couldn't control the fluttering in his heart, as if a door had cracked open in his coal cellar, bringing in light, promising a future when he had visualized none.

ROSS, NOW OFFICIALLY THOMAS'S GUARDIAN, decided Thomas should go to boarding school in England. Thomas didn't even consider going to see his father in the infirmary in Madras before he sailed.

Two terms had gone by when Ross wrote to say that Justifus had died. A modest inheritance under Ross's guardianship would allow him to finish schooling and go to university.

Ross had led Thomas in the direction of medical school as if it were inevitable. Thomas had no reason to resist. Life thus far had convinced him of his aptitude for two things: sickness and suffering.

In medical school in Edinburgh, he lost himself in his studies, finding a stability and a sanctity missing before. He had no need to lift his head from his books, no desire to go anywhere but for classes or demonstrations. When his eyes tired, he went diffidently to the infirmary, hoping no one would throw him out. He got to know a house officer here, a senior student there, and before long, and well before his class had reached the clinical years, he was being pointed to interesting patients.

The hospital porter nicknamed him “the Lurker,” and Thomas didn't mind. In the organized chaos of the hospital, in the labyrinth of corridors, in the stink and confinement of its walls, he found both order and refuge; he found home. Misery and suffering were his closest kin.

A drunk named Jones looked eerily like his father; Thomas realized it was the waxy complexion, the swollen parotids, the loss of the outer third of the eyebrows, and the puffy eyelids of alcoholism that gave both men a leonine appearance. Now that he was trained to see, he put together the other clues he recalled: red palms, the starburst of capillaries on cheek and neck, the womanly breasts, and the absence of armpit hair. His father had cirrhosis. Perhaps that was the “punky” thing that Ross had been too polite to mention.

IT WAS SLEETING on a bitter cold evening in the Founders’ Library when the final piece came together, and when it did, Thomas slammed his book shut, alarming Mrs. Pincus, the librarian. The young man, who practically lived in the study carrel farthest from the fireplace, suddenly ran out into the spitting snow, hatless and distraught.

Thomas negotiated the long corridor leading to his room in the pitch-dark. Walking in the dark was something his father could not have done. The signals coming up from Thomas's toe and ankle and knee told him where he was in space, but in Justifus Stone those messages had been blocked in his spinal cord. His father's stamping, crashing gait, always worse at night when he no longer could see where his feet were planted—that was from syphilis of the spinal cord, or tabes dorsalis. No child should possess such knowledge of a parent.

The meandering conversation, the boastful tales at the dinner table, the delusions of grandeur—that was syphilis of the brain, not just the spinal cord.

Once in his room, Thomas stripped before the wardrobe mirror. With a second handheld mirror he examined every inch of his skin. No syphilids. No gumma on his skin. He listened to his heart but heard nothing unusual. He'd been spared congenital syphilis. But then he realized that his fear was absurd because congenital syphilis had to come through the placenta to him, it had to come from his mother. Absurd for him to worry. What his mother had was tuberculosis. Pure as the Virgin, his mother could never have had….

He cried out suddenly, the anguish of a child whose final illusion is stripped away. He understood at last.

It had been under his nose all this time. Tuberculosis didn't cause aneurysms like the one that killed her, but syphilis did. “Mother. Poor Mother,” he cried, grieving for her all over again. His father had murdered Hilda with his unbridled lust. She might have recovered from her TB, but she probably never knew she had syphilis until that aneurysm blossomed and began eroding painfully through the breastbone when she was at the sanatorium. Ross would have told her what it was. She knew. By that point neither salvarsan nor even penicillin, had it been available, would have been of any use.

WHEN THOMAS STONE BOUGHT his own cadaver in his final year of medical school, it was unheard-of, but did not surprise anyone. He was planning a second complete dissection, searching for mastery of the human body.

“Is Stone around?” was a common question in the casualty room, because he was the medical student who was more constant than Hogan or the other porters, always willing to stitch up a laceration, or pass a stomach tube, or run to the blood bank. He was the happiest of students when asked to scrub in and hold a retractor during emergency surgery.

One night, Dr. Braithwaite, Senior Consultant Surgeon and Chief Examiner for the Royal College of Surgeons, came in to see a patient with a high stab wound to the abdomen. Braithwaite was a legend for having pioneered a new operation for esophageal cancer, a notoriously difficult condition to cure. The patient, already inebriated, was terrified, abusive, and combative. Braithwaite, a compact man with silver hair, wore a blue three-piece suit that was the same shade as his blue eyes; he dismissed the porters restraining the patient and he put his hand gently on the man's shoulder and said, “Don't worry. It is going to be all right.” He kept his hand there, and the patient, staring at the elegant doctor, quieted down and stayed that way during the brief interview. Then Braithwaite examined him quickly and efficiently. When he was done, Braithwaite addressed his patient as if he were a peer, someone he might see later in the day at his club. “I'm glad to tell you that the knife spared your big blood vessels. I am confident you are going to do very well, so I want you not to worry. I'll operate, to repair whatever is cut or torn. We are going to take you to the operating theater now. Everything is going to be fine.” The docile patient extended a grubby hand of thanks.

When they were out of earshot of the patient, Braithwaite asked the entourage of registrars and house-officers, “What treatment is offered by ear in an emergency?”

This was an old saw, particularly in Edinburgh. Still, the old saws were not well known anymore, a matter that distressed Braithwaite greatly. He saw it as emblematic of a slackness in the new generation of trainees, and it was sad that only one person knew the answer. And that too a medical student, of all people.

“Words of comfort, sir.”

“Very good. You can come and assist me in surgery if you like, Mr. …”

“Stone, sir. Thomas Stone.”

During the surgery Braithwaite found Thomas knew how to stay out of the way. When Braithwaite asked him to cut a ligature, Stone slid his scissors down to the knot and then turned the scissors at a forty-five-degree angle and cut, so there was no danger to the knot. Indeed, Stone so clearly understood his role that when the senior registrar showed up to assist, Braithwaite waved him off.