Abraham Verghese - Cutting for Stone

The increasing swelling in my brain made me desperately sleepy. I held on to consciousness long enough to ask Deepak to come near. “Whatever happens,” I whispered, “don't take me from Our Lady. If I must die and can't die at Missing, I want to die here.”

At some point I was aware that Thomas Stone came to my bedside and was studying me, but not with the concern of a clinician. It was the petrified look I knew so well, the look of a parent whose child had suffered some misfortune. It was at about this time that I lost consciousness.

AS I LEARNED LATER, the cable to Hema read: COME AT ONCE STOP MARION CRITICALLY ILL STOP THOMAS STONE STOP P.S. DO NOT DELAY STOP—and she did not. Hema called in her favor with the Comrade President-for-Life's wife, who understood all too well Hema's need to be at her son's sickbed. The American Embassy readily provided visas, and by day's end, Hema and Shiva were on their way to Frankfurt via Cairo. Then, still on Lufthansa, they crossed the Atlantic. Hema pulled out the telegram more than once, studying the letters, looking for a hopeful anagram. Over Greenland, she said to Shiva, “Perhaps this means Thomas Stone is near death, not Marion.”

Shiva said with absolute certainty, “No, Ma. It's Marion. I can feel it.”

At ten in the night New York time, they floated into the Intensive Care Unit, a graying woman in a maroon sari, the face striking despite the raccoon rings around her eyes. With her was a tall youthful man who was so obviously her son and my identical twin.

They slowed outside my glass cubicle, weary Old World travelers peering into the glow of a New World hospital room. There I was, the son who went to the States for higher studies, who became a practitioner of the artful, lavish, disposable-everything, lucrative, and incredibly effective American brand of medicine, with no prices on the menu, so different in style and substance from what they did at Missing; only now it must have appeared to them as if the American medicine had turned on me, like the tiger turning on its trainer, so that I lay moored to a blue-gray ventilator, chained to moni tors on the consoles behind my bed, comatose and invaded by plastic tubing, by catheters and wires. There was even a stiff wire like a nail poking up from my skull.

They saw Thomas Stone seated on the side of my room closest to the window, his head resting awkwardly against the bed's safety rail, his eyes closed as if in sleep. In the seventy-two hours since he sent the telegram, my condition had worsened. Thomas Stone opened his eyes, suddenly aware of them. He stood up, bedraggled, stiff, and somewhat shrunken in his borrowed scrubs, relieved but apprehensive. Worry lines ran into his eyes, and his face was drawn and pale under his shock of white hair.

The two old colleagues and combatants had last seen each other in a delivery room, moments after my birth and our mother's death. That was also when Stone had last seen Shiva: in Operating Theater 3, held tight in Hema's arms.

The bedside table and the ventilator blocked Hema's approach to the near side of the bed. She circled to where Stone stood, her eyes on me.

“He is ‘critically ill’ from what, Thomas?” Hema said, referring to the two words in the telegram that had most frustrated her. Her tone was professional, as if she were asking a colleague about a patient; it allowed her the pretense of being calm when inside she was quaking.

“It's hepatic coma,” Thomas said, responding in the same manner, grateful that she'd elected to converse in the language of disease, a fallback which allowed even their son to be reduced to a diagnosis. “He has a fulminant hepatitis. The ammonia level is very high and the liver hardly functioning.”

“What from?”

“Viral hepatitis. Hepatitis B.”

Stone let down the bed rail and the two of them stood over me. Hema's hand reached behind her for the tail end of her sari, the part that went over her shoulder. She brought it to her mouth.

“He looks anemic, not just icteric,” she managed to say at last, clinging to the idiom of medicine to describe my pallor and jaundice. “What's his hemoglobin?”

“Nine, after four units of blood. He's bleeding from his gut. His platelets are down and he isn't making clotting factors. The biliru-bin is twelve, and his creatinine just today is four, rising from three yesterday …”

“What's this, please?” Shiva said, pointing at my skull. He stood across from Thomas Stone, the bed between them.

“An intracranial pressure monitor. Goes into the ventricle. He has cerebral edema. They're giving him mannitol and adjusting the ventilator settings to keep the pressure down.”

Shiva looked skeptical. “It goes through his skull, through brain into the ventricle just to measure? It does not treat?”

Thomas Stone nodded.

“How did this begin?” Hema asked.

As Thomas Stone recounted the sequence of events, Shiva freed the bedside table and found slack between the bed and ventilator. He let down the bed rail on his side. Moving with the slow efficiency of a contortionist, he slid under the tubes and wires. Deepak entered in time to see Shiva lying on his side next to me, his head touching mine. His being there looked both precarious and entirely natural. All Deepak could do was stare, noting, however, that my intracranial pressure tracing, which had done nothing but go up for three days, went down.

No sooner had Deepak introduced himself than Vinu Mehta, the gastroenterologist, filled the doorway, panting from taking the stairs. Vinu had been an internal medicine resident at Our Lady when I was a surgery resident. After specializing in gastroenterology he'd joined a lucrative practice in Westchester but wasn't happy and had returned to the salaried staff of Our Lady.

“Vinu Mehta, Dr. Madam,” he said, putting his palms together in a ñamaste before grasping Hema's hand with both of his. “And this must be Shiva,” he said, unfazed at seeing Shiva in my bed. “I know this only because I am certain the other gentleman is Marion.” He turned back to Hema. “What a shock this must be, madam. For everyone here, too. Our whole world is upside down! Marion is one of us.” This sudden switch to the vernacular of feelings made Hema's lips tremble.

One look at Vinu and you knew the stories about him buying groceries for patients he discharged were probably true. Id seen him extend a patient's stay to insulate her from some madness at home. He was the best friend to everyone on the staff and regularly baked cakes and cookies for me. I always sent him a card on Mother's Day, which pleased him no end.

“I was called the minute that Marion was brought here, Dr. Madam,” Vinu went on. “Hepatology, the liver, that is my field. Hepatitis B swims around here. Lots of carriers, intravenous drug addicts and people who acquire it from their mothers at birth—very common in immigrants from the Far East. Madam, we see no end of silent cirrhosis and even liver cancer from this virus. But acute fulminant hepatitis B? In my career I have seen only two other patients quite this severe.”

“Vinu, tell me the truth,” Hema said, taking on a no-nonsense, Mother India tone with this young doctor who was all too ready to play the role of nephew. “Is my son a drinker?”

I suppose it was a fair question. I hadn't seen her in more than seven years. She knew it was in my genes. What did she really know of who or what I had become?

“Madam, categorically no!” Vinu responded. “No, no. A gem of a son you have.”

Hema's stern expression softened.

“Although, madam,” Vinu continued, “in the past few weeks, madam—don't take this wrongly—by the report of his neighbor, Marion had been troubled and drinking.”

Deepak had found a new prescription in my house for isoniazid, a drug used to prevent tuberculosis. Isoniazid was also famous for causing severe liver inflammation. It was routine to check liver enzymes two weeks after starting treatment so the drug could be discontinued if there was any sign of liver damage.