Abraham Verghese - Cutting for Stone

“My hypothesis, madam, is that Marion- bhaiya started isoniazid on his own. The prescription is a month old. He probably didn't get his blood drawn to check liver functions the way he was supposed to. He is a surgeon after all, poor fellow. What does he know about these fine matters? If he'd only consulted me! I would have been honored to take care of him. After all, Mari on-bhaiya took care of my hernia so lovingly.

“In any case, madam, I personally went to Manhattan, to Mount Sinai, and I chauffeured over the world's best liver man, the man who trained me in this specialty. I said, ‘Professor, this is a not a case of hepatitis, but a case of my own brother.’ He is in agreement that the alcohol and the isoniazid might be contributory, but there is no doubt that what we are dealing with here first and foremost is hepatitis B.”

“What is the prognosis?” Hema said. “Will someone tell me that?” It was the most basic thing a mother wanted to know. “Will he get better?”

Vinu looked to Deepak and Thomas Stone, but neither man was willing to speak. The disease was, after all, Vinu's area of expertise.

“Just tell me. Will he live?” Hema spat out.

“It is undoubtedly very grave,” Vinu said, and the fact that he was fighting back tears told her everything.

“Come on!” Hema said, annoyed by this and turning to Thomas Stone, and then to Deepak. “It's hepatitis. I understand hepatitis. We see the damage it does in Africa. But … here, America! In this wealthy place, this rich hospital”—she swept her hands at all the machinery— “surely here in America you can do more for hepatitis than to wring your hands and say it is very grave. “

They must have winced when she said “rich.” Compared with the state-of-the-art ICUs in the money hospitals, such as Thomas Stone's institution in Boston, ours was bare-bones.

“We tried everything, madam,” Deepak said now in a more subdued tone. “Plasma exchange. Whatever anyone in the world can do for this disease, we are doing that here.”

Hema looked skeptical.

“And praying, madam,” Vinu added. “The sisters have a prayer chain going around the clock for two days now. Honestly, we need that kind of a miracle.”

Shiva had quietly followed every word from where he lay.

Hema stood looking down at my unconscious form, stroking my hand and shaking her head.

Vinu convinced the two of them to retire to a room readied for them in the house-staff building; he'd even arranged for a light dinner of cha-patti and dal. Hema was too tired to argue.

THE NEXT MORNING, Hema appeared in an orange sari, looking rested, yet as if she had aged a few years in the course of the night.

Thomas Stone was exactly where she had left him. He looked past her in the doorway, as if expecting Shiva, but Shiva wasn't there.

She stood by my bed again, anxious to see me in daylight. The previous night she'd found it all too unreal, as if it were not me on the bed but some extension of all the noisy machinery which had taken the form of flesh. But now she could see me, see the rise and fall of my chest, the puffiness of my eyes, my lips contorted by the breathing tube. It was real. She couldn't help herself, and began to weep silently, forgetting Thomas Stone was there, or not caring one way or the other. She was only conscious of him when he tentatively offered a handkerchief. She snatched it from him, as if he'd been slow to offer it.

“It feels as if this is happening because of me,” Hema said. She blew her nose. “I know that sounds selfish, but to lose Ghosh, then to see Marion like this … You don't understand, it feels as if I have failed them all, that I let this befall Marion.”

Had she turned, she might have seen Thomas Stone stir, seen him rub his knuckles against his temples, as if trying to erase himself. He spoke, his voice hoarse. “You … you and Ghosh never failed them. I did. I failed all of you.”

There it was, Hema must have thought; it was both the sorry and the thank-you that was so long overdue, and the funny thing was that at this moment, she didn't care. It no longer mattered. She didn't even look his way.

SHIVA ENTERED, and if he saw Thomas Stone, he didn't acknowledge his presence. He had eyes only for me, his brother.

“Where were you?” Hema said. “Did you sleep at all?”

“In the library upstairs. I took a nap there.” Shiva surveyed me, then he studied the settings on the ventilator, and then the labels on the fluid-containing bags hanging over my bed.

“There is one thing I didn't ask Vinu,” Hema said to Stone. “How did Marion get hepatitis B?”

Thomas shook his head as if to say he did not know. But since she wasn't looking his way, he had to speak. “It … was probably during surgery. Nicking himself. It's an occupational hazard for surgeons.”

“It can also be acquired by sexual intercourse,” Shiva said, addressing Thomas Stone. Thomas Stone stammered assent. Hema glared at Shiva, one hand on her hip. She didn't get a chance to speak, because Shiva had more to say: “Genet was at Marion's house, Ma. She showed up there six weeks ago. She was sick. She stayed for two nights and then disappeared.”

“Genet … ?” Hema said.

“There are two people in the waiting room you need to meet. One is an Ethiopian lady, Tsige. She used to live opposite Missing. Ghosh took care of her infant years ago. Marion met her again in Boston. The other is Mr. Holmes—he is Marion's neighbor. They want to speak to you.”

BY MIDMORNING, Hema knew the whole story. Genet had been ill with TB. But Appleby had his hands on the prison health records and they showed what we had not known before: Genet was also a silent carrier of hepatitis B. She contracted it (or so the prison doctor postulated) from an improperly sterilized needle or a transfusion or a tattoo when she was in the field in Eritrea; she could also have acquired it sexually. Genet had bled readily when we slept together, and I had been generously exposed to her blood and thereby to the virus. The incubation period of hepatitis B fit Shiva's hypothesis: it was six weeks from her visit to my falling ill.

Hema paced the waiting room, cursing Genet and bemoaning my stupidity in letting Genet get close to me again after everything she had put us through. Had Genet appeared just then, I would have feared for her life.

WHEN DEEPAK AND VINU made rounds together that afternoon they shared the latest lab results: my kidneys were failing; my liver, normally the source of clotting factors, wasn't producing any. If there were any viable liver cells left, they were showing no signs of recovering. There was not a bit of good news they could convey. They withdrew, Shiva following them. Thomas Stone and Hema stayed, silent around my immobile form. Now it was a watching game, a vigil to the end. There was no hope. The two of them as physicians knew it all too well, but if anything, experience made it even less palatable.

AT NOON, an ICU nurse paged both Deepak and Vinu to a Stone family conference. They came to find Hema and Shiva seated across from Thomas Stone in the small meeting room.

Hema, weary, head in her hands and elbows on the table, gazed up at the two young doctors in white coats, her son's peers. “You wanted to see us?” she said impatiently to Vinu and Deepak.

Deepak looked puzzled. “I didn't call this meeting.” He turned to Vinu, who shook his head.

“I did,” Shiva said. He had a stack of photocopied papers in front of him. A yellow legal pad was covered with notations in his careful script. Hema noticed an authority to his voice, a sense of action and energy and initiative that no one else seemed capable of displaying in the face of my terrible prognosis. “I called the meeting because I want to talk about a liver transplant.”