Abraham Verghese - Cutting for Stone

“Thomas Stone!” Hema's voice was sharp as a Bard-Parker blade and it nailed him in his seat. “Once before I asked you for something, Thomas,” she said. “It had to do with these boys. You walked away then. But this time if you walk away, neither I nor Ghosh can help these boys.” Stone turned pale. He sat back in the chair. Hema's voice broke. “Thomas, do you think I would want to subject Shiva to a risk he couldn't surmount? Do you think I want to lose my sons?”

When she had composed herself, and after blowing noisily on her kerchief, she said, “Thomas, please dismiss from your head the idea that they are your sons. This is a surgical problem and you are in the best position to help them, precisely because they were never your sons. They never held you back, they never slowed your research, your career.” There was no rancor in her voice. “Dr. Stone, these are my sons. They are a gift given to me. The pain, the heartbreak, if there is to be heartbreak, are all mine—that comes with the gift. I am their mother. Please hear what I say. This has nothing to do with your sons. Make your decision by deciding what you must do for your patient.”

After an eternity, Deepak dragged the yellow pad from Shiva's side of the table and turned to a fresh page. He uncapped his pen and said to Shiva, “Tell me, why are you willing to subject yourself to such a risk?”

Shiva, for once, did not have a ready reply. He closed his eyes and made a steeple of his fingers, as if to shut out their faces. It worried Hema to see him this way. When he opened his eyes, he seemed for the first time since his arrival to be sad. He said, “Marion always thought that I never looked back. He saw me as always acting only for myself. He was right. He would be surprised if I were to risk my life to donate part of my liver. It isn't rational. But … seeing that my brother might die, I have looked back. I have regrets.

“If I was dying, if there was a chance he could save me, Marion would have pushed you to operate. That was his way. I never understood it before because it's irrational. But I understand it now.” He glanced at Hema, then shouldered on.

“I had no reason to think about all this till I got here. But at his bedside … I realized if something happens to him, it happens to me, too. If I love myself, I love him, for we are one. That makes it a risk worth taking for me—it wouldn't be for anyone else, unless they loved him. I am the only one who is a perfect match. I want to do this. I couldn't live with myself if I didn't do this, and I think you wouldn't be able to live with yourselves if you didn't try. This is my destiny. My privilege. And yours.”

Hema, composed till then, pulled Shiva to her and kissed him on the forehead.

Deepak, pen poised, had yet to write a word. He put the pen down.

At that moment it sunk in that they were going to go ahead with what had never been done before.

Shiva said to Deepak, “You said there was a second reason you had initially dismissed the idea of a transplant. What was it?”

Deepak said, “Before he lost consciousness, Marion made me promise not to transfer him. This hospital was special to him. It was more than a place for us foreign medical graduates to train. It welcomed us when other places did not. This is our home.”

Hema sighed and dropped her head into her hands. Just when they had come this far, another obstacle.

“We can do it here,” Thomas Stone said softly. He had listened to Shiva without moving a muscle, and those blue and steady eyes were now shiny and bright. He pushed his chair back and stood up, his movements purposeful. “Surgery is surgery is surgery. We can do it here as well as anywhere if we have the tools and the people. Fortunately, the world's expert in splitting the liver is sitting right next to me,” he said, putting a hand on Deepak's shoulder, “and the tools, many of which he designed, are also here and will need to be sterilized at once. We have a lot to get ready. Hema, at any time if you or Shiva have a change of heart, all you need to do is say so. Shiva, please don't eat or drink anything from this moment on.”

As he walked past Shiva's chair, he clamped his hand on my brother's shoulder, squeezed hard, and then he was gone.

AHELICOPTER FROM BOSTON GENERAL landed on Our Lady of Perpetual Succour's helipad during the night. It brought special instruments and the key personnel from Boston General's well-oiled liver transplant program. The corridor outside Our Lady's operating suites, normally a desolate stretch where one might find an empty stretcher or a portable X-ray machine parked while the tech took a cigarette break, was now like battalion headquarters at the start of a military campaign. Two large blackboards had been set up, one labeled DONOR and the other RECIPIENT, each listing what had to be accomplished with a check box next to the task. Our Lady of Perpetual Succour's team with Deepak as lead surgeon would handle the donor (Shiva's) operation, and the Boston General crew with Thomas Stone as lead surgeon would staff the recipient (my) surgery. The Our Lady team wore blue scrubs, while the Boston General crew wore white, and just to be certain, the former had a big D (for “donor”) marked on their hats and scrub shirts with a black marker, whereas the latter had an R. The adrenaline flow kept these disparate teams in good spirits; one Bronx wag even suggested to his Dorchester counterpart that they could call the teams Crackers and Homeboys. Only Thomas Stone and Deepak Jesudass would be common to both teams, each man assisting the other.

A dry run at midnight with dummy patients in both operating rooms had uncovered a few critical glitches: anesthesia from Boston General needed a better orientation to the setup at Our Lady, and there was need to anoint a “ringmaster” whose job was to be timekeeper, to keep abreast of the activities of both teams, and who was the only person authorized to carry and, most important, record all messages from Team R to Team D and vice versa. Two new blackboards were brought in to be placed inside each theater, and tasks to be ticked off written on these. Our Lady of Perpetual Succour was put on diversion, with trauma being rerouted to other hospitals in neighboring boroughs. By 4:00 a.m. it was time for the real thing.

Thomas Stone threw up in the surgeons’ locker room. The Our Lady crew saw this as a bad omen, but the Boston General crew assured their counterparts that a pale, diaphoretic Stone augured a good outcome (though in truth, they had never seen him quite so pale and weak, lying prostrate on the bench, a puke basin at his side).

With so many people from two hospitals involved, it would have been difficult to keep the operation a secret. There were two television crews parked outside Our Lady. Newspaper editors were past the deadline for the morning paper, but they were preparing to weigh in on the ethics of this historic transplant, and now they could wait to see how it went before committing themselves.

Making history or keeping it a secret was the last thing on the surgeons’ minds. Deepak, sitting on a bench separated by a row of lockers from where Stone suffered, tried to block out the sickening sound of his colleague's retching by reviewing a liver atlas.

At 4:22 a.m. Shiva was given diazepam and then pentothal, and a tube was passed into his trachea. The donor operation had begun. Thomas Stone and Deepak expected it to take anywhere from four to six hours.

IF THE BEATING HEART is pure theater, a playful, moody, extroverted organ cavorting in the chest, then the liver, sitting under the diaphragm, is a figurative painting, stolid and silent. The liver produces bile, without which fats are not digested, and the liver stores excess glucose in the form of glycogen. In silence and without outward signs, it detoxifies drugs and chemicals, it manufactures proteins for clotting and for transport, and it clears the body of ammonia, a waste product of metabolism.