Abraham Verghese: Cutting for Stone

She felt the response arrive as distinctly as if it were a voice or a touch: first, a lightness in her forehead, then a calmness in her chest that said she had been heard. Thank you, thank you, Hema said. I promise to keep you updated.

She returned to the waiting room. She was so exhausted that she could only wonder how Stone and Deepak managed to stay upright. From the waiting room window the earth looked as if it were mostly sky and concrete—no real earth to speak of, no manifestation of nature on the ground other than the sun setting in that direction. It was so odd, and yet this was the view her son had known for the last six years.

At 7:00 p.m., Thomas Stone was at her side. He nodded, then smiled, an expression so rare that she knew it had gone well. He said nothing, and she, too, was speechless, tears running down her cheeks. In studying Stone's face, grooved where his magnifying spectacles and lamp had sat, and grooved also from worry and work, she realized with a start how old he had become, how old they had both become, and how if they had nothing else in common, they had this: that they were both still standing after all these years, and that her sons (his, too, at some level, she had to admit) were both alive.

Thomas Stone sat down, or rather fell into the sofa, and he didn't protest when she forced juice and a sandwich on him from Vinu's ice chest of goodies. Stone washed the juice down with a bottle of water and started on a second before life seemed to stir within him. His gaunt face filled out. “Technically, everything has gone well,” he said. “Marion's new liver, Shiva's old lobe, was already making bile before we had even finished the anastomosis.” He smiled again, a shy twist of the corners of his mouth, pride in his voice. The bile, he said, was an excellent sign.

“We had a scare,” he added. “There was a moment when Marion's blood pressure dropped precipitously. No explanation for it. We were ahead on fluid and blood, but still his heart raced to one hundred and eighty beats a minute. We poured fluid in, tried this and that … and just as suddenly, the pressure came back up.” She was about to ask him precisely what time that was, but then she didn't bother, because she knew. She closed her eyes and thanked Sister for her intercession. When she opened them, Thomas Stone was staring at her as if he understood. She felt so close to him, so grateful. She couldn't go so far as to hug him, but she did reach for his hand.

“So, I must leave now,” he said to Hema after a minute. “It will be touch-and-go for a while for Marion, given how sick he was when we started. But at least he has a working liver. His kidneys are still not functioning, and he needs dialysis, but I trust it is just hepatorenal syndrome and the new liver will fix that.” He was holding things back from her. He didn't tell her how, when things had looked so dire in the operating room, hed looked up at the ceiling and prayed not to a God or to spiders, but to Sister Mary Joseph Praise, asking to be redeemed for a lifetime of mistakes.

THERE WAS REJOICING in the hospital, first that one of its own who had been near death was still alive, and second that Our Lady had made history. The Mass of Gratitude in the chapel was packed, Hema and Vinu in the front pew and the crowd spilling out to the cloisters.

Outside Our Lady of Perpetual Succour, the news vans were lined up—international as well as national. Every previous liver transplant in the world had its origins in a corpse-to-be, in someone who was brain-dead. A living donor—and an identical twin who had given half his liver to his brother—that was big news. The media didn't quite get that this technical breakthrough would be most meaningful to babies born with congenital biliary atresia—lack of bile ducts. Adult organs from people dying of trauma were scarce enough; a child donor was exceedingly rare. Stone and Deepak opened the way for a parent to donate part of his or her liver to save their infant.

By the second day, the ferreting journalists had connected Shiva to his fame as the fistula surgeon—”fixing holes is what I do”—and by the third day, they'd labeled Thomas Stone the “estranged father.” It was perhaps only a matter of time before they discovered the story of Sister Mary Joseph Praise, though it would probably necessitate a reporter traveling to Addis to unearth that tidbit.

I CAME AWAKE on the fifth day. My first memory is that of floating up from the ocean bottom, my eyes still waterlogged and with what felt like scuba gear stuffed in my mouth and throat—I couldn't speak. As I broke to the surface, I understood that I was still in the ICU at Our Lady, but I heard nothing of what anybody said. I saw Hema and Stone and I looked for Shiva. He's decided not to come from Addis, I remember thinking, and I was disappointed.

Twelve hours later, in the late evening of the fifth day (though it was perpetual twilight in the ICU), I surfaced for good, relieved to see that Hema was there, and that I hadn't imagined her presence.

She stayed by my side, holding my hand. I craved her touch, fearful I might sink back into the abyss where it was all dark and from which there was no promise of return. But I would drift off into light sleep for short periods. Night turned to day, bringing with it a new bustle and energy and more traffic through our room.

On the seventh day, I was awake long enough for Hema to make the fantastic statement that half of Shiva's liver was in me. Sick patients need to have everything explained at least twice, because you can presume they will not have heard half of what you said. Hema repeated herself at least ten times, and it was only when she showed me the Times, and the picture of me and of Shiva, that I believed.

“Shiva is recovering,” Hema said. “He's fine. But you've developed pneumonia and there is fluid collecting around your right lung. That's why you are still on the ventilator. But it's getting better, so Deepak says you will be off the ventilator tomorrow. Your new liver is functioning well, and your kidneys have bounced back.” This was not the reunion I had imagined with Hema, but the expression on her face, her joy, her relief, were priceless. She rarely left my side.

I saw Deepak and Stone for the first time later that same day. I struggled with my emotions. I know I was supposed to feel gratitude. Sometimes I think we surgeons wear masks to conceal our desires, to hide our willingness to violate the body of another. Only the guarantee of amnesia, the fact that the patient will remember nothing but the anesthetist's saying “Sweet dreams,” allows us to be surgeons. They stood before me, these perpetrators of organized violence on my body. The fact that both men were shy and unassuming seemed almost deceitful given the ambition, the hubris, that had allowed them to risk Shiva's life for mine. It was the only time I was thankful for that evil tube going down my throat and between my vocal cords, because what I would have said to them would have sounded ungrateful: It's a good thing Shiva made it, otherwise I'd be after your hides.

When I awoke sometime later, I forgot about the tube and tried to speak, which made me feel I was choking, which made me panic. My struggles triggered the ventilator alarm, and now I was terrified that the nurse would decide I was “fighting the ventilator,” which could bring an order for intravenous curare. That drug, derived from the poison darts of Amazon tribes, paralyzes all the muscles, leaving you still as death, so that the ventilator can do its work unimpeded. But God help you if you aren't given a strong sedative along with it, because then you are awake, alert, but unable to twitch or even blink. The thought of being in that paralyzed, locked-in state had always horrified me, even as I blithely ordered curare ( and sedation) for hundreds of patients. Now that I was a patient, my curse was that I knew too much.