Abraham Verghese: Cutting for Stone

With Hema's help, her soothing voice, I did my best to calm down, to let the machine push air into me, and the nurse retreated. When I felt better I wrote, How is Shiva?

She didn't have to reply, because just then my other half came in, led by Thomas Stone.

My brother, whom I had not seen for seven years, looked haggard, not at all like the picture in the Times. I felt vertigo in seeing my reflection moving independently of me. Shiva wore a hospital gown, one palm resting carefully on his belly, the other hand pushing his intravenous pole ahead of him, and using it as a walking stick. My brother wasn't given to laughing and most jokes were wasted on him, but when he saw me, he grinned like the chimp who'd locked up the zookeeper.

You monkey, you, I wanted to say, and I reached hungrily for his hand, our fingers interlocking. You should laugh more, it suits you: see how the furrows around your brow vanish and your ears ease back? I felt fluid running down my temples, and his eyes were full, too. I squeezed his fingers, a Morse code to convey what was in my heart. He nodded— You don't have to tell me anything is what he was saying. He bent forward gingerly, and I wondered what he was up to, surely not a kiss … He clinked his skull against mine. It was such an unexpected, jarring, and surprising act, a throwback to being little boys, the softest of testas, that it made me laugh, which made that horrible tube scratch the inside of my throat, and so I had to stop.

I pointed to Shiva's belly. He pulled aside his gown and I could see some of the incision, though a gauze pad with a drain passing through it hid the remainder. I raised my eyebrows at him, asking if it hurt. And he said, Only when I breathe, and we both laughed and both had to cut that off because of the pain. Stone stood looking on at this silent dialogue, amazed, a strange expression on his face.

Little did I know that Shiva's recovery had been complicated by a bile infection requiring antibiotics. Or that he had developed a blood clot in the vein in his right arm through which he'd been getting fluids. He was on a blood thinner, and the clot was resolving.

I held his hand for a long time, content to look at him, to thank him with my fingers, but he kept shrugging off my thanks. I reached for my pen, and Hema pushed the pad in front of me and I wrote, Greater love hath no man—

He didn't let me finish. He held my pen. He said, You would have done the same. I had my doubts, but he nodded. Yes, you would.

That evening, Deepak drained fluid from around my right lung, and my breath expanded in that direction. Then he took the wretched tube out of my throat. My first words were “Thank you,” and when that ugly blue machine left my room, I fell into a deep sleep.

The next morning was full of small miracles: being able to turn and gaze at the window and see sky, being able to say “Ouch” when the movement pulled on my incision. Hema wasn't around. The ICU was quiet. My nurse, Amelia, was unnaturally cheery. I assumed it was still early morning. “We have an X-ray to do downstairs,” she said, unhooking me from the tethers, and readying my bed to roll.

In Radiology I was lifted into the doughnut for a CAT scan, but oddly, it was of my head and not my belly. Surely it was a mistake. But no, the order was from Deepak, and it read, “CAT scan of the head with and without contrast.”

Back in my room and by noon, still no sign of Hema, or Stone, or Shiva. Amelia said they would be along presently.

The physical therapist helped me stand beside my bed for a few seconds. My legs felt like Jell-O sticks. I took a few steps with assistance, then sat in the chair, exhausted, woozy, as if I had run a marathon. I dozed there, ate what little I could. After lunch, I took a few more steps, and even peed upright. The nurses helped me back to bed. In retrospect, they seemed pleased to get out of my room.

IT WAS 2:00 P.M. when Thomas Stone appeared at my door. There were dark circles around his eyes. He sat self-consciously on the edge of the bed. He touched my hand. His lips parted.

“Wait,” I said. “Don't say anything yet.” I looked out of the window at the clouds, at distant smokestacks. The world was intact now, but I knew once he spoke it wouldn't be so.

“Okay,” I said. “What happened to Shiva?”

“He had a massive bleed in his brain,” he said, his voice hoarse. “It happened last night, about an hour after we left your room. Hema was with him. He suddenly clutched his head in pain … Then, in a matter of seconds, he was … unconscious.”

“Is he gone?”

Thomas Stone shook his head. “He bled from an arteriovenous malformation, a cavernous tangle of blood vessels in the cortex. He has probably had it all along … He was on anticoagulants for the blood clot in his arm … In a week we would have stopped.”

“Where is he?”

“Here. In the ICU. On a ventilator. Two neurosurgeons have seen him.” He shook his head. “It isn't feasible to evacuate the bleed. They think it's too late. And that he's brain-dead.”

I didn't register much of what he said after that. I remember he said that my CAT scan showed a similar but smaller spider knot of vessels, but mine wasn't bleeding, a miracle of sorts, I suppose, since I'd bled from everywhere till I got Shiva's liver.

A few minutes later, Hema, Deepak, and Vinu came into the room. I understood now that Stone had been delegated to break the news.

Poor Hema. I should have tried to comfort her, but I was too full of grief and guilt. I felt so very tired. They sat around my bed, Hema weeping, bent over, resting her head on my thigh. I wanted them to leave. I closed my eyes for a moment. I woke up when a nurse came in to silence one of the intravenous pumps. There was no one else in the room. I had her walk me to the bathroom and then I sat in the armchair. I wanted my strength back.

WHEN I AWOKE, Thomas Stone was by my chair. “He can't breathe on his own, and there are no pupillary or other reflexes,” he said in response to my silent query. “He's brain-dead now.”

I said I wanted to see him.

My father wheeled me down the hall where Shiva lay. Hema was with him, her eyes puffy and red, and when she turned to me, I felt ashamed to be alive, ashamed to be the cause of her sorrow.

Shiva looked asleep. It was his turn to sport the spike coming out of his skull—the intracranial pressure monitor. The endotracheal tube skewed his lips, angling his chin up unnaturally. The rise and fall of his chest from the ventilator offered a spot on which to rest my eyes, and my ifs were coming in that rhythm: If I hadn't come to America. If I hadn't seen Tsige. If I hadn't opened the door for Genet …

HEMA WHEELED ME BACK to my room, helped me back in bed.

I said to her, “It would have been better if you and Shiva had buried me. Youd be on your way to Missing now with your favorite son.”

It was a stupid, churlish thing to say, a primitive and subconscious urge to wound her so as to assuage my pain and guilt. But if I expected her to strike back, she didn't. There is a point when grief exceeds the human capacity to emote, and as a result one is strangely composed—she had reached that point.

“Marion, I know you think I favored Shiva … And maybe I did. What can I say but that I'm sorry. A mother loves her children equally … but sometimes one child needs more help, more attention, to get by in the world. Shiva needed that.

“Marion, I have to apologize to you for more than that. I thought you were responsible for Genet being mutilated, circumcised, and all that followed. I held that against you. When we came here, Shiva told me everything. My son, I hope you can forgive me. I'm a stupid mother.”