Abraham Verghese - Cutting for Stone

I was speechless at this news. What else had gone on when I was unconscious?

Outside a siren drew closer and closer, an ambulance coming to Our Lady.

“They want to discontinue the ventilator on Shiva,” Hema said. “I can't bear for them to do that. As long as he is breathing, even if it is the ventilator breathing for him, he's alive for me.”

The next morning, after the nurse seated me in the shower and helped me with my first bath, I put on a fresh gown and I asked to be wheeled to Shiva's room.

“Stop here,” I said, well before his room, because I saw through the half-open door that Thomas Stone was seated by Shiva's bed, just as I was told he had sat by mine. His fingers rested on Shiva's wrist, feeling the pulse. His hand lingered there long after he had registered the heart rate. I wondered what he was thinking. I watched him for a full ten minutes before he stood up and came out, his eyes haunted and red. He didn't see me as he walked off in the other direction.

I rolled my chair after him. “Dr. Stone,” I said. Every fiber of my being wanted to cry out, Father!

He came to me. “Dr. Stone,” I said. “Surely an operation … is his only chance. Can't the neurosurgeons go in, tie off the tangled vessels, and evacuate the clot in his brain? So what if it's a long shot? It's his only shot.”

He considered this for a while.

“Son, they say the tissue in there is—sorry to say this—the consistency of wet toilet paper. Blood mixed with brain. The pressure's so high, if they so much as touch him, they tell me it'll only make him bleed further.”

I didn't want to accept that. “Can't you do it? You and Deepak? You've done burr holes. I've done burr holes. What's there to lose? Please? Let's give him that chance.”

He waited so long that even I could hear the fallacy of what I was suggesting. My father put his hand on my shoulder. He spoke to me gently, as to a junior colleague, not to his son. “Marion, remember the Eleventh Commandment,” he said. “Thou shall not operate on the day of a patient's death.”

When I was back in my room, Thomas Stone brought up Shiva's CAT scan. I was shocked to see the huge white splotch—which is how blood looks on a CAT scan—involving both hemispheres and spilling into the ventricles. It compressed the brain within the rigid confines of the skull. I knew then that it was hopeless.

BECAUSE OF THE ANEURYSM or tangled vessel malformation in his brain, Shiva was not a potential donor for heart or kidneys, for fear there might be similar changes in those organs.

Hema didn't want to be there when the ventilator was discontinued. I said I'd be with him. I asked to be alone with Shiva when he passed.

Hema said her good-bye first.

I was outside the room when Vinu escorted her out. It was a heartbreaking sight to see my mother, the tail end of her sari draped over her head, her shoulders slumped, leave her still-breathing child. It must have felt to her as if she were abandoning him. Every eye in the unit was on her, and not one was dry, as her shimmering, sari-clad form floated down the hall on her way to the Quiet Room.

With Deepak's assistance I climbed onto Shiva's bed. It was eight in the evening. I settled myself next to him. Everything but his breathing tube and an intravenous line had been removed. Deepak peeled away the tape that held the tracheal tube to Shiva's cheeks. Then, with a nod from me, he injected morphine through Shiva's intravenous tubing. If any part of Shiva's brain was alive, we didn't want it to sense pain, or fear, or suffocation. Deepak turned off the ventilator, silenced its immediate shrill protest, slid the endotracheal tube from Shiva's mouth, and then he left the room.

I LAY THERE, my head against Shiva's, a finger resting on his carotid pulse. His body was warm. He never took a breath after the tube came out. His facial expression never changed. His pulse stayed regular for almost a minute, then it paused, as if it had just realized its lifelong partner—the lungs—had quit. His heart sped up, became faint, and then, with a final throb under my fingers, it was gone. I thought of Ghosh. Of all the pulse types, this was both the rarest and the most common, a Janus quality that every pulse possesses: the potential to be absent.

I closed my eyes and clung to Shiva. I cradled him, his skull buttressed against mine and now wet with my tears. I felt physically vulnerable in a way I'd never felt when we were a continent apart, as if with his death my own biology was now altered. The heat was rapidly leaving his body.

I rocked Shiva, wedging my head against his, remembering how for so long I was unable to sleep except like this. I felt despair. I didn't want to leave this bed. Chang and Eng had died within hours of each other, because when the healthy one was offered the opportunity to be freed from the dead one, he declined. I understood so well. Let Deepak give me a lethal dose of morphine and let my life end this way, let my respiration cease, my pulse fade and then disappear. Let my brother and me leave the world in the same embrace with which we began in the womb.

I PICTURED SHIVA getting the telegram, his coming to me, then putting himself at risk to save me. Would I have done the same for him? Perhaps when he saw me, he'd felt the way I did now: that it didn't matter what might have transpired between us, but life would not be worth living and would end soon if something happened to the other.

His body continued to lose heat in my arms as if I were drawing it away, siphoning it over. I remembered the two of us running up the hill in a relay, carrying a lifeless and cold child to Casualty, the parents trailing behind us. He was now that lifeless child.

The minutes passed.

Ultimately it was the rude coldness of Shiva's skin, the terrible separation it delineated of the living and the dead, the disarticulation of our bound flesh, that forced me to a new understanding, a new way of seeing us in the face of such rapid attrition, and this is what I came to:

Shiva and I were one being—ShivaMarion.

Even when an ocean separated us, even when we thought we were two, we were ShivaMarion.

He was the rake and I the erstwhile virgin, he the genius who acquired knowledge effortlessly while I toiled into the night for the same mastery; he the famous fistula surgeon and I just another trauma surgeon. Had we switched roles, it wouldn't have mattered one bit to the universe.

Fate and Genet had conspired to kill my liver, but Shiva had a role in Genet's fate, and hence my fate. Every action of ours turned out to be dependent on the other. But now by a brilliant and daring rearrangement of organs, ShivaMarion had readjusted. Four legs, four arms, four kidneys, and so on, but instead of two livers, we had downsized to one. Then karma and bad luck took us even further, forced further concessions: we lost ground on his side, a few organs died. Okay—just about everything on his side died, but we retained half his liver, and it was thriving. What we had to do now was economize further, go halves again, tough measures for tough times: two legs sufficed, so also with eyes, kidneys. We'd go with half a liver, one heart, one pancreas, two arms … but we were still ShivaMarion.

Shiva lives in me.

Call it a far-fetched scheme that I conjured up to allow me to go on … Well then, it allowed me to go on. It gave me comfort. It dried my tears, helped me untwine my arms and legs from the body that we were discarding. In the eerie quiet of that room, so primed for machines but with the machines all silent, the blinds closed, and with an icy corpse next to me, I felt Shiva was instructing me. He had rowed over from the sinking ship and he was telling me to think this way, and it was just Shiva's kind of logic. One being at birth, rudely separated, we are one again.