Abraham Verghese: Cutting for Stone

But Thomas Stone did come. Surely she would have registered his arrival. As he picked her up, carried her, ran with her, every tear that fell from his eyes onto her face she would have interpreted as affirmations of his love. He came not because of the letter: he never got it. He came because some part of him knew what he had done, and what he had to do: some part of him knew what he felt.

I pictured Ghosh visiting Thomas Stone's quarters after my mother's death, searching for him. He would have seen on Stone's desk the new textbook and bookmark, and on top of them, conspicuously perhaps, this letter. Thomas Stone never saw the book or the letter because he spent the previous night sleeping in the lounge chair in his Missing office, as he often did, and then after my mother's death he never returned to his quarters. Why hadn't Ghosh simply mailed the letter directly to Thomas Stone? Thomas never wrote or communicated; Ghosh had no address at first. But as the years went by, Ghosh could probably have found Stone's whereabouts. After all, Eli Harris had always known them. But perhaps by then Ghosh was hurt by Stone's silence and his willingness to forget his old friend and leave him caring for his children as he ran from his past. As more years went by, Ghosh might have pondered the effect of the letter on Stone—perhaps it would in fact be a disservice to send it to him. It might have precipitated another meltdown, or, as Hema had always feared, Stone might have returned to claim the children. And perhaps Stone wouldn't understand—or believe—anything the letter said.

Then, as death approached, it must have worked on Ghosh's conscience to be the keeper of this letter. What if the contents could save Stone, put his heart at ease? What if it made Stone do, even belatedly, the right thing by his sons? By this time all Ghosh's resentment for Stone, if he ever had any, had vanished.

So ultimately Ghosh gave the textbook and bookmark to Shiva, and the letter to me, but hidden from me. I marveled at the foresight of a dying man who would entomb a letter within a framed picture. He would leave it to fate—how like Ghosh this was! When would I find Thomas Stone? When would I find the letter? If and when I found it, would I give the letter to its intended recipient? Ghosh trusted me to do whatever it is I would choose to do. That, too, is love. Hed been dead more than a quarter century and he was still teaching me about the trust that comes only from true love.

“Shiva,” I said, looking up at the sky where the stars were warming up for their nightly show while I recalled the night I fled Missing in haste, and how Shiva had thrust at me my father's book— A Short Practice, that bookmark inside. The few words on the bookmark penned by my mother were the only way any of us knew a letter even existed. Years ago, over the telephone, I had asked him, “Shiva, what made you give me the book?” He didn't know. “I wanted you to have it” was all he could say. The world turns on our every action, and our every omission, whether we know it or not.

WHEN I REACHED MY QUARTERS, I sat down and spread the letter on my lap, and with shaky hands I dialed Thomas Stone's number. My father was well past eighty now, an emeritus professor. Deepak said the old man's eyes were fading, but his touch was so good he could have operated in the dark. Still, he rarely operated anymore, though he would often assist. Thomas Stone was once known for The Expedient Operator: A Short Practice of Tropical Surgery. Now he was famous for pioneering a breakthrough transplant procedure. I was proof that the operation worked, but Shiva's death was proof of the attendant risks. Surgeons around the world had learned to do the operation, and many infants born without a working bile-drainage system had been saved by a parent's gift of a part of his or her liver.

IN MY EARPIECE I heard the hush of the void that hangs over the earth, and then out of that ether, the sound of the phone ringing far away, its high-pitched summons so brisk and efficient, so different from the lackadaisical analog clicks and the coarse ring when I dialed an Addis Ababa number. I pictured the phone trill and echo in the apartment that I had visited once, and which I had left open like a sardine can so that Thomas Stone would know that his son had arrived in his world.

I thought of my mother writing this letter, her whole life compressed on one side of this parchment. She had probably delivered it (and the book with bookmark) in the late afternoon when the pains hit her. She had worsened in the night, slowly slipping into shock, and then the next day she died. But not before Thomas Stone came to her. It was the sign she had waited for. He did the right thing, and yet for the last half century, he was unaware that he had done so.

Thomas Stone answered after the first ring. It made me wonder if he were wide awake even though it was the middle of the night in Boston.

“Yes?” My father's voice was crisp and alert, as if he expected this intrusion, as if he were ready for the story of trauma or massive brain bleed that made an organ available, or ready to hear of a child, one in ten thousand, born with biliary atresia who would die without a liver transplant. The voice I heard was that of someone who would bring all the skill and experience he carried in his nine fingers to the rescue of a fellow human being, and who would pass on that legacy to another generation of interns and residents—it was what he was born to do; he knew nothing else. “Stone here,” he said, his voice sounding so very close, as if he were there with me, as if nothing at all separated our two worlds.

THIS IS A WORK OF FICTION, and all the characters are imagined, as is Missing Hospital. Some historical figures, such as Emperor Haile Selassie and the dictator Mengistu, are real; an attempted coup did occur in Ethiopia, but five years earlier than the one I describe. The Colonel and his brother are loosely based on the real coup leaders. The details of their capture and the words at the Colonel's trial and before he was hung are from published reports, particularly Richard Greenfield's Ethiopia: A New Political History; John H. Spencer's Ethiopia at Bay: A Personal Account of the Haile Selassie Years; the published work of Richard Pankhurst for historical backdrop; and Edmond J. Keller's Revolutionary Ethiopia: From Empire to People's Republic. A remarkable physician by the name of John Melly died after being shot by a looter, but his dialogue with Matron is imagined. The Ibis and other bars are inventions. The LT&C school is imagined; any resemblance to my wonderful school (where Mr. Robbs and Mr. Thames encouraged my writing) is not intentional.

The following sources, books, and people were invaluable: The birth scene and the phrases “white asphyxia” and “in the obscurity of our mother's womb” are inspired by the wonderful memoir of the late great Egyptian obstetrician and fistula surgeon Naguib Mahfouz, The Life of an Egyptian Doctor, as is the idea of the copper vessel. Nergesh Tejani's essays describing her experiences in Africa with version clinics and with fistula, as well as our correspondence, were extremely helpful. I consulted the published work of Dr. Reginald Hamlin and Dr. Catherine Hamlin, pioneers of fistula surgery. As a medical student, I would see them and was very aware of their work. Recently, I had the opportunity to visit the “Hospital by the River,” which is also the title of Catherine Hamlin's lovely memoir. The fistula surgeons in my book are not in any way based on the Hamlins. The late Sir Ian Hill was in fact the dean of the medical school, and if I use his name, and that of Braithwaite, in the book, it is as a tribute to two people who took a chance on me. The attempted hijackings of the Ethiopian Airlines jets during the 1960s and 1970s are historical facts; one would-be hijacker was my senior in medical school; she and her fellow hijackers perished in the attempt. The present prime minister of Ethiopia, Meles Zenawi, was one year my junior in medical school; he became a guerilla fighter, ultimately leading the forces that toppled Mengitsu. The heroism of the security crew and the incredible skill of the pilots are very real. Ethiopian Airlines remains, in my opinion, the safest and best international airline I have flown, with the most hospitable and dedicated flight attendants. Louse-borne relapsing fever was studied by the late Peter Perine and the late Charles Leithead, and I had the pleasure of seeing patients with both men when I was a student.