Abraham Verghese - Cutting for Stone

She held him. His puzzled look collapsed into one of fear and pain. Hema spotted the curve in his shin—like bending a green stick, the bone too young to snap clean. She took all this in even as her body registered that they were plunging, losing altitude.

A young Armenian, bless his practicality scrambled to free the leg. Incredibly, the Armenian was smiling. He tried to tell her something— a reassurance of sorts. She was shocked to see someone calmer than herself when all around the cries of passengers made the situation worse.

She lifted the little boy to her lap. Her thoughts were both clear and disconnected. The leg is already straightening but there is no doubt that it is fractured and the plane is going down. She stopped his stunned parents with an outstretched palm and clamped a hand on the mouth of the wailing mother. She felt the familiar calmness of an emergency, but she understood the falseness of that feeling, now that it was her life at stake.

“Let him be with me,” she said, removing her hand from the woman's face. “Trust me, I'm a doctor.”

“Yes, we know,” the father said.

They squeezed in next to her on the bench. The boy didn't cry; he only whimpered. His face was pale—he was in shock—and he clung to her, his cheek against her bosom.

Trust me, I'm a doctor. She thought it ironic that these would be her last words.

Through the porthole Hemlatha saw the white crests getting closer, looking less and less like lace on a blue cloth. She had always assumed that she would have years to sort out the meaning of life. Now, it seemed she would only have a few seconds, and in that realization came her epiphany.

As she bent over the child she realized that the tragedy of death had to do entirely with what was left unfulfilled. She was ashamed that such a simple insight should have eluded her all these years. Make something beautiful of your life. Wasn't that the adage Sister Mary Joseph Praise lived by? Hema's second thought was that she, deliverer of countless babies, she who'd rejected the kind of marriage her parents wanted for her, she who felt there were too many children in the world and felt no pressure to add to that number, understood for the first time that having a child was about cheating death. Children were the foot wedged in the closing door, the glimmer of hope that in reincarnation there would be some house to go to, even if one came back as a dog, or a mouse, or a flea that lived on the bodies of men. If, as Matron and Sister Mary Joseph Praise believed, there was a raising of the dead, then a child would be sure to see that its parents were awakened. Provided, of course, the child didn't die with you in a plane crash .

Make something beautiful of your life— this whimpering little fellow with his shiny eyes and long eyelashes, his oversize head and the puppy-dog scent of his unruly hair … he was about the most beautiful thing one could make.

Her fellow passengers looked as terrified as she felt. Only the Armenian shook his head at her, and smiled as if to say, This isn't what you think it is.

What an idiot, Hema thought.

An older Armenian—his father perhaps—was impassive, staring straight ahead. The older man had looked morose on boarding and his mood now was no better, and no worse. Hema found herself amazed that she should notice such trivial details at a time like this when, instead of deconstructing faces, she should be bracing for the moment of impact.

As the sea rushed up to meet the plane, she thought of Ghosh. She was shocked when a flood of tender feelings for him overcame her, as if he were about to die in a plane crash, as if his grand adventure in medicine and his carefree days were ending and with it any chance of his achieving the thing he wanted most: to marry Hema.

YOUR PATIENT, DR. STONE,” Matron said again, vacating the stool between Sister Mary Joseph Praise's legs. Seeing his face, she wondered if he was about to throw something.

Thomas Stone was an occasional flinger of instruments, though never in front of Matron. It was rare that Sister Mary Joseph Praise ever handed him the wrong implement, but from time to time, a hemostat failed to release with light counterpressure, or a Metzenbaum didn't cut at its tip. He had good aim; one spot on the wall of Operating Theater 3, just above the light switch and perilously close to the glass instrument cabinet, was his usual target.

No one but Sister Mary Joseph Praise took it personally—she would be crestfallen, even though she tested every instrument before she put it in the autoclave. Matron insisted the throwing was a good thing. “Feed him a ratchetless hemostat from time to time,” she said to Sister Mary Joseph Praise. “Otherwise he'll keep it bottled up till it comes oozing out of his ears and we'll have a right mess then.”

The plaster above the light switch had stellate pits and scratches as if a firecracker had gone off there. The strike on the wall occurred after the word “COMPLETELY” and before the word “USELESS!” left his mouth. Once in a great while he exploded at Nurse Asqual, the anesthetist, if the patient were too lightly under or had been given too little curare so that the belly muscles clamped down like a vice on his wrists as he fished inside the abdomen. More than one etherized patient had woken in holy terror hearing Stone bellow, “I'll need a pickax if you can't give me more relaxation down here!”

But at this moment, with Sister Mary Joseph Praise's lips ashen, her breathing shallow, her eyes seeing past him, her unrelenting bleeding, and then with Matron having passed the baton to him, Stone was speechless. He was experiencing the helplessness that patients’ relatives must feel, and he didn't like it in the least bit. His lips trembled and he felt shame at how his wet face displayed his emotions. But more than that he felt fear, and an astonishing paralysis of thought which only shamed him further.

When he finally spoke it was to say in a quavering voice, “Where is Hemlatha? Why isn't she back? We need her,” which was an act of uncharacteristic humility.

He swiped at his eyes using the back of his forearm, a childlike gesture. Matron watched in disbelief: instead of taking the stool she offered, he retreated. Stone walked to the wall that bore the marks of his anger. He struck his head on the plastered surface, a head butt worthy of a mountain goat. His legs wobbled. He clung to the glass cabinet. Matron felt obliged to murmur “Completely useless” on the off chance that if his violence had meaning, God forbid it should fail for lack of its accompanying mantra.

True, Stone could have done a Cesarean section, though, strangely for a tropical surgeon, it was one of the few operations he hadn't done. “See One, Do One, Teach One” was a chapter heading in his textbook , The Expedient Operator: A Short Practice of Tropical Surgery. But what his readers didn't know, and what I learned only many years later, was that he had an aversion to anything gynecological (not to mention anything obstetrical). It stemmed from his final year of medical school, when he did what was unheard of: he bought his very own cadaver so that he could master the anatomy he had already learned so well on a shared cadaver in his first year of medical school. The male poorhouse specimen of his first-year anatomy class had been ancient and shriveled with ghostly muscles and tendons, such being the common tender of Edinburgh anatomy theaters. He'd shared that body with five other students. But he lucked out with the cadaver he purchased in his final year: a well-fed, middle-aged female, a type he associated with the linoleum factories in Fife. Stone's dissection of the hand was so elegant (with just the tendon sheath exposed on the middle finger, while on the ring finger he carried it further to lay open the sheath and show the tendons of flexor sublimis like the wires of a suspension bridge, the profundus tendon coursing between them) that the anatomy professor preserved it to show the first-year students. For weeks Thomas Stone toiled over his cadaver, spending more time with her than he had with any other female save his mother. He felt an ease with her, a fluency that came from intimate knowledge. On one side, he had filleted her cheek to the ear, tying the flap back with sutures to expose the parotid gland and the facial nerve passing through, its branches splayed out like a goose's foot, hence the name pes anserinus. On the other side of the face hed removed all subcutaneous tissue and fat to reveal the myriad muscles of expression whose concerted movements in life had conveyed her sorrow, joy, and every emotion in between. He didn't think of her as a person. She was simply knowledge embodied, embalmed, and personified. Every evening he folded back the muscles and then the skin flaps dangling on narrow hinges, and then he spread the formalin-soaked rags over her to ensheathe her. Sometimes when he fastened the rubber sheet around her and tucked the edges in, it reminded him of his mother's ritual of putting him to bed. Back in his room, his solitude and loneliness always felt more acute.