Abraham Verghese - Cutting for Stone

Stone stood and unfurrowed his brows at the sight of Hema. Though he didn't say a word, his expression was that of a man who, having fallen into a crevasse, spotted the bowline lowered from the heavens.

Hema, recalling this event many years later, said to me, “My saliva turned to cement, son. A sweat broke out over my face and neck, even though it was freezing in there. You see, even before I digested the medi cal facts, I'd already registered that smell.”

“What smell?”

“You won't find it any textbooks, Marion, so don't bother looking. But it's etched here,” she said, tapping her head. “If I chose to write a textbook, not that I have any interest in that kind of thing, I'd have a chapter on nothing but obstetric odors.” The smell was both astringent and saccharine, these two contrary characteristics coming together in what she'd come to think of as fetor terribilis. “It always means a labor room catastrophe. Dead mothers, or dead babies, or homicidal husbands. Or all the above.”

She couldn't believe the amount of blood on the floor. The sight of instruments lying helter-skelter— on the patient, next to the patient, on the operating table—assaulted her senses. But most of all—and shed been resisting this—she couldn't accept the fact that Sister Mary Joseph Praise, sweet Sister, who should have been standing, gowned, masked, and scrubbed, a beacon of calm in this calamity instead lay all but lifeless on the table, her skin porcelain white and her lips drained of all color.

Hema's thoughts became dissociated, as if they were no longer hers but instead were elegant copperplate scrolling before her in a dream. Sister Mary Joseph Praise's left hand lying supine on the table drew Hema's eye. The fingers were curled, the index finger less so, as if she'd been pointing, when sleep or coma overcame her. It was a posture of repose that one rarely associated with Sister Mary Joseph Praise. Hema's eyes would be drawn to that hand repeatedly as the hour unfolded.

The sight of Thomas Stone brought her back to her senses and galvanized her. Seeing Stone in the hallowed place between a woman's legs that was reserved for the obstetrician rankled Hema. That was her spot, her domain. She shouldered him aside, and in his haste he knocked the stool over. He tried to explain what had happened: finding Sister, their discovery of her pregnancy and then her obstructed labor, the shock, the bleeding that never stopped—

“Ayoh, what is this?” she said, cutting him off, her eyes round with alarm, brows shooting up and her mouth a perfect O. She pointed at the bloody trephine and the open textbook resting by Sister Mary Joseph Praise's belly. “Books and whatnots?” She swiped them aside, and they clattered to the floor, the sound reverberating off the walls.

The probationer's heart hammered against her breast like a moth in a lamp. Not knowing where to put her hands, she stuffed them in her pockets. She reassured herself that she had no part in the books and whatnots. Her failure (and she was beginning to see this) was a failure of Sound Nursing Sense; she'd missed the gravity of Sister Mary Joseph Praise's condition when she delivered Stone's message. She'd assumed that others would look in on Sister Mary Joseph Praise. No one had been aware that Sister Mary Joseph Praise was that ill, and no one had told Matron.

SISTER MARY JOSEPH PRAISE moved her head, and Matron believed that she was at least transiently aware that Matron held her hand. But so relentless was her pain that Sister couldn't acknowledge Matron's kindness.

In his hands I saw a large golden spear and at its iron tip there seemed to be a point of fire.

Matron's guess from the fragments she could understand was that Sister Mary Joseph Praise's mumbled words were perhaps the words of St. Teresa that they both knew so well.

I felt as if he plunged it into my heart several times, so that it penetrated all the way to my entrails. When he drew it out, he seemed to draw them out, and left me inflamed with a great love for God. The pain was so severe, it made me moan several times. The sweetness of this intense pain is so extreme, there is no wanting it to end, and the soul is not satisfied with anything less than God.

But unlike St. Teresa of Avila, Sister Mary Joseph Praise surely did want the pain to end, and just then, Matron said, the pain seemed to loosen its grip on her belly, and Sister sighed and clearly said, “I marvel, Lord, at your mercy. It is not something I deserve.”

A brief period of lucidity with roving eye movements followed, along with more attempts at speech, but it was unintelligible. Light splashed into the room, and Matron said it was as if a shroud that had formed in front of her face melted away. In that moment, as Sister Mary Joseph Praise looked around OT3—her operating theater for all these years— Matron thought the young nun realized that she was now the patient to be operated on and that the odds were against her.

“Perhaps she felt she deserved to die,” Matron said, guessing at my mother's thoughts. “If faith and grace were meant to balance the sinful nature of all humans, hers had been insufficient, and so what she felt was shame. Still she must have believed, even with all her imperfections, that God loved her and forgiveness awaited her in His abode, if not on earth.”

Matron wondered if it scared my mother that she might die in Africa, a continent away from her birthplace. Perhaps deep in her— perhaps deep in every being—there lingers a desire to bring the circle of life back to its starting point, which in her case was Cochin.

Then Matron heard my mother clearly whisper “Miserere mei, Deus” before sound left her. Matron carried her through the rest of the psalm in Latin, serving as her voice box while Sister Mary Joseph Praise's lips moved: “… Behold, I was shapen in iniquity; and in sin did my mother conceive me … Purge me with hyssop, and I shall be clean: wash me, and I shall be whiter than snow …”

When she finished, Matron said the shroud was back. The light was slipping away from her world.

“PICK UP THE STOOL, Stone,” Hema barked. “And you,” Hema said, snapping her fingers at the probationer, “get your hands out of your pockets.”

Stone set the stool upright just as Hemlatha eased down onto it. The key bunch Hema had fished out to open her house was now tucked into the waist of her sari, and it jingled as she settled herself. Under the theater lights the diamond in her nose sparkled. Strands of loose hair fell over her ears and in front of her eyes; through pursed lips she blew these wayward locks aside. She squared her shoulders, squared them to the horror and the unloveliness of what was before her. In that gesture she slipped off the mantle of the traveler and put on that of the obstetrician. The task ahead, however difficult, dangerous, or unpleasant, was hers and hers alone.

Hema felt herself gasping for air. Her lungs would need a week to acclimatize. Shed come from sea level in Madras to an operating room 8,202 feet above sea level, not counting the stool on which she sat. Her nostrils flared with each inhalation, like a thoroughbred after the quarter mile.

But her breathlessness came also from what was before her eyes. Gebrew hadn't lost his mind or imbibed too much talla; hed been telling the truth. The everyday miracle of conception had taken place in the one place it should not have: in Sister Mary Joseph Praise's womb. Yes, Sister Mary Joseph Praise was pregnant, had been for months before Hema left for India! And not just pregnant, but now in extremis. And the father?

Who else? She glanced at Stone's gray face.

But why not? she thought. Why should I be surprised? “The incidence of cancer of the cervix,” she remembered her professor saying, “is highest in prostitutes, and almost zero in nuns. Why almost zero and not zero? Because nuns are not born nuns! Because not all nuns were chaste before they became nuns! Because not all nuns are celibate!” That's neither here nor there, Hema admonished herself, while she thrust her hands into gloves that Matron produced.