Abraham Verghese: Cutting for Stone

On the ninth night, four of the sixteen passengers and one of the crew came down with a fever whose flesh signs were rose spots that appeared on the second febrile day and that arranged themselves like a Chinese puzzle on the chest and abdomen. Sister Anjali suffered grievously, her skin burning to the touch. By the second day of illness she was raging in feverish delirium.

Among the Calangutes passengers was a young surgeon—a hawk -eyed Englishman who was leaving the Indian Medical Service for better pastures. He was tall and strong, and his rugged features made him look hungry, yet he avoided the dining room. Sister Mary Joseph Praise had run into him, literally, on the second day of the voyage when she lost her footing on the wet metal stairs leading up from their quarters to the common room. The Englishman coming up behind her seized her where he could, in the region of her coccyx and her left rib cage. He righted her as if she were a little child. When she stuttered her thanks, he turned beet red; he was more flustered than she by this unexpected intimacy. She felt a bruising coming on where his hands had clutched her, but there was a quality to this discomfort that she did not mind. For days thereafter, she didn't see the Englishman.

Now, seeking medical help, Sister Mary Joseph Praise gathered her courage to knock on his cabin. A faint voice bid her to enter. A bilious, acetone odor greeted her. “It is me,” she called out. “It is Sister Mary Joseph Praise.” The doctor lay on his side in his bunk, his skin the same shade as his khaki shorts, his eyes screwed shut. “Doctor,” she said, hesitating, “are you also with fever?”

When he tried to look at her, his eyeballs rolled like marbles on a tilting plate. He turned and retched over a fire-bucket, missed it, which didn't matter, as the bucket was full to the brim. Sister Mary Joseph Praise rushed forward and felt his brow. It was cold and clammy, not at all feverish. His cheeks were hollowed, and his body looked as if it had shrunk to fit the tiny cabin. None of the passengers had been spared seasickness, but the Englishman's affliction was severe.

“Doctor, I am wanting to report a fever that has affected five patients. It comes with rash, chills, and sweats, a slow pulse and loss of appetite. All are stable except for Sister Anjali. Doctor, I am most worried about Anjali …”

She felt better once it was off her chest, even though other than letting out a moan the Englishman made no response. Her eyes fell on a catgut ligature that was looped around a bed rail near his hands and that displayed knot thrown on top of knot, ten-score of them. The knots were so plentiful that the thread stood up like a gnarled flagpole. This was how he had logged the hours, or kept track of his bouts of emesis.

She rinsed out the bucket and put it back within his reach. She mopped the mess on the floor with a towel, then she rinsed the towel out and hung it up to dry. She brought water to his side. She withdrew, wondering how many days it had been since he'd eaten anything.

By evening he was worse. Sister Mary Joseph Praise brought sheets, towels, and broth. Kneeling, she tried to feed him, but the smell of food triggered dry heaves. His eyeballs had sunk into their orbits. His shriveled tongue looked like that of a parrot. She recognized the room's fruity odor as the scent of starvation. When she pinched up a skin fold at the back of his arm and let go, it stayed up like a tent, like the buckled deck. The bucket was half full of clear fluid. He babbled about green fields and was unaware of her presence. Could seasickness be fatal, she wondered. Or could he have a forme fruste of the fever that afflicted Sister Anjali? There was so much she did not know about medicine. In the middle of that ocean surrounded by the sick, she felt the weight of her ignorance.

But she knew how to nurse. And she knew how to pray. So, praying, she eased off his shirt which was stiff with bile and spit, and she slid down his shorts. As she gave him a bed bath, she was self-conscious, for shed never ministered to a white man, or to a doctor for that matter. His skin displayed a wave of goose bumps at the touch of her cloth. But the skin was free of the rash shed seen on the four passengers and the one cabin boy who had come down with fever. The sinewy muscles of his arms bunched together fiercely at his shoulder. Only now did she notice that his left chest was smaller than his right; the hollow above his collarbone on the left could have held a half cup of water, while that on the right only a teaspoon. And just beyond and below his left nipple, extending into the armpit, she saw a deep depression. The skin over this crater was shiny and puckered. She touched there and gasped as her fingers fell in, not meeting bony resistance. Indeed, it appeared as if two or perhaps three adjacent ribs were missing. Within that depression his heart tapped firmly against her fingers with only a thin layer of hide intervening. When she pulled her fingers away, she could see the thrust of his ventricle against his skin.

The fine, translucent coat of hair on his chest and abdomen looked as if it had drifted up from the mother lode of hair at his pubis. She dispassionately cleaned his uncircumcised member, then flopped it to one side and attended to the wrinkled and helpless-looking sac beneath. She washed his feet and cried while she did, thinking inevitably of her Sweet Lord and His last earthly night with His disciples.

In his steamer trunks she found books dealing with surgery. He had penned names and dates in the margins, and only later did it occur to her that these were patients’ names, both Indian and British, mementos to a disease hed first seen in a Peabody, or a Krishnan. A cross next to the name she took as a sign the patient had succumbed. She found eleven notebooks filled with an economical handwriting with slashing down-strokes, the text dancing just above the lines and obeying no margin save for the edge of the page. For an outwardly silent man, his writing reflected an unexpected volubility.

Eventually she found a clean undershirt and shorts. What did it say when a man had fewer clothes than books? Turning him first this way and then that, she changed the sheets beneath him and then dressed him.

She knew his name was Thomas Stone because it was inscribed inside the surgical textbook hed placed at his bedside. In the book she found little about fever with rash, and nothing about seasickness.

That night Sister Mary Joseph Praise negotiated the heaving passageways, hurrying from one sickbed to the next. The mound where the deck had buckled resembled a shrouded figure and she averted her eyes. Once she saw a black mountain of a wave, several stories high, and the Calangute looked poised to fall into a hole. Sheets of water smashed over the bow, the noise more terrifying than the sight.

In the middle of the tempestuous ocean, groggy from lack of sleep, facing a terrible medical crisis, her world had become simplified. It was divided into those with fever, those with seasickness, and those without. And it was possible that none of these distinctions mattered, for very soon they might all drown.

She awoke from where she must have drifted off next to Anjali. In what seemed like the next instant she awoke again, but this time in the Englishman's cabin where she'd fallen asleep kneeling by his bed, her head lolling on his chest, his arm resting on her shoulder. In the time it took her to recognize this, she was asleep again, waking at daybreak finding herself on the bunk, but on its very edge, pressed against Thomas Stone. She hurried back to Anjali to find her worse, her respirations now sighing and rapid. There were large confluent purple patches showing on Anjali's skin.

The anxious faces of the sleepless crew and the fact that one fellow had knelt before her and said “Sister, forgive my sins!” told her that the ship was still in danger. The crew ignored her pleas for help.