Abraham Verghese - Cutting for Stone

Evangeline, an Anglo-Indian, a bridge regular, turned to Colonel Mebratu: “A little bird told me that we might soon be calling you Brigadier General. Is that true?”

Colonel Mebratu frowned. “Such vicious rumors. Such an incestuous community. And I fear, Evangeline, you are at the center of it. But in this case I must correct you, my dear. I am not soon to be called Brigadier General. As of yesterday, I am Brigadier General.”

Well, there was no stopping them after that. Zemui and Gebrew made two runs for food from the Ras Hotel.

Much later that night, Mebratu and Ghosh palavered over cognac and cigars. “In Korea in ‘52 we were one of fifteen countries in the UN forces. I wasn't long out of command training when I went there. The other countries underestimated us. You see, they knew nothing about Ethiopian courage or the battle of Adowa or any of that. By God, we proved ourselves in Korea. By the time we got to the Congo, they knew what to expect. We had an Irish commander, then a Swedish commander, and in the third year, they made our own General Guebre commander of all the UN forces. You know, Ghosh, as a career military man that was my proudest moment. Even more than this promotion I got yesterday.”

I'LL NEVER KNOW HOW, but Ghosh understood what I was going through after the pantry episode; perhaps he recognized that I was quarantined from Genet and that Shiva didn't share in that experience; perhaps he saw my confusion when Zemui was around. Maybe it was written on my face that I'd become aware of human complexity—that's a kinder word than “deceit.” I was trying to decide where to peg my own truth, how much to reveal about myself—it helped to have such a steadfast father in Ghosh, never fickle, never prying, but knowing when I needed him. Had Hema learned what went on in the pantry, I'd hear about it two seconds later. But Ghosh, if he knew, was capable of keeping his peace, biding his time, hearing me out; he'd have even kept it secret from Hema if he didn't think it served any purpose to tell her.

One wet afternoon, when Genet and Shiva were having their dance lesson with Hema, Ghosh telephoned and asked me to meet him in Casualty. “I want you to feel a most unusual pulse.” Ghosh was primarily a surgeon now, operating electively three days a week and doing the emergency cases as needed. But, as he often said at dinner, he was still an internist at heart and couldn't resist coming down to Casualty to see certain patients who presented a diagnostic puzzle, one that neither Adam nor Bachelli could crack.

I was grateful for Ghosh's call. I never had any interest in dancing, but it bothered me to see Genet enjoying something in which I had no part. I put on my gutta-percha boots and raincoat and dashed out with my umbrella.

Demisse was in his twenties, sitting on the examining stool in front of Ghosh, wearing only torn jodhpurs. I noticed at once the bobbing of his head, as if an eccentric flywheel turned within him. It was my first formal visit with a patient, and I was embarrassed. What would this barefoot farmhand think of a young boy entering the exam room? But he was thrilled to see me. Later I realized that patients felt privileged to be singled out in this fashion. Not only had they made it past Adam, not only had they seen the tilik doctor, the same big doctor whom the royalty came to see, but now they got a bonus—me.

Ghosh guided my fingers to Demisse's pulse at the wrist. It was easy to feel, unavoidable, a surging, slapping, powerful wave under my fingertips. Now I could see that his head bobbing happened in time with the pulse.

“Now feel mine,” Ghosh said, holding out his wrist. It was harder to find, subtle.

He had me go back to Demisse's pulse.

“Describe it,” Ghosh said.

“Big … strong. Like something alive under the skin, slapping,” I said.

“Exactly! That is a classic collapsing or water hammer pulse. Its full name is the Corrigan's water hammer pulse.”

He handed me a foot-long thin glass tube that Id seen lying across his table. “Hold it up. Now turn it over.” The tube was sealed at both ends and had a little water in it. When I flipped it, the water raced down to the bottom of the tube with an unexpected smacking sound and a shock. “There's a vacuum inside, you see,” he said. “It's a toy that kids played with in Ireland. It's a water hammer. Dr. Corrigan was reminded of the toy when he first felt a pulse like Demisse's.”

Ghosh had made the water hammer for me. He had sealed one end of a glass tube with a Bunsen flame. Then he put a few drops of water inside the tube through the open end. He heated the length of the tube above the liquid to drive the air out and quickly sealed the open end under the flame.

“Demisse's heart shoots blood out into the aorta. That's the big highway leading out of the heart,” he said, making a sketch for me on paper. “A valve right here at the exit from the heart is supposed to close after the heart contracts, to keep the blood from falling back into the heart. His doesn't close well. So his heart squeezes blood out just fine, but half of that ejected blood falls right back into the heart between squeezes. That's what gives it the collapsing quality.” How exciting to be able to touch a human being with one's fingertips and know all these things about them. I said as much to Ghosh, and from his expression you would think Id said something profound.

He sent for me often during those holidays. Shiva came at times, but not if it interfered with his dance lesson or if he was in the middle of a drawing. I learned to recognize the slow, heaving, plateaulike pulse of a narrowed aortic valve. It was the opposite of a collapsing pulse. The small valve opening made that pulse both weak and prolonged. Pulsus parvus et tardus, Ghosh called it.

I loved those Latin words for their dignity, their foreignness, and the way my tongue had to wrap around them. I felt that in learning the special language of a scholarly order, I was amassing a kind of force. This was the pure and noble side of the world, uncorrupted by secrets and trickery. How extraordinary that a word could serve as a shorthand for an elaborate tale of disease. When I tried to explain this to Ghosh, he was excited.

“Yes! A treasure trove of words! That's what you find in medicine. Take the food metaphors we use to describe disease: the nutmeg liver, the sago spleen, the anchovy sauce sputum, or currant jelly stools. Why, if you consider just fruits alone you have the strawberry tongue of scarlet fever, which the next day becomes the raspberry tongue. Or how about the strawberry angioma, the watermelon stomach, the apple core lesion of cancer, the peau d'orange appearance of breast cancer … and that's just fruits! Don't get me started on the nonvegetarian stuff!”

One day I showed Ghosh the notebook in which I kept a written cata log of everything he had told me, and every pulse I had seen. Like a birder, I listed the ones I sought: pulsus par-adoxus, pulsus alternans, pulsus bisferiens … and simple drawings of what they might look like. He wrote in the fly leaf: Nam et ipsa scientia potestas est! “That means ‘Knowledge is power!’ Oh, I do believe that, Marion.”

We didn't stop at pulses. I went to Ghosh as often as I could. Fingernails, tongues, faces—soon my notebook was chock-full of drawings and new words. I found use at last for my penmanship: each figure was carefully labeled.

On a Friday evening, our last weekend before school started, I rode with Ghosh to see Farinachi, the toolmaker. Ghosh handed Farinachi two old stethoscopes and a drawing of his idea for a teaching stethoscope. Farinachi, a dour, stooped Sicilian, wore a vest under his leather apron. He studied the drawing carefully through a haze of cigar smoke, tracing the outline with a large forefinger. He had fashioned several contraptions for Ghosh, including the Ghosh Retractor, and the Ghosh Scalp Clip. Farinachi shrugged, as if to say if that was what Ghosh wanted, he would do it.