Abraham Verghese - Cutting for Stone

As we were driving back, Ghosh pulled out a present hed wrapped for me. It was my very own brand-new stethoscope. “You don't have to wait for Farinachi. Now that you know your pulses, we're going to start listening to heart sounds.” I was moved. It was the first gift I'd ever received that wasn't one of a pair. This was mine alone.

Looking back, I realize Ghosh saved me when he called me to feel Demisse's pulse. My mother was dead, and my father a ghost; increasingly I felt disconnected from Shiva and Hema, and guilty for feeling that way. Ghosh, in giving me the stethoscope, was saying, Marion, you can be you. It's okay. He invited me to a world that wasn't secret, but it was well hidden. You needed a guide. You had to know what to look for, but also how to look. You had to exert yourself to see this world. But if you did, if you had that kind of curiosity if you had an innate interest in the welfare of your fellow human beings, and if you went through that door, a strange thing happened: you left your petty troubles on the threshold. It could be addictive.

ONE MORNING toward the end of Michaelmas term, as Shiva, Genet, and I walked to Missing's gate, school satchels in hand, I saw a couple racing up the hill toward us, a child flopping lifeless in the man's arms. They were ready to drop, yet still trying to run up that incline when they had no breath to walk. But as long as they ran with the child in their arms, it was still alive to them, and there was hope.

Without a moment's hesitation, ShivaMarion raced to meet them. The parents’ distress triggered this, gave us no time to debate our response, as a higher brain emerged, doing the deciding for us and guiding us to move as one organism if we knew what was best. I remember thinking, in the midst of that panic, how much I missed that state and how exhilarating it was to be ShivaMarion. Even as I grabbed the infant boy from the father (whose gait by now had become a weary shuffle) and raced away, Shiva's steady hand on my low back was my afterburner, and he matched my stride perfectly, ready to take over when I tired. I was conscious of the baby's skin, the way it chilled my hand, sucking the heat out of it as I ran—I knew I'd never again take being “warm-blooded” for granted, having now felt the alternative.

We handed the child over in Casualty and we waited outside, panting. When the parents caught up, we held the doors open for them. Minutes later we heard a scream, then loud protests, and ultimately the wailing that means the same in any language. It was all too familiar a sound.

There was another Missing sound that made my adrenaline flow: it was the shrieking, grating sound of Gebrew dragging the big gate open as fast as it would go. It always signaled a dire emergency.

A childhood at Missing imparted lessons about resilience, about fortitude, and about the fragility of life. I knew better than most children how little separated the world of health from that of disease, living flesh from the icy touch of the dead, the solid ground from treacherous bog.

Id learned things about suffering that weren't taught to me by Ghosh: First, that white was the uniform of suffering, and cotton its fabric. Whether it was thin (a shama or nettald) or heavy as a blanket (in which case it was a gabby), it must keep the head warm and the mouth covered—no sun or wind should hit because these elements carried the mitch, the birrd, and other evil miasmas. Even the minister with the waistcoat and fob watch would, when he was ill, throw a nettala over his coat, cram eucalyptus leaf up his nose, take an extra dose of kosso for tapeworm, and then hurry over to be seen.

Day after day a white-robed mass flowed up our hill, gravity the current against which they swam. Those whose breath ran short as well as the crippled and the lame stopped at the halfway point to look up, to gaze past the tops of the flanking eucalyptus to where the African hawks soared against the blue sky.

Once they crested the hill, patients went to the registration desk to get their card. From there it was on to Adam, the man whom Ghosh called the World's Greatest One-Eyed Clinician. “Short of breath, are you?” Adam might say to a patient. “But still you managed to run up the hill and get the fourth card of the day?” In Adam's book, a number under ten on the outpatient card identified a hypochondriac more accurately than any test Ghosh might do.

From my spot observing the daily influx, I once saw a proud Eritrean woman carrying a heavy basket; inside was something large, sprouting, with a surface that was red, raw, and weeping. It was her breast. It had become so huge from cancer that this was the only way for her and her breast to come to Missing.

I drew such sights in my notebook. My sketches were nothing like Shiva's, but they served me well. A glance at them allowed me to recall the memory, even if it was not Shiva's photographic kind.

On page thirty-four I drew a child in profile, chubby-cheeked, healthy. But from the other side, his profile showed a chunk of his cheek, one nostril, and the eye missing, so that his glistening teeth and pink gum and the recess of the orbit were visible. I learned from Ghosh to call this ghastly sight cancrum oris. It came about from a trivial gum or tooth infection which spread because of malnutrition and neglect, often during an episode of measles or chicken pox. Once ignited, it progressed rapidly, usually causing death before the child could be brought to Missing. Sometimes, the disease simply ran out of steam, or the body's defenses were finally able to contain the march, but at the expense of half the face. Death was perhaps a better fate than to live with the disfigurement. I watched Ghosh operate on this child. It was terrifying, and then I was in awe at what this man who sat down to dinner with us each night was capable of doing: rotate a flap of skin to cover the cheek, and another the hole in the nose. Further flaps and reconstruction he planned for a later surgery. Even so there was no restoring to normal the face, much less the soul, of a child so scarred. After the surgery, what Ghosh said to me was, “Don't be too impressed. I'm an accidental surgeon, son. I do all I can do. But your father … what he could have done to that face would have been as good as the best plastic surgeon alive. You see, your father was a real surgeon. I don't think I've seen anyone better.” What made someone a real surgeon, I asked. Ghosh didn't hesitate: “Passion for his craft … and skill, dexterity. His hands were always ‘quiet.’ I mean he had no wasted movements, no dramatic gestures. It looked slow, routine, but when you looked at the clock you realized how fast it must have been. But even more important is the confidence once you make the first cut, the belief in yourself, which allows you to do more and get better results. I'm thankful I can do the simple things, the bread-and-butter operations. But I'm scared to death half the time.”

He was being modest. But it was true that Ghosh was a different being in the outpatient department where he saw “consultations”—the patients Bachelli and Adam kept for him to render an opinion. Ghosh's real skill emerged with those who looked “normal” to my gaze. Hidden from us unschooled observers, a disease had left its traces. A woman who wove baskets said, “On St. Stefano's Day I passed urine on a barbed-wire fence …” Or this from a sad, distraught coolie: “The morning after the Wednesday fast, I accidentally stepped over the cast-off water from a prostitute's morning wash …” Ghosh listened, his eyes taking in the blister marks on the sternum which said the native healer had been consulted; he noted the thick speech and guessed that the uvula had probably been recently amputated on a second visit to the same charlatan. But Ghosh had an ear for what lay beneath those surface words, and a pointed question uncovered a story which matched with one in his repertoire of tales. Then it was time to look for the flesh signs, the bookmarks of the disease, and to palpate and percuss and listen with his stethoscope for clues left behind. He knew how that story ended; the patient only knew the beginning.