Abraham Verghese’s Cutting for Stone centres on the twins, Marion and Shiva Stone, the sons of a secret liaison between a Malayali nun and an English doctor. The boys grow up in a rudimentary hospital in Addis Ababa with Genet, the daughter of a servant, who influences their lives more than they can imagine. Verghese’s epic story of love, loss, and longing shifts from India, to Africa to the United States but is set largely against the backdrop of an Ethiopia that has regained its independence but is blighted by political instability and civil war. In prose that is clear, measured, and often achingly beautiful, Verghese intersperses the narrative with meditations on medicine, which emerges as a metaphor for life itself — its unexpected twists, its small miracles, its propensity to thrust emergency-like situations on us that elicit hope, provoke despair, instil courage and call for forgiveness.
A professor of internal medicine at Stanford University in California, Verghese is regarded as one of the finest contemporary exponents of the ‘non-fiction novel.’ He is the author of two acclaimed books, My Own Country: A Doctor’s Story, and The Tennis Partner: A Story of Friendship and Loss. His debut novel, which has just been launched in the United States and India (where it is published by Random House), is a magical work that reveals he has an extraordinary talent for fiction as well. Excerpts from a telephonic interview:
First, the obvious question. If fiction is your first love as you say, why has a novel taken so long to emerge?
I think I got sidetracked into non-fiction. I was publishing short stories but I had just lived through that extraordinary period in American history — the arrival and spread of HIV into the hinterland. There was a lot of interest in that. In the publishing world there’s lot more demand for non-fiction, an inherent interest. I had thought I would take that HIV experience and capture it through fiction. But it turned out there was much more interest in non-fiction, so I got sidetracked into that first non-fiction book [My Own Country]. It did well and the publishers were very interested in another one. And it so happened I lived through what I thought was another extraordinary personal story.
The Tennis Partner.
Right. And then when I was done with that, they were interested in what other non-fiction ideas I had. I said I really want to write a novel. Honestly, there wasn’t much interest in that. With a novel, at least in America, you have to write the novel to sell it. You can’t sell it on spec, sell an idea. So I began on the novel quietly and after about a year and a half, I told my agent I want a contract, an affirmation that it’s worth spending a few more years of my life on this. It takes a long time for me, given my day job and all that. At that point we showed it around and Knopf bought the book. That’s why it took so long. If I had not had an early opportunity to write non-fiction, I would have come up with a novel. Not this exact one, of course.
I learnt so much writing this book. I started with just an image of a south Indian nun being far away from home and giving birth in a mission hospital. That’s all I knew. I had a voice that developed around that, a tone I felt I had found — a somewhat nostalgic, distant kind of antique tone. And then I just kept going with that. I didn’t know exactly where I was going, but I was following my voice. There were many dead-ends, many diversions that my wonderful editor was able to pull me back from. Somewhat late in the book, we sat down and hammered out an ending. Because at that point there were too many possibilities.
I have learnt that there are two schools of writing. There are these people like John Irving who have it all plotted out, who begin at the end in a way and work back. Then there are people like Michael Ondaatje, and [E.L.] Doctorow as well, who says it’s like driving at night with your headlights on. You see only as far as your headlights show you. I think I wound up using up both forms. I started with a voice and then used my headlights.
But even if you wrote Cutting for Stone in open-ended fashion, there is a strong autobiographical underpinning to it. You were born in Ethiopia (as Marion was); you had a brother with a greater aptitude for math than medicine (like Shiva); there is the link with Madras (where you studied); and the story moves to the United States (as you did). The narrative follows the trajectory of your life.
Well, my brother, even though he’s a math whiz and so on, was very much a normal kid, as I was. I did not mean to portray Shiva and his eccentricities as relating to my brother. I think I followed the geography of my life, and what knowledge I had of the political situations that these characters were steeped in. In that sense, it was autobiographical. At some level, all novels are. A lot of the beliefs that I hold about medicine are in this book. Some of the things the characters wrestle with are things I have thought about in my life.
In your novel, the practice of medicine — the task of healing, if you like — emerges as something that unites people of different races and religions. You have Christians, Hindus, Westerners, Indians, Africans all working for a common purpose. In the end, there is a realisation that nothing separates the world of physicians.
It was a very conscious thought. But this is not really a book about medicine but about life. My belief is that when it works, fiction tells more truth than non-fiction. One of my favourite quotes is that of Dorothy Allison who said fiction is the great lie that tells the truth about how the world lives. So the universal truth about maybe every novel, or at least the ones I like, is that life is ultimately ironic and slightly tragic. I wanted to say that medicine is universal, as you point out. But I also wanted to develop this understanding of medicine as a double-edged sword: that you could lose yourself like Thomas Stone, and everything of value to you.
You also make another kind of statement: that the practice of medicine is not only about curing but healing. You talk about the physician’s job as being compassionate, empathetic. I recall a trick question in the book: ‘What treatment is administered by the ear?’ And the answer is: ‘Words of comfort.’
You have really caught on to this. I think there are a lot of these dualities — putting the conceit of cure against healing, giving your life to medicine against having your life robbed by it. So I wanted to take these extremes and look at it. As you point out, words of comfort are not a therapeutic tool that brings about any cure. But they can be the most important thing — they can bring the heart rate down, stop people from panicking, from making things worse.
Isn’t there another kind of duality, in your attitude to Ethiopia? The political environment is portrayed in a not-so-flattering — in fact, a negative — light. You have Haile Selassie with his autocratic and suspicious ways and the depravity under Mengistu. But there is also a huge underlying affection for the people, the food, the land.
I am so glad to hear you say that. My fear is that Ethiopians who read it may somehow see it as being disrespectful of the land. I hope the sense [of affection] I have does come across, especially for the lower class, the uneducated. There was a tremendous dignity and grace to them that I have come to recognise, as I have got older. There are Ethiopian Jews in Israel and there is a huge diaspora of Ethiopians in America who is going to read this very closely. And I am delighted to hear you articulate something that I hope these readers will recognise. I loved that land. I was born in that land. I could have seen myself living there for the rest of my life had the political situation been different.
You said in an interview that you wanted to tell an ‘old-fashioned truth-telling’ story. And there is undeniably a raw realism to the narrative despite the odd liberty you have taken with some historical dates. But there is one chapter in which Genet discovers that Marion has a paranormal sense of smell. What is the point of this bit of magic thrown in what is largely a realist narrative? Is it there for a reason?
That’s a good question. Sometimes these things are not conscious. They just emerge. I think it was a desire to give Shiva and Marion some sort of awareness that was distinct from everyone else’s, that alerted them to danger, allowed them to be conscious of things before other people. It comes back in a fashion in the novel. Shiva’s perverse sense of smell, which leads him to be attracted to women with fistula, changes the direction of his life. In Marion’s case, the odour comes back in that he begins to recognise the smell of death. We have all these new diseases but no one now talks about odours. But I think there are some new odours that have emerged in medicine. As we have become more technologically sophisticated, we have become more retarded in our sensory nature.
That’s an interesting idea. That diagnostics should involve such things as a sense of smell.
It should. I joke, but only half-joke, that when someone comes into the hospital missing a finger, no one believes him until a bone scan or MRI is done. We have lost the ability to use common sense and our senses because we are so heavily dependent on technology. Maybe it [the talk about smells] was just a way of harking back to that.
The narrative suggests that life is a series of accidents or coincidences. An illness, an unwanted pregnancy, a mistaken identity, a romantic expectation, chance meetings, an unread letter — it is almost as if you suggest our lives are shaped by things beyond our control.
Or else that there really are no accidents. That many of these things that seem accidental are pre-ordained. Why would Marion travel to America and not think that one day he would run into his father? My own life has been like that. My parents wound up in Ethiopia as schoolteachers only because the Christian Emperor made a state visit to India where he wanted to see the churches of St. Thomas in Kerala. He decided to hire all his schoolteachers from this one State. I grew up in Ethiopia with a heavily Syrian Christian population of teachers, with our own church. Life has shown me time and time again that geography is destiny