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Listen: Audio Chat With Author Abraham Verghese

Apr 7, 2011

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As a culmination of our March NPR Book Club reading of Cutting for Stone, we spoke to author Abraham Verghese, a doctor and writer, about his bestselling novel.

We took the questions for Dr. Verghese from our NPR Books Facebook page, where we were grateful to receive such thoughtful suggestions.

In our chat, Dr. Verghese talks about how the book came into being from the first images and faint impressions in his mind with the help of a caring editor. A deep passion for medicine guides the book, and Dr. Verghese says he sees his work as a physician and as a writer as a seamless process. When he takes on a new patient, he listens for a history, and the varying symptoms and diagnostic problems fit together in a similar fashion to how a literary story is constructed.

Thank you for taking the time to listen, and please share your thoughts about Cutting for Stone in the comments section below!


Highlights from the interview

On how the book started in the author's mind:

It all began with this image of a beautiful South Indian nun giving birth in a mission hospital in Africa. I don't quite know where that came from, but that was something I had in my mind. I also knew I wanted to pour into this book everything I loved about medicine, particularly the study of medicine, the sense of a young person entering this field; to me, it has always felt like a romantic and passionate pursuit. I wanted to populate the book with that strong sense of medicine, its ups and downs. I did not actually know the plot in any fashion, and I think I'm one of those writers who has an image and a tone and a voice and pushes it forward, which has led to a lot of dead ends, a lot of retreating. But as soon as I did begin to see patterns, I would go back and amplify them.

On the process of working with an editor to write Cutting For Stone:

Where [my editor] was so precious was, first of all, her faith in me; second her forbearance as I went down these dead ends. And she had the most wonderful way of saying, "Abraham, these 300 pages, 6 months of work, is just gorgeous stuff but it doesn't belong in this book." You have to have great faith in an editor to be able to take that. And frankly, there's a point where you lose all perspective. You want someone who's objective to reinforce the parts that are good, that you might not even recognize are good, and to take away those parts that you are very fond of but are tiresome to the reader. "Killing your darlings," as they say in writing; she was very good at helping me kill my darlings ... I honestly think that her faith that a story with so much of Ethiopia in it could be of compelling interest to the reader really carried the day.

On the similarities between being a doctor and writing a novel:

When I see a patient, I take a history, and what is a history but a story? And the older I get, the more I'm conscious that when I see a patient, if I'm able to add something to that patient or unearth something to help solve the issue that they're wrestling with, it's rarely because I bring some superior knowledge. Knowledge has become quite democratic, we carry it on cell phones and PDAs and so on. It's usually because I hear that story and I have a greater repository of stories that I can match that story with, or it echoes for me in a right brain sort of way with a vague story that I recall and I look for the other missing elements. Then I go to the body and I'm looking again for the parts of the narrative that would fit the story that I have in mind ... Physicians are all engaged in a kind of narrative, if you will.

On the choice between life and work:

Medicine presents us with this false dichotomy, or rather this temptation, that you come to medicine incomplete, you come to medicine because in a way you're wounded, and the grand privilege that medicine gives you is that you care for others and your woundedness becomes healed ... My sense was that if I just did this medicine thing very well, then I would be forgiven everything else. I didn't need to be a good husband or a father who was very present ... Perfection of the work won't get you perfection of the life. You have to think of these as two parallel trains; there's life and there's work, and they run on parallel tracks and there's times when one gets a little ahead of the other, but you can't let them get too far away ... Humans beings need to work to feel fulfilled; human beings need to love and feel loved ... Maybe that is the name for the two trains — instead of calling it life and work, you could call it love and work. And they can't get too far apart before you get into trouble.

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Cutting for Stone by Abraham Verghese ( )

NPR Book Club For March: 'Cutting For Stone'

Mar 8, 2011

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NPR Books is proud to announce that for the second installment of our Book Club experiment, we will read and discuss Abraham Verghese's cross-cultural epic of family, love and medicine, Cutting For Stone. And, to keep things interesting, we're introducing a new wrinkle to the Book Club this month: The author will personally call in to (or videochat with) three local meet-ups, chosen at random from among qualifying groups. Read on for details on how to participate.

THE BOOK

Cutting For Stone follows twin brothers Marion and Shiva Stone, born of a secret union between an Indian nun and a brash British surgeon. They are orphaned at a young age and must learn to navigate the world together as they grow up in Ethiopia on the brink of a revolution. The twins' story swings from Addis Ababa to New York City and explores the themes of family, betrayal, health care, everyday magic and the way that two lives can forever intertwine. When NPR's Lynn Neary picked the book as one of her favorites, she had the following to say: "This big, old-fashioned novel is at once a family saga that crosses continents and cultures and a love story with tragic consequences. ... The book is very much about what it means to be a doctor and what it takes to be a good one."

NPR has interviewed Verghese (who works as a professor at Stanford University School of Medicine when not writing best-sellers) several times. You can hear the author read from Cutting for Stone here and hear him on All Things Considered here.


HOW TO PARTICIPATE

We are excited to present a new way to connect with Verghese as you read the book — the doctor will personally drop in on three book club meet-ups. Read on for how to put your local club in the running (and how to participate online along the way).

1) Read the book. We will be aiming to finish it by the first week of April.

2) Discuss the book on Twitter. We have set up an account, @nprbkclub, where we will be asking questions and leading discussions about the book. Follow us for more. You can also discuss the book on your own account by using the hashtag #nprbookclub.

3) Talk to the author and fellow readers on Facebook. We have set up a discussion board called "Ask Abraham Verghese" on our Facebook page (LINK). He will be there throughout the month to answer questions and spark conversations.

4) Register for a local meet-up at www.meetup.com/NPR-Book-Club/. AND HERE'S THE GOOD PART: All meet-ups that can get over 10 people to sign up will be entered for a drawing — the three winning groups will enjoy a visit from Verghese himself (over video or phone depending on location). [Signup for the drawing is closed (though you are still welcome to organize a meetup). We'll announce the winning clubs soon here and on Facebook.]

We are excited to get your thoughts and start reading together.

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'The Interrogative Mood' Detail ()

Best Books For A Book Club? Lynn Neary's '09 Picks

Dec 15, 2009

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w: 'The Interrogative Mood' Detail Custom: 'Cutting Stone' by Abraham Verghese Custom: 'The Interrogative Mood: A Novel' by Padget Powell Custom: 'Too Much Happiness' by Alice Munro Custom: 'A Reliable Wife' by Robert Goolrick Custom: 'In Other Rooms, Other Wonders' by Daniyal Mueenduddin

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There are different kinds of book clubs. Some focus on nonfiction; others love novels. Some are very serious, considering it bad form not to finish the assigned book. Others are more laissez faire. I know one woman who reads about 50 pages of every book. If she likes it, she finishes it; if she doesn't, she uses the meeting to find out whether everyone else thinks she should continue.

From my experience, it's not necessary for the whole group to like the book at hand. Some of the best conversations occur when people don't agree. So on this list, I've tried to include a couple of books that will spark debate. I've also included a couple that I love. Most are pretty quick reads. Two are short-story collections, which means, in a pinch, you can read a few stories and still join in the discussion. One more thing: All of them are fiction, because it's my list and I love fiction. So have a glass of wine, maybe a bite to eat, and let the conversation begin.


Cutting for Stone

Cutting for Stone, by Abraham Verghese, hardcover, 560 pages, Knopf, list price: $26.95

This big, old-fashioned novel is at once a family saga that crosses continents and cultures and a love story with tragic consequences. As the novel begins, an Indian nun named Sister Mary Joseph Praise (just the name won my heart) gives birth to conjoined twins in a small mission hospital in Adis Ababa, Ethiopia. She dies in childbirth, and the father, a brilliant surgeon, disappears almost as soon as they are born. The boys, Marion and Shiva, are physically separated shortly after birth but remain unusually close throughout their childhood. Raised by a childless couple who also practice medicine at the hospital, the twins grow up to be doctors as well.

This book is very much about what it means to be a doctor and what it takes to be a good one. Verghese, a practicing physician, spares no details in revealing the inner workings of the world of medicine. His descriptions of often complex medical procedures are both harrowing and fascinating (hear a reading in which one of the twins assists with a vasectomy). Cutting for Stone is a sprawling story that takes readers from India to Africa to America as the twins are separated by political turmoil and jealousy. Their reunion with each other and with the father who abandoned them is a testament to both the power and limitations of modern medicine and to the enduring love that binds families together.


The Interrogative Mood: A Novel?

The Interrogative Mood: A Novel? by Padgett Powell, hardcover, 176 pages, Ecco, list price: $21.99

This is a book like no other. If everyone in your book club loves it, I'd be very surprised. It's composed entirely of questions, which, on the face of it, seems sort of ridiculous. And on one level it is — wildly ridiculous and laugh-out-loud funny. At first, you just go along for the ride, amused by the sheer number and range of the questions and by the odd juxtapositions the author imposes in the asking of them. Open the book at any page, and I dare you not to be intrigued.

But a strange thing happens as you get further into it. What seems like a light, breezy read can suddenly turn serious, even profound, as the questions begin to provoke memories of the past and fears of the future. Just as you are about to get lost in your own thoughts, the narrator (interrogator?), a guy's guy if ever there was one, barges back in with yet another silly, sometimes even rude question. So what does it all add up to? Is it, as its subtitle asks, really a novel? Great question, I think, for a book club to ponder. (Don't you want to see how Powell pulls off this writing-exclusively-in-questions thing? Would an excerpt from the book be helpful here?)


Too Much Happiness

Too Much Happiness, by Alice Munro, hardcover, 320 pages, Knopf, list price: $25.95

Alice Munro's latest book of short stories is peopled with flawed human beings in compromising, even desperate situations. In some stories, her characters' responses to their circumstances seem to embody the very idea of "the banality of evil." Children commit murder as if it were a game; a young woman docilely complies with the perverted wishes of an old man. In all of the stories, people who seem to be living ordinary lives do unexpected, sometimes disturbing things.

These stories are like accidents we can't look away from, mirrors to our own souls that make us wonder, "What would I do if that happened to me?" I love the fact that Munro manages to be so provocative in such a quiet way. The moral dilemma sneaks up on you, then slaps you in the face and leaves you wondering, "How did she do that?" And, oh, she gives you so much to talk about. (Read from Munro's title story, about a Russian mathematician in love with the cousin of her late husband.)


A Reliable Wife

A Reliable Wife, by Robert Goolrick, hardcover, 291 pages, Algonquin Books, list price: $23.95

Don't let that title fool you. No one, especially the wife, is reliable in this novel. This is a tale of murder, madness and passion. And that's what makes it a fun read. As the story begins, a lonely, wealthy man with dark secrets in his past awaits the arrival of a mail-order bride who will share his mansion in the middle of nowhere. The bride is a beauty with a past of her own and a sinister plan for the future.

From there, the plot takes so many unexpected turns, it's impossible to really know whether the characters are good or evil, heroes or villains until the very end. This book has a hint of romance novel about it, and at times the writing is a bit overwrought. But it's a page turner, and people are likely to either love it or hate it. (Read about Ralph Truitt waiting for his mail-order bride on a train platform, in front of a large — and impatient — crowd.)


In Other Rooms, Other Wonders

In Other Rooms, Other Wonders, by Daniyal Mueenuddin, hardcover, 256 pages, W.W. Norton & Co., list price: $23.95

This book was a finalist for the National Book Awards and is starting to turn up in many "Best of the Year" lists, for good reason. It's a mesmerizing read about a way of life that is now almost extinct. Set mostly in rural Punjab and the city of Lahore, these interwoven stories, which take place over several decades, explore the lives of both rich and poor under Pakistan's rigid, almost feudal class structure. All of the characters are related to, or dependent on, a wealthy landowner who is only vaguely aware of what happens to them as they live out their lives in the "other rooms" on his land and in his homes. Every room has its secret story, every character a vibrant, sometimes tragic life.

Mueenuddin is half American, half Pakistani and has spent his life between the two countries. Now he manages his family's farm in the Punjab, and his life there has given him a unique insight into this world that few westerners have experienced firsthand. Whether he's writing about the lowliest servant girl or a privileged beauty, an ambitious politician or clever electrician, one senses that these are people Mueenuddin understands and cares for. (Read — or listen to Mueenuddin read — the complete opening story of the book, about the crafty and determined electrician Nawabdin.)

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Terrence Holt ()

Story Specialists: Doctors Who Write

Nov 17, 2009 (All Things Considered)

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w: 'The Interrogative Mood' Detail Custom: 'Cutting Stone' by Abraham Verghese Custom: 'The Interrogative Mood: A Novel' by Padget Powell Custom: 'Too Much Happiness' by Alice Munro Custom: 'A Reliable Wife' by Robert Goolrick Custom: 'In Other Rooms, Other Wonders' by Daniyal Mueenduddin

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It's not uncommon for writers to have a day job. Lawyers write. Soldiers and teachers write. But there seems to be a special connection between the medical profession and the art of writing. The list of doctors who are also novelists, playwrights and poets is long, and quite impressive: Anton Chekhov, William Carlos Williams, Walker Percy, W. Somerset Maugham and Arthur Conan Doyle, to name just a few.

Doctors continue to add their names to that list. For Abraham Verghese, writing and medicine are inextricably entwined. Verghese, who is the senior associate chair for the theory and practice of medicine at Stanford University's School of Medicine, based his first book, a memoir called My Own Country, on his experience as a doctor treating AIDS patients in rural Tennessee.

"I think I was drawn to medicine with a strong sense of medicine being a romantic pursuit, a calling," Verghese says. "I still really am very much in love with medicine, and I love what I do. And I often think the writing emanates from that stance of being a physician. And I worry that I would become mute if I ever left medicine and tried to write."

In his writing, at least, Verghese is inching away from his own direct experience. He published his first novel, Cutting for Stone, this year. It tells the story of a family of doctors, a saga that takes readers into hospitals and operating rooms from Ethiopia to America.

Terrence Holt, who has a new book of stories called In the Valley of the Kings, comes from a family of doctors, but he was a writer and a teacher long before he decided to go to medical school. Holt's new book reflects his fascination with language rather than his life as a physician, but he insists that being comfortable in the world of literature is enormously helpful in the practice of medicine.

"You are used to dealing with ambiguities if you are familiar with literature, and a lot of medicine is ambiguous," Holt says. Even more important: "You get, vicariously, but in a very useful way, experience with other people that you couldn't get any other way, with seeing the world as other people see it."

Holt, who is on the faculty at the University of North Carolina School of Medicine, thinks writing can help reframe the experience of being a doctor.

"Patients bring us stories," he explains. "We drop into the middle of patients' stories and try to change the plot for the better. First we have to understand it, however. The first thing that happens when a patient comes in is they start telling a story, and you try to figure what it means."

"I think narrative is huge in medicine," Verghese says. He adds that if you listen carefully, you will hear clues needed to make a diagnosis: "It's very rare that some extra piece of knowledge in my brain solves the puzzle. Much more often it's the fact that the story I am hearing resonates with my collection of stories. Or there is an element in that story that reminds of something in my catalog of stories, and I go seek out the other element."

In Cutting for Stone, Verghese set out to create an epic story that encompasses family, politics, history, culture and love against a backdrop of life in and near hospitals. In an effort to reveal the inner workings of the world of medicine, Verghese spares no details in his descriptions of often complex medical procedures and the human emotions that surround them.

Visiting a hospital, Verghese says, means that, "Suddenly you are in this crucible where every human emotion, every passion is exaggerated; where great truths and mysteries are revealed for the first time, sometimes to close family. So I think hospitals are inherently places of great drama."

Holt's fiction takes place far away from hospital life, though one of his stories is about a plague that first appears on its victims in the form of a word. In another, a man is so obsessed with the idea that he is dying that he ends up in a tomb from which there is no escape.

Because doctors deal with death more than most people, Holt says, it should be no surprise that the ones who write would end up exploring the concept in their art.

"I think it is true that death is the mother of beauty," he says. "And an appreciation of human suffering and our limited tenure on this Earth is essential to seeing our lives and seeing the world we inhabit."

In a hospital, where the routine can quickly become a matter of life or death, there is precious little time to sift through the events of the day to uncover what it all means. In their time away from hospitals, it is little wonder that some doctors would turn to that most contemplative of arts, where they can be alone with their thoughts, searching for just the right words to find release or understanding.

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PND: 'Cutting Stone' by Abraham Verghese ()

Excerpt: 'Cutting for Stone'

by Abraham Verghese
Mar 10, 2009

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After eight months spent in the obscurity of our mother's womb, my brother, Shiva, and I came into the world in the late afternoon of the twentieth of September in the year of grace 1954. We took our first breaths at an elevation of eight thousand feet in the thin air of Addis Ababa, capital city of Ethiopia. The miracle of our birth took place in Missing Hospital's Operating Theater 3, the very room where our mother, Sister Mary Joseph Praise, spent most of her working hours, and in which she had been most fulfilled.

When our mother, a nun of the Diocesan Carmelite Order of Madras, unexpectedly went into labor that September morning, the big rain in Ethiopia had ended, its rattle on the corrugated tin roofs of Missing ceasing abruptly like a chatterbox cut off in midsentence. Over night, in that hushed silence, the meskel flowers bloomed, turning the hillsides of Addis Ababa into gold. In the meadows around Missing the sedge won its battle over mud, and a brilliant carpet now swept right up to the paved threshold of the hospital, holding forth the promise of something more substantial than cricket, croquet, or shuttlecock.

Missing sat on a verdant rise, the irregular cluster of whitewashed one- and two-story buildings looking as if they were pushed up from the ground in the same geologic rumble that created the Entoto Mountains. Troughlike flower beds, fed by the runoff from the roof gutters, surrounded the squat buildings like a moat. Matron Hirst's roses overtook the walls, the crimson blooms framing every window and reaching to the roof. So fertile was that loamy soil that Matron — Missing Hospital's wise and sensible leader — cautioned us against stepping into it barefoot lest we sprout new toes.

Five trails flanked by shoulder-high bushes ran away from the main hospital buildings like spokes of a wheel, leading to five thatched-roof bungalows that were all but hidden by copse, by hedgerows, by wild eucalyptus and pine. It was Matron's intent that Missing resemble an arboretum, or a corner of Kensington Gardens (where, before she came to Africa, she used to walk as a young nun), or Eden before the Fall.

Missing was really Mission Hospital, a word that on the Ethiopian tongue came out with a hiss so it sounded like "Missing." A clerk in the Ministry of Health who was a fresh high-school graduate had typed out the missing hospital on the license, a phonetically correct spelling as far as he was concerned. A reporter for the Ethiopian Herald perpetuated this misspelling. When Matron Hirst had approached the clerk in the ministry to correct this, he pulled out his original typescript. "See for yourself, madam. Quod erat demonstrandum it is Missing," he said, as if he'd proved Pythagoras's theorem, the sun's central position in the solar system, the roundness of the earth, and Missing's precise location at its imagined corner. And so Missing it was.

Not a cry or a groan escaped from Sister Mary Joseph Praise while in the throes of her cataclysmic labor. But just beyond the swinging door in the room adjoining Operating Theater 3, the oversize autoclave (donated by the Lutheran church in Zurich) bellowed and wept for my mother while its scalding steam sterilized the surgical instruments and towels that would be used on her. After all, it was in the corner of the autoclave room, right next to that stainless-steel behemoth, that my mother kept a sanctuary for herself during the seven years she spent at Missing before our rude arrival. Her one-piece desk-and-chair, rescued from a defunct mission school, and bearing the gouged frustration of many a pupil, faced the wall. Her white cardigan, which I am told she often slipped over her shoulders when she was between operations, lay over the back of the chair.

On the plaster above the desk my mother had tacked up a calendar print of Bernini's famous sculpture of St. Teresa of Avila. The figure of St. Teresa lies limp, as if in a faint, her lips parted in ecstasy, her eyes unfocused, lids half closed. On either side of her, a voyeuristic chorus peers down from the prie-dieux. With a faint smile and a body more muscular than befits his youthful face, a boy angel stands over the saintly, voluptuous sister. The fingertips of his left hand lift the edge of the cloth covering her bosom. In his right hand he holds an arrow as delicately as a violinist holds a bow.

Why this picture? Why St. Teresa, Mother?

As a little boy of four, I took myself away to this windowless room to study the image. Courage alone could not get me past that heavy door, but my sense that she was there, my obsession to know the nun who was my mother, gave me strength. I sat next to the autoclave which rumbled and hissed like a waking dragon, as if the hammering of my heart had roused the beast. Gradually, as I sat at my mother's desk, a peace would come over me, a sense of communion with her.

I learned later that no one had dared remove her cardigan from where it sat draped on the chair. It was a sacred object. But for a four-yearold, everything is sacred and ordinary. I pulled that Cuticura-scented garment around my shoulders. I rimmed the dried-out inkpot with my nail, tracing a path her fingers had taken. Gazing up at the calendar print just as she must have while sitting there in that windowless room, I was transfixed by that image. Years later, I learned that St. Teresa's recurrent vision of the angel was called the transverberation, which the dictionary said was the soul "inflamed" by the love of God, and the heart "pierced" by divine love; the metaphors of her faith were also the metaphors of medicine. At four years of age, I didn't need words like "transverberation" to feel reverence for that image. Without photographs of her to go by, I couldn't help but imagine that the woman in the picture was my mother, threatened and about to be ravished by the spear-wielding boy-angel. "When are you coming, Mama?" I would ask, my small voice echoing off the cold tile. When are you coming?

I would whisper my answer: "By God!" That was all I had to go by: Dr. Ghosh's declaration the time I'd first wandered in there and he'd come looking for me and had stared at the picture of St. Teresa over my shoulders; he lifted me in his strong arms and said in that voice of his that was every bit a match for the autoclave: "She is CUM-MING, by God!"

Forty-six and four years have passed since my birth, and miraculously I have the opportunity to return to that room. I find I am too large for that chair now, and the cardigan sits atop my shoulders like the lace amice of a priest. But chair, cardigan, and calendar print of transverberation are still there. I, Marion Stone, have changed, but little else has. Being in that unaltered room propels a thumbing back through time and memory. The unfading print of Bernini's statue of St. Teresa (now framed and under glass to preserve what my mother tacked up) seems to demand this. I am forced to render some order to the events of my life, to say it began here, and then because of this, that happened, and this is how the end connects to the beginning, and so here I am.

We come unbidden into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. My intent wasn't to save the world as much as to heal myself.

Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.

I chose the specialty of surgery because of Matron, that steady presence during my boyhood and adolescence. "What is the hardest thing you can possibly do?" she said when I went to her for advice on the darkest day of the first half of my life. I squirmed. How easily Matron probed the gap between ambition and expediency. "Why must I do what is hardest?"

"Because, Marion, you are an instrument of God. Don't leave the instrument sitting in its case, my son. Play! Leave no part of your instrument unexplored. Why settle for 'Three Blind Mice' when you can play the 'Gloria'?"

How unfair of Matron to evoke that soaring chorale which always made me feel that I stood with every mortal creature looking up to the heavens in dumb wonder. She understood my unformed character.

"But, Matron, I can't dream of playing Bach, the 'Gloria' . . . ," I said under my breath. I'd never played a string or wind instrument. I couldn't read music.

"No, Marion," she said, her gaze soft, reaching for me, her gnarled hands rough on my cheeks. "No, not Bach's 'Gloria.' Yours! Your 'Gloria' lives within you. The greatest sin is not finding it, ignoring what God made possible in you."

I was temperamentally better suited to a cognitive discipline, to an introspective field — internal medicine, or perhaps psychiatry. The sight of the operating theater made me sweat. The idea of holding a scalpel caused coils to form in my belly. (It still does.) Surgery was the most difficult thing I could imagine.

And so I became a surgeon.

Thirty years later, I am not known for speed, or daring, or technical genius. Call me steady, call me plodding; say I adopt the style and technique that suits the patient and the particular situation and I'll consider that high praise. I take heart from my fellow physicians who come to me when they themselves must suffer the knife. They know that Marion Stone will be as involved after the surgery as before and during. They know I have no use for surgical aphorisms such as "When in doubt, cut it out" or "Why wait when you can operate" other than for how reliably they reveal the shallowest intellects in our field. My father, for whose skills as a surgeon I have the deepest respect, says, "The operation with the best outcome is the one you decide not to do." Knowing when not to operate, knowing when I am in over my head, knowing when to call for the assistance of a surgeon of my father's caliber — that kind of talent, that kind of "brilliance," goes unheralded.

On one occasion with a patient in grave peril, I begged my father to operate. He stood silent at the bedside, his fingers lingering on the patient's pulse long after he had registered the heart rate, as if he needed the touch of skin, the thready signal in the radial artery to catalyze his decision. In his taut expression I saw complete concentration. I imagined I could see the cogs turning in his head; I imagined I saw the shimmer of tears in his eyes. With utmost care he weighed one option against another. At last, he shook his head, and turned away.

I followed. "Dr. Stone," I said, using his title though I longed to cry out, Father! "An operation is his only chance," I said. In my heart I knew the chance was infinitesimally small, and the first whiff of anesthesia might end it all. My father put his hand on my shoulder. He spoke to me gently, as if to a junior colleague rather than his son. "Marion, remember the Eleventh Commandment," he said. "Thou shall not operate on the day of a patient's death."

I remember his words on full-moon nights in Addis Ababa when knives are flashing and rocks and bullets are flying, and when I feel as if I am standing in an abattoir and not in Operating Theater 3, my skin flecked with the grist and blood of strangers. I remember. But you don't always know the answers before you operate. One operates in the now. Later, the retrospectoscope, that handy tool of the wags and pundits, the conveners of the farce we call M&M — morbidity and mortality conference — will pronounce your decision right or wrong. Life, too, is like that. You live it forward, but understand it backward. It is only when you stop and look to the rear that you see the corpse caught under your wheel.

Now, in my fiftieth year, I venerate the sight of the abdomen or chest laid open. I'm ashamed of our human capacity to hurt and maim one another, to desecrate the body. Yet it allows me to see the cabalistic harmony of heart peeking out behind lung, of liver and spleen consulting each other under the dome of the diaphragm — these things leave me speechless. My fingers "run the bowel" looking for holes that a blade or bullet might have created, coil after glistening coil, twenty-three feet of it compacted into such a small space. The gut that has slithered past my fingers like this in the African night would by now reach the Cape of Good Hope, and I have yet to see the serpent's head. But I do see the ordinary miracles under skin and rib and muscle, visions concealed from their owner. Is there a greater privilege on earth?

At such moments I remember to thank my twin brother, Shiva — Dr. Shiva Praise Stone — to seek him out, to find his reflection in the glass panel that separates the two operating theaters, and to nod my thanks because he allows me to be what I am today. A surgeon. According to Shiva, life is in the end about fixing holes. Shiva didn't speak in metaphors. Fixing holes is precisely what he did. Still, it's an apt metaphor for our profession. But there's another kind of hole, and that is the wound that divides family. Sometimes this wound occurs at the moment of birth, sometimes it happens later. We are all fixing what is broken. It is the task of a lifetime. We'll leave much unfinished for the next generation.

Born in Africa, living in exile in America, then returning at last to Africa, I am proof that geography is destiny. Destiny has brought me back to the precise coordinates of my birth, to the very same operating theater where I was born. My gloved hands share the space above the table in Operating Theater 3 that my mother and father's hands once occupied.

Some nights the crickets cry zaa-zee, zaa-zee, thousands of them drowning out the coughs and grunts of the hyenas in the hillsides. Suddenly, nature turns quiet. It is as if roll call is over and it is time now in the darkness to find your mate and retreat. In the ensuing vacuum of silence, I hear the high-pitched humming of the stars and I feel exultant, thankful for my insignificant place in the galaxy. It is at such times that I feel my indebtedness to Shiva.

Twin brothers, we slept in the same bed till our teens, our heads touching, our legs and torsos angled away. We outgrew that intimacy, but I still long for it, for the proximity of his skull. When I wake to the gift of yet another sunrise, my first thought is to rouse him and say, I owe you the sight of morning.

What I owe Shiva most is this: to tell the story. It is one my mother, Sister Mary Joseph Praise, did not reveal and my fearless father, Thomas Stone, ran from, and which I had to piece together. Only the telling can heal the rift that separates my brother and me. Yes, I have infinite faith in the craft of surgery, but no surgeon can heal the kind of wound that divides two brothers. Where silk and steel fail, story must succeed. To begin at the beginning . . .

Excerpted from Cutting for Stone by Abraham Verghese. Copyright 2009 by Abraham Verghese. Excerpted by permission of Knopf, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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