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Wednesday, June 24, 2009

Book Review: Cutting for Stone

I have to start by clearing up the confusion I had with Abraham Verghese's title, Cutting for Stone. As the book mentions several times but never precisely explains, the reference is to the Hippocratic Oath, "I will not cut for stone." However I had to look it up in Wikipedia to find the meaning, which is probably apparent to medical professionals. It was a prohibition from operating on stones, or calcified deposits, in the kidney or bladder. The ancient Greeks apparently thought surgeons should leave this menial procedure to barbers. The modern meaning seems to be that doctors should recognize they can't specialize in all areas. But I'd say closer to the original intent, and perhaps more relevant to today's medicine, would be: "I won't perform treatments just for the sake of making money."

Okay, I got that off my chest!

The title has at least a double meaning. The story flows from the unlikely and surprising conception of a pair of twins by an English surgeon, Thomas Stone, and an Indian-born nun, Sister Mary Praise, in Ethiopia in the mid-twentieth century. The story is narrated by one of the twins, Marion, who eventually becomes a surgeon himself.

Verghese is likewise a practicing surgeon, now living in the U.S., who grew up in Ethiopia. His account seems autobiographical, but much of it is invented, as he explains in detail in his Acknowledgments.

If I say too much about this book, I'll have to throw in a lot of spoilers, and suspense has its delicious rewards in this leisurely paced plot. So I won't. Suffice it to say, I believe your patience with Verghese will be rewarded.

I heard him speak at a book signing at an Ethiopian restaurant in Los Angeles, and he mentioned that he admired W. Somerset Maugham. This book does remind me of Cakes and Ale, in more ways than one, including the crafting of its sentences. (Maugham also studied medicine.) It's not the page-turning, plain-vanilla, cliffhanger prose of Tom Clancy or Dan Brown. It's thoughtful, colorful, and literary. Slow down and enjoy it.

This novel is about family, community, betrayal, parental love and estrangement, sibling bonding and rivalry, personal bravery, not-so-uncommon acts of kindness, the heroic practice of medicine, suffering and compassion--and irony.

Lots of irony.

Cutting for Stone is selling well, so lots of other people must think it's worthwhile. The story doesn't read like a movie plot, but neither does The English Patient. Yes, this book is that big--in its scope and its ambitions, and in the magnitude of its achievement.

12 comments:

Anonymous said...

Just logged on to google "Cutting for Stone". Found your link so thanks for the explanation (expanded) of the title. This book is a wonderful, engrossing read.

Beckie said...

I just finished this wonderful book. I'm ethereally breathless.I


I, too, continued throughout the read to be perplexed by the title. The phrase was mentioned many times and still I couldn't quite understand. So thanks for your explanation.

Catharine Larsen, MA, LP said...

Thanks for your explanation; I have been pondering "cutting for stone" without understanding. I agree, this is a wonderful book, one of the best I have ever read--it is so rich. I laughed and I cried, and I turned pages to find out what would happen next.

Annie said...

Thank you for the explanation. I just finished the book. I really thought it was the best book I've read in a while.

Anonymous said...

In an interview the author clarifies,

"There is a line in the Hippocratic Oath that says: ‘I will not cut for stone, even for patients in whom the disease is manifest.’ It stems from the days when bladder stones were epidemic, a cause of great suffering, probably from bad water and who knows what else. […] There were itinerant stonecutters—lithologists—who could cut either into the bladder or the perineum and get the stone out, but because they cleaned the knife by wiping it on their blood-stiffened surgical aprons, patients usually died of infection the next day. Hence the proscription ‘Thou shall not cut for stone.’ […] It isn’t just that the main characters have the surname Stone; I was hoping the phrase would resonate for the reader just as it does for me, and that it would have several levels of meaning in the context of the narrative." So this relates to 'do no harm' more than just surgery for money.

boychik said...

Yes, "even for patients in whom *the disease* is manifest" would seem to be a reference to a specific condition. I happily defer to this more insightful definition. It has been amazing to me how many interpretations of this reference there have been, and how much speculation about its meanings, not only in the Hippocratic oath, but as a metaphor in the book.

Helen Barr said...

The book was given to me by a very literate periodontist and I have the advantage of his margin notes and underlinings of things that impressed him or he found lyrical, but I'm wondering about the title. I appreciate the various explanations, which are like petals folded back searching for the truth--like this book. Helen Barr

Dwain Rowe said...

A point of clarification: Dr. Verghese, whom I know from his time in Johnson City, TN, is an Infectious Disease specialist and an Internist... he is not a surgeon. This makes the quality of his descriptions of surgeries and surgical assessments even more enjoyable for me.

Anonymous said...

Thank you for your review and for an explanation of the title. (I enjoyed reading the other comments to this post as well.) I just finished the book today and liked it a lot. Keep up the great work with your blog.

Anonymous said...

Really enjoyed this book. Sometimes, felt it a little heavy-going but there was always an uplifting segment to get past my literary understanding lacking. Did have to go further for the meaning of the title and to my thinking, does have a double meaning. After several attempts found an explanation of 'cutting for stone' that I could grasp. Thanks to the writer for the entertaining and informative read.

Anonymous said...

I just finished this book and I guess the word I would use is "powerful". Such a wonderful insight into the political&cultural history of Ethiopia & India & a story to grab at your emotions. Thank you all for your explanations of the title. Karen

Anonymous said...

I found this link to try to find the meaning of the title. I had a hard time getting into the book, but after about the middle, couldn't put it down.