the guardian Fri 08 May 2009
Abraham Verghese, an Indian, grew up in Addis Ababa, has lived in Madras and various cities in America, and thus, regardless of temperament, would always have felt something of a watchful outsider. This first novel was preceded by two non-fiction books: The Tennis Partner, about his distressing friendship with a drug addict and fellow doctor, and My Own Country, a memoir of working with Aids patients in a conservative southern US town. Some of the best passages in all three books are those in which he reads the language of the body - its colours and betraying odours, its telltale pulses - and the emotions that obscure and interrupt that language.
Cutting for Stone - the phrase is from the Hippocratic oath - is about twins born joined at the head, in a mission hospital in Addis Ababa half a century ago. Their mother, a nun from Madras, does not survive the birth. Their father, a British surgeon called Thomas Stone, cannot bear the loss and flees, so Marion and Shiva are raised by two Indian doctors in the hospital where their parents worked; both become surgeons. Verghese carefully (and sometimes rather unbelievably - he is unapologetic about coincidences) interweaves their story with that of Ethiopia's past half-century. About three-quarters of the way through, the book moves to the US - as many Ethiopians did, after the revolution that replaced the emperor with a Marxist/military regime.
While I don't know Verghese personally, I know the streets and shops he evokes, the hospitals; I know that his setting, seemingly so rich and strange, is real. Only occasionally is there a wrong note or mis-transcription from Amharic. In fact, when I worried about anything it was for the opposite reason: when one twin becomes famous abroad for his fistula operations, it felt rather too much of an appropriation of the achievements of Reginald and Catherine Hamlin, the latter of whom was nominated for a Nobel peace prize. Surely there were other procedures to choose from? It is a little strange to move major revolutions by a year or two, just to suit your plot. And there is too unquestioning a reliance on Ryszard Kapuscinski's The Emperor; Kapuscinski was himself an observer from another land, and he had his own agenda. (As, apparently, did whoever designed the cover: it's the worst kind of laziness to depict an "African coastline" as if everything on that continent were interchangeable - never mind that it's a book set in cities. What coast there was, until Eritrea gained independence in 1991, consisted of desert and volcanic rock rather than lush palm trees; Ethiopia no longer has a coast at all.)
But all the rich detail in the world is as nothing if you don't have command of emotion and narrative. One could argue, given everything from ER to House, that medicine cannot help but be dramatic, but that isn't necessarily true: Verghese's achievement is to make the reader feel there really is something at stake - birth, love, death, war, loyalty. There's no smug postmodern self-undermining (otherwise known as irony) here: the mythic arises seamlessly from the quotidian; telepathy or saintly intercessions are simply accepted - as they often are in Ethiopian life. You conserve pages because you don't want it to end.
But irony is a useful thing, too, when considered as an ability to hold contradictory meanings in suspension. Richard Eyre compared this book to Chekhov and Shakespeare, an enthusiasm presumably prompted by the variety and colour of Verghese's world, its earthiness and drama, its concreteness of detail and unselfconscious swing. And this, often accompanied by a real delicacy and honesty, is pleasing, but there was an extra element I missed: a serious playfulness of meaning, a compassion arising from an understanding of perspective and of all that cannot be controlled.
This is a book narrated by a surgeon, and structured as a surgeon might structure it: after the body has been cut open and explored everything is returned to its place and carefully sutured up - which is not, in the end, how life actually works. And, like surgery, there's a certain brutality involved, particularly evident in the novel's gender politics. Of course the narrator arises from a patriarchal society, but it is difficult not to feel discomfited by the fact that the virgin/whore/mother/passive sufferer roles of the women (particularly the Ethiopian women, who are prostitutes, or servants, or simply available and, if not, righteously punished for their wilfulness) are so unquestioned.
A major strand of the plot is the love that one twin, Marion, has for a girl he knows from childhood, Genet; but there is surprisingly little imaginative projection of what Genet might feel. Which of course is a character's prerogative - except that it was a niggle I had with The Tennis Partner as well: Verghese was recklessly honest about his feelings and vulnerabilities, but there might have been a bit more sympathy for what his friend was suffering. Perhaps this is a function of the detachment of observation and, specifically, a medical manifestation of it: a doctor must be the most attentive observer, but also, ultimately, a judge as well. And that is a tricky place for a novelist to occupy.