What the doctor ordered"Cutting for Stone," by Abraham Verghese; Alfred A. Knopf, 2009; 541 pp.; $26.95; Vintage Books, 2010; 667 pp.; $15.95
Epic debut novel is a story of love, medicine and intrigue
by Carol Blitzer
Somewhere at Stanford University's medical school Abraham Verghese, professor of medicine and senior associate chair, has a second, secret office. There's no name on the door, no telephone — just the subtle clacking of computer keys as he types away on his next project. Or the luxury of silence.
Dr. Verghese had nearly completed his first novel, "Cutting for Stone," when he was recruited by medical school chief Dr. Ralph Horwitz in 2007 to his dream job: teach at a major medical school with time to write.
A native of India who grew up in Ethiopia, the child of two teachers, Dr. Verghese always wanted to be a doctor. Choices for middle-class Indian children were clear: "doctor, lawyer, engineer or failure," he said recently at his official office.
"If I'd grown up here, I wonder if I'd been something else," he said.
But the doctor who wrote a book — actually three — came to medicine because of another book, "Of Human Bondage" by Somerset Maugham, which suggests that "anyone with empathy for the human condition can be a very good physician."
In Dr. Verghese's first published book, a memoir called "My Own Country: A Doctor's Story," he writes about the beginning of the AIDS epidemic and his experience in rural Tennessee. Throughout that nonfiction account, his love of medicine is a constant theme — no matter how daunting the circumstances.
Medicine played a large role in his second memoir, "The Tennis Partner: A Story of Friendship and Loss," a personal account of a fellow doctor's drug addiction while his own personal life was in shambles.
So it's no surprise that the key characters in his first novel are all doctors.
Set in Ethiopia, with many characters originally from India, "Cutting for Stone" is an epic novel that spans continents, generations and cultures, spinning the tale of conjoined twins born of an illicit joining of a nun and a British doctor. It's an ambitious first novel that took him eight years to complete.
The idea for the book bubbled up from an image of a very beautiful South Indian nun.
"I had an image of her far away from home, giving birth to twins in an operating room. ... I didn't really have a plot for the whole story, just a voice and a tone that I was trying to keep pushing forward.
"The result was a lot of dead ends. I would write hundreds of pages in one direction — months and months — only to find that's not the book," he said.
At one point he met with his editor and agreed that there were too many options: He had created well-developed characters, but he needed to know what to do with them.
So they hammered out the rest of the story.
"Even then, there were huge surprises in the book. (A character's) dying I didn't see coming. When I am surprised, I'm pretty sure the reader is surprised," he said.
Dr. Verghese cites John Irving as saying, "If you don't know the whole story and you're trying to tell it, you're not a story teller, you're just a liar; you're just making it up as you go along."
Verghese, on the other hand, prefers to discover as he writes.
"You never know quite what's going to come out until you sit down. Writing is a serious act. I write in order to understand what I'm thinking. That's really the joy of it," he said.
But he had the title from the beginning, based on a quote from the Hippocratic Oath, repeated at all medical-school graduations. The expression harks back to Medieval society, when bladder and kidney stones were rampant and itinerant surgeons traveled from city to city removing stones. But the patient often died of infection, he said, so the expression really means if you're not expert, don't try it.
Today Dr. Verghese devotes regular time to writing and researching, yet he describes himself as "an inconstant diarist."
"It is hard to find time to do anything outside of medicine," he said.
Each of his memoirs took him four years. In Tennessee, he kept notes, but "I had no intention of what they were for. I was also writing short stories at that time. I had the sense I could not control the world I was in, in the daytime, but at night through fiction, I could cross all boundaries," he said.
He got more serious about writing after attending the Iowa Writers Workshop at the University of Iowa and earning a master of fine arts degree in 1991.
After Iowa, he accepted a position in El Paso, Texas, "where all they wanted was for me to take care of patients and teach. My evenings were free. I love to teach, I love medicine," he said, and he loved having discretionary time to write.
He had written a short story on AIDS, called "Lilac," for The New Yorker, when an editor suggested he submit a proposal for a two-part series on the topic. When the editor left, "Essentially we were left with a book proposal. It was this strange moment in time, when there was enormous interest in the subject. The door subsequently closed.
"But at that moment in time, the idea of a heterosexual male physician, a foreigner too, telling the story of HIV in rural America — that hit a lot of chords," he said.
As for what's next, Dr. Verghese isn't sure whether he wants to venture into another novel or nonfiction. When "Cutting for Stone" was published, "I felt the tank was empty. I felt I hoarded every anecdote, aphorism, joke, and found a way to put it in the book," he said.
But he recently received a letter from a physician he knew in McAllen, Texas, who had practiced there for 45 years.
"There was something about the man; his family had lived there for six generations. I don't know quite what, but I'd like to write a story set there," he said.
"I always am curious about why people make so much of the doctor/writing thing.
"Writing and medicine are not separate. My writing emanates from this stance that I take, looking at the world, and the stance is purely from being a physician — it's one of observing, cataloguing, being in wonder and awe of what I see. Writing comes directly out of that impulse.
"Training as a physician, at least in internal medicine, you're always looking at the body as text, you're always looking at what people say as a story and you're trying to match it to your repertoire of stories."
At 54, Dr. Verghese lives with his second wife, Sylvia, in Menlo Park, and his 12-year-old son, Tristan. So far, neither of his two older sons, whom he wrote about in his memoirs, has shown a proclivity for medicine.
"I'd enjoy one of them in medicine, but they have to feel a passion for it," he said.
And his own passion never ceases.
Referring back to why he came to Stanford, he said: "It happened because of my boss, Ralph Horwitz, chairman of medicine. He valued the art and craft of medicine, the very thing I've written about and am interested in.
"All my writing — fiction and nonfiction — is driven by the love of medicine. If you took me out of medicine, I would worry that I have nothing to say."
Associate Editor Carol Blitzer can be e-mailed at email@example.com.