CUTTING FOR STONE
ABRAHAM VERGHESE
WMBC DISCUSSION QUESTIONS
1) Open with the Hippocratic oath and discuss its relationship to the book’s title.
Wikipedia – the Hippocratic Oath meaning of “cutting for stone”
Original, translated into English:[4]
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I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:
To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.
But I will preserve the purity of my life and my arts.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot. |
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Classic translation of the English:[5]
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I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art–if they desire to learn it–without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.
I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself holding such things shameful to be spoken about.
If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot. |
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A widely used modern version[6] of the traditional oath was penned by Dr. Luis Lasagna, former Principal of the Sackler School of Graduate Biomedical Sciences of Tufts University.[7]
In the 1970s, many American medical schools chose to abandon the Hippocratic Oath as part of graduation ceremonies, usually substituting a version modified to something considered more politically and medically correct, or an alternate pledge like the Oath of Maimonides.
The Hippocratic Oath has been updated by the Declaration of Geneva. In the United Kingdom, the General Medical Council provides clear modern guidance in the form of its Duties of a Doctor[8] and Good Medical Practice[9] statements.
Modern Version
The Hippocratic Oath (Modern Version)[10]
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I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. |
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2) What does SHIVA mean? – (7) “sitting” shiva, in Hebrew, is a week-long bereavement ritual for those in grief. To Hema, (pg 120) Shiva was the name of her personal deity, the God whom others thought of as the Destroyer, but who she believed was the Transformer, the one who could make something good come out of something terrible… (author foreshadowing?)
3) Who is MARION SIMS, GYN – a pioneer in gynecology w/arguments about his legacy because Sims used slaves as experimental subjects. (Wikipedia) Founded Women’s Hospital 1855 and was a leading expert/pioneer in the field of vesciovaginal fistula, a rip or hole in the vesciovaginal wall the result of pregnancy/birth/rape/hysterectomy.
4) Many miracles occur in this book and reference is made immediately with the twin’s birth: rain ended, meskel flowers bloomed turning the hills into gold, sedge became a brilliant carpet that swept right up to the threshold of the hospital holding promise of something more substantial than cricket, croquet, or shuttlecock…What miracles came from this hospital? The sun shining on SMJP’s uterus/hematoma…to find the unborn… Shiva – fistula surgery (ref: Marion Sims vs brother), Marion coming to life in the basin after the sun warmed it and where he was placed – lifeless –pg 120. His wail brought Shiva to life…
5) What was the significance of ST. TERESA OF AVILA and the painting – Very ill in the cloisters…experienced religious ecstasy…On St. Peter's Day in 1559, Teresa became firmly convinced that Jesus Christ presented himself to her in bodily form, though invisible. These visions of Jesus Christ lasted almost uninterrupted for more than two years. In another vision, a seraph[5]drove the fiery point of a golden lance repeatedly through her heart, causing an ineffable spiritual-bodily pain.
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I saw in his hand a long spear of gold, and at the iron's point there seemed to be a little fire. He appeared to me to be thrusting it at times into my heart, and to pierce my very entrails; when he drew it out, he seemed to draw them out also, and to leave me all on fire with a great love of God. The pain was so great, that it made me moan; and yet so surpassing was the sweetness of this excessive pain, that I could not wish to be rid of it... |
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This vision was the inspiration for one of Bernini's most famous works, the Ecstasy of St Teresa at Santa Maria della Vittoria in Rome.
The memory of this episode served as an inspiration throughout the rest of her life, and motivated her life-long imitation of the life and suffering of Jesus, epitomized in the motto usually associated with her: Lord, either let me suffer or let me die.
Could this painting also describe the birth of the twins? Pg.117 – After labor stalled, I dragged my brother back into the womb and out of harm’s way as lances and spears came at him thought our only natural exit…
6) PG 4 --What do you think is the significance of “missing” vs “Mission” Hospital and that the hospital was all but hidden by copse, hedgerows, wild eucalyptus & pine….
7) pg 49 – power prose of love & hate.
8) Pg. 54-55 comparison of Emperor Menelik’s electric chair and Ghosh’s Kelley-Koot x-ray machine.
9) PG 226 AMANUENSIS -- latin – “manual or performing function by hand”. Marion is breastfeeding on Almaz’s breast while Shiva, in the pram, sends silent instruction “throw it to me…” Marion has the breast and is Shiva’s amanuensis.
10) pgs 242-250 – killing of puppy’s…adult reasoning? Childhood nightmare?
11) 337-8 –Ghosh’s release from prison and Almaz daily vigil with framed photo of family to tell him they were okay. It sustained Ghosh…tears, tears, tears for me when they see Ghosh!!!
12) 349 – “ethyo-pya” not eee-thee-op—eee-ya.
13) 408-411 – Genet’s castration.
14) 413 all the questions!!! Pg 414 – Rosina hangs herself!
15) 446 – all the questions – good guestions!!
16) 543- 544 -- Syphilis & Cirrhosis symptoms!
17) 554 - 557 – Stone’s lacuna of memory – a gap of memory, paragraph 1 – Stone recalls his sexual memory of SMJP….in sort of a “ruptured fairytale” way.
18) 576 – cutting for stone…
19) 596 – Pyrrhic victory/pyretic victory -- Pyrrhic victory (pronounced /ˈpɪrɪk/) is a victory with such devastating cost to the victor, it carries the implication that another such will ultimately cause defeat. Marion feels this after he gives Genet aspirin and his bed, but before he sleeps with her.
20) 648 – Marion goes full circle with SMJP, kneeling in front of Teresa statue – life completed, forgiveness done.
21) 655 – the “missing” letter found inside the framed painting of St Teresa – not very original – but the word “missing” is poignant, as in “missing vs Mission” hospital. Could this be connected and also indicate a “full circle” in the story?
Reader's Guide bookbrowse.com
Abraham Verghese has said that his ambition in writing Cutting for Stone was to "tell a great story, an old-fashioned, truth-telling story." In what ways is Cutting for Stone an old-fashioned story-and what does it share with the great novels of the nineteenth century? What essential human truths does it convey?
What does Cutting for Stone reveal about the emotional lives of doctors? Contrast the attitudes of Hema, Ghosh, Marion, Shiva, and Thomas Stone toward their work. What draws each of them to the practice of medicine? How are they affected, emotionally and otherwise, by the work they do?
- Marion observes that in Ethiopia, patients assume that all illnesses are fatal and that death is expected, but in America, news of having a fatal illness "always seemed to come as a surprise, as if we took it for granted that we were immortal" (p. 396). What other important differences does Cutting for Stone reveal about the way illness is viewed and treated in Ethiopia and in the United States? To what extent are these differences reflected in the split between poor hospitals, like the one in the Bronx where Marion works, and rich hospitals like the one in Boston where his father works?
- In the novel, Thomas Stone asks, "What treatment in an emergency is administered by ear?" The correct answer is "Words of comfort." How does this moment encapsulate the book's surprising take on medicine? Have your experiences with doctors and hospitals held this to be true? Why or why not? What does Cutting for Stone tell us about the roles of compassion, faith, and hope in medicine?
- There are a number of dramatic scenes on operating tables in Cutting for Stone: the twins' births, Thomas Stone amputating his own finger, Ghosh untwisting Colonel Mebratu's volvulus, the liver transplant, etc. How does Verghese use medical detail to create tension and surprise? What do his depictions of dramatic surgeries share with film and television hospital dramas-and yet how are they different?
- Marion suffers a series of painful betrayals-by his father, by Shiva, and by Genet. To what degree is he able, by the end of the novel, to forgive them?
- To what extent does the story of Thomas Stone's childhood soften Marion's judgment of him? How does Thomas's suffering as a child, the illness of his parents, and his own illness help to explain why he abandons Shiva and Marion at their birth? How should Thomas finally be judged?
- In what important ways does Marion come to resemble his father, although he grows up without him? How does Marion grow and change over the course of the novel?
- A passionate, unique love affair sets Cutting for Stone in motion, and yet this romance remains a mystery-even to the key players-until the very conclusion of the novel. How does the relationship between Sister Mary Joseph Praise and Thomas Stone affect the lives of Shiva and Marion, Hema and Ghosh, Matron and everyone else at Missing? What do you think Verghese is trying to say about the nature of love and loss?
- What do Hema, Matron, Rosina, Sister Mary Joseph Praise, Genet, and Tsige-as well as the many women who come to Missing seeking medical treatment-reveal about what life is like for women in Ethiopia?
- Addis Ababa is at once a cosmopolitan city thrumming with life and the center of a dictatorship rife with conflict. How do the influences of Ethiopia's various rulers-England, Italy, Emperor Selassie-reveal themselves in day-to-day life? How does growing up there affect Marion and Shiva's worldviews?
- As Ghosh nears death, Marion comments that the man who raised him had no worries or regrets, that "there was no restitution he needed to make, no moment he failed to seize" (p. 346). What is the key to Ghosh's contentment? What makes him such a good father, doctor, and teacher? What wisdom does he impart to Marion?
- Although it's also a play on the surname of the characters, the title Cutting for Stone comes from a line in the Hippocratic Oath: "I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art." Verghese has said that this line comes from ancient times, when bladder stones were epidemic and painful: "There were itinerant stone cutters-lithologists-who could cut into either the bladder or the perineum and get the stone out, but because they cleaned the knife by wiping their blood-stiffened surgical aprons, patients usually died of infection the next day." How does this line resonate for the doctors in the novel?
- Almost all of the characters in Cutting for Stone are living in some sort of exile, self-imposed or forced, from their home country-Hema and Ghosh from India, Marion from Ethiopia, Thomas from India and then Ethiopia. Verghese is of Indian descent but was born and raised in Ethiopia, went to medical school in India, and has lived and worked in the United States for many years. What do you think this novel says about exile and the immigrant experience? How does exile change these characters, and what do they find themselves missing the most about home?