Cutting for Stone

The story is told by the protagonist, Marion Stone. He and his conjoined twin Shiva are born at Mission Hospital (called "Missing" in accordance with the local pronunciation), Addis Ababa, in September 1954. Their mother, Sister Mary Joseph Praise, an Indian Carmelite nun, dies during childbirth. Their father, Thomas Stone, the English surgeon of Missing, abandons them and disappears. Orphaned at birth, the pair grow up in the household of two physicians of Missing, both from Madras, the obstetrician Kalpana Hemlatha (Hema) and Abhi Ghosh, who fall in love while caring for the infants. Hema names them Marion (after J. Marion Sims) and Shiva (after the Hindu deity). Ghosh teaches himself surgery to replace Stone. The tissue link between the twins has been separated at birth and the two grow up together being very close initially.

Both twins are exposed to the changing political environment in Ethiopia. There is an unsuccessful rebellion by Haile Selassie's bodyguard, General Mebratu. Ghosh is imprisoned, then released, in the aftermath of the coup, due to his friendship with Mebratu. Through their parents, both boys are exposed to medical knowledge and taught medical procedures at the hospital.

Over time, though, individual differences begin to become pronounced. When entering puberty their relationship to Genet, the daughter of Rosina, a domestic help, finally tears them apart. Marion is in love with Genet and intends to marry her, but it is Shiva who, interested in sexual pursuits, becomes her first lover. Marion feels betrayed. Rosina forces Genet to submit to female genital mutilation, and Rosina commits suicide shortly thereafter. Genet later joins the Eritrean liberation movement. While Marion goes to medical school, his brother stays at Missing. Focused on the repair of birth-related fistulas, he takes up his surgical training with Hema, eschewing a formal medical education. On his deathbed, Ghosh has three wishes for Marion – to get the best medical education, to find Stone, and to forgive his brother.

When Genet and her comrades hijack an Ethiopian Airlines airplane in 1979, Marion's name is found in a list of her connections. To avoid arrest, he flees the country overnight to Kenya. He goes to New York City where he finds a position at Our Lady of Perpetual Succour, a hospital in the Bronx. There, he enters a surgical residency. One day, while assisting his senior in a complicated trauma operation, an unknown surgeon enters and looks over their shoulders. It is Thomas Stone, by now a renowned liver surgeon from Boston. Marion's encounter with his biological father redirects his life, leading to a painful reconciliation and reunion with his estranged brother.

The book contains descriptions of many medical diseases and interventions. The title relates to the oath of Hippocrates that calls his acolytes not to cut for (bladder) stones. Marion's mother dies during a complicated delivery (conjoined twins) from a uterine rupture. The babies are born premature. Shiva becomes an expert in the repair of vesico-vaginal and recto-vaginal fistulas. A vasectomy is described in detail "so charming and surgically precise, it could serve, in a pinch, as a how-to-manual."^[2]

The surgery of an intestinal volvulus establishes a relationship between Ghosh and Mebratu, but leads to his later imprisonment. Ghosh later dies from leukemia possibly related to his handling of outdated x-ray equipment. Genet undergoes female genital mutilation (female circumcision) and suffers from its complications. The book describes conditions in a tuberculosis sanatorium where Stone's mother dies from a ruptured aneurysm, the underlying condition acquired from her husband who has syphilis, or more specifically, tabes dorsalis. Marion's participation in the setting of an atriocaval shunt (a "Shrock") during trauma surgery in New York sets the scene when he encounters his biological father. The reader is further confronted with typhoid fever and hepatitis with liver failure. Other topics covered are depression, appendicitis, amputation, rickets, intestinal cancer, phlebitis, and intracranial hemorrhage.