Cutting for Stone

by: Abraham Verghese

About the Title

  • “While the good doctor [Thomas Stone] recited Cicero and excised a part of himself as blithely as if he were cutting for stone on the body of another” (80).

  • “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...” Hippocratic Oath, Part Three Title Page

When and Where

Abraham Verghese’s novel Cutting for Stone mostly takes place in Addis Ababa, Ethiopia, Africa in the time which brothers Shiva and Marion were alive starting “in the late afternoon of the twentieth of September in the year of grace 1954,” and going until about the 1980s (3). The author chose this time period and setting because during this period Africa was experiencing external pressures from the invasions and crusades by the Italians and English, who were attempting to colonize the country. This colonization left the city a “juxtaposition of culture and brutality;” however, Addis Ababa still remained a region of Africa yet to be fully colonized by the Italians (102). Verghese chose a setting that is “molding the new out of the crucible of primeval mud” to represent the changing and developing of his characters and make a statement about the importance of evolution without conceding in society (102).

Many characters throughout the story also visited Aden, “a city built on top of a dormant volcanic crater, hell on earth” (52). This “gateway to hell” was a city fully colonized by the Europeans during the time the story is set and is used by Verghese to represent the evil in surrendering to outside forces instead of using them to develop and improve.

New York is the main setting for the second half of the novel. Being the place Sims, the famous gynecologist Marion is named after, perfected his fistula surgery and “opened the Woman’s Hospital” (378). Sims “[breaks] a fundamental rule” of the society he lived in by being a male gynecologist; however, in doing so also brought much improvement to medicine (378). This, along with Marion going to New York in order to perfect his gynecologist skills as well, makes New York into a model city for how to evolve and change for the better without conceding to external pressures and expectations.

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Social Context

Social limitations and regulations are often specific to a country's culture or geographic location. There are three main locations discussed in Cutting for Stone: India, Ethiopia, and New York.

One of the main locations of the novel is India, which strengthens strict divides between social classes using a caste system. Though class systems exist everywhere, the caste system strictly defines them, laying out guided expectations for every level. Saint Mary Joseph Praise was born in the city of Kerala India, and struggled with the expectations placed on her, saying “They [her parents] couldn’t have been more disappointed had she become a Muslim or a Hindu. It was a good thing her parents didn’t know that she was also a nurse, which to them would mean that she soiled her hands like an untouchable,” (15). Women were expected to marry, and were shunned if they were not. A husband outside their religion- their most sacred social culture- is better than no husband at all. For example, on page 46, Verghese writes “Despite Hema’s lack of interest in marriage, her mother was terrified that her daughter would end up with a non-Brahmin, someone like Ghosh. And yet as Hema neared thirty, her mother had begun to feel that any husband was better than no husband at all,” (46).

A male dominated culture was emphasized by female social subjugation through things like the caste system. Hema felt the sting of this culture, saying “She felt her rage boil over, and it was directed not just at him but at all men, every man who in the Government General Hospital in India had pushed her around, taken her for granted, punished her for being a woman, played with her hours and her schedule, transferred her here and there without so much as a please or by-your-leave” (87). This frustration caused Hema to leave, though she still goes to visit her family, saying “She left behind Madras, left behind labels of caste, gone so far away that the word ‘Brahmin’ meant nothing” (68).

Ethiopia shares many similarities, but just as many differences with India, including the strict moral guidelines shared in communities. Purity and chasteness are valued, to the point where some women would rather die a painful death than allow a male do what she believed in indecent. Hema tells the story she heard from a male physician, of a woman who “...rather than allow a male doctor to see her, she wedged her body behind the bedroom door so that any attempt to open it would crush her. The woman died alone, behind that door, an act much admired by her peers” (94). This value is shared with women in India as well. As Hema notes when diagnosing a patient in the Missing women’s clinic, “Whether it is India or here, the ladies are all the same” (285).

In countries like Ethiopia, even the simple things in life are a struggle. Illness, for example. Even the smallest disease could be a death sentence with limited access to healthcare, as Marion notes when saying, “It was as if in Ethiopia, and even in Nairobi, people assumed all illness, even a trivial or imagined one- was fatal; they expected death,” (458). Noting the story of a pregnant patient from a nearby village, Marion says, “In a developing country or a big city, she might have had a Cesarean section as soon as her contractions started. But in a remote village, without the help of anyone but her mother-in-law, she would suffer for days” (405). While a disease could be life threatening, a disfigurement was worse, ruining their life as they struggled to live. For patients at Missing, “Death was perhaps a better fate than to live with the disfigurement” (267).

Education was also a challenge. When Marion describes the government school he was supposed to go do, he says, “Why not the rough-and-tumble of the government schools? If we’d gone there we might have been the only non-native children, and we would have been in a minority of kids with more than one pair of shoes and a home with running water and indoor plumbing” (227). Perhaps due to the abysmal conditions of their surroundings, religion has a great sway on Ethiopians. Every single patients prayed before stepping through the hospital’s gate. Ghosh notes that “These visitors to Missing feared illness and death, but their fear of damnation was greater” (318).

New York stands as a distinct contrast to both India and Ethiopia, wielding a powerful and wealthy influence as a country as a whole. Immediately upon deplaning, Marion notes that his fellow travels were like “Wide-eyed like animals coming off the ark” (432). Indeed, foreigners were treated like they had the intellectual capabilities of animals. Marion had his own presumptions, however: ““The locals were of all colors and shapes, not the sea of white faces I had expected” (432).

Marion noted that in the hospital “Money’s no object...A menu without prices” (358). The excess of money in America was greater than any Marion has ever experienced. Indeed, he says, “What I considered scarce and precious was in fact plentiful and cheap, and what I counted as rapid progress turned out to be glacially slow” (438). Marion is amazed by the power America wields, noting, “What America needs, the world will supply. Cocaine? Columbia steps to the plate. Shortage of farmworksers...Thank God for Mexica. Baseball players? Viva Dominica” (464).

Ironically enough, as a foreign Marion finds more acceptance in America, perhaps for that reason. While in Ethiopia, Marion notes that, “Despite speaking Amharic like a native, and going to medical school with him, to Solomon I was a ferengi- a foreigner” (423). Marion and Shiva have no Ethiopian blood, so they will always be outsiders. However, in America, Marion finds a diverse array of cultures. Marion fondly reflects on one of his favorite New Yorkers, saying “What’s more important, he was a fine man. Truly color-blind” (469).

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Political Context

When the book begins “It was 1947, and the British were finally leaving India; the Quit India Movement and made the impossible come about.” (27). The British had colonized India, but through the nonviolent independence movement called “The Quit India Movement” helped to removed them from power.

Meanwhile, in Africa, religious ambassadors of every faith spread across the continent. Saint Mary Joseph Praise was one such person; as both a nun and nurse, she was sent to Africa to heal and show her patients the power of God, ending up in Addis Ababa, Ethiopia. After the Italian’s invasion and colonization, and their subsequence departure, Ethiopia’s government is unstable, and through out the book there are multiple military government overthrows. The commotion is enough to attract the attention of Europe, as “‘Reports from Addis Ababa, the capital of Ethiopia, indicate that a bloodless coup has taken place while Emperor Selassie was away on a state visit to Liberia” (276) were reported on BBC

Due to the cutthroat nature of government rule, its citizens have adapted to be the same. After seeing a police officer kill an Ethiopian citizen, Marion “saw the motorcycle riders had turned on the policeman, giving him a good thrashing. His [the policeman] mistake was not clubbing the woman down before she opened her mouth and embarrassed them all” (238). Due to the political instability, the social culture generated is cruel and unjust. Enemies of the state would often end up in a prison called Kerchele, which Marion calls “a butcher shop” where “enemies of the state came to their ends. Bodies and body parts were carried out in trucks every night and posed throughout the city, a macabre public arts program that served to educate and edify” (418).

The political conflict abets the harsh social climate present, as well as providing instigation for conflict between characters.

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Modern Content

Though this novel is set in the past of a 3rd world country, many ideas can be translated to modern society. The idea of constantly improving the condition of society and “leav[ing] much unfinished for the next generation” to fix is explored through the work being done at missing hospital (23). This idea goes hand in hand with the concept of constantly striving to master “the hardest thing you can possibly do,” (20). Our modern society still works toward improvement in all facets of life; however, some aspects still remain difficult for our society such as equality. Similarly, Ethiopia deals with these gaps in equality constantly obsessing over race and “ask[ing] about [the] nationality” of others (72). Far greater than this however is the gap between the treatment of women and men throughout the novel. Especially in India, women are thought to be inferior to men specifically in careers. Hema, one of the women working in the medical field, is laughed at by “the men in [her] group” when called on to present in front of her class. This battle for equality continues today in America as we work toward equal pay for males and females and equal opportunities for all races.

Significance to Peers

As a teenager, dealing with the pressures and stresses of everyday life can seem overwhelming. These pressures come from disapproving parents, such as Sister Mary Joseph Praise’s parents disapprove of her “bec[oming] a Carmelite nun, abandoning the ancient Syrian Christian tradition of St. Thomas,” (15). It is easy to relate with the characters’ confusion as they search for their identities and are left feeling “neither an obligation to join the herd nor any urge to try to stand out from it” (66). The association felt to these characters is due to the similar feelings of living up to expectations all people experience as teenagers. The ties created between audience and character through these shared experiences serve to make the characters of the novel more relatable and easier for the reader to understand and feel connected to.

Literary Value (Text to Text)

There are a variety of Foster’s lenses present in this metaphor- rich novel.

  • One such lens is the water, which can represent a variety of things. Sister Mary Joseph Praise arrives to Missing “after hours and days of the sound and sight of water” (27). This is a rebirth of her identity after a horrifying and emotionally scaring journey there. Indeed, in the boat on the way there, “In the middle of that ocean surrounded by the sick, she felt the weight of her ignorance” (30). This is further emphasized by her journey across the ocean to get there.
  • Another lens represented is weather. In literature, the sun can represent birth and hope. Indeed, when Shiva and Marion are born, “the sunbeam fell directly on Sister Mary Joseph Praise..” The sun acts as a ray of hope for the twins amidst a difficult delivery, which Matron felt “had been the sun’s intent all along- to find the unborn. We had seen each other anew. We are unmasked” (119). On the other hand, rain is also a common occurrence. When Marion’s love leaves, “That very night, the wind picked up, the leaves were swishing and rustling, and by morning a squall arrived, heralding the long rains” (346). School breaks were also held during monsoon seasons, which “Old hands in Addis referred to the monsoon months are “winter”” (243). Both winter and rain have negative connotations, which reflect Marion’s feelings.
  • Another lens represented is the blindness lens. The pharmacist in Missing “With his one good eye (the other milky white from a childhood infection)…could spot the seriously ill among the many…” (159). Marion also realizes his romantic feelings for a woman when she blindfolds him. He feels a rush of emotion when his other senses are taken away, and notes that “Blindfolded, I suddenly saw this so clearly” (253). He has an epiphany of sight when his sight is taken away.
  • The names of characters are also highly significant. Marion muses that “To name a dog in Ethiopia is to save it” (238). The same is true for people. Hema comes up with names for the twins that carry great significance. “Hema decided to name the first twin to breathe Marion. Marion Sims, she would tell me later, was a simple practitioner in Alabama, USA, who has a revolutionized women’s surgery. He was considered the father of obstetrics and gynecology, the patron saint in naming me for him, she was both honoring him and giving thanks. ‘And Shiva, for Shiva,’... naming the child... the last to breathe... a child all but dead until she had invoked Lord Shiva’s name, at which point he took his first gasp” (137). Hema’s name itself carries a significant meaning. In science, the prefix “hema” means blood. Hema is family to those who don’t have her blood, and as a surgeon operates through rivers of blood.

Cutting for Stone Recap


Cutting for Stone, by Abraham Verghese, follows the life- from birth to death- of twin boys Shiva and Marion as they struggle to grow up in brutal rural Ethiopia. Set in the 1940s to the 1980s in Addis Ababa, political unrest creates a hateful and angry culture for the twins to grow up in. Marion and Shiva are born with an attachment to each other, and are very close until unfortunate events eventually pull them apart. The twins spend the majority of their childhood at Missing Hospital where they were born, shadowing doctors and learning from patients. Showing the boys the wonders of medicine and the satisfaction to be had in helping others as well as exposing them to all kinds of culture from a young age can make for an interesting childhood. Cutting for Stone is a thrilling novel about childhood love and sibling bonds, abandonment and acceptance. Verghese opens the door for readers into a whole new world of cultural norms and ways of thinking, shocking the audience with the brutal realities of the impoverished conditions of a third world nation.

Verghese uses his novel to persuade readers of the intense influence a person’s upbringing, including their geographical culture and familial traditions, wields on their future. He is able to do this through the use of an arsenal of emotion provoking characters to draw readers in, along with a melodic style of writing to keep readers hooked until the last page. To enhance the effects of culture on a person, he chose a location rich with political and social turmoil; Africa, which also is known for their tight knit communities and longstanding traditions.

Cutting for Stone is a book suitable for anyone, because it seems like every page has a life lesson written just for you. The wonder of Abraham Vergese’s writing is the magical quality other novels seem to lack. You don’t have to find value in the book: it finds you. The complexity of character interactions, abundance of universally applicable life lessons, and intensely emotional plot should make this book on the top of your To Read List.

Other Books Like This

Other books by the same author:

  • My Own Country: A Doctor’s Story by: Abraham Verghese

  • The Tennis Partner by: Abraham Verghese

Other books about African colonization:

  • King Leopold’s Ghost by: Adam Hochschild

  • Heart of Darkness by: Joseph Conrad

Works Cited

Verghese, Abraham. Cutting for Stone. New York: Alfred A. Knopf, 2011. Print.