'Are You Also With Fever?'
In this exclusive excerpt from Dr. Abraham Verghese’s debut novel, Cutting for Stone, a young Indian nun meets an English surgeon for the first time.
Sister Mary Joseph Praise had come to Missing Hospital from India, seven years before our birth. She and Sister Anjali were the first novitiates of the Carmelite Order of Madras to also go through the arduous nursing diploma course at the Government General Hospital, Madras. Instead of answering to “Probationer” (in the hospital) and “Novitiate” (in the convent), they could now be addressed in both places as “Sister.” Their aged and saintly abbess, Shessy Geevarughese, affectionately called Saintly Amma, had wasted no time in giving the two young nurse-nuns her blessing, and her surprising assignment: Africa…
On the day they were to sail, all the novitiates rode from the convent in a caravan of cycle-rickshaws to the harbor to send off their two sisters. In my mind’s eye I can see the novitiates lining the quay, chattering and trembling with excitement and emotion, their white habits flapping in the breeze, the seagulls hopping around their sandaled feet. I have so often wondered what went through my mother’s mind as she and Sister Anjali, both just 19 years old, took their last steps on Indian soil and boarded the Calangute…
She and Sister Anjali secluded themselves in their cabin, bolting the door against men and sea. Anjali’s ejaculatory prayers startled my mother. The ritualized reading of the Gospel of Luke was Sister Anjali’s idea; she said it would give wings to the soul and discipline to the body. The two nuns subjected each letter, each word, line, and phrase to dilatatio, elevatio, and excessus—contemplation, elevation, and ecstasy. Richard of St. Victor’s ancient monastic practice proved useful for an interminable ocean crossing...
On the ninth night, four of the 16 passengers and one of the crew came down with a fever whose flesh signs were rose spots that appeared on the second febrile day and that arranged themselves like a Chinese puzzle on the chest and abdomen. Sister Anjali suffered grievously, her skin burning to the touch. By the second day of illness she was raging in feverish delirium.
Among the Calangute’s passengers was a young surgeon—a hawk-eyed Englishman who was leaving the Indian Medical Service for better pastures. He was tall and strong, and his rugged features made him look hungry, yet he avoided the dining room. Sister Mary Joseph Praise had run into him, literally, on the second day of the voyage when she lost her footing on the wet metal stairs leading up from their quarters to the common room. The Englishman coming up behind her seized her where he could, in the region of her coccyx and her left rib cage. He righted her as if she were a little child. When she stuttered her thanks, he turned beet red; he was more flustered than she by this unexpected intimacy. She felt a bruising coming on where his hands had clutched her, but there was a quality to this discomfort that she did not mind. For days thereafter, she didn’t see the Englishman.
Now, seeking medical help, Sister Mary Joseph Praise gathered her courage to knock on his cabin. A faint voice bid her to enter. A bilious, acetone odor greeted her. “It is me,” she called out. “It is Sister Mary Joseph Praise.” The doctor lay on his side in his bunk, his skin the same shade as his khaki shorts, his eyes screwed shut. “Doctor,” she said, hesitating, “are you also with fever?”
When he tried to look at her, his eyeballs rolled like marbles on a tilting plate. He turned and retched over a fire-bucket, missed it, which didn’t matter, as the bucket was full to the brim. Sister Mary Joseph Praise rushed forward and felt his brow. It was cold and clammy, not at all feverish. His cheeks were hollowed, and his body looked as if it had shrunk to fit the tiny cabin. None of the passengers had been spared seasickness, but the Englishman’s affliction was severe.
“Doctor, I am wanting to report a fever that has affected five patients. It comes with rash, chills, and sweats, a slow pulse and loss of appetite. All are stable except for Sister Anjali. Doctor, I am most worried about Anjali . . .”
She felt better once it was off her chest, even though other than letting out a moan the Englishman made no response. Her eyes fell on a catgut ligature that was looped around a bed rail near his hands and that displayed knot thrown on top of knot, ten-score of them. The knots were so plentiful that the thread stood up like a gnarled flagpole. This was how he had logged the hours, or kept track of his bouts of emesis.
She rinsed out the bucket and put it back within his reach. She mopped the mess on the floor with a towel, then she rinsed the towel out and hung it up to dry. She brought water to his side. She withdrew, wondering how many days it had been since he’d eaten anything.
By evening he was worse. Sister Mary Joseph Praise brought sheets, towels, and broth. Kneeling, she tried to feed him, but the smell of food triggered dry heaves. His eyeballs had sunk into their orbits. His shriveled tongue looked like that of a parrot. She recognized the room’s fruity odor as the scent of starvation. When she pinched up a skin fold at the back of his arm and let go, it stayed up like a tent, like the buckled deck. The bucket was half full of clear fluid. He babbled about green fields and was unaware of her presence. Could seasickness be fatal, she wondered.
Or could he have a forme fruste of the fever that afflicted Sister Anjali? There was so much she did not know about medicine. In the middle of that ocean surrounded by the sick, she felt the weight of her ignorance.
But she knew how to nurse. And she knew how to pray. So, praying, she eased off his shirt which was stiff with bile and spit, and she slid down his shorts. As she gave him a bed bath, she was self-conscious, for she’d never ministered to a white man, or to a doctor for that matter. His skin displayed a wave of goose bumps at the touch of her cloth. But the skin was free of the rash she’d seen on the four passengers and the one cabin boy who had come down with fever. The sinewy muscles of his arms bunched together fiercely at his shoulder. Only now did she notice that his left chest was smaller than his right; the hollow above his collarbone on the left could have held a half cup of water, while that on the right only a teaspoon. And just beyond and below his left nipple, extending into the armpit, she saw a deep depression. The skin over this crater was shiny and puckered. She touched there and gasped as her fingers fell in, not meeting bony resistance. Indeed, it appeared as if two or perhaps three adjacent ribs were missing. Within that depression his heart tapped firmly against her fingers with only a thin layer of hide intervening. When she pulled her fingers away, she could see the thrust of his ventricle against his skin.
The fine, translucent coat of hair on his chest and abdomen looked as if it had drifted up from the mother lode of hair at his pubis. She dispassionately cleaned his uncircumcised member, then flopped it to one side and attended to the wrinkled and helpless-looking sac beneath. She washed his feet and cried while she did, thinking inevitably of her Sweet Lord and His last earthly night with His disciples.
In his steamer trunks she found books dealing with surgery. He had penned names and dates in the margins, and only later did it occur to her that these were patients’ names, both Indian and British, mementos to a disease he’d first seen in a Peabody, or a Krishnan. A cross next to the name she took as a sign the patient had succumbed. She found 11 notebooks filled with an economical handwriting with slashing downstrokes, the text dancing just above the lines and obeying no margin save for the edge of the page. For an outwardly silent man, his writing reflected an unexpected volubility.
Eventually she found a clean undershirt and shorts. What did it say when a man had fewer clothes than books? Turning him first this way and then that, she changed the sheets beneath him and then dressed him.
She knew his name was Thomas Stone because it was inscribed inside the surgical textbook he’d placed at his bedside.
Excerpted from Cutting for Stone by Abraham Verghese Copyright © 2009 by Abraham Verghese. Excerpted by permission of Knopf, a division of Random House Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Dr. Abraham Verghese is senior associate chairman and professor of the theory and practice of medicine in the Department of Medicine at Stanford University. His nonfiction books, My Own Country, about AIDS in rural Tennessee, and, The Tennis Partner, were critically acclaimed.