Handle With Care
In an excerpt from his novel Cutting for Stone, Abraham Verghese examines the importance of words of comfort.
The word care, in a medical sense, implies the many things physicians do for patients, among them: ordering tests, writing prescriptions, performing surgery. Or perhaps used to do. Abraham Verghese, an infectious disease specialist and professor at the Stanford University School of Medicine, thinks doctors have distanced themselves from the word’s basic definition: to show empathy and compassion. “The patient in the bed is merely an icon for the real patient, who exists in the computer,” Verghese has lamented.
At the center of Verghese’s first work of fiction, Cutting for Stone (Knopf, February 2009), is compassion shown and withheld—between physicians and patients, and physicians and their families. In Addis Ababa in the 1950s, twins Marion and Shiva are born to Indian nun Sister Mary Joseph Praise and British surgeon Thomas Stone. When Praise dies giving birth, Stone abandons the twins, who are raised—and eagerly inducted into medical careers—by married doctors. Marion leaves Ethiopia to complete his residency in the Bronx. On a visit to a Boston teaching hospital, he sits in on a morbidity and mortality conference (an examination of cases gone wrong) and sets eyes on his father for the first time.
While I looked at Thomas Stone, a slow fuse burned inside me. I was ready to hurl furniture, activate the ceiling sprinklers, scream obscenities, disrupt this orderly meeting. As my rage peaked, then gradually subsided, I had to grab the arms of my chair.
“It was my fault,” Stone said, turning to face me, and for a moment, I thought he was clairvoyant. “Without a doubt, we can do better surgically. I am installing a video camera in the two trauma bays. I want us to review the video after every major trauma that comes in. Were we standing in the right place? Did we take three steps to reach for an endotracheal tube when it should have been at hand? Did we distract each other with what we said? Who didn’t need to be there? Is there a better way? That is always the challenge.” He pulled a piece of paper from his pocket and unfolded it.
“I take responsibility also for something addressed in this letter.”
His accent was faintly British, the years in America having softened it, but without accruing any jarring American inflections. “This letter came to me from the deceased patient’s mother: ‘Dr. Stone—My son’s terrible death is not something I will ever get over, though perhaps in time it will be less painful. But I cannot get over one final image that could have been different. Before I was asked to leave the room in a very rough manner, I saw my son terrified, and no one who addressed his fear. The only person who tried was a nurse. She held my son’s hand and said, “Don’t worry, it will be all right.” Everyone else ignored him. My son and I were irritants. Your doctors would have preferred for me to be gone and for him to be quiet. Eventually, they got their wish.
“‘Dr. Stone, as head of surgery, perhaps as a parent yourself, do you not feel some obligation to have your staff comfort the patient? Would the patient not be better off with less anxiety, less fright? The fact that people were attentive to his body does not compensate for their ignoring his being.’”
Thomas Stone folded the letter and returned it to his breast pocket.
There was a rustle in the auditorium, a murmur, an uncomfortable shifting of body weight. I sensed a willingness in the room to shrug off the letter, to scoff at what it said, but Stone’s demeanor made it necessary to conceal that urge. He stood silent, looking out, as if considering the letter’s context, unaware of his audience.No one spoke.
As the moment stretched on, even the smallest noises were stilled until there was only the hum of the air conditioning. Thomas Stone’s expression was reflective. Now, as if waking, he searched the room for a reaction, wondering if the letter struck a chord. When he finally spoke, it was in a quiet voice that was firm and commanded attention. He asked a question. I knew the answer because it was in his book, a book I’d read carefully and more than once.
“What treatment in an emergency is administered by ear?”
Surely, with 200 people in the room, at least 50 would know.
No one spoke.
He waited. The discomfort grew more acute. He spread his feet and put his hands behind his back. He appeared willing to stand there all day. He raised his eyebrows. Waiting.
Then he looked over to me, surprised to see a response from the row of dark suits. I felt his eyes bore into mine. It was only the second time he registered my being in this world; the first was when I was born. This time, I only had to raise my hand.
“Yes?” he said. “Tell us, please, what treatment in an emergency is administered by ear?”
All eyes were on me. I was in no hurry. None at all.
Thomas Stone probably never had a day of discomfort over Shiva, or over me. How unjust it was that his reward for his failings, for his selfishness, should be to command the respect, the awe, and the admiration of the people in this room. Surely you couldn’t be a good doctor and a terrible human being—surely the laws of man, if not of God, didn’t allow it.
I met his gaze and did not blink. “Words of comfort,” I said to my father.
The intervening years lay compressed between us as if by bookends. The others in the room looked from my face to his, distressed, uncertain if mine was the right answer. But no one else existed for me, or for him.
“Thank you,” he said, his voice altered. “Words of comfort.”
He left the room, but looked back at me once when he reached the door.
Adapted from Cutting for Stone. Copyright © 2009 by Abraham Verghese.