Cutting for Stone

would have told her what it was. She knew. By that point neither salvarsan nor even penicillin, had it been available, would have been of any use.

WHEN THOMAS STONE BOUGHT his own cadaver in his final year of medical school, it was unheard-of, but did not surprise anyone. He was planning a second complete dissection, searching for mastery of the human body.

“Is Stone around?” was a common question in the casualty room, because he was the medical student who was more constant than Hogan or the other porters, always willing to stitch up a laceration, or pass a stomach tube, or run to the blood bank. He was the happiest of students when asked to scrub in and hold a retractor during emergency surgery.

One night, Dr. Braithwaite, Senior Consultant Surgeon and Chief Examiner for the Royal College of Surgeons, came in to see a patient with a high stab wound to the abdomen. Braithwaite was a legend for having pioneered a new operation for esophageal cancer, a notoriously difficult condition to cure. The patient, already inebriated, was terrified, abusive, and combative. Braithwaite, a compact man with silver hair, wore a blue three-piece suit that was the same shade as his blue eyes; he dismissed the porters restraining the patient and he put his hand gently on the man's shoulder and said, “Don't worry. It is going to be all right.” He kept his hand there, and the patient, staring at the elegant doctor, quieted down and stayed that way during the brief interview. Then Braithwaite examined him quickly and efficiently. When he was done, Braithwaite addressed his patient as if he were a peer, someone he might see later in the day at his club. “I'm glad to tell you that the knife spared your big blood vessels. I am confident you are going to do very well, so I want you not to worry. I'll operate, to repair whatever is cut or torn. We are going to take you to the operating theater now. Everything is going to be fine.” The docile patient extended a grubby hand of thanks.

When they were out of earshot of the patient, Braithwaite asked the entourage of registrars and house- officers, “What treatment is offered by ear in an emergency?”

This was an old saw, particularly in Edinburgh. Still, the old saws were not well known anymore, a matter that distressed Braithwaite greatly. He saw it as emblematic of a slackness in the new generation of trainees, and it was sad that only one person knew the answer. And that too a medical student, of all people.

“Words of comfort, sir.”

“Very good. You can come and assist me in surgery if you like, Mr. …”

“Stone, sir. Thomas Stone.”

During the surgery Braithwaite found Thomas knew how to stay out of the way. When Braithwaite asked him to cut a ligature, Stone slid his scissors down to the knot and then turned the scissors at a forty-five-degree angle and cut, so there was no danger to the knot. Indeed, Stone so clearly understood his role that when the senior registrar showed up to assist, Braithwaite waved him off.

Braithwaite pointed to a vein coursing over the pylorus. He asked Thomas what it was.

“The pyloric vein of Mayo, sir …,” Thomas said, and appeared about to add something. Braithwaite waited, but Thomas was done.

“Yes, that's what it's called, though I think that vein was there long before Mayo spotted it, don't you think? Why do you think he took the trouble to name it?”

“I believe it was as a useful landmark to identify the prepyloric from the pyloric area when operating on an infant with pyloric stenosis.”

“That's right,” Braithwaite said. “They should really call it the pre -pyloric vein.”

“That would be better, sir. Because the right gastric vein is also referred to in some books as the ‘pyloric vein.’ Which is very confusing.”

“Indeed, it is, Stone,” Braithwaite said, surprised that this student had picked up on something that even surgeons with a special interest in the stomach might not know. “If we have to give it an eponym, maybe call it the vein of Mayo if we must, or even the vein of Laterjet, which seems to me much the same thing. Just don't call it pyloric.”

Braithwaite's questions became more difficult, but he found the young man's knowledge of surgical anatomy to be shockingly good.

He let Thomas close the skin, and he was gratified to see him use both hands and take his time. There was room for improvement, but this was clearly a student who'd spent many waking hours tying knots one-handed and two-handed. Stone had the good sense to stick to a two-handed knot, tied well and with care, rather than showing off to Braithwaite with one-handed knots.

The next morning, when Braithwaite returned, he found Stone asleep in a chair at the bedside in the recovery room, having kept an all-night vigil on the patient. He did not wake him.

At year's end, after passing his final exams, when Thomas was appointed to the coveted position of Braithwaite's house officer, Shawn Grogan, a bright and well-connected medical student, found the courage to ask Braithwaite what he might have done to be selected instead of Stone.

“It's quite simple, Grogan,” Braithwaite said. “All you have to do is know your anatomy inside out, never leave the hospital, and prefer surgery over sleep, women, and grog.” Grogan became a pathologist, famous as a teacher in his own right, and famous for his extraordinary girth.

During the war, Thomas was commissioned. He traveled with Braith waite to a field hospital in Europe. In 1946, he returned to Scotland, became a junior registrar, then a senior registrar. He'd skipped a real childhood and gone directly to doctorhood.

Ross came to Scotland on a rare visit. He told Thomas how proud he was of him. “You're my consolation for never having married. That wasn't by choice, by the way—not being married. ‘Perfection of the life or of the work’—I could only do the one. I hope you don't make that mistake.”

Ross planned to retire near the sanatorium, to play rummy at the Ooty Club every night, to catch up on a lifetime of reading, and to learn to play golf with the retired officers who lived there. But just as he did, a cancer made itself known in Ross's good lung. Thomas returned to India at once. He stayed with Ross for the next six months, during which time the cancer spread to his brain. Ross died peacefully, Thomas at his side, the faithful Muthu, old and gray, on the other side, with the many nurses and attenders who had worked with Ross holding vigil.

The funeral brought Europeans and Indians from as far away as Bombay and Calcutta to pay tribute. Ross was buried in the same cemetery where many of his patients rested. “They are heroes, one and all, all those who sleep in this cemetery,” said the Reverend Duncan at the graveside service. “But no greater hero, and no humbler a man, and no better servant of God is buried here than George Edwin Ross.”

THOMAS TOOK AN APPOINTMENT as a consultant surgeon in the Government General Hospital, Madras. But after independence in 1947, things were not the same. Indians now ran the Indian Medical Service, and they were not excited by Englishmen who wanted to stay on, though many did. Thomas knew he had to leave; if it had ever been his land, it no longer was. And that was how, in response to a notice from Matron in the Lancet, he made his voyage on the Calangute to Aden. It was on that ship that Sister Mary Joseph Praise literally fell into his arms and entered his life.

Thomas Stone believed there existed within him the seeds for harshness, for betrayal, for selfishness, and for violence—after all, he was his father's son. He believed the only virtues passed down to him were the virtues of his profession, and they came through books and by apprenticeship. The only suffering that interested him was that of the flesh. For the heartache and the grief of his own loss, he had found the cure and he'd found it by himself. Ross had it wrong, or so Thomas thought: perfection of the life came from perfection of the work. Thomas stumbled on an address by Sir William Osler to graduating medical students in which the man articulated this very thesis:

The master-word is Work, a little one, as I have said, but fraught with momentous sequences if you can but write it on the tablets of your hearts, and bind it upon your foreheads.

“The master-word is Work.” Stone bound it to his forehead. He wrote it on the tablet of his heart. He woke to it and fought sleep for it. Work was his meat, his drink, his wife, his child, his politics, his religion. He thought work was his salvation, until the day he found himself seated in Our Lady of Perpetual Succour, in the room of a child he had abandoned; only then did he admit to his son how completely work had failed him.