Cutting for Stone

Hema's arms.

The bedside table and the ventilator blocked Hema's approach to the near side of the bed. She circled to where Stone stood, her eyes on me.

“He is ‘critically ill’ from what, Thomas?” Hema said, referring to the two words in the telegram that had most frustrated her. Her tone was professional, as if she were asking a colleague about a patient; it allowed her the pretense of being calm when inside she was quaking.

“It's hepatic coma,” Thomas said, responding in the same manner, grateful that she'd elected to converse in the language of disease, a fallback which allowed even their son to be reduced to a diagnosis. “He has a fulminant hepatitis. The ammonia level is very high and the liver hardly functioning.”

“What from?”

“Viral hepatitis. Hepatitis B.”

Stone let down the bed rail and the two of them stood over me. Hema's hand reached behind her for the tail end of her sari, the part that went over her shoulder. She brought it to her mouth.

“He looks anemic, not just icteric,” she managed to say at last, clinging to the idiom of medicine to describe my pallor and jaundice. “What's his hemoglobin?”

“Nine, after four units of blood. He's bleeding from his gut. His platelets are down and he isn't making clotting factors. The biliru-bin is twelve, and his creatinine just today is four, rising from three yesterday …”

“What's this, please?” Shiva said, pointing at my skull. He stood across from Thomas Stone, the bed between them.

“An intracranial pressure monitor. Goes into the ventricle. He has cerebral edema. They're giving him mannitol and adjusting the ventilator settings to keep the pressure down.”

Shiva looked skeptical. “It goes through his skull, through brain into the ventricle just to measure? It does not treat?”

Thomas Stone nodded.

“How did this begin?” Hema asked.

As Thomas Stone recounted the sequence of events, Shiva freed the bedside table and found slack between the bed and ventilator. He let down the bed rail on his side. Moving with the slow efficiency of a contortionist, he slid under the tubes and wires. Deepak entered in time to see Shiva lying on his side next to me, his head touching mine. His being there looked both precarious and entirely natural. All Deepak could do was stare, noting, however, that my intracranial pressure tracing, which had done nothing but go up for three days, went down.

No sooner had Deepak introduced himself than Vinu Mehta, the gastroenterologist, filled the doorway, panting from taking the stairs. Vinu had been an internal medicine resident at Our Lady when I was a surgery resident. After specializing in gastroenterology he'd joined a lucrative practice in Westchester but wasn't happy and had returned to the salaried staff of Our Lady.

“Vinu Mehta, Dr. Madam,” he said, putting his palms together in a namaste before grasping Hema's hand with both of his. “And this must be Shiva,” he said, unfazed at seeing Shiva in my bed. “I know this only because I am certain the other gentleman is Marion.” He turned back to Hema. “What a shock this must be, madam. For everyone here, too. Our whole world is upside down! Marion is one of us.” This sudden switch to the vernacular of feelings made Hema's lips tremble.

One look at Vinu and you knew the stories about him buying groceries for patients he discharged were probably true. Id seen him extend a patient's stay to insulate her from some madness at home. He was the best friend to everyone on the staff and regularly baked cakes and cookies for me. I always sent him a card on Mother's Day, which pleased him no end.

“I was called the minute that Marion was brought here, Dr. Madam,” Vinu went on. “Hepatology, the liver, that is my field. Hepatitis B swims around here. Lots of carriers, intravenous drug addicts and people who acquire it from their mothers at birth—very common in immigrants from the Far East. Madam, we see no end of silent cirrhosis and even liver cancer from this virus. But acute fulminant hepatitis B? In my career I have seen only two other patients quite this severe.”

“Vinu, tell me the truth,” Hema said, taking on a no-nonsense, Mother India tone with this young doctor who was all too ready to play the role of nephew. “Is my son a drinker?”

I suppose it was a fair question. I hadn't seen her in more than seven years. She knew it was in my genes. What did she really know of who or what I had become?

“Madam, categorically no!” Vinu responded. “No, no. A gem of a son you have.”

Hema's stern expression softened.

“Although, madam,” Vinu continued, “in the past few weeks, madam—don't take this wrongly—by the report of his neighbor, Marion had been troubled and drinking.”

Deepak had found a new prescription in my house for isoniazid, a drug used to prevent tuberculosis. Isoniazid was also famous for causing severe liver inflammation. It was routine to check liver enzymes two weeks after starting treatment so the drug could be discontinued if there was any sign of liver damage.

“My hypothesis, madam, is that Marion-bhaiya started isoniazid on his own. The prescription is a month old. He probably didn't get his blood drawn to check liver functions the way he was supposed to. He is a surgeon after all, poor fellow. What does he know about these fine matters? If he'd only consulted me! I would have been honored to take care of him. After all, Marion-bhaiya took care of my hernia so lovingly.

“In any case, madam, I personally went to Manhattan, to Mount Sinai, and I chauffeured over the world's best liver man, the man who trained me in this specialty. I said, ‘Professor, this is a not a case of hepatitis, but a case of my own brother.’ He is in agreement that the alcohol and the isoniazid might be contributory, but there is no doubt that what we are dealing with here first and foremost is hepatitis B.”

“What is the prognosis?” Hema said. “Will someone tell me that?” It was the most basic thing a mother wanted to know. “Will he get better?”

Vinu looked to Deepak and Thomas Stone, but neither man was willing to speak. The disease was, after all, Vinu's area of expertise.

“Just tell me. Will he live?” Hema spat out.

“It is undoubtedly very grave,” Vinu said, and the fact that he was fighting back tears told her everything.

“Come on!” Hema said, annoyed by this and turning to Thomas Stone, and then to Deepak. “It's hepatitis. I understand hepatitis. We see the damage it does in Africa. But … here, America! In this wealthy place, this rich hospital”—she swept her hands at all the machinery— “surely here in America you can do more for hepatitis than to wring your hands and say it is very grave.“

They must have winced when she said “rich.” Compared with the state-of-the-art ICUs in the money hospitals, such as Thomas Stone's institution in Boston, ours was bare-bones.

“We tried everything, madam,” Deepak said now in a more subdued tone. “Plasma exchange. Whatever anyone in the world can do for this disease, we are doing that here.”

Hema looked skeptical.

“And praying, madam,” Vinu added. “The sisters have a prayer chain going around the clock for two days now. Honestly, we need that kind of a miracle.”

Shiva had quietly followed every word from where he lay.

Hema stood looking down at my unconscious form, stroking my hand and shaking her head.

Vinu convinced the two of them to retire to a room readied for them in the house-staff building; he'd even arranged for a light dinner of cha-patti and dal. Hema was too tired to argue.

THE NEXT MORNING, Hema appeared in an orange sari, looking rested, yet as if she had aged a few years in the course of the night.

Thomas Stone was exactly where she had left him. He looked past her in the doorway, as if expecting Shiva, but Shiva wasn't there.

She stood by my bed again, anxious to see me in daylight. The previous night she'd found it all too unreal, as if it were not me on the bed but some extension of all the noisy machinery which had taken the form of flesh. But now she could see me, see the rise and fall of my chest, the puffiness of my eyes, my lips contorted by the