Cutting for Stone

precious, and I cannot express to her sufficiently my gratitude and admiration. Thanks also to Ed Salztein, Jack Peacock, Stuart Levitz, and Franz Theard. I met Thomas Starzl when I was a Chief Resident in Tennessee and have since renewed the acquaintance. He is truly a surgeon's surgeon, and his pioneering work establishing the field of liver transplantation is no fiction; I refer to him in the book in tribute. Thomas Stone is his fictional contemporary. Francisco Cigarroa, president of the University of Texas Health Science Center, San Antonio, was kind enough to let me watch as he performed a liver transplant on a child. The remarkable group in San Antonio, led by Glenn Halff, who make liver transplant appear almost routine, are part of Starzl's legacy—until very recently, it was fair to say that every liver transplant surgeon in the world was trained by Starzl or by someone who trained with Starzl.

“Birth, and copulation, and death / That's all the facts when you come to brass tacks: I've been born, and once is enough” is a partial quote form T. S. Eliot's Sweeney Agonistes.

“Indeed to think of life as tragic is a posture of delusion, for life is uniformly worse than tragic” is a line from Heinrich Zimmer's The King and the Corpse, edited by Joseph Campbell, as is “Not only our actions but also our omissions become our destiny.”

“They saw in the plague a sure and God-sent means of winning eternal life” is from Camus’ The Plague.

I am greatly indebted to the late Ryszard Kapuscinski's take on a city and a country which I thought I knew well. Details of the Emperor's court, the palace, the funding of the health departments, the Amhara character, the motorcycle escort, the Minister of the Pen, and the palace intrigues were things most residents knew about and had in some cases seen firsthand, but Kapuscinski's particular talent was, as an outsider, making those things more visible to us, which he did in his extraordinary book The Emperor.

“The crookedness of the serpent is still straight enough to slide through the snake hole” is paraphrased from one of the Bhakti poems in Speaking of Siva, edited by the late, great A. K. Ramanujam.

For information about the Carmelites I thank Fred de Sam Lazaro and Eliam Rao and the incomparable Sister Maude. There is no convent of Carmelites to my knowledge in Egmore.

The details of the the Rock of East Africa, AFRS Asmara, are from http://www.kagnewstation.com/.

For the scenes of the escape from Asmara, I thank Naynesh Kamani, who was my senior in medical school and who made that heroic walk; he read the manuscript and had many corrections and suggestions. I was greatly influenced by Thomas Kennealy's wonderful novel To Asmara, with its observations about the Eritrean guerrilla camps which Kennealy appeared to have visited; he remains a champion of the Eritrean people. I should state that my affection is equal for both Ethiopia and Eritrea, and I have dear friends in both places.

“As if I had given him the greatest gift a man could ever give another” is a paraphrase of a line in Raymond Carver's “What the Doctor Said,” from New Path to the Waterfall.

For the scenes at the tuberculosis sanatorium, I am indebted to Jean Mason's “The Discourse of Disease: Patient Writing at the ‘University of Tuberculosis,’ “ which I was fortunate to hear at the Psychoanalysis and Narrative Medicine Conference, University of Florida, Gainesville, in 2002.

“May no English nobleman venture out of this world without a Scottish Physician, as I am sure there are none who venture in” was said to be a toast used by William Hunter, M.D., the elder of the Hunter brothers. I have paraphrased this as a toast that B. C. Gandhi uses.

“Call no man happy until he dies” is what the Athenian Solon tells Croesus, the wealthy king of Lydia, according to Herodotus. These are words that Sir William Osler quoted on hearing the news of his beloved son Revere's death at Flanders. The imagined nursing textbook that describes Sound Nursing Sense is a recasting of one of Osler's aphorisms.

For the information on psychosomatic ailments among Ethiopians, I am grateful to my friend Rick Hodes, M.D., internist, writer, and mensch. His life in Ethiopia is a story of its own. Thanks to Thomas “Appu” Oommen for his incredible recollections of his time in Addis as a schoolboy and later as a journalist, and of the period of the coup. An e-mail Appu shared with me from Yohannes Kifle gave me great insight into Kerchele. My parents, George and Mariam Verghese, shared their memories, and my mother made extensive notes just for my use. To them I have dedicated this book.

In the course of writing this novel over several years, I consulted many other works, most of which I hope are listed in the bibliography, and any failure to acknowledge a person or source is something I would like to correct. The scene of Genet's damp gift to Marion was inspired by a similar scene from a novel or short story whose authorship I cannot recall; similarly, the metaphor of Aden as a city at once dead yet alive like maggots on a corpse (or words to that effect) is one that I would love to attribute to a source.

I am grateful to the extraordinary Advisory Board in San Antonio that allowed us to build a Center for Medical Humanities, but even more grateful for the personal friendships I formed with its members. Steve Wartman, my tennis partner and friend, recruited me to San Antonio when he was dean. Edith McAllister was my teacher, my coach, my inspiration, and the person who understood better than anyone the need I had for protected time, even if it meant my leaving; in my next life my ambition is to come back as her. For Marvin and Ellie Forland and for Judy McCarter, words cannot do justice to the support and love they gave me; to hold a distinguished professorship named after Marvin, and a distinguished chair named after Joaquin Cigarroa Jr. (both consummate internists), was the greatest honor. Judy remains my counselor and conscience; with every passing year I grow in admiration of her wisdom. Thanks to UTHSCA, to the extended Cigar roa family, Bill Henrich, Robert Clark, Jan Patterson, Ray Faber, Tom Mayes, Somayaji Rama-murthy Deborah Kaercher, the late David Sherman, and so many others who made it a special place to work; so also to Texas Tech, El Paso, where this work first began. Dr. Erika Brady of Western Kentucky University's folk studies department was an expert in matters ranging from Alpha Omega Alpha to Religio Medici to details about prayers and dress; I could always rely on her research. Michele Stanush also helped me with research, and I am most grateful.

My Wednesday-morning brothers (Randy Townsend, Baker Duncan, Olivier Nadal, Drew Cauthorn, Guy Bodine, and especially Jack Willome) and their wives (and especially you, Dee!) gave me love and faith and held me accountable. “No greater love …”

Tom Rozanski, neighbor, colleague, and urologist, gave me advice on the vasectomy scene as well as other surgical issues, for which I am most grateful. Rajender Reddy and Gabe Garcia helped me think through issues related to hepatitis B.

Anand and Madhu Karnad, my dearest and oldest friends, read and heard many sections of this and all my previous books over the years; they gave and continue to give me love and sustenance, and I know I have a home wherever they are.

I am grateful to John Irving for his friendship all these years. I have learned so much from him both in our correspondence and in his published work.

Ralph Horwitz, M.D., chairman of medicine at Stanford, created a home for me; I am so grateful for his vision and his and Sally's friendship. I thank my brother, George, and his wife, Ann, and the Kailaths, as well as Helen Bing, for introducing me to Stanford's charms years before I dreamed of coming here.

My lovely wife, Sylvia, spent hours entering the changes that I would write on the manuscript and did this several times over the years. She more than anyone, but also Tristan, Jacob, and Steven, put up with my absences from society and sustained me through the ups and downs in the writing of this book. Gracias mi amor; con los anos que me quedan …

Mary Evans, my agent, sold my first story to The New Yorker before we met in person, and she has kept the faith with me since those days in Iowa in 1991. Her discerning eye and wise counsel have made a writer of me, and her friendship has made me a better person. Robin Desser had a hand in my first book, and it was a privilege to get to work with her on this one. Robin saw this book through its many iterations and spent innumerable hours with it and with me, and I am so indebted to her. I have often thought that the grace, passion, humility, and extraordinary skill she brings to her craft are attributes she shares with the physicians I most admire. My thanks also to Sarah Rothbard, Robin's wonderful assistant. I am most grateful to Sonny Mehta for his enthusiasm for this story and his steadfast support of my writing.

Medicine is a demanding mistress, yet she is faithful, generous, and true. She gives me the privilege of seeing patients and of teaching students at the bedside, and thereby she gives meaning to everything I do. Like Ghosh, every year, at commencement, I renew my vows with her: I swear by Apollo and Asclepius and Hygieia and Panaceia to be true to her, for she is the source of all … I shall not cut for stone.