Cutting for Stone

on his experience or his careful interpretation of the experience of others. Readers pictured him as a revolutionary, but one who operated on the poor instead of preaching land reform. Students wrote him adoring letters, and when his dutiful responses (penned by Sister Mary Joseph Praise) didn't match the gushy, confessional tone of their letters, they pouted.

The illustrations in the textbook (all drawn and lettered by Sister Mary Joseph Praise) had a simple quality as if done on a napkin; no attempt was made at getting proportion or perspective right, but they were models of clarity. The book was translated into Portuguese, Spanish, and French.

Daring operations performed in darkest Africa—that was how the publisher had described the book on the back cover. The reader, knowing nothing about the “dark continent,” filled in the blanks, pictured Stone in a tent, a kerosene lamp held up by a Hottentot providing the only light, elephants stampeding outside while the good doctor recited Cicero and excised a part of himself as blithely as if he were cutting for stone on the body of another. What neither the reader nor Stone would accept was that his self-amputation was as much an act of conceit as it was an act of heroism.

“YOUR PATIENT, Dr. Stone,” Matron said for the third time.

Stone took the spot between Sister Mary Joseph Praise's legs that Matron vacated, though, after all that, Matron seemed reluctant to let him by, as if she didn't want him to sit there any more than he wanted to sit. It wasn't a vantage point that he was accustomed to, at least not often with a woman. With men, he sat there to repair a watering-can scrotum, and in both sexes he might be seated to drain rectal abscesses, or to ligate and excise hemorrhoids or fistula-in-ano. But otherwise, he was a surgeon who was rarely seated.

When Stone clumsily parted the labia, blood poured out. He adjusted the gooseneck lamp and then his own neck to sight up the birth canal.

He tried to remember the citrus rule from his student days. What was it? Lime, lemon, orange, and grapefruit corresponded to four, six, eight, and ten centimeters of dilation of the cervix. Or was it two, four, six, and eight? And was there a grape or plum involved?

What he saw made him turn pale: the cervix was past grapefruit, on its way to melon. And there, as if at the bottom of a bloody well, was a baby's head, the tissues around it flattened. The fine wet black hair on the skull reflected the theater lights.

At that moment it was as if someone who'd lain dormant within Stone took over.

If there was a connection between him and the poor infant within, it was something that Stone didn't see. Instead, the sight of that skull agitated him. Fear was driven out by anger, and anger had its own perverted reasoning: What cheek this invader had to put Mary's life in jeopardy! It was as if he'd spotted the corpse of a burrowing mole that had attacked Mary's body, and the only way he could bring her relief was to extract it. The sight of that bright scalp wrought no tenderness from Thomas Stone, only revulsion. And it gave him an idea.

“Find the enemy and win the firefight” was a saying of his.

He had found the enemy.

“ Flatus, Fluid, Feces, Foreign Body, and Fetus feel better out than in,” he said aloud, as if he'd just invented the phrase. In his book he had called it the Five-F rule. He drove himself to his terrible decision. Far better, he decided, to drill a hole in the skull of the mole—he'd already stopped thinking of it as a baby—than to experiment on Sister Mary Joseph Praise by doing a Cesarean, an operation that was both unfamiliar and one that he feared would kill her in her fragile state. The enemy was more a foreign body, a cancer, than it was a fetus. No doubt the creature was dead. Yes, he would tap that skull, empty its contents, crush it just as if he were crushing a bladder stone, and then he'd pull out the deflated head which was the part that was hung up in the pelvis. If need be, he'd use scissors on its collarbones, scalpel on ribs; he would grab, slash, slit, and smash whatever fetal part obstructed delivery, because only by getting it out could Mary be out of her misery and the bleeding cease. Yes, yes—better out than in.

Within the boundaries of his irrational logic, this was a rational decision. Doing the wrong thing to do the right thing, as Sister Mary Joseph Praise might have said.

To a shocked and horrified Matron, the man who sat between Sister Mary Joseph Praise's legs didn't resemble their fierce, shy, and exceedingly competent Thomas Stone. This man had nothing in common with Thomas Stone, FRCS, author of The Expedient Operator. His place had been taken by this desperate, agitated fellow who did not look like a Fellow of the Royal College of Surgeons, but rather someone for whom the letters FRCS could mean (as Dr. Ghosh often claimed they did) “Farting Round the Country-Side.”

Stone, animated now, consumed by a sense of mission, propped Munro Kerr's Operative Obstetrics open, cookery-book fashion, on the down slope of Sister Mary Joseph Praise's protuberant belly. “Damn it, Hemlatha, you picked a hell of a time to be away,” he said aloud, feeling his courage return.

Two blasphemies, Matron noted. “Custody of the tongue,” she murmured under her breath. She took her own pulse because despite her faith in the Lord she was anxious about the heart flutter that had turned up in the last year like a surprise guest. Her heart was skipping beats now and she felt faint.

The strange instruments that Stone had requested and that Matron dug up from an old supply closet refused to be tamed by his hands. “Where the devil is Ghosh?” he shouted, because Ghosh often pitched in to help Hema with abortions and tubal ligations, and, as a jack-of-all-trades, he had more experience with a women's reproductive anatomy than Stone. Matron once again sent a runner over to Ghosh's bungalow, more to placate Stone than with any faith that Ghosh was back. Perhaps she would have done better to send the maid to inquire at the Blue Nile Bar or its vicinity for the banya doctor. But even an inebriated Ghosh could counsel Stone that what he was about to do was not the act of an expedient surgeon but an idiotic one, and that his decision was wrong, his logic illogical. Matron felt this pregnancy, this birth, was somehow her fault—some inattention on her part had resulted in this. Still, she also assumed in the face of torrential bleeding that the child was long dead. Had she believed for a moment that the child was alive (she knew nothing about twins), she would have intervened.

Stone cocked his head from side to side, trying to match Munro Kerr's illustrations of instruments—Smellie scissors, Braun's cranioclast, Jar-dine's cephalotribe—with the objects he juggled in his hand. His tools were distant cousins of the ones depicted in the book, but clearly designed for the same sinister purpose.

With two Jacobs clamps, he grabbed the oval of my brother's scalp. “I see you in the depths, burrowing creature! Damn you for torturing Mary,” he muttered. Then, using scissors, he cut the skin between the two clamps and gave the intruder its first introduction to pain.

His next move was to try to put the cephalotribe—the skull crusher— on the head. This awkward medieval instrument had three separate pieces. The middle was a spear meant to go deep into the brain, cutting a big opening in the skull as it did so. Flanking it were two forcepslike structures to clamp to the outside of the skull. Once all three pieces were in place, their stems interlocked to form a single handle with convenient finger indentations. Stone would be able to crush and grip the skull so it wouldn't slide away. Out would come the intruder.

It was cool in the operating theater, but sweat from his brow trickled into his eyes and wet his mask.

He tried to drive the spear in.

(The child, my brother, Shiva, sheltered for eight months and already hurting from the cut of scissors on his scalp, cried out in the womb. I pulled him to safety as the spear slid over the skull.)

Stone decided it would be easier if he first applied the outer two blades of the cephalotribe, then dragged the head within reach, and then inserted the spear. His hands were clumsy in this awkward space. Matron shuddered at the damage he might be doing to Sister Mary Joseph Praise's tissues and to the baby as he jammed each piece past an ear until, finally, he had the skull in his grasp, or thought he did.

Matron was close to dropping. “It is the duty of the nurse to assist and anticipate the doctor's every need.” Wasn't this what she herself preached to her probationers? But it was all wrong, all wrong, and she didn't know how to begin to turn it around. She was sorry she ever dug out the instruments. A humane obstetrician invented these instruments for mothers with the most desperate needs, not for desperate physicians. A fool with a tool is