Cutting for Stone

turned inward. But gradually, the valley, the scent of laurel, the vivid green colors, the gentle breeze, the way light fell on the far slope, the gash left by the stream, and above all this the sweep of sky with clouds pushed to one side—it had its effect on her. For the first time since Sister Mary Joseph Praise's death, Matron felt a sense of peace, a sense of certainty where there had been none. She was certain that this was the spot—this was where the long voyage of Sister Mary Joseph Praise would end. She remembered, too, how in her first days in Addis, when things had looked so bleak, so terrifying, so tragic with Melly's death—it was at those moments that God's grace came, and that God's plan was revealed, though it was revealed in His time. “I can't see it Lord, but I know You can,” she said.

13. Praise in the Arms of Jesus

THE BAREFOOT COOLIES were jovial men. Told by Ghosh what their task would be, they made clucking sounds of condolence. The big fellow with the prognathic jaw shed his fraying coat; his shorter companion pulled off his tattered sweater. They spat on their palms, hefted the pickaxes, and set to it; happened-had- happened and be-will-be as far as they were concerned, and though it was a grave they were digging, it guaranteed the night's bottle of tej or talla and perhaps a bed and a willing woman. Sweat oiled their shoulders and foreheads and dampened their patchwork shirts.

The sky had started off bluffing, convoys of gray clouds scurrying across like sheep to market. But by afternoon a perfect blue canopy stretched from horizon to horizon.

GHOSH, SUMMONED to the casualty room by Matron, spotted a lean and very pale white man waiting by a pillar. Ghosh kept his head down, certain this was Eli Harris, and thankful that the man's back was to him.

Inside, Adam pointed to a curtain. Ghosh heard regular grunting, coming with each breath and in the rhythm of a locomotive. He found four Ethiopian men standing there, three in sports coats and one in a burly jacket. They were gathered around the stretcher, as if in prayer. All four had spit-shined brown shoes. As they squeezed out to make room for Ghosh, he glimpsed a burgundy holster under a coat.

“Doctor,” the man lying on the table said, offering his hand and trying to rise, but wincing with the effort. “Mebratu is my name. Thank you for seeing me.” He was in his thirties, his English excellent. A thin mustache arched over a strong mouth. Pain had given him a peaked expression, but it was nevertheless an extraordinary, handsome face, the broken nose adding to its character. He looked familiar, but Ghosh couldn't place him. Unlike his companions, he seemed stoic, not fearful, even though he was the one in pain.

“I tell you, I have never hurt like this.” He grinned from ear to ear as if to say, A man is going along when out of the blue comes a banana peel, a cosmic joke that leaves you upended and clutching your belly. A wave of pain made him wince.

I can't possibly see you today. Beloved Sister has died and any minute I expect someone to tell me they have found Dr. Thomas Stone's body. For God's sake go to the military hospital. That was what Ghosh wanted to say, but in the face of such suffering he waited.

Ghosh took the proffered hand and while supporting it he felt for the radial artery. The pulse was bounding at one hundred and twelve per minute. Ghosh's equivalent of perfect pitch was to be able to tell the heart rate without a watch.

“When did this start?” he heard himself say, taking in the swollen abdomen that was so incongruent on this lean, muscled man. “Begin at the beginning …”

“Yesterday morning. I was trying to … move my bowels.” The patient looked embarrassed. “And suddenly I had pain here.” He pointed to his lower abdomen.

“While you were still sitting on the toilet?”

“Squatting, yes. Within seconds I could feel swelling … and tightening. It came on like a bolt of lightning.”

The assonance caught Ghosh's ear. In his mind's eye he could see Sir Zachary Cope's little book, The Diagnosis of the Acute Abdomen in Rhyme. He'd found that treasure on the dusty shelf of a secondhand bookstore in Madras. The book was a revelation. Who knew that a medical text could be full of cartoon illustrations, be so playful, and yet provide serious instruction? Cope's lines regarding sudden blockage of the normal passage through the intestine came to him:

… rapid onset of distention

Will certainly attract your keen attention.

He asked the next question, even though he knew the answer. There were times like this when the diagnosis was written on the patient's forehead. Or else they gave it away in their first sentence. Or it was announced by an odor before one even saw the patient.

“Yesterday morning,” Mebratu replied. “Just before the pain began. Since then no stool, no gas, no nothing.”

Sometimes a bowel-coil gets out of place

By twisting round upon a narrow base …

“And how many enemas did you try?”

Mebratu let out a short sharp laugh. “You knew, huh? Two. But they did nothing.”

He wasn't just constipated but obstipated—not even gas could pass. The bowel was completely obstructed.

Outside the cubicle the men seemed to be arguing.

Mebratu's tongue was dry, brown, and furred. He was dehydrated, but not anemic. Ghosh exposed the grotesquely distended abdomen. The belly didn't push out when Mebratu took a breath. In fact it moved hardly at all. This is my work, Ghosh thought to himself as he pulled out his stethoscope. This is my grave-digging equivalent. Day in and day out. Bellies, chests, flesh.

In place of the normal gurgling bowel sounds, what he heard with his stethoscope was a cascade of high- pitched notes, like water dripping onto a zinc plate. In the background he heard the steady drum of the heartbeat. Astonishing how well fluid-filled loops of bowel transmitted heart sounds. It was an observation he'd never seen in a textbook.

“You have a volvulus,” Ghosh said, pulling his stethoscope off his ears. His voice came from a distance, and it didn't sound like it belonged to him. “A loop of the large bowel, the colon, twists on itself like this—” He used the tubing of his stethoscope to demonstrate first the formation of a loop, then the twist forming at the base. “It's common here. Ethiopians have long and mobile colons. That and something about the diet predisposes to volvulus, we think.”

Mebratu tried to reconcile his symptoms with Ghosh's explanation. His mouth turned up; he was laughing.

“You knew what I had as soon as I told you, right, Doctor? Before you did all these … other things.”

“I suppose I did.”

“So … will this twist untwist by itself?”

“No. It has to be untwisted. Surgically.”

“It's common, you say. My countrymen who get this … what happens to them?”

At that moment, Ghosh connected the face with a scene he wished he could forget.

“Without surgery? They die. You see, the blood supply at the base of the loop of bowel is also twisted off. It's doubly dangerous. There's no blood going in or out. The bowel will turn gangrenous.”

“Look, Doctor. This is a terrible time for this to happen.”

“Yes, it is a terrible time,” Ghosh burst out, startling Mebratu. “Why here, if I may ask? Why Missing? Why not the military hospital?”

“What else have you understood about me?”

“I know you're an officer.”

“Those clowns,” he said, nodding his chin in the direction of his friends outside. “We don't do a good job of