Picture taken from Amazon.com
picture taken from amazon.com
“He invited me to a world that wasn’t secret, but it was well hidden. You needed a guide. You had to know what to look for, but also HOW to look. You had to exert yourself to see this world. But if you did, if you had that kind of curiosity, if you had an innate interest in the welfare of your fellow human beings, and if you went through that door, a strange thing happened: you left your petty troubles on the threshold. It could be addictive” (264). Abraham Verghese, Cutting for Stone
Marion Praise Stone, the protagonist of Abraham Verghese’s sprawling novel Cutting for Stone, writes the above words in reference to Ghosh, an Indian doctor who practices in Ethiopia. Ghosh not only raised Marion, but also opened the door to his life-long fascination with medicine. These words can also be applied to the effect this novel had on me. Verghese invited me into the well-hidden world of a mission hospital in Addis Ababa, Ethiopia and I became addicted. The same thing happened when I read Jennifer Worth’s Call the Midwives, her memoir of working as a midwife in the East End of London in the late 1950s. (The PBS series of the same name is based on Worth’s memoir.) Reading Verghese and Worth’s narrative accounts of treating the poor transported me happily, if temporarily, to the streets of the East Side of London and Addis Ababa, Ethiopia to witness the everyday miracles of healing ministry.
I have watched doctors, nurses, and other health care professionals heal the sick on “Grey’s Anatomy,” “House,” “ER,” “Doc Martin,” “Scrubs,” “MASH,” and “Nurse Jackie, ” to name just a few. Not once did any of them entice me to enter the medical field, or even to take a particular interest in medicine. Perhaps I read One Flew Over the Cuckoo’s Nest at too early an age and was emotionally scarred by battle-axe Nurse Ratched. Or maybe it was the soap operas of my youth, in which nurses seemed more interested in the doctors than in the patients, while the doctors seemed more interested in their careers and their personal lives. In any case, television and fictional works about doctors and nurses have never particularly interested me. This has more to do with me than with the works. I am simply intellectually and temperamentally unsuited for a career in health care.
For this reason, my obsessive interested in Cutting for Stone and Call the Midwives took me by surprise. I’m not sure, really, why I responded so deeply to these works, but I think it has something to do with the way the heroes and heroines of these works practiced medicine: not as competent yet detached professionals, but as healers following a spiritual calling.
Cutting for Stone is the best-selling novel by Abraham Verghese, an Indian medical doctor who grew up in Ethiopia and now practices medicine in the United States. His novel is about twin sons Marion and Shiva who, like him, are were raised in Ethiopia by Indian parents. (In the case of Marion and Shiva, the people who raised them were not their biological parents.) The novel is about many things, including family bonds, Ethiopian history, and erotic love. However, I think what I found most compelling is Verghese’s portrayal of the characters who work at Missing Hospital in Addis Ababa. (The actual name of the hospital is “Mission,” but the word “mission” “on the Ethiopian tongue came out with a hiss so it sounded like Missing. ) There are few doctors and nurses at Missing Hospital, but they are all fiercely devoted to their calling (as opposed to rising in their careers.) Sister Mary Joseph Praise says this, for example, about Dr. Thomas Stone:
“Stone, risen like Lazarus, then brought his entire being into understanding the fever. . . His fierce passion had been a revelation to her. At the medical college hospital in Madras where she trained as a nurse, the civil surgeons (who at the time were mostly Englishmen) had floated around serene and removed from the patients, with the assistant civil surgeons and junior and senior house surgeons (who were all Indian) trailing behind like ducklings. At times it seemed to her they were so focused on disease that patients and suffering were incidental to their work. Thomas Stone was different.” (37)
In an interview with Meenakshi Kumar in the The Hindu newspaper, Verghese refers to himself as an “old-fashioned” practitioner who practices “bed-side medicine.” From what I can tell, “bed-side medicine” means treating the patient as a whole person, not just a set of organs about which the doctor has special knowledge. We see this “bed-side” attitude in all of the Ethiopian practitioners in Cutting for Stone. However, when the setting moves to the medically advanced United States, it seems that personal attention is less common. In the United States, one distraught mother, for example, complains about the fact that her son died in surgery. She understands that the doctors cannot always save people. What upsets her, though, is the way these doctors treated her son like a body rather than a person. She cries out in distress that, “The fact that people were attentive to his body does not compensate for their ignoring his being” (489).
Although the medical staff at Missing Hospital is a mixed band of expatriates who have no historic roots in Ethiopia, they become deeply, even spiritually, rooted in the community of Addis Ababas and do pioneering medical work for the desperately poor people who live there. The success of this mission hospital is due in large part to the nun who runs the place. Everybody refers to her as “Matron,” even herself, and she allowed herself at one point to feel pride at “the resourcefulness she’d discovered that allowed her to make a cozy hospital—an East African Eden, as she thought of it—grow out of disorganized jumble of rudimentary buildings; and the core group of doctors whom she’d recruited and who by long association had evolved into her Cherished Own.” (117) Matron and her staff work tirelessly to relieve the suffering of the poor. As Matron explains it to an American donor who disapproves of the Ethiopian version of Christianity: “God will judge us, Mr. Harris . . . by what we did to relieve the suffering of our fellow human beings. I don’t think God cares what doctrine we embrace.” (187)
The order of nuns described in Call the Midwives was equally resourceful in bringing much-needed care to a community of the poor. We learn from Jennifer Worth that up through the nineteenth century, most poor women in England could not afford a doctor to delivery their babies. Furthermore, no woman had any specialist obstetric care during pregnancy because such a field did not exist. She explains that “The first time a woman would see a doctor or midwife was when she went into labour. Therefore, death and disaster, either for mother or child, or both, were commonplace. Such tragedies were looked upon as the will of God, whereas, in fact, they were the inevitable result of neglect and ignorance” (82).
Women before the 20th century relied on untrained “handywomen” to deliver their babies and suffered a maternal mortality rate of around 35-40 percent. The Midwives of St. Raymund Nonnatus started to change this by advocating legislation that required proper training and control of the work of midwives. After a long struggle, the first Midwives Act was passed in 1902 and the Royal College of Midwives was born. The St. Raymund midwives worked in the slums of London among the poorest of the poor and were for a long time the only reliable midwives working there. Worth notes that
they labored tirelessly through epidemics of cholera, typhoid, polio and tuberculosis. In the early twentieth century, they worked through two world wars. In the 1940s, they remained in London and endured the Blitz with its intensive bombing of the docks. They delivered babies in air-raid shelters, dugouts, church crypts and underground stations. This was the tireless, selfless work to which they had pledged their lives, and they were known, respected and admired throughout the Docklands by the people who lived there. Everyone spoke of them with sincere love. (19)
Both Cutting for Stone and Call the Midwives depict healers who dedicate their lives to making others feel better. This is not to suggest, however, that the portraits of working with the suffering poor are all saccharine sweet. Far from it. Along with the many scenes of mothers who are thrilled to have delivered a healthy baby come stories of death and other types of trauma. Not only do the practitioners and readers have to deal with trauma, but we are also exposed to simple disgust at human bodies and behaviors. Worth devotes a significant amount of print to detail the revulsion she often felt, especially at first—not only to the women’s bodies, but sometimes to the women themselves.
“What really got me, I think, was the sheer concentration of unwashed female flesh, the pulsating warmth and humidity, the endless chatter, and above all the smell. However much I bathed and changed afterwards, it was always a couple of days before I could get rid of the nauseating smells of vaginal discharge, urine, stale sweat, unwashed clothes. It all mingled into a hot, clinging vapour that penetrated my clothes, hair, skin—everything.” (71)
Worth also confesses to feeling occasional contempt for the “slatterns” and abusive mothers she meets. She also learns to overcome this contempt and to develop a profound respect for the toughness of the women with whom she works.
In the end, I think what draws me most to these works are the characters—the nuns, midwives, doctors and nurses–themselves. They seem to be touched by a radiant quality that transcends mere competence. I suspect is it no coincidence that both works center around health care run by nuns. The quality that stands out from these books is ultimately a spiritual one. Jennifer Worth noticed this quality of the nuns she worked with. She noticed how happy and relaxed she felt around Sister Julienne in particular:
“The impact Sister Julienne made upon me—and, I discovered, most people—was out of all proportion to her words or her appearance. She was not imposing or commanding, nor arresting in any way. She was not even particularly clever. But something radiated from her and, ponder as I might, I could not understand it. It did not occur to me at that time that her radiance had a spiritual dimension, owing nothing to the values of the temporal world.”
Verghese also weaves into his novel the interrelatedness of the material world and the spiritual world in his works. “I felt a great peace, a sense that coming to this spot had completed the circuit, and now a blocked current would flow and I could rest. If “ecstasy” meant the sudden intrusion of the sacred into the ordinary, then it had just happened to me” (602).
I suspect it is the spiritual dimension of these works is, at least in part, what drew me into them so deeply. I am grateful to Veghese and Worth for serving me as a guide–however briefly–to this world and teaching me “how to look” differently at the world of medicine.
[The interview with Meenakshi Kumar cited above can be found here: http://www.thehindu.com/opinion/interview/fiction-as-a-truthtelling-device/article5456677.ece ]