the developing human

Love in the Time of Cholera - Review

Love in the Time of Cholera (dir. Mike Newell)

I read the book about three years ago and had mixed feelings about its plot, prose, and overall purpose, but I still found it to be a pretty thought-provoking read. I had heard the film adaptation was pretty awful, but I randomly found myself in the possession of the soundtrack (composed by Antonio Pinto) and was struck by how amazing it was. I figured I should eventually give the movie a watch just to see how the gorgeous soundtrack played out onscreen.

The story revolves around an obsessive lover named Florentino Ariza (played decently by Javier Bardem) and his passion, Fermina Daza (the dazzling Giovanni Mezzogiorno - can a name get more Italian?). The triangle is completed by Dr. Juvenal Urbino, portrayed perfectly by the uber-suave Benjamin Bratt, who marries Daza soon after she spurns Ariza. The film opens with Dr. Urbino’s death, and its first act concludes with a 70-year-old Ariza showing up at Daza’s doorstep, proclaiming that he has loved her endlessly for 54 years. We then go back and see how their relationship began, evolved, and ended, and trace his ongoing obsession with her throughout the years even during her marriage to Dr. Urbino.

One of the main problems I had with the novel was the fact that it asked us to buy into Florentino Ariza as its protagonist, even though he was easily the most unlikeable character of all. Unfortunately, the film renders him just as slimy, creepy, and bland as he is on page. He’s just as madly in love with the concept of love itself as any woman, and unfortunately that translates to frequent, banal platitudes on the glories of romantic emotion. Painful examples:

“Love is the only thing that interests me.”

“Please, I need love!”

“I will now give you a lesson. In love.”

Blech. It’s nauseating, and the end result is that his character seems like a parody of the idea of love instead of a celebration as he was probably intended to represent. I could never tell if Marquez wrote these lines in the novel to be intentionally groan-inducing, or if he was presenting a deeper commentary on the excessive ways we use language to express feelings, and it was one of the things that made it a fascinating novel to contemplate. But the film isn’t depicted in such a way that allows us to consider that as a legitimate possibility.

Regardless, some of the scenic shots are gorgeous, and as mentioned earlier, the soundtrack is one of the best I’ve ever heard, featuring several phenomenal songs written and performed by Shakira at Marquez’s behest. They’re mournful, beautiful tunes, and if the film itself had even come close to capturing the glorious melancholy of its soundtrack, we could have had a real winner on our hands. When the soundtrack overlays Newell’s scenic shots, the film exudes a calm confidence and solemnity that captures, albeit fleetingly, the kind of fiery passion and subtle beauty found in the novel.

But as with any work that makes love its primary focus, there’s a big risk of veering off course from actual, heartfelt feeling and plunging into forehead-slapping cheesiness. Unfortunately, Newell never achieves this balance, and the awful delivery of particular lines from the novel that barely survived on the page to begin with doesn’t help the film’s cause. In the end, I was hoping for a more meditative film that fleshed out the relationships between its characters. Instead, all we’re left with is a painfully corny adaptation of a flawed novel.

Listen to the soundtrack, try out the novel, avoid the film.

Here’s one of Shakira’s songs from the soundtrack -

http://www.youtube.com/watch?v=mjhgiOq5SSQ

And a few selections from Pinto’s OST (Spotify links):

Antonio Pinto – Love

Antonio Pinto – 1900

Antonio Pinto – Hildebranda

Antonio Pinto – Los Dos

The Emperor of All Maladies

“Aymar Pahreek? Did I get that right?”

Sure.

“You have the patient in room B-28. She, uh, she should be alright with you performing a full history and physical on her…I’m not sure. I guess just let me know if you have any problems.”

With that reassuring introduction, the resident directs me to ‘my’ very first patient - DR in room B-28. I’m standing in the Surgery Ward of Elmhurst Hospital, one of the primary clinical sites that Mount Sinai medical students are dispatched to throughout their clinical training. DR is the person I’ll be speaking to for the next 2 hours in a clumsy, misguided attempt to practice obtaining a ‘thorough patient history’ as well as a pantomime performance of the ‘full physical exam’. Up until this point, we’ve been practicing on peers and professional actors hired to serve as standardized patients. But today, for the first time as students training for careers in medicine, we are to be set loose into the wild, armed only with a clipboard, pen, and several archaic diagnostic instruments that include, of all things, a tuning fork and reflex hammer. I hesitate outside her door and gather my wits about me - Stay confident. Don’t let her sense the fear on you, I tell myself. I close my eyes and briefly envision the image of the doctor all guys wish they were - a towering figure with a commanding presence and resonant voice, possessing a reassuring touch and an efficiency of movement and words that inspires confidence in all my patients. Never mind that I’m 5’8”, my voice more tenor than bass, and I’m nervous as hell. I take a deep breath and walk in.

DR is lying on the hospital bed, in obvious fatigue and distress. Sunlight streams into her room from the window, and I quickly try to take in as many details as I can upon my first survey of the room:

1. She looks like she’s Filipino and in her 50s. There’s a palpable, quiet resignation on her face.
2. She has a catheter in place. I can see it leading out from underneath her gown, and it’s partly filled with urine.
3. Another tube leads out from her left chest and is draining what appears to be a small amount of blood. I make a mental note to ask about this later.
4. The chair that I was planning to sit in is draped in a white cloth and features a sizable bloodstain. Probably not a good idea to sit there. Slight panic, this isn’t the way it was scripted - should I stand for this entire thing? But wouldn’t that create a physical distance between us? That’s gotta be breaking some rule of patient etiquette, right? But I can’t sit there! Shit.

As all this flits through my mind instantaneously, I introduce myself to her, and I can already feel my voice slipping into that cloying, ‘hi I’m just a medical student, please put up with me’ tone that I was trying so hard to avoid. She turns to look me right in the eye and hits me with a smile that I won’t forget, especially in the context of what I am about to learn.

I move to her side and begin the conversation about why she’s at Elmhurst. I watch as my blank sheet of paper slowly fills up with scribbles, notes, question marks, cross-outs, abbreviations. Somewhere in this mess, her story emerges.

“DR is a 52-year-old asthmatic woman who began experiencing a sharp, stabbing pain below her left lower rib roughly 2 weeks ago. The pain was so severe that it woke her up at night, and on a scale of 1 to 10, the pain initially presented as a 10/10. She took tylenol to relieve the pain which helped, though 4 days later, the pain became unbearable, and she checked herself into the Elmhurst ED. Imaging studies were done, and a mass was found in her left lower lung —”

I pause here. I know where this is going. I could sense it from the broken smile she gave me the second I walked in.

“—a lung biopsy was subsequently performed and analyzed, revealing a malignant, cancerous hilar mass with an array of cancerous nodules spreading throughout her left lung.”

I pause again, and look up at her as she relays this information to me. Her breath catches as she stops mid-sentence. I feel paralyzed. The year and a half of training we’ve undergone has left me completely unprepared for how to handle this. For all of our small group sessions on medical ethics, DNRs, tort reform, and other variations of legalese, not once had we ever spent even five minutes on the best way to respond to a patient that tells you they have metastatic lung cancer. Yet here I am, not with an actor, not with a peer, but with an actual human being who is looking to me, the 2nd year medical student, for an appropriate response.

My voice weakens, my attempt at projecting confidence now replaced by an overwhelming sense of empathy. What comfort can words offer in a situation like this? As someone who majored in the English language, I’ve never felt more acutely at a loss for words in my life. I offer up some platitudes, and I mean them, but they feel cliched, fake, and pre-packaged the second they tumble from my lips.

We continue talking. She tells me that she has no family history of cancer, and that she never drinks alcohol, has never tried drugs, and, perhaps most frustratingly, has never smoked a single cigarette in her life. Yet here she is, a fatal tumor festering in her lung. She tells me that she exercises 30 minutes every day because she absolutely loves the feeling she gets when she’s had a good workout, and I can tell by the glow in her face as she says this that it’s true. She’s married, but her husband and 2 daughters are still in the Philippines. Her eldest daughter is 24 and works as a nurse, and her younger daughter is 21 and looking for a job in Singapore. She came to America in 2008 to find a job to support her family, as they’re struggling to make ends meet. She tells me she hasn’t been able to find any jobs since she came here, and has been working part-time as a nanny.

I ask her if her family knows that she’s in the hospital, and she slowly shakes her head. She tells me that she doesn’t want to bother them because they would rush to find a way to America even though they have no money or means to do so. She tells me her dream is to be flown back to the Philippines so she can die at peace with her family, but she can’t even do that because she hasn’t been able to find a job or earn any money in the past few years. She says that doctors have recommended a colonoscopy, mammogram, and pap smear to search for metastastic cancer to her colon, breasts, and cervix, respectively, but that she declined all of those procedures. She’s resigned to her fate. She has no money to fly home, and her family has no money to fly to America to see her. Her only option is to die in this hospital in peace. 

I’m speechless. There’s nothing inherently wrong with her reasoning, but that can’t be the only option left…can it?  I struggle to think of or voice any alternative. I look at the next question on my checklist. “How many sexual partners have you had in your lifetime?” I put my clipboard away. We’re beyond this now.

As I’m contemplating all of this, there is a lull in our conversation. She breaks the silence and tells me that the doctor said to her that her cancer was ‘incurable’. She then asks me the question I had been dreading - how much time does she has left? A million answers are flitting through my head. In this short amount of time, I’ve been so impressed by this woman’s courage, yet heartbroken by her resignation and her solitude. I want to say anything I can to make her feel better yet I know I ethically can’t say anything to give her any false hope.

“Well, ‘incurable’ is a vague word. It could simply mean that the cancer is ‘treatable’ but won’t completely go away, so you could have a significant amount of time left till it returns. Or it could mean that it truly is very dangerous and that there’s not much doctors can do. I wish I could tell you definitively which of these is the case, but don’t lose hope.’

She smiles again and says that all she can do now is pray, and that’s what she was doing before I walked into her room. I brush this aside and try again in vain to convince her to tell her family. I can’t begin to picture the thought of her two daughters, who are my age, waking up one morning to find out that their mother died from lung cancer, tucked away alone in a corner room at Elmhurst Hospital, in the middle of Queens, NY, thousands of miles away from the very reason she came to America to begin with - her daughters, and their happiness. She tells me she’ll consider it, but makes no promises.

I don’t even attempt to perform the physical exam on her. The last thing I’m going to do is check her reflexes with my hammer, or see if she has earwax with my otoscope. I’m angry. This is what medical school has armed us with when we walk into the rooms of patients like this? I want 5-fluorouracil, 6-mercaptopurine, vincristine, methotrexate, cyclophosphamide. Yet here I stand holding a goddamn tuning fork.

The chest tube I noticed upon first entering the room was inserted to drain a pneumothorax, a pathological condition where an excess of air accumulates and surrounds the lung, exerting a force upon it so that the lung is unable to expand normally when breathing in air. Yet the tube was mistakenly placed in the wrong location, necessitating an emergency ‘do-over’ without proper anesthesia. She cringes when she tells me that she spent the last night howling in pain in the aftermath of the procedure. I’m not sure how much more this woman can take.

Our time is up, and I struggle to find something helpful to say, something that makes my presence here worth it. I note that there’s an empty cup on her tray, and ask her if I can get her more water. She smiles again and replies that she’s been wanting water all morning. I feel a flush of victory - so I am able to do something to help her. Yet it leaves just as quickly - is this all the help I can offer as a medical student, a doctor in training? A cup of water? I feel as useless and irrelevant as the tuning fork in my coat pocket.

I thank her for her time and tell her that she was my first real patient. I tell her that I won’t forget her, and that she’ll be in my thoughts. I move to leave, but she reaches out her arm and touches my hand. She ends our interaction with a simple set of words that sears itself into my mind: “You know, I had so many dreams. I had so many plans.” She shakes her head and sinks back into her bed. It all feels surreal, like something out of a novel or movie. But it’s as real as it gets. I nod my head, which feels like it weighs 10 tons, and we grip hands tightly before I leave. I realize that apart from her doctor, I’m the only person she’s actually talked to about this.

I walk a few steps before I dart down a side hallway and press my back up against the wall, taking deep, measured breaths. I can’t wrap my mind around the suddenness of it all. Hell, 2 weeks ago, I checked myself into the Mount Sinai ER for a sudden stabbing pain in the exact same location as hers. It turned out to be nothing, but I can’t stop thinking about the ‘what if’. 2 different people, one 23 year old medical student and one 52 year old mother of two, walk into an ER with the same exact kind of pain. The 23 year old walks out fine, goes home at midnight and hangs out with his friends at home. The 52 year old gets an X-ray, undergoes an invasive, painful biopsy, and finds out she’s dying. Two sides to the same coin, yet my Fate just happened to correctly call heads as it flipped in the air, and I was spared. She wasn’t. For her, there’s no reversal of facts, no twist in fate or do-overs. She can’t just shut her eyes tight and hope her reality changes when she opens them. It sits there, weighing on her, an immovable boulder, a crushing finality. And the worst thing is, she’s alone.

I know that I will wake up tomorrow and will begin to move on. I know that inevitably, after 2-3 days, I won’t be thinking about this as often. And within a week, I’ll most likely forget about this entirely. I have the ability to shut this out of my mind and occupy myself with other tasks at hand. But she doesn’t. She wakes up and her reality is the same, unchanging, staring her in the face like the unflinching, merciless God she was praying to before I walked in.

——————————————————————————————————————————————

I re-read what I’ve written and it sounds so trite, so obvious. This is the story of every budding medical student and physician’s first emotional encounter with a terminally ill patient - what have I brought to the table that’s any different? But maybe that’s not really what this is about. There’s a reason cliches become cliched - they hold an inherent truth that is common to all those who experience it. Maybe the point isn’t to be different and write a scintillating tale for an audience, but to write about this first patient encounter for myself. Maybe the point is simply to document my feelings at this point in time so that in a few years, when I inevitably become jaded to the horror that is senseless, random, and undeserved death, I can remember how it affected me the first time I encountered it in a clinical setting as a medical student, and maybe I’ll retain a stronger sense of humanity and empathy as a result. Maybe.

Fittingly enough, I’m about to finish The Emperor of All Maladies by Siddartha Mukherjee, a phenomenal biography of cancer. In it, he writes, “Medicine begins with storytelling. Patients tell stories to describe illness; doctors tell stories to understand it.” So I want this story to serve as my very first attempt to understand disease as it senselessly strikes down inspiring, beautiful people like DR. I will try to always remember her as my first patient, my first story, and as such, the true beginning of my career in medicine.

Drive - Review

Drive, dir. Nicolas Winding Refn, is an ambient and atmospheric thriller that oozes attitude and confidence, making it a “hip” movie for both critics and audiences alike to easily endorse. Drive is a different kind of action flick that emphasizes style over substance, but its patience is what really sets it apart in my eyes. I loved Refn’s lingering camera, the moody, pulsating electro-synth soundtrack, and the brazen choice to eliminate almost all dialogue. It all comes together to give the flick an intentionally-stylized 80’s retro vibe, and you know from the gripping opening sequence and the subsequent neon-pink title cards that you’re in for something different than, say, Fast Seven or whichever number they’re on now.

The story itself is almost laughably trite — 1. Hero falls in love with girl; 2. Hero gets in deep with the wrong crowd; 3. Wrong crowd threatens girl; 4. Hero must kill them before they hurt her. Fin. Yet the whole enterprise is packaged in this fresh, sexy veneer that makes it seem deeper than it really is. Even though the plot itself is standard, there are still several shocks to be had, mostly for the sudden bursts of violence that rock the screen in an orgiastic display of bloodletting, and it’s a visceral thrill to behold.

As mentioned, the movie has barely any dialogue. The characters instead opt for long, penetrating stares that make every interaction unbearably tense. The figures in the story speak with violence rather than language, and each has a distinct style of inflicting pain that says much more about their character than words ever could.

The movie would be nothing without Gosling, however. As much as I fail to understand the recent female obsession with this guy, he fucking owns this flick. He plays ‘The Driver’, an awesome, contemporary “Man With No Name” that updates the Clint Eastwood-archetype for today’s viewers. The Driver’s brutal ferocity to protect what he loves most at any cost is a startling contrast to his calm, collected, distant demeanor, and that’s what makes his character so enthralling. Ebert describes him as an ‘existential hero’, and I guess the fact that he has no actual name bolsters that notion, but I take it more at face-value. He’s simply a hero in the vein of fairy tale archetypes - the silent knight in shining armor, the calm but brutal force of nature, the kind-man-pushed-to-his-limit - yet placed within an updated contextualization of villains and damsels in distress, complete with modern standards of violence and gore.

Look out for a scene in an elevator that will take your breath away, as well as a beautifully shot climax lit by thunderstorms that takes place by the sea at night. In a way, the fact that the climax takes place here functions as a perfect metaphor for The Driver (and maybe the movie itself) - like the ocean waters at night, The Driver is a beautiful, mysterious, and silent entity, but its capacity for ruthless violence and utter indifference is not to be underestimated.

8.5/10

PS - I need that scorpion jacket immediately

Lisztomania

The list is the origin of culture. It’s part of the history of art and literature. What does culture want? To make infinity comprehensible. It also wants to create order — not always, but often. And how, as a human being, does one face infinity? How does one attempt to grasp the incomprehensible? Through lists, through catalogs, through collections in museums and through encyclopedias and dictionaries. There is an allure to enumerating how many women Don Giovanni slept with: It was 2,063, at least according to Mozart’s librettist, Lorenzo da Ponte. We also have completely practical lists — the shopping list, the will, the menu — that are also cultural achievements in their own right.” ~ Umberto Eco

On Relativity

Fucking awesome.

Cutting for Stone - Quotes & Thoughts

So there are a lot of quotes here, most of them long. This is more for myself to look back on and read than anything else. I’ve also included brief thoughts about particular quotes that struck me as I was reading.

“We come unbidden into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. I chose the specialty of surgery because of what Matron told me: ‘Marion, you are an instrument of God. Don’t leave the instrument sitting in its case, my son. Play! Leave no part of your instrument unexplored. Why settle for ‘Three Blind Mice’ when you can play the ‘Gloria’? The greatest sin is ignoring what God made possible in you.’

And so I became a surgeon.” - (7)

“I venerate the sight of the abdomen or chest laid open. I’m ashamed of our human capacity to hurt and maim one another, to desecrate the body. Yet it allows me to see the cabalistic harmony of heart peeking out behind lung, of liver and spleen consulting each other under the dome of the diaphragm — these things leave me speechless. My fingers run the bowel, looking for holes that a blade or bullet might have created, coil after glistening coil, 23 feet of it compacted into such a small space. I see the ordinary miracles under skin and rib and muscle, visions concealed from their owner. Is there a greater privilege on Earth?” 9

“What I owe Shiva most is this: to tell the story. It is one my mother did not reveal and my fearless father ran from, and which I had to piece together. Only the telling can heal the rift that separates my brother and me. Yes, I have infinite faith in the craft of surgery, but no surgeon can heal the kind of wound that divides two brothers. Where silk and steel fail, story must succeed.” 10

“She had always assumed that she would have years to sort out the meaning of life. Now, it seemed she would only have a few seconds, and in that realization came her epiphany. As she bent over the child she realized that the tragedy of death had to do entirely with what was left unfufilled. Make something beautiful of your life. She understood for the first time that having a child was about cheating death. Children were the foot wedged in the closing door, the glimmer of hope.” 64 

“Stone’s dissection of the hand was so elegant that the anatomy professor preserved it to show the first-year students. On the other side of the face he’d removed all subcutaneous tissue and fat to reveal the myriad muscles of expression whose concerted movements in life had conveyed her sorrow, joy, and every emotion in between. But he didn’t think of her as a person. She was simply knowledge embodied, embalmed, and personified.” 68
—>This quote struck me because it made me realize that I didn’t recognize the enormity of the privilege I was granted in Anatomy during first-year. I’d give anything to go back and demonstrate the reverence and respect I know I would have for the opportunity now.

“Her skills were so rare, so needed for the poorest of the poor, and even at times in the royal palace, that she felt valued. Wasn’t that the definition of home? Not where you are from, but where you are wanted?” 95

“It would have surprised her to know how much he relished occupying the space that she’d just vacated, and covering himself with a blanket still scented with her dreams. The jingling of Shiva’s ankle bracelet filtered into his sleep, and one night he dreamed that the sound was that of Hema dancing for him. Naked. It was so vivid, so real, that the next morning, he hurried to Cook’s Travel, waited till they opened, and canceled his ticket to America. He did it before he had any coffee – or a chance to 2^nd guess himself.” 201
—>One of the twins, Shiva, suffers from “premature apnea”, in which an infant’s brain, still underdeveloped, occasionally ‘forgets’ to trigger the neural impulses responsible for initiating each breath. Ghosh loops an anklet around Shiva’s foot that moves and rattles upon breathing, so that if he does ‘forget’ to breathe, the lack of movement and corresponding silence will alert his vigilant parents, who then tug at the anklet to re-stimulate his respiratory system.) I love this quote because it’s one of many examples where Verghese takes the medical practicality of a situation and subtly imbues it with a mystical beauty. The simple sound of the anklet is transformed into the seductive jingle of a dancer, and this simple, vivid dream is what compels Ghosh to stay in Ethiopia, irrevocably altering the trajectory of the plot as a result.

“By mid-morning, the kitchen is alive. Steam rises in plumes. Almaz’s sure hands chop onions, tomatoes, and fresh coriander, making hillocks that dwarf the tiny mounds of ginger and garlic. She keeps a palette of spices nearby: curry leaves, turmeric, dry coriander, cloves, cinnamon, mustard seed, chili powder. A mad alchemist, she throws a pinch of this, a fistful of that, then wets her fingers and flings that moisture into the mortar. She pounds with the pestle, the wet, crunchy thunk, thunk soon changes to the sound of stone on stone. Mustard seeds explode in the hot oil. She adds the cumin seeds, which sizzle, darken, and crackle. A dry, fragrant smoke chases out the mustard scent. Only then are the onions added, handfuls of them, and now the sound is that of life being spawned in a primordial fire.”   225
—>This quote adds little in terms of narrative, but I love any good writing about food. There’s something so inherently fascinating in the alchemy and artistry of cooking, and he nails it. I also felt like this was a great description of Verghese’s own function as a novelist – similar to a chef working in a kitchen, he takes little bits and pinches of various storytelling techniques, literary devices, and styles of prose and throws them all into this steaming pot of a novel. The ‘life being spawned in a primordial fire’ is really the story itself, and it loops back to one of the opening quotes I listed above, where Verghese writes that “no surgeon can heal the kind of wound that divides two brothers. Where silk and steel fail, story must succeed.” The ‘primordial’ power, the ‘life’ and vitality of the story lies in its potential to heal and rekindle Marion’s relationship with his estranged brother.

“In our household, you had to dive into the din and push to the front if you wanted to be heard. The foghorn voice was Ghosh’s, echoing and tailing off into laughter. Hema was the songbird, but when provoked her voice was sharp as Saladin’s scimitar.” 229
—>I want my children to grow up in a chaotic household like this.

“Ghosh’s real skill emerged with those who looked ‘normal’ to my gaze. Hidden from us unschooled observers, a disease had left its traces. Ghosh listened, his eyes taking in the blister marks on the sternum; he noted the thick speech and guessed that the uvula had probably been recently amputated. But Ghosh had an ear for what lay beneath those surface words, and a pointed question uncovered a story which matched with one in his repertoire of tales. Then it was time to look for the flesh signs, the bookmarks of the disease, and to palpate and to percuss and listen with his stethoscope for clues left behind. He knew how that story ended; the patient only knew the beginning.” 279
—>This level of observation and hyper-vigilance, this Sherlock Holmesian quality to the clinician, this is what I want to cultivate and hone over my years of medical training.

“Whenever she came at him like that, all her cylinders firing, it was Ghosh’s habit to flourish an imaginary cape like a matador facing a charging bull. We found it funny, even if Hema never did…. ‘Another day in paradise’ was his inevitable pronouncement when he settled his head on his pillow. Now I understood what that meant: the uneventful day was a precious gift.” 310-317 —>Ghosh is an amazing character.

“Ghosh, working in an obscure African hospital, far from the academic mainstream, had his way. Now, here he was, a professor. Hema bought our new professor two beautiful pin-striped suits, one black and the other blue. Also a tweed coat with leather elbow patches, as if to put “Professor” in quotes. The bow tie was his idea. In all things, especially when it cost little and did no harm to others, Ghosh was his own man. The bow tie told the world how pleased he was to be alive and how much he celebrated his profession, which he called ‘my romantic and passionate pursuit’. The way Ghosh practiced his profession, the way he lived his life, it was all that.” 418
—>You can probably tell by now why I love this quote. I want to look at my studying not as a chore of rote memorization, but an opportunity to learn one more fact, one additional concept, a single stray bit of arcana that can end up being the difference in the care I offer a patient years later. I want to be so passionate about my career that it has an element of romance, something I can truly say I love doing.

*******SPOILER —“With his death came a new understanding of the word “loss.” The hand that patted me and put me to sleep, the lips that trumpeted bedtime songs, the fingers that guided mine to percuss a chest, to feel an enlarged liver or spleen, the heart that coaxed my ears to understand the hearts of others, was now stilled.”

“The glass doors parted just in time. I thought of these things as minor miracles, everyday efficiencies that were such a contrast to what I’d know in Africa.” 498

“The smoke made sinuous shapes in the shaft of light leaking past the bathroom door. I remembered our kitchen at Missing and how the dust motes dancing in the morning rays formed their own galaxy. When I was a child, that sight had hinted at the wonderful and frightening complexity of the universe, of how the closer one looked the more one saw revealed, and one’s imagination was the only limit.” 527

“I walked slowly down the hall to our Quiet Room, a euphemism for the place we chose to give bad news, a place with chairs, a table, a sofa, a big picture window, a cross on the wall, but no TV, no magazines, only a solid and soundproof door. How many times had I made this walk as a trauma surgeon? So often I had lingered outside the door, conscious of the devastation my news would be bringing. Had I honored the feelings and the dignity of those who waited in that room, the parents, siblings, spouses, and children, even if what I had to say dashed all their prayers? I could remember every such encounter; I could recall each face as it turned in hope and apprehension when the door opened.” 641
—>I’m truly dreading the first time I’ll have to deliver this kind of news to a patient. But what I’m dreading even more is becoming used to it.

“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 “ecstacy” meant the sudden intrusion of the sacred into the ordinary, then it had just happened to me.”
—>Finally, this is what gives Verghese’s writing such a beautiful, unique quality — he sees the ‘ecstacy’ in every single moment. He illuminates normal, everyday events in our lives and scenes in the stories we tell with a mystical, supernatural beauty that truly elevates living into an art. I walk away from this novel striving to achieve that type of vision as well, to view life through the same lens as Verghese. I too want to see the sacred in the ordinary, and I want to make an effort from here on out to try and see it every single day I have left.

—

Cutting for Stone - Review

So, as I wrote in an earlier post, one of the new things I’m trying out this year is to actually catalogue my thoughts about the things I read, watch, and hear. I read a fantastic novel called Cutting for Stone by Abraham Verghese over winter break, and wanted to write up my opinion about the book itself, share my favorite quotes, and offer my thoughts about the questions and themes the novel addresses.

First, a brief review:

I truly enjoyed this book in a way that I haven’t enjoyed a novel in a long time. There’s something particularly satisfying about reading an ‘old-school’ novel, and by that I mean a story that possesses a few key features. Off the top of my head, that would include the following:

1 - Generally set in a unique location that readers don’t know much about. In this case, Addis Ababa, the capital of Ethiopia;

2 - A variation on some sort of intense family conflict — here, we trace the lives of twin brothers, abandoned by their father and orphaned by their mother’s death, that grow up together but slowly take separate paths in life;

3 - Political undercurrents unique to the geographical setting that impact the narrative at key points. Cutting for Stone incorporates the 1960 coup attempt of Emperor Haile Selassie by key members of his Imperial Bodyguard, serving as the first time in the political history of Ethiopia that a monarchy was seriously challenged by its constituents;

4 - Long. At 650+ pages, Cutting for Stone fulfills this requirement and then some.

The novel incorporates all of these elements and more to make for a truly moving reading experience. Of particular interest to me was the way in which Verghese, himself a practicing physician at Stanford, infuses his main characters with an inspiring passion for medicine. As a medical student that had been losing interest in the field at the time I was reading this, this aspect of the novel really resonated with me, and really signaled a shift in the way I think about the practice and my future within the field.

Verghese’s writing isn’t as polished as, say, Rohinton Mistry’s classical literary style, though his prose isn’t nearly as manically exuberant as Rushdie’s either. I think he serves as a nice bridge between the two extremes, settling in a groove somewhere between classic Dickensian storytelling and mystical modernism, taking the best qualities of both and coming up with his own unique hybrid. He suffers from the occasional cliche, and there are times where his writing comes off as overly dramatic and amateurish, but you’ll be able to tell by the quotes below that when he writes well, he writes very well.

The story starts off a little slow, but once it picks up steam, it’s a wildly plot-driven and emotionally devastating journey that begins in Madras, sails to Africa under the shadow of a typhoid outbreak, lingers in a minimally-staffed, humble mission clinic in Addis Ababa, climaxes in a gritty New York City Hospital, and ends back where it began with a stop in Italy along the way. The dynamic between the twins, Marion and Shiva, is fascinating in its complexities, and Verghese does a fantastic job of depicting how siblings can initially grow up together, and then grow apart. The highlight for me, however, was how I came to truly care for their surrogate parents, Ghosh and Hema, more so than any other character in the book due to Verghese’s amazingly well-rounded characterization. Their love is imbued with such humor, passion, and mutual respect that it was hard not to be moved by their journey together from beginning to end. Verghese also does an amazing job of capturing the essence of Ethiopia, and the intense nostalgia that his characters feel for their homeland is extraordinarily palpable. The passion with which he describes the sights, sounds, smells, and cuisine of Ethiopia is infectious, so much so that I actually visited one of the few Ethiopian restaurants in NYC to taste the fiery flavors of injera and wot purely based on his descriptions once I finished the novel.

The plot takes several extremely satisfying twists and turns towards its climax, and one particular twist was revealed in a scene so well-constructed that even though most will see it coming, I was still so shocked that I closed the book, got up, and walked off the subway in a daze a full 6 stops earlier than I was supposed to. Overall, Cutting for Stone isn’t flawless, but for me personally, it was a potentially life-changing reading experience that I wouldn’t hesitate to recommend to anyone.