Cutting for Stone
Cutting for Stone
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Abraham Verghese on Cutting for Stone
In his own words: quotes and insights from the author.Why he wrote it
An image with no plot, and a debt to medicineThe novel did not begin with a plan. It began with a single, uninvited image that Verghese carried for years before he knew what to do with it.
It all began with this image of a beautiful South Indian nun giving birth in a mission hospital in Africa. I don’t quite know where that came from, but that was something I had in my mind. I also knew I wanted to pour into this book everything I loved about medicine, particularly the study of medicine, the sense of a young person entering this field; to me, it has always felt like a romantic and passionate pursuit.
Television medicine, in his view, had buried the thing that most mattered about the work. The mission hospital in the novel was not chosen for atmosphere but for what it makes impossible to hide: the full, unmediated demand the profession places on a person.
My ambition as a writer was to tell a great story, an old-fashioned, truth-telling story. But beyond that, my single goal was to portray an aspect of medicine that gets buried in the way television depicts the practice: I wanted the reader to see how entering medicine was a passionate quest, a romantic pursuit, a spiritual calling, a privileged yet hazardous undertaking.
Getting back to that ambition cost him more than writing time. He had spent years on two nonfiction books that felt obligatory, and returning to fiction meant surrendering financial security and a tenured position to attend the Iowa Writers’ Workshop.
The Iowa Writers’ Workshop was the hinge on which the novel turned, and reaching it required a bet that put his family’s stability at risk. He describes the decision with clear-eyed ambivalence, naming both the cost and the necessity in the same breath.
Iowa took me, and I wound up cashing in my 401K plan and giving up my tenured position to drive out there with my wife and two young children. As I look back, I think it was a very selfish thing to put my family through, but it was an act of self-preservation, too — I felt I would implode if I didn’t take a break.
How he wrote it
Eight years, a ruthless editor, and a toy plane he had forgottenVerghese does not outline. He follows an image and a voice forward, which meant the eight years the novel took were filled with accumulated pages that had to be cut and with long retreats to find the thread again.
She had the most wonderful way of saying, ‘Abraham, these 300 pages, 6 months of work, is just gorgeous stuff but it doesn’t belong in this book.’ You have to have great faith in an editor to be able to take that. And frankly, there’s a point where you lose all perspective. You want someone who’s objective to reinforce the parts that are good, that you might not even recognize are good, and to take away those parts that you are very fond of but are tiresome to the reader.
His subconscious delivered material he had no idea he still held. A scene built around a little boy gripping a toy plane on a diverted aircraft came from a real childhood incident, but the specific, telling detail, the toy itself, had been completely erased from his conscious memory until his brother confirmed it.
I have him clutching this little toy plane, and my brother told me that during that whole trip I was clutching a toy plane.
He has pointed to moments like that one as the reason he calls writing mysterious: the material is already there, but only the sustained act of sitting down and pushing forward will surface it.
Time, in a novel that spans a birth, a childhood, an exile, and a return, is not a backdrop but an engineering problem. He tried many structural approaches before settling on the one that gave the narrator, Marion Stone, the authority to hold all of it together.
In Cutting for Stone, I experimented with time in so many ways, ultimately settling on the idea of the narrator being an older individual looking back at the moment of his birth. The great power of a novel is that you can leap 10 years in the course of a page.
Only after the manuscript was complete did he learn what theme had been organizing it from below. His editor named it: every situation in the book, she told him, reduced to separation and displacement. The observation landed because those terms described his own biography as much as the novel’s plot.
books ultimately are very revealing about the author [paraphrased from audio]
The personal thread
The same lens, carried from ward to pageVerghese grew up in Addis Ababa, began medical school there, and left when civil war ended those studies. The Ethiopia in the novel is not research; it is the place he actually knew. When he describes what the physician’s training gives a writer, he is drawing on a habit of attention formed across decades of clinical work.
The same lens that I have used for many years as a physician — looking at patients with a great deal of curiosity and empathy — is the same lens that I bring to writing. We physicians have some advantage as writers in that we’re taught to observe and to bring separate facts together into a unifying diagnosis. Some of those elements take place in writing as well.
Marion Stone’s arc, in which medicine both sustains and deforms the life around it, is not a neutral thought experiment. Verghese spent years in rural Tennessee caring for AIDS patients at a cost to himself he only later articulated, and the exhaustion that drove him to Iowa gave the novel its central dramatic question.
Medicine presents us with this false dichotomy, or rather this temptation, that you come to medicine incomplete, you come to medicine because in a way you’re wounded, and the grand privilege that medicine gives you is that you care for others and your woundedness becomes healed.
What he wants us to sit with
Stories as machines for justice, medicine as a ritual that healsThe most quoted exchange in the novel, where Thomas Stone asks what treatment in an emergency is administered by ear and the answer is ‘words of comfort,’ is the book’s argument about medicine in miniature. In the Religion & Ethics NewsWeekly interview, Verghese framed that argument biologically: the physician-patient encounter, one person confessing what they would tell no one else and then submitting to examination, does measurable work on the body. Destroying it through inattention destroys a real chance to heal. The novel dramatizes the cost of that destruction across a generation of the Stone family. [paraphrased from audio]
Perfection of the work won’t get you perfection of the life. You have to think of these as two parallel trains; there’s life and there’s work, and they run on parallel tracks and there’s times when one gets a little ahead of the other, but you can’t let them get too far away.
Behind everything the novel stages about surgery, exile, and loyalty is a claim about what fiction itself is for. He stated it as a definition, not a hope.
Yes, I think writing is how we make sense of the world, how we explain ourselves to ourselves. Stories are justice-dealing machines, a way to take the world in for repairs.