<p>SJCM,
I had no idea of your history. Could you expand? Did you have to repeat years in India? What was it like when you came to USA?</p>
<p>Mary13-Thank you, “I guess”, for the link regarding Sims and the history of fistulas.
What a horrific condition! Thank you to Oprah for putting this on America’s radar screen! </p>
<p>In defense of J Marion Sims-
Sims paper records the elation in the successful operation on Anarchia and reveals something of his motivation, ‘ I thought only of relieving the loveliest of all God’s creation of one of the most loathsome maladies that can befall poor human nature… Full of sympathy and enthusiasm, thus I found myself running headlong after the very class of sufferers that I had all my life most studiously avoided.</p>
<p>About Fistulas- my heart breaks for what woman/ young girls endure.</p>
<p>From Mary13’s link:
"The duration of this pressure is related to the risk of necrosis and fistula formation.</p>
<p>In an Ethiopian study the average length of labour was 3.9 days with some as long as 6 days.
The ischaemic process is compounded by the fact that women in developing countries marry young and many commence childbearing before growth is complete.
In a Nigerian study 9% of girls suffering from fistulas married before menarche."</p>
<p>Dieffenbach in 1836 gave a vivid portrayal of the grim plight of women afflicted by fistulas. Their horrendous condition and frequent rejection by family members led many to despair and suicide, ‘ A sadder situation can hardly exist than that of a woman afflicted by vesico-vaginal fistula. A source of disgust even to herself, the woman beloved by her husband becomes in this condition the object of bodily revulsion to him and filled with repugnance everyone else likewise turns his back, repulsed by the intolerable, foul, uriniferous odour… Intolerable burning and itching torment the patients… Even the richest are usually condemned for life to a straw sack (for a bed), whose straw must be renewed daily.'</p>
<p>Psychmom-Verghese spent 6-8 years writing this novel, ripe with “complexity and contradictions”.
Ie -Marion’s namesake, quite controversial. </p>
<p>The American Medical system, considered the best in the world, has a tiered system, needing 20,000 foreign interns to work in the hospitals, because the American trained doctors won’t go into these centers, plus there is a shortage. </p>
<p>The Meccas are the world’s best medical facilities, conducting cutting edge research, with the organs from the Ellis Island hospitals. </p>
<p>Yes, Psychmom, this book is quite draining.</p>
<p>Bookworm --Whoops- that was a quote from Verghese, I should have used quotations. My bad.</p>
<p>SCJM, Given the information you provided about the author, I do feel writing this book had a healing effect for him. It was his “forum” for expressing what he went through in his passion to become a doctor…the good, the bad, and the ugly(similar to what we do on THIS forum)!</p>
<p>I bet he was a bit drained by the whole thing, too!</p>
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<p>Darn…I thought our discussion was about to take a very interesting turn! 
:)</p>
<p>SJCM, you are right about Tsige sending Genet to Marion. So I guess we can’t accuse Genet of trying to take advantage of Marion by seeking him out for money or shelter. I’m sure that Tsige, who loved Marion (probably more than he deserved for his small act of childhood kindness) believed she was sending him a great gift. Instead, she was sending him death.</p>
<p>Shifting gears from the bad and the ugly to the good…What did you think of Ghosh? From the Readers’ Guide:</p>
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<p>One reviewer writes, “Verghese creates in the adoptive parents, Hema and Ghosh, marvelous characters that readers come to know well. Ghosh may be the book’s best creation. His robust affection for life fills the page, even as he deals day to day with death.” <a href=“http://www.abrahamverghese.com/images/Dallas%20Morning%20News,%20February%2015,%202009.pdf[/url]”>http://www.abrahamverghese.com/images/Dallas%20Morning%20News,%20February%2015,%202009.pdf</a></p>
<p>I thought Ghosh was an important “anchor” in a book prone to melodrama. His good sense and good humor rarely wavered. He was even able to see the benefits of his incarceration: “Prison,” I’d heard Ghosh laughingly tell Adid, “is the best thing for a marriage. If you can’t send your spouse, then go yourself. It works wonders.” ;)</p>
<p>Why was Ghosh so content? Well, part of it was his love for Hema. Early in the book, he was restless and uncertain about his life until she agreed to marry him. But I also think it was his personality, just the way he was made. If he had been more like Marion, he might have dwelt on the woes of growing up without a father, or the permanent estrangement from his sister, but he didn’t. He lived in the present moment and found value in everything and everyone.</p>
<p>LOVED Ghosh! Even in death, he was the epitome of dignity and selflessness. Just wondering…Why do you think he had hidden Sister Mary’s note so well? I recall that Marion had an explanation for it, but it puzzled me.</p>
<p>Marion theorized that Ghosh found the letter shortly after Sister Mary’s death, but he never knew quite what to do with it. It was too important to destroy; however, the time was never right to reveal it. Ghosh didn’t want to upset Hema or give Thomas Stone any reason to return for the twins. When Ghosh was dying and had to finally do something with the letter, he hid it behind the picture. Marion comments, “He would leave it to fate—how like Ghosh this was!” To me, it was more of a plot device than behavior particularly characteristic of Ghosh, but that’s okay. It is a novel, after all, and we knew that letter had to show up somewhere, somehow. Ghosh is as good a deus ex machina as anybody.</p>
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<p>Yes, this reasoning confused me. Ghosh, in my mind, seemed like a man of action and logic rather than one who would allow the fates to decide something so meaningful. After all, he had gone ahead and made plans to leave, having been “rejected” by Hema so many times. He was always so sensible…thus, my confusion.</p>
<p>Ghosh managed to be a passionate doctor, with a happy, fulfilling personal life. What was Missing from his life? </p>
<p>“We stopped you from going, didn’t we? Me and Shiva. Our birth?”
Don’t be silly. Can you imagine me giving up this?" he said sweeping his hand to indicate family, Missing, the home he’d made out of a bungalow. “I’ve been blessed. My genius was to know long ago that money alone wouldn’t make me happy. Or maybe that’s my excuse for not leaving you a huge fortune! I certainly could have made more money if that had been my goal. But one thing I won’t have is regrets. My VIP patients often regret so many things on their deathbeds. They regret the bitterness they’ll leave in people’s hearts. They realize the no money, no church service, no eulogy, no funeral procession no matter how elaborate, can remove the legacy of a mean spirit”</p>
<p>Does anyone know what “Afterbird” means, the title of the last chapter? Just curious.</p>
<p>Psychmom- I share your confusion about that issue. What if the letter had not be discovered?</p>
<p>Curious about another “word” in the first chapter. if anyone would venture an explanation. The word at the end of the paragraph below “CUM-MING”- capitalized for emphasis. Why this misspelled ?</p>
<p>From the first chapter, Marion is four years old wanders to the photo, which probably contains the hidden letter.</p>
<p>“When are you coming, Mama?” I would ask, my small voice echoing off the cold tile. When are you coming?</p>
<p>I would whisper my answer: “By God!” That was all I had to go by: Dr. Ghosh’s declaration the time I’d first wandered in there and he’d come looking for me and had stared at the picture of St. Teresa over my shoulders; he lifted me in his strong arms and said in that voice of his that was every bit a match for the autoclave: “She is CUM-MING, by God!”</p>
<p>re: Afterbird, Perhaps it is a play on the word afterbirth? As Marion turns into MarionShiva, he is reborn? </p>
<p>re: Cum-ming, The image of St. Teresa has an orgasmic quality to it, I believe we’re told.</p>
<p>^ psychmom, I think you nailed it on both counts. </p>
<p>“Afterbird” is the word the boys used for “afterbirth” when they were just learning about what their parents did for a living. </p>
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<p>The line “It was feared, and yet its arrival was necessary” could apply to much in the book—Sister Mary’s (Delayed) letter; Genet’s final meeting with Marion; the phone call to Thomas Stone; Shiva’s death, so that Marion could live.</p>
<p>Also, psychmom, I completely agree with you that it was odd for the straightforward Ghosh to hide the letter. I think it was Verghese who didn’t know where to hide it, so he ended up laying it on Ghosh.</p>
<p>SJCM, the letter would not actually have been behind the picture when Marion and Ghosh were looking at it. Ghosh had it framed much later in life, when he was dying. (Hema to Marion: “Ghosh had this framed in the last month of his life. In his will he said that if you ever left the country, he wanted this picture to go with you.")</p>
<p>Mary13 and psychmom - impressive! Thanks.</p>
<p>Mary13,Psychmom, and others (that means lurkers out there ) how does this book stack up compared to the others we’ve read?</p>
<p>I liked this book a lot, but can see that Ignatius (hello there, we missed you in this discussion) would have been turned off by the medical details.
So, it isn’t a book for everyone, but as a “House” and “Medical Mystery” TV fan, it appealed to me. </p>
<p>After reading Let the Great World Spin, this book, Cutting for Stone, did not have the same emotional impact that LRGWS did ,even though Cutting for Stone dealt with some deep issues. </p>
<p>Do others agree ? Verghese seemed more “detached” as a story teller, whereas McCann wrote with his heart. Is it their style, their personalities, or was it the cultural differences and, as an American familiar with NYC in the 70’s, LTGWS resonated more with me.</p>
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<p>I just want to add to psychmom’s comment that I found the scene in which Marion goes to Hema after Shiva’s death very moving. Even though Marion has just lost an essential part of himself, there is no tearful breakdown, no overwrought emotion. He internalizes the loss—literally—and goes to his mother:</p>
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<p>Marion’s rebirth as ShivaMarion reminded me of the phoenix rising from the ashes.</p>
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<p>It’s always so hard to compare the books we’ve read. It’s like comparing apples and oranges—and bananas and pears! </p>
<p>I feel like we’ve leaned toward darker fare lately. Looking back, The Guernsey Literary and Potato Peel Pie Society seems like a long time ago and a relatively light read. As for Cutting for Stone and Let the Great World Spin, I think the former is more action-driven and the latter more introspective. I found that I read Cutting for Stone fairly quickly, despite its length, because it was a good old-fashioned family saga, and I was eager to see what happened next. With Let the Great World Spin, I tended to reflect more on what McCann was trying to say, and how the various stories were interwoven. LTGWS left me feeling more melancholy than Cutting for Stone. I quoted a reviewer earlier who wrote: </p>
<p>“This is a book narrated by a surgeon, and structured as a surgeon might structure it: after the body has been cut open and explored everything is returned to its place and carefully sutured up - which is not, in the end, how life actually works.”</p>
<p>Maybe not. But I think it’s how some of the great novels are structured—be it Dickens, Bronte, Tolstoy or whomever—and to me, it’s very satisfying.</p>
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<p>Thanks for the thought. I am a faithful lurker - and find the insights offered by everyone enriching. I should finish up Cutting for Stone today or tomorrow and then I’ll post something. :)</p>
<p>As usual, SouthJerseyChessMom has it right. The medical details have not helped. (When my father-in-law’s doctor explained a soon-to-be performed surgery, I hit the floor shortly after he mentioned cutting open the abdomen. In my defense, if you ever need to faint and hit the floor hard enough to raise a lump on your head, a hospital is a good place to do so.)</p>
<p>^LOL. ignatius, are you telling us that you don’t find passages like this romantic?:</p>
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<p>(someone pick up ignatius off the floor :))</p>