Cutting For Stone Part 45

"Be careful what you eat, drink ...," he said. It was his way of telling me to protect his handiwork.

I felt better than well. Other transplant patients had to fight to keep their bodies from rejecting the lifesaving organ. The cortisone they took led to cataracts, diabetes, hip fractures, and other side effects. I was blessed not to have to swallow a single pill. I felt no pain if you didn't count the twinges under my ribs, which I considered promising and not painful; they were the sign of s.h.i.+va's half liver growing to fully occupy its new home.

"How about you?" I had yet to find a comfortable way to address my father; it was "Dr. Stone" in the hospital and nothing at times like this. "Will you have a job to go back to?" I teased. He hadn't seen Boston since I fell ill.

His slow smile only exaggerated the sadness in his face. He took s.h.i.+va's death personally, as if fate had never forgotten that he'd once attempted to destroy s.h.i.+va, and so when he had operated to save s.h.i.+va, his original intent had betrayed him.

My father made no attempt to shake my hand. Our one hug after s.h.i.+va's pa.s.sing was good for a lifetime. We parted with a nod.

Hema, however, took Thomas Stone's hand in both of hers. I had missed their reunion at my bedside. Now, I watched like a nosy child.

"Thomas, stop this at once!" Hema said, chiding him for his melancholic expression. "You did everything you could, do you hear me? You did your best for your sons. No one else in the world could have done what you did. Thomas, if Ghosh were here, he'd say the same thing. He'd have been so proud of you and he'd say, 'Go on with your work because it is so important.' " She released his hand, after patting it one last time, then she turned and walked away.

Later, as our plane banked over Queens and headed for open water, I thought about Hema's parting words to Stone. Buried in there had been her apology for having fas.h.i.+oned him into a monster in her mind for all these years. In patting his hand and walking away, she was releasing herself.

Alitalia took us to Rome. Mechanical problems on the connecting flight had the agent projecting a fourteen-hour layover. It gave me an idea. In no time Hema and I were once again in a taxi on a freeway, but this time we were heading to downtown Rome. We were like children playing hooky from school.

Hema had needed little convincing. We went to a first-cla.s.s hotel, the Ha.s.sler, Rome's best, I was once told. It was a grand building that overlooked the Spanish Steps. From the rooftop at dusk the sky's red hue outlined the dome of St. Peter's in the distance.

Each morning we set out for the briefest sightseeing. We returned to our hotel for lunch and a long afternoon nap. The evenings we wandered down the streets and alleyways beneath the Spanish Steps. Eventually we'd pick an outdoor cafe for dinner. "It's so familiar, isn't it?" Hema said. "These menus, typed out and mimeographed, minestrone and pasta f.a.gl-oli, the waiters with white s.h.i.+rts, black pants, white ap.r.o.ns ..." I knew what she meant. The Italians had brought it all to Ethiopia, right down to the umbrellas that hung over the little Formica-topped round tables. Hema's face at dinner was as tranquil as Id seen it since I became conscious of her at my bedside at Our Lady. "I wish Ghosh could have been with us. How he would have enjoyed this," she said, smiling.

ON THE FOURTH MORNING, we let the concierge talk us into a private tour with a guide from our hotel. What did we want to see? Surprise us, we said. Take us off the cow path. Places where there isn't too much walking or waiting in line.

He began with the Santa Maria della Vittoria, a ten-minute ride from our hotel. It was a homely church, sitting right on the street, cars pa.s.sing by, the elaborate faade looking as if it had been slapped on to the front of an unadorned stone box. Our guide said it was built about 1624, first dedicated to St. Paul, and later to the Virgin Mary. The interior was small-tiny when compared with St. Peter's-with a short nave under a low vault. Off to the side, Corinthian pillars flattened into the wall demarcated three "chapels" which were nothing more than recesses, each with a rail for private prayer and a place to light candles. As we came to the end of the nave, our guide turned to the left and pointed. "This is the Cornaro Chapel. It is what I wanted you to see," he said.

It took a few seconds for my eyes to relay the sight to my brain, and longer still for my brain to believe. The blue marble sculpture floating before me was Bernini's Ecstasy of St. Teresa. I wanted to silence our guide and say, Stop, I know this sculpture. But in truth what I knew was only a print that found its way onto a calendar which my mother had then thumbtacked to the wall of the autoclave room. It had been up for perhaps thirty years before Ghosh had taken that aging piece of paper and framed it for me, to protect it from further deterioration. The print meant the world to me, yet it had never seemed at ease on my walls in America, where it looked like the cheapest kind of tourist gewgaw. I'd packed it with me on this journey, planning to restore it to the one place where I knew it was at home, the autoclave room.

I looked over to Hema. Her face was aglow. She understood. What providence had brought us to this spot? Surely this was Ghosh announcing his presence, because Ghosh was the sort of man who could be counted on to know that Bernini's Ecstasy of St. Teresa was minutes from our hotel, even if he'd never been to Rome before. Ghosh had brought us here, led us to this spot, not to see St. Teresa in marble, but to see Sister Mary Joseph Praise in the flesh, for that is what the figure was to me. I have come, Mother.

WE LIT CANDLES. Hema fell to her knees, the flame throwing a flickering light on her face. Her lips moved. She believed in every kind of deity and in reincarnation and resurrection-she knew no contradictions in these areas. How I admired her faith, her lack of self-consciousness-a Hindu lighting candles to a Carmelite nun in a Catholic church.

I knelt, too. I addressed G.o.d and Sister Mary Joseph Praise and s.h.i.+va and Ghosh-all the beings I carried with me in the flesh and in spirit. Thank you for letting me be alive, letting me see this marble dream. 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.

My mother had spoken.

What I didn't know then was that she had more to say.

CHAPTER 54.

Homefires.

IT WAS DUSK when we landed. I had been away from Addis for seven years. The white buildings of Missing looked rounded at the edges, worn down, as if theyd been excavated in an archaeological dig but not restored.

When the taxi reached s.h.i.+va's toolshed I had the driver let me out. I told Hema to go on because I wanted to walk the rest of the way.

I stood listening once the car pulled away; the dry rustle of the leaves was like a child's hand sifting through a box of coins. The sound had lost all its menace for me. I found that dented and bent curb, which had stopped a motorcycle but not its rider. I looked down into the trees and the shadows where he fell. The spot no longer generated any dread for me. All my ghosts had vanished; the retribution that they sought had been exacted. I had nothing more to give, and nothing to fear. I looked out over trees to the city. The sky was a mad painter's canvas, as if halfway through the artist had decided against azure and had instead splashed ochre and crimson and black on the palette. The city was alight, glowing, but here and there it was obscured by great puffs of mist which smudged my view, like the smoke of many small battles.

I walked up the hill to the house, a thousand memories now of s.h.i.+va and me doing our three-legged race to be in time for dinner, or the two of us and Genet walking back with our school books, of Zemui coming up with his motorcycle and then coasting the last hundred yards. Up ahead I could see the figures huddled around our taxi and around Hema. Then Matron, Gebrew, and Almaz separated from the vehicle, silhouetted against the last embers of the sky, and they waited for me.

I'D BEEN BACK just three days when Matron summoned me to Casualty. A young girl with a bull-gore wound to the abdomen was exsanguinating before our eyes. The child would have died if wed tried to send her elsewhere. I took her to Operating Theater 3 at once, and found the bleeder. What followed next-cutting out damaged bowel, was.h.i.+ng out the peritoneal cavity, fas.h.i.+oning a colostomy, was routine, but its effect on me was anything but. I felt I was on consecrated soil, standing on the same spot where Thomas Stone, Ghosh, and s.h.i.+va had stood, each with scalpel in hand. At the end of the surgery, when I turned to leave, weaving around the bucket and wires on the floor, I looked up and saw s.h.i.+va in the new gla.s.s that separated Theater 3 from its spanking-new mate, Theater 4. The sight took my breath away. I remembered s.h.i.+va's first words when the killing of Koochooloo's puppies prompted him to break years of silence: Will you forget if someone kills me or Marion?

No, s.h.i.+va, we'll never forget you, I said to my reflection. In saying that I think I decided my future.

AMONG s.h.i.+VA'S BELONGINGS in his room, I found a key on a key-holder shaped like the Congo. In s.h.i.+va's toolshed was a strange-looking motorcycle, with bright red, stubby fenders, a teardrop-shaped red fuel tank, handlebars that would have been called ape hangers in America, and lovely chrome wheels. Hema said that s.h.i.+va had bought the bike secondhand a few years back and that he kept tinkering with it. She said he had only ridden it late at night when there was no traffic. The udderlike engine looked very familiar, and its low rumble when I kick-started it gave away its true ident.i.ty.

I operated three days a week, and when my return ticket to New York was about to expire, I did nothing.

s.h.i.+va's liver functioned beautifully in me year after year. The shots of hepat.i.tis B immunoglobulin helped. The virus became so dormant that my blood tests showed I wasn't a carrier, and that I couldn't infect anyone. Matron insisted it was a miracle, and I had to agree.

In 1991, five years after my return, I stood by the gates of Missing just as I had when I was a child, and I watched the forces of the Tigre People's Liberation Front and other freedom fighters make their way into the city. They were dressed in the same functional s.h.i.+rts, shorts, and sandals of the guerrillas I had seen in Eritrea, bandoliers crisscrossing their chests, rifles in their hands. They didn't march in formation, yet their faces showed the discipline and confidence of men who believed in their cause. There was no looting, no mayhem. The only looting was by the Comrade President-for-Life, who emptied the Treasury and flew with his loot to Zimbabwe, where his fellow looter, Mugabe, gave him refuge. Mengistu was a despised figure, a blight on the nation, a man about whom to this day no one can find a good word to say Almaz said that the souls of all those he murdered were a.s.sembled in a stadium, waiting to give him a reception on his way to h.e.l.l.

EVERY EVENING I checked on Matron before I went to bed. She was so tremulous and bent over with age, but her joy in life was unchanged. We would have a cup of cocoa together. Her only LP-Bach-played in the background on the small gramophone I had bought for her. She never tired of the "Gloria," which I will always a.s.sociate with her. As Id sit with her, she would look over and smile as if she always knew Id come back to the land I had once disowned. It had been Matron's wish that G.o.d might call her either during her prayers or her sleep, and He obliged. It was 1991, a few months after the President-for-Life fled; I found her in her chair, the record still spinning on her gramophone. Just the previous morning she had been supervising the planting of a new cultivar, the Rosa rubiginosa s.h.i.+va, which she had officialy registered with the Royal Society. To me it looked as if the whole city, rich and poor, turned out for her funeral. Almaz said that the streets to heaven were lined by the souls of those who were grateful to Matron, and that her throne was next to Mary's.

Almaz and Gebrew were retired and ensconced in new, comfortable quarters built for them at Missing, free to spend their time in any way they chose. I suppose it should not have surprised me that they would spend it in fasting and prayer.

The s.h.i.+va Stone Inst.i.tute for Fistula Surgery with Hema as its t.i.tular head grew, as did its funding. Hema worked every day, and zealous young gynecologists from within the country, but also from other African nations, came to train and take up the cause. The Staff Probationer, whose room I had visited so many years ago, had become a skilled a.s.sistant under s.h.i.+va's tutelage, and now, with Hema's encouragement, she was a confident surgeon on her own, well suited to the painstaking task of training the young doctors who came to learn how to treat this one condition. I insisted on learning her real name, and reluctantly she told me it was Naeema. But it was not a name she ever used; she had become the Staff Probationer even to herself.

In going through Matron's papers, I discovered that the anonymous donor who had modestly funded s.h.i.+va's work for so many years was none other than Thomas Stone. Now he worked to direct other donors and foundations to support Missing.

I HAD TO WAIT till 2004 for Sister Mary Joseph Praise's message to reach me. It happened just after New Year's on the Western calendar, a time when the mimosa trees that surrounded the outpatient building had sprung their violet and yellow blooms and Missing was enveloped in the scent of vanilla.

I'd gone into the autoclave room between patients. The framed print of Bernini's Ecstasy of St. Teresa looked slightly askew. In straightening it, I found the hook was loose. When I took the frame down to tighten the hook, I noticed the thick paper backing had come unglued at one edge. The room stayed humid because of the autoclave, and it appeared to have weakened the glue. On trying to get the backing to stick again, I spied a gossamer-thin letter paper folded and ensconced behind that backing, the lines of blue writing showing through.

I fished it out.

I slumped back into my chair. My hands never tremble, but for some reason that delicate slip of paper shook.

The letter looked discolored by age, almost transparent, in danger of crumbling into dust. Like Ghosh, I had a moment to decide whether to read a private letter that was meant for another. I was certain that this was the letter my mother had penned just before I was born. Then it was in Ghosh's possession. When I was twenty-five years old, the letter came to me. I had carried it to America, then I had brought it back. For twenty-five years I was unaware that I had it. Until today. "When are you coming, Mama?" I used to ask when I was a small boy gazing up at the picture. She had come at last.

CHAPTER 55.

The Afterbird.

September 19 Dear Thomas.

Last night, G.o.d told me I must confess to you what I have never confessed, even to G.o.d. Years ago, in Aden, I turned from G.o.d as He turned from me. Something happened to me there that should not happen to any woman. I could not forgive the man who harmed me. I could not forgive G.o.d. Death would have been better than what I endured. But I came here, to Missing. I came in the dress of a nun to hide my bitterness and shame from the world.

In Jeremiah 17 it is written, "The heart is deceitful above all things and beyond cure, and who can understand it?" I came to Ethiopia in deceit.

But our work changed me. I would have been your a.s.sistant till my last breath. Now, things have changed again.

A few months ago, you were like a man possessed, and I tried to comfort you. Now I am with child. Do not blame yourself.

It was difficult to hide my body from Matron and the others. Many times I thought of telling you. I could never find a way. But now I am frightened. My time is short. Last night the movements became strong. It made me think, What if Thomas wishes me to stay? I should not leave in the way I came to Missing and to you, hiding and in deceit. That is why I write.

I must flee Missing to spare it my shame just as I once fled to it to hide my shame. If you come to me when you get this letter, I will know that you wish me to be with you. But whatever you do, my love will always be the same.

Mary.

It took such concentration to finish my last surgical case-a routine vagotomy and gastrojejunostomy for a duodenal ulcer-and not let my mind wander. At last, with that letter in hand, I walked back to my quarters, feeling as if I had never come up this path before.

She loved him. She loved him so much she ran to him from Aden. The bloodstains with which she came to Missing told me what she could not. She made her way to the doctor-the man-she had met on that s.h.i.+p out of India. And then, years later, she loved him so much she was ready to leave him. At the eleventh hour she decided to write and tell him. Then she waited for him to come, or not.

But Thomas Stone did come. Surely she would have registered his arrival. As he picked her up, carried her, ran with her, every tear that fell from his eyes onto her face she would have interpreted as affirmations of his love. He came not because of the letter: he never got it. He came because some part of him knew what he had done, and what he had to do: some part of him knew what he felt.

I pictured Ghosh visiting Thomas Stone's quarters after my mother's death, searching for him. He would have seen on Stone's desk the new textbook and bookmark, and on top of them, conspicuously perhaps, this letter. Thomas Stone never saw the book or the letter because he spent the previous night sleeping in the lounge chair in his Missing office, as he often did, and then after my mother's death he never returned to his quarters. Why hadn't Ghosh simply mailed the letter directly to Thomas Stone? Thomas never wrote or communicated; Ghosh had no address at first. But as the years went by, Ghosh could probably have found Stone's whereabouts. After all, Eli Harris had always known them. But perhaps by then Ghosh was hurt by Stone's silence and his willingness to forget his old friend and leave him caring for his children as he ran from his past. As more years went by, Ghosh might have pondered the effect of the letter on Stone-perhaps it would in fact be a disservice to send it to him. It might have precipitated another meltdown, or, as Hema had always feared, Stone might have returned to claim the children. And perhaps Stone wouldn't understand-or believe-anything the letter said.

Then, as death approached, it must have worked on Ghosh's conscience to be the keeper of this letter. What if the contents could save Stone, put his heart at ease? What if it made Stone do, even belatedly, the right thing by his sons? By this time all Ghosh's resentment for Stone, if he ever had any, had vanished.

So ultimately Ghosh gave the textbook and bookmark to s.h.i.+va, and the letter to me, but hidden from me. I marveled at the foresight of a dying man who would entomb a letter within a framed picture. He would leave it to fate-how like Ghosh this was! When would I find Thomas Stone? When would I find the letter? If and when I found it, would I give the letter to its intended recipient? Ghosh trusted me to do whatever it is I would choose to do. That, too, is love. Hed been dead more than a quarter century and he was still teaching me about the trust that comes only from true love.

"s.h.i.+va," I said, looking up at the sky where the stars were warming up for their nightly show while I recalled the night I fled Missing in haste, and how s.h.i.+va had thrust at me my father's book-A Short Practice, that bookmark inside. The few words on the bookmark penned by my mother were the only way any of us knew a letter even existed. Years ago, over the telephone, I had asked him, "s.h.i.+va, what made you give me the book?" He didn't know. "I wanted you to have it" was all he could say. The world turns on our every action, and our every omission, whether we know it or not.

WHEN I REACHED MY QUARTERS, I sat down and spread the letter on my lap, and with shaky hands I dialed Thomas Stone's number. My father was well past eighty now, an emeritus professor. Deepak said the old man's eyes were fading, but his touch was so good he could have operated in the dark. Still, he rarely operated anymore, though he would often a.s.sist. Thomas Stone was once known for The Expedient Operator: A Short Practice of Tropical Surgery. Now he was famous for pioneering a breakthrough transplant procedure. I was proof that the operation worked, but s.h.i.+va's death was proof of the attendant risks. Surgeons around the world had learned to do the operation, and many infants born without a working bile-drainage system had been saved by a parent's gift of a part of his or her liver.

IN MY EARPIECE I heard the hush of the void that hangs over the earth, and then out of that ether, the sound of the phone ringing far away, its high-pitched summons so brisk and efficient, so different from the lackadaisical a.n.a.log clicks and the coa.r.s.e ring when I dialed an Addis Ababa number. I pictured the phone trill and echo in the apartment that I had visited once, and which I had left open like a sardine can so that Thomas Stone would know that his son had arrived in his world.

I thought of my mother writing this letter, her whole life compressed on one side of this parchment. She had probably delivered it (and the book with bookmark) in the late afternoon when the pains. .h.i.t her. She had worsened in the night, slowly slipping into shock, and then the next day she died. But not before Thomas Stone came to her. It was the sign she had waited for. He did the right thing, and yet for the last half century, he was unaware that he had done so.

Thomas Stone answered after the first ring. It made me wonder if he were wide awake even though it was the middle of the night in Boston.

"Yes?" My father's voice was crisp and alert, as if he expected this intrusion, as if he were ready for the story of trauma or ma.s.sive brain bleed that made an organ available, or ready to hear of a child, one in ten thousand, born with biliary atresia who would die without a liver transplant. The voice I heard was that of someone who would bring all the skill and experience he carried in his nine fingers to the rescue of a fellow human being, and who would pa.s.s on that legacy to another generation of interns and residents-it was what he was born to do; he knew nothing else. "Stone here," he said, his voice sounding so very close, as if he were there with me, as if nothing at all separated our two worlds.

Acknowledgments.

THIS IS A WORK OF FICTION, and all the characters are imagined, as is Missing Hospital. Some historical figures, such as Emperor Haile Sela.s.sie and the dictator Mengistu, are real; an attempted coup did occur in Ethiopia, but five years earlier than the one I describe. The Colonel and his brother are loosely based on the real coup leaders. The details of their capture and the words at the Colonel's trial and before he was hung are from published reports, particularly Richard Greenfield's Ethiopia: A New Political History; John H. Spencer's Ethiopia at Bay: A Personal Account of the Haile Sela.s.sie Years; the published work of Richard Pankhurst for historical backdrop; and Edmond J. Keller's Revolutionary Ethiopia: From Empire to People's Republic. A remarkable physician by the name of John Melly died after being shot by a looter, but his dialogue with Matron is imagined. The Ibis and other bars are inventions. The LT&C school is imagined; any resemblance to my wonderful school (where Mr. Robbs and Mr. Thames encouraged my writing) is not intentional.

The following sources, books, and people were invaluable: The birth scene and the phrases "white asphyxia" and "in the obscurity of our mother's womb" are inspired by the wonderful memoir of the late great Egyptian obstetrician and fistula surgeon Naguib Mahfouz, The Life of an Egyptian Doctor, as is the idea of the copper vessel. Nergesh Tejani's essays describing her experiences in Africa with version clinics and with fistula, as well as our correspondence, were extremely helpful. I consulted the published work of Dr. Reginald Hamlin and Dr. Catherine Hamlin, pioneers of fistula surgery. As a medical student, I would see them and was very aware of their work. Recently, I had the opportunity to visit the "Hospital by the River," which is also the t.i.tle of Catherine Hamlin's lovely memoir. The fistula surgeons in my book are not in any way based on the Hamlins. The late Sir Ian Hill was in fact the dean of the medical school, and if I use his name, and that of Braithwaite, in the book, it is as a tribute to two people who took a chance on me. The attempted hijackings of the Ethiopian Airlines jets during the 1960s and 1970s are historical facts; one would-be hijacker was my senior in medical school; she and her fellow hijackers perished in the attempt. The present prime minister of Ethiopia, Meles Zenawi, was one year my junior in medical school; he became a guerilla fighter, ultimately leading the forces that toppled Mengitsu. The heroism of the security crew and the incredible skill of the pilots are very real. Ethiopian Airlines remains, in my opinion, the safest and best international airline I have flown, with the most hospitable and dedicated flight attendants. Louse-borne relapsing fever was studied by the late Peter Perine and the late Charles Leithead, and I had the pleasure of seeing patients with both men when I was a student.

For information about Teresa of Avila, and the description of Bernini's statue, I drew on Teresa of Avila: The Progress of a Soul by Cath-leen Medwick. Even after seeing the original in Rome, I found Med-wick's descriptions so insightful. Any of St. Teresa's words that I quote, as well as the ideas about faith and grace, and the idea of Sister Mary Joseph Praise reciting the Miserere at her death and the idea of the inex-picably sweet scent, are based on Medwick's account of the life of Teresa. The words "celestial billing and cooing" are from H. M. Stutfield quoted in Medwick's book.

The line "I owe you the sight of morning" is by W. S. Merwin from the poem "To the Surgeon Kevin Lin," originally published in The New Yorker. A limited-edition print of this poem prepared by Caro lee Campbell of Ninja Press and signed by William Merwin hangs in my office. I owe a great debt to physician, writer, and friend Ethan Canin for first inviting me to the Sun Valley Writers Festival and thereby introducing me to Reva Tooley and the remarkable people who gather there.

The line "her nose was sharp as a pen" is from Henry V, Part II and relates to my belief that it represents Shakespeare's astute clinical observation, which I described in "The Typhoid State Revisited," in The American Journal of Medicine (79:370; 1985).

My own impressions of Aden and my memories of sitting in khat sessions were aided by the most vivid descriptions in Eric Hansen's wonderful book Motoring with Mohammed: Journeys to Yemen and the Red Sea and also Eating the Flowers of Paradise: One Man's Journey Through Ethiopia and Yemen by Kevin Rushby. The image of the woman with the charcoal brazier on her head and also the wheelbarrows transporting people come from Hansen's book.

The Italian occupation, the description of Aweyde, and many aspects of the Italian-Ethopian conflict, including the desire to win by any means-Qualsiasi mezzo-were informed by Paul Theroux's wonderful Dark Star Safari: Overland from Cairo to Capetown and many other sources.

"Squared her shoulders to the unloveliness" is a paraphrase of James Merrill's line in the poem "Charles on Fire": "No one but squared / The shoulders of his unloveliness."

Bliss Carnochan showed me an early edition of his Golden Legends: Images of Abyssinia, Samuel Johnson to Bob Marley and helped me see how Western ideas about Ethiopia were shaped.

I and countless Commonwealth medical students admired Bailey and Love's Short Practice of Surgery; Stone's imagined textbook is based on Bailey and Love, and the wombat and the appendix story is from there. As a student I was impressed with the photograph of Bailey and his nine fingers. Other than that, the character of Stone has no connection with Hamilton Bailey, who practiced only in England before retiring.

"A careful decision was needed so as not to blunder again. It was often the second mistake that came in the haste to correct the first mistake that did the patient in" and "A rich man's faults are covered with money, but a surgeon's faults are covered with earth" are both from Aphorisms and Quotations for the Surgeon by Moshe Schein. For these and many other surgical notions, I owe Moshe, maverick surgeon, brilliant teacher, author of several wonderful surgical textbooks, essayist, and friend. He not only read early drafts but also introduced me to the community of surgeons on SURGINET I delighted in, learned from, and borrowed ideas from their musings, particularly the vasectomy details, which made for a series of memorable exchanges. Karen Kwong shared with me her experiences (and those of her husband, Marty) as a trauma surgeon, and she was a careful reader of the ma.n.u.script both early and at the end. Her long, thoughtful e-mails were precious, and I cannot express to her sufficiently my grat.i.tude and admiration. Thanks also to Ed Salztein, Jack Peac.o.c.k, Stuart Levitz, and Franz Theard. I met Thomas Starzl when I was a Chief Resident in Tennessee and have since renewed the acquaintance. He is truly a surgeon's surgeon, and his pioneering work establis.h.i.+ng the field of liver transplantation is no fiction; I refer to him in the book in tribute. Thomas Stone is his fictional contemporary. Francisco Cigarroa, president of the University of Texas Health Science Center, San Antonio, was kind enough to let me watch as he performed a liver transplant on a child. The remarkable group in San Antonio, led by Glenn Halff, who make liver transplant appear almost routine, are part of Starzl's legacy-until very recently, it was fair to say that every liver transplant surgeon in the world was trained by Starzl or by someone who trained with Starzl.

"Birth, and copulation, and death / That's all the facts when you come to bra.s.s tacks: I've been born, and once is enough" is a partial quote form T. S. Eliot's Sweeney Agonistes.

"Indeed to think of life as tragic is a posture of delusion, for life is uniformly worse than tragic" is a line from Heinrich Zimmer's The King and the Corpse, edited by Joseph Campbell, as is "Not only our actions but also our omissions become our destiny."

"They saw in the plague a sure and G.o.d-sent means of winning eternal life" is from Camus' The Plague.

I am greatly indebted to the late Ryszard Kapuscinski's take on a city and a country which I thought I knew well. Details of the Emperor's court, the palace, the funding of the health departments, the Amhara character, the motorcycle escort, the Minister of the Pen, and the palace intrigues were things most residents knew about and had in some cases seen firsthand, but Kapuscinski's particular talent was, as an outsider, making those things more visible to us, which he did in his extraordinary book The Emperor.

"The crookedness of the serpent is still straight enough to slide through the snake hole" is paraphrased from one of the Bhakti poems in Speaking of Siva, edited by the late, great A. K. Ramanujam.

For information about the Carmelites I thank Fred de Sam Lazaro and Eliam Rao and the incomparable Sister Maude. There is no convent of Carmelites to my knowledge in Egmore.

The details of the the Rock of East Africa, AFRS Asmara, are from http://www.kagnewstation.com/.

For the scenes of the escape from Asmara, I thank Naynesh Kamani, who was my senior in medical school and who made that heroic walk; he read the ma.n.u.script and had many corrections and suggestions. I was greatly influenced by Thomas Kennealy's wonderful novel To Asmara, with its observations about the Eritrean guerrilla camps which Kennealy appeared to have visited; he remains a champion of the Eritrean people. I should state that my affection is equal for both Ethiopia and Eritrea, and I have dear friends in both places.

"As if I had given him the greatest gift a man could ever give another" is a paraphrase of a line in Raymond Carver's "What the Doctor Said," from New Path to the Waterfall.

For the scenes at the tuberculosis sanatorium, I am indebted to Jean Mason's "The Discourse of Disease: Patient Writing at the 'University of Tuberculosis,' " which I was fortunate to hear at the Psychoa.n.a.lysis and Narrative Medicine Conference, University of Florida, Gainesville, in 2002.

"May no English n.o.bleman venture out of this world without a Scottish Physician, as I am sure there are none who venture in" was said to be a toast used by William Hunter, M.D., the elder of the Hunter brothers. I have paraphrased this as a toast that B. C. Gandhi uses.

"Call no man happy until he dies" is what the Athenian Solon tells Croesus, the wealthy king of Lydia, according to Herodotus. These are words that Sir William Osler quoted on hearing the news of his beloved son Revere's death at Flanders. The imagined nursing textbook that describes Sound Nursing Sense is a recasting of one of Osler's aphorisms.

For the information on psychosomatic ailments among Ethiopians, I am grateful to my friend Rick Hodes, M.D., internist, writer, and mensch. His life in Ethiopia is a story of its own. Thanks to Thomas "Appu" Oommen for his incredible recollections of his time in Addis as a schoolboy and later as a journalist, and of the period of the coup. An e-mail Appu shared with me from Yohannes Kifle gave me great insight into Kerchele. My parents, George and Mariam Verghese, shared their memories, and my mother made extensive notes just for my use. To them I have dedicated this book.

In the course of writing this novel over several years, I consulted many other works, most of which I hope are listed in the bibliography, and any failure to acknowledge a person or source is something I would like to correct. The scene of Genet's damp gift to Marion was inspired by a similar scene from a novel or short story whose authors.h.i.+p I cannot recall; similarly, the metaphor of Aden as a city at once dead yet alive like maggots on a corpse (or words to that effect) is one that I would love to attribute to a source.

I am grateful to the extraordinary Advisory Board in San Antonio that allowed us to build a Center for Medical Humanities, but even more grateful for the personal friends.h.i.+ps I formed with its members. Steve Wartman, my tennis partner and friend, recruited me to San Antonio when he was dean. Edith McAllister was my teacher, my coach, my inspiration, and the person who understood better than anyone the need I had for protected time, even if it meant my leaving; in my next life my ambition is to come back as her. For Marvin and Ellie Forland and for Judy McCarter, words cannot do justice to the support and love they gave me; to hold a distinguished professors.h.i.+p named after Marvin, and a distinguished chair named after Joaquin Cigarroa Jr. (both consummate internists), was the greatest honor. Judy remains my counselor and conscience; with every pa.s.sing year I grow in admiration of her wisdom. Thanks to UTHSCA, to the extended Cigar roa family, Bill Henrich, Robert Clark, Jan Patterson, Ray Faber, Tom Mayes, Somayaji Rama-murthy Deborah Kaercher, the late David Sherman, and so many others who made it a special place to work; so also to Texas Tech, El Paso, where this work first began. Dr. Erika Brady of Western Kentucky University's folk studies department was an expert in matters ranging from Alpha Omega Alpha to Religio Medici to details about prayers and dress; I could always rely on her research. Michele Sta.n.u.sh also helped me with research, and I am most grateful.