Cutting for Stone by Abraham Verghese
When I was in high school, my father dearly wanted me to follow in his footsteps and hop on board the pre-med train. “Any profession is good in good times but people will always need doctors in good times and bad.” Although I had the aptitude for it, I didn’t have the fortitude. As a compromise, we agreed that I would take AP Biology, AP Chemistry, and AP Physics and if I inexplicably still did not fall in love with science, I didn’t have to take any more classes of that sort. So I did. And I did well. I did spectacularly well. I came up with clever mnemonics for all of the elements. I dissected a frog bloated with flies from his last meal. I learned something or the other in physics but when I look at my notes from then, it’s complete gibberish to me now. When I received my final report card and saw that I aced each class (highest marks all around), I held my father to his promise and never step foot in a med-based classroom again. To his credit, he didn’t push back or renege.
As an adult, I can see why he wanted me to train as a doctor and I kind of hope the same for my kids. After this weekend’s back-pulling incident (suffice it to say, I am not an acrobat), I’m thankful we still have doctors in the family who can easily be reached and asked for advice and prescriptions. It is with my background as the offspring of an immigrant doctor that I approached this book which spoke to me on so many levels. It’s phenomenal. It’s gory. It’s lovely. Three cc’s of blurbs, stat!
With the end of the rains, makeshift stalls had popped up selling red and green chilies, lemons, and roasted maize. A man with a bleating sheep draped around his neck like a cape struggled to see the road in front of him. A woman sold bundles of eucalyptus leaves used as cooking fuel for making injera—the pancakelike food made from a grain, tef. Farther on Hema saw a little girl pour batter on a huge flat griddle which sat on three bricks with a fire underneath. When the injera was ready, it would be peeled off like a tablecloth, then folded once, twice, and once more, and stored in a basket. An old woman in the black clothes of mourning stopped to assist a mother sling her baby onto her back in a pouch made out of her shama—the white cotton cloth that men and women alike wrapped around their shoulders. A man with withered legs that were folded into his chest swung stiff armed along the dirt sidewalk. He had blocks of wood with a handle in each hand, which he planted on the ground, and then he swung his bottom forward. He moved surprisingly well, like the letter M marching down the road. Her brief absence made these sights a novelty again.
On Addis again because you know I love these kinds of rat-a-tat-tat descriptions and observations:
The Arab souks all over Addis were like this, as if they’d come from the same womb. Dangling down from the ceiling, on clothespins attached to a string, were single-use packets of Tide, Bayer aspirin, Chiclets, and paracetamol. They twirled like party decorations. A meat hook hanging from the rafters held squares of newspaper, ready to use as wrapping. A roll of twine hung on another hook. Loose cigarettes sat in a jar on top of the counter, unopened cigarette packs stacked next to them. The shelves were stuffed with matchboxes, bottled sodas, Bic pens, pencil sharpeners, Vicks, Nivea Creme, notebooks, erasers, ink, candles, batteries, Coca-Cola, Fanta, Pepsi, sugar, tea, rice, bread, cooking oil, and much more. Mason jars full of caramela and cookies flanked the counter, leaving an opening in the middle over which I leaned. I saw Ali Osman, lace cap glued to his head, seated on the mat along with his wife, infant daughter, and two men. The floor space was hardly big enough for Ali and his family to sleep spooned against one another, knees bent, and now he had visitors. They sat around a pile of khat.
On immigrant doctors coming to the States in the 70′s and 80′s which completely sums up how I ended up here myself.
“No, no. Let’s call [this saltshaker] an Ellis Island hospital. Such hospitals are always in places where the poor live. The neighborhood is dangerous. Typically such hospitals are not part of a medical school. Got it? Now take this saltshaker. That is a Mayflower hospital, a flagship hospital, the teaching hospital for a big medical school. All the medical students and interns are in super white coats with badges that say SUPER MAYFLOWER DOCTOR. Even if they take care of the poor, it’s honorable, like being in the Peace Corps, you know? Every American medical student dreams of an internship in a Mayflower hospital. Their worst nightmare is coming to an Ellis Island hospital. Here’s the problem—who is going to work in hospitals like ours when there is a bad neighborhood, no medical school, no prestige? No matter how much the hospital or even the government is willing to pay, they won’t find full-time doctors to work here.
“So Medicare decided to pay hospitals like ours for internship and residency training programs, get it? It’s a win-win, as they say—the hospital gets patients cared for by interns and residents around the clock, people like us who live on site, and whose stipend is a bloody fraction of what the hospital would pay full-time physicians. And Medicare delivers health care to the poor.
“But when Medicare came up with this scheme, it created a new problem. Where do you get your interns to fill all these new positions? There are many more internship positions available than there are graduating American medical students. American students have their pick, and let me tell you, they don’t want to come and be interns here. Not when they can go to a Mayflower hospital. So every year, Our Lady and all the Ellis Island hospitals look for foreign interns. You are one of hundreds who came as part of this annual migration that keeps hospitals like ours going.”
B.C. sat back in his chair.
“Whatever America needs, the world will supply. Cocaine? Colombia steps to the plate. Shortage of farmworkers, corn detasselers? Thank God for Mexico. Baseball players? Viva Dominica. Need more interns? India, Philippines zindabad!”
I felt stupid for not having seen this before.
“So the hospitals where I was going to interview,” I said. “In Coney Island, Queens—”
“All Ellis Island hospitals. Just like us. All the house staff are foreigners and so are many of the attending physicians. Some are all Indian. Some have more of a Persian flavor. Others are all Pakistani or all Filipino. That’s the power of word of mouth. You bring your cousin who brings his classmate and so on. And when we finish training here, where do we go, Marion?”
I shook my head. I didn’t know.
“Anywhere. That’s the answer. We go to the small towns that need us. Like Toejam, Texas, or Armpit, Alaska. The kinds of places American doctors won’t go and practice.”
“Because, salah, in those villages there’s no symphony! No culture! No pro-ball team! How is an American doctor supposed to live there?” …
“A toast! Ladies and gentlemen. May no American venture out of this world without a foreign physician at his or her side, just as I am sure there are none who venture in.”