Novelist Abraham Verghese Writes of Addis Ababa

This is an interview I did recently for the Ethiopia & Eritrea RPCVs  newsletter (The Herald) that I thought would-be writers would like to read. Dr. Abraham Verghese used aspects of his own life story to write this novel, setting his narrative in Addis Ababa, Ethiopia, and the U.S. Dr. Verghese is not only a noted doctor, he is also a well published writer of fiction and non-fiction. jc

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Abraham Verghese was born in Addis Ababa, Ethiopia and is the Professor for the Theory and Practice of Medicine at the Stanford University School of Medicine and Senior Associate Chair of the Department of Internal Medicine. In February 2009, Knopf published his first novel, Cutting for Stone. The novel is set in Addis Ababa.

Dr. Verghese is also the author of two books of non-fiction, My Own Country and The Tennis Partner. Dr. Verghese began his medical training in Ethiopia, but his education was interrupted when Emperor Haile Selassie was deposed and a military government took over.

Coming to the U.S. with his parents in 1974, he worked as worked as an orderly for a year before going to India and completing his medical studies at Madras Medical College. Finishing his medical degree in 1979, he returned to the United States in 1980, one of the hundred of foreign medical graduates, or FMGs, from India seeking residency positions. He wrote about this in an article in The New Yorker, describing how most FMGs find work only in the less popular hospitals and communities, and frequently in inner cities.

He next obtained a residency in a brand-new program in Johnson City, Tennessee affiliated with East Tennessee State University. He was a resident there from 1980 to 1983, and then secured a fellowship at Boston University School of Medicine in 1983, where he worked for two years at Boston City Hospital where he saw the early signs of the urban epidemic of HIV in that city.

Returning to Johnson City in 1985 as assistant professor of medicine (he later became a tenured associate professor there), he encountered the first signs of a second epidemic, that of rural AIDS. His work with the patients he cared for and his insights into his personal transformation from being “homoignorant,” as he describes it, resulted in his first book.

Overwhelmed by work, and wanting to write, he cashed in his retirement plan and his tenured position at the hospital, and applied to, and was accepted by, the prestigious Iowa Writers Workshop at the University of Iowa where he earned a Master of Fine Arts degree in 1991.

After Iowa, he accepted a position as Professor of Medicine and Chief of the Division of Infectious Diseases at Texas Tech Health Sciences Center in El Paso, Texas, where he lived for the next 11 years. During these years he wrote My Own Country: A Doctor’s Story about his experiences in East Tennessee. This book was one of five chosen as Best Book of the Year by Time magazine. It was later made into a movie.

Next he was recruited to San Antonio as the founding director for the Center for Medical Humanities and Ethics at th e University of Texas Health Sciences Center San Antonio. Then in 2007 he was recruited  to Stanford University as a tenured professor. He is renowned at Stanford for his weekly bedside rounds, where he insists on examining patients without knowledge of their diagnosis to demonstrate the wealth of information available from the physical exam.

A journalist interviewing Verghese asks, “Was there a single idea behind or genesis for Cutting for Stone?”

Dr. Verghese’s complex answer was the following, “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.”

His novel, Cutting for Stone, was written about the time Abraham was coming of age himself, a time of great loss for the author, who as an expatriate had to leave the country even though he had been born there.

I am not writing a review of the book (others have written glowingly of the novel) and someone else will write a review of the novel for the website. I’ll say only that Cutting for Stone is an old fashioned novel, a 19^th Century novel, a good read, a saga with numerous story lines and many, many characters. Verghese does a fine job in moving characters and situations from one point to another, of layering his novel with history, and of tying everything together in the way Thomas Hardy did with his big books.

Several months ago, Mike McCaskey (Ethiopia 1965-67) met Dr. Verghese in Chicago and the doctor expressed an interest in having the Peace Corps community, especially the Ethiopian RPCVs, know about Cutting for Stone as he felt they would find much in it that would remind them of their years in Ethiopia. At Mike McCaskey’s suggested I contacted Dr. Verghese and we began this exchange of emails.

The purpose of this very limited interview was to make a connection between Dr. Verghese and all of us. We overlapped each other in Ethiopia. (Though Abraham is a mere kid compared to most of us.) What I asked him were not the usual questions about the prose and poetry of his book, which there is much of, but of the facts, history, and interesting details that made me curious because of having lived in Ethiopia when it once was an Empire.

I would recommend that you buy and read Cutting for Stone and enjoy it for what it is, a big, sweeping emotionally riveting first novel, an enthralling family saga that begins and ends in Addis Ababa. I promise you that reading it you’ll again smell the burning of a hundred thousand eucalyptus fires, smell Africa distilled at eight thousand feet.

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John Coyne: To set the time frame for your own years in Ethiopia, Dr. Verghese, when and where were you born?

Abraham Verghese: I was born in Addis Ababa in 1955.

JC: What did your parents do in Addis?

AV: They were school teachers at first, and later my Mom taught in the teachers college, and my Dad was in the Engineering School at the University. They left Ethiopia on a sabbatical in England in 1965-66 where my father did post doc work, and returned again, and they left for good in 1972.

JC: You went to secondary school in Addis?

AV: Yes, I attended the British run Sanford School. I left Ethiopia in 1970.

JC: The title of your novel: Cutting For Stone. What was your thinking? A play off of words? The reference to the Hippocratic Orth?

AV: There is an antique line in the Hippocratic Oath. . . . I will not cut for stone, even for patients in whom the disease is manifest . . . It stems from the days when bladder stones were epidemic, and were a cause of great suffering, probably from bad water and who knows what else. Adults and children suffered so much with these stones and they died prematurely of infection and kidney failure. There were itinerant stone cutters–lithologists-who could cut either into the bladder or the perineum and get the stone out, but because they cleaned the knife by wiping it on their blood stiffened surgical aprons, patients usually died of infection the next day. Hence the proscription, “thou shall not cut for stone.”

It has always seemed to me a curious thing to say when we recite the oath in this day and age. But I love the Hippocratic oath (or oaths, because the origins and authorship are far from clear), and always try to attend the commencement ceremony. When  my students  stand and take the oath, all the physicians in the room are invited to stand and retake the oath.  It chokes me up every time. Not only am I renewing my faith, but I am bursting with pride in seeing my students graduate. You see, another part of the oath is “to teach them this art, if they desire to learn it; to give a share of precepts and oral instruction and all the other learning to my children and to the children of those who instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law . . .”

So the title has that meaning, that allusion to the oath, which it turns out binds all the major characters in the book in some fashion;  then again the main characters have the surname ‘Stone’ and they are surgeons on top of that. So the sons are (unwittingly) following in the father’s footsteps, taking the baton when is passed on, “cutting for Stone” as it were.  Ultimately, I thought the title had a nice ring to it, because it’s an usual expression, not one you will hear in every day parlance. It was my working title for the book from the earliest pages.

JC: Are all the medical procedures that you detail accurate? I presume that they have been well sourced as they are extremely well described in the course of the novel.

AV: Yes. They recapitulate the history of liver transplants and also of fistula surgery. The business of the conjoined twins and their separation obviously takes liberties with what are exceedingly rare events.

JC: You mentioned Waugh in your novel his visits to Abyssinia? What do you think of Waugh?

AV: I Though Waugh’s account was terribly condescending, contemptuous of the people and the culture. He could have been insightful  and descriptive (like Maugham or V.S. Naipaul) and let the readers judge for themselves.

JC: In your fiction you mix in real figures of Ethiopian history as well as fictional account. Tell us, you have Emperor Menelik eating the bible when he was sick. Is this a legend?

AV: No, true story. At least it is reported in several good sources.

JC: Again, you have a story of Menelik importing an electric chair to the Empire as a handy way to kill his enemies, but then when he discovered it needed electricity, he simply used it as a throne. Is that another Ethiopian legend?

AV: No, that’s a true story.

JC: You have a mission school in Debre Zeit. I was in Ethiopia during the years that you have set your novel, and I don’t recall a mission school in that town.

AV: No, that is imagined.

JC: You have a wonderful scene where the woman doctor seizes the airplane pilots’ “testicular atrophy’. Now, I have never heard of a woman doing that. You are writing fiction, of course, but much of this novel is what I call, “a novel of information” and the hospital operations are certainly that. The pilot is making an illegal run for khat, and later we learn that this woman doctor crews the drug. I guess I am asking: what is the plot element that you are developing with this scene for your novel?

AV: All of this scene is imagined. The purpose was, I suppose ( though one does not write with that kind of left brain ‘purpose’– it all sort of just happens and come out on paper) to establish Hema’s character, to demonstrate the khat economy which was responsible for the existence of Ethiopian airlines, and how many unlikely people chewed khat. So, it all came together in the developing of the narrative.

JC: You mentioned also in this chapter that Ethiopian Airlines was ‘created” for the khat trade? Is this rumor/tall tale?

AV: No, I think it is true. Khat is a very lucrative business then and now. Don’t know where I read this, but I saw this in more than one source.

JC: You have the Sudan Interior Mission arrive in Ethiopia in 1935. I know several of them in 1962-67 Did they first arrive in Ethiopia in the ’40? Also, you have Matron teaching in a ‘convent school’ in England? I wasn’t aware that the SIM had convents anywhere. She isn’t Catholic, I know.

AV: All of that is imagined. I have no idea when the Sudan Interior Mission arrived in Ethiopia.

JC: Then on page 147….the Indian Catholic nun marrying Christ, which was the custom, I know, when nuns took vows, but how could she have her bridal dress in Ethiopia for her burial? It would not belong to her. She would have left in India, as it would have been used by other nuns.

AV: I meant her bridal dress simply as in her nuns outfit. When I deviate from fact it was simply because I am writing fiction. The coup, for example, I have occurring in the year that suits my narrative, while I still use parts of that history that were factual.

JC: There is another text situation that I found interesting. You have a paragraph on the two children play Blind Man’s buff. It is a telling scene where the protagonist says …”Nothing would be the same after this, I knew. …”my consciousness felt as ripe as it would ever be…” …”I would soon have more knowledge and experience, but all that was me, all that was Marion, ….” Yet in the course of the novel you don’t come back to that scene, there is no bank shot in terms of resolution, or at least I couldn’t identify one that was. What was “seated inside my (Marion’s) body”?

AV: I think I am trying to convey the dawning of both self awareness and nascent sexuality. But honestly, I think each reader makes of this something personal defined by their own makeup. I am always struck when people send me their master’s or doctoral thesis that has involved my book when they ascribe me motives that I was never aware of in writing this or that.  The readers experience is very subjective and it is part of the trust between author and reader-the author offers words and the great joy of reading is to form one’s OWN pictures (which is why a movie always winds up cracking the images of character we formed in our head from a book).

JC: I find it interesting that you change the point-of-view…moving from interior Ghosh to Marion, and then staying with Marion when he was in a coma….I think you pulled it off in terms of the novel (though Henry James might be turning over in his grave) but what was your thinking as a novelist?

AV: I wanted it to be a first person novel on page one, but then have the reader forget that in a sense while the action unfolds, only to pick it up again I later chapters. My models were, for example, The Tin Drum (where Oskar observes his grandmother’s impregnation well before he was born) and many others. As you say, the key is that it has to work for the reader, and if not, you are in trouble.

JC: As someone who lived in Ethiopia for several years I came away from the novel without a sense of the country itself…the brief scenes with HIM are given, as are many scenes within the hospital, but I don’t have an image of Addis, or the beautiful landscape of the country….was this deliberate? The same is true of the Bronx, which I know very well (I live within walking distance of the Bronx), as you tend to stay inside the minds of your main characters. I realize, of course, that you can’t do everything in a book!

AV: Hmmm, It may be that you are too close to the subject and know it too well!! It is the problem I have with watching medical TV shows. Other reviews have emphasized how this book brings the landscape and sight and smell of Addis and Ethiopia to the forefront almost as though geography is a character.

Simon Schama in the Financial Times says: Verghese can limn the townscape of Addis Ababa, “at once dead and in continuous motion like a blanket of maggots animating a corpse”, a street scene full of vendors of lemons and chillis and roasted maize where a solitary man, a bleating sheep slung around his neck, struggles to see the road along which he trudges. But he can also, presumably from direct experience, convey the precise look of the interior of the peritoneum, opened to emit “a straw coloured fluid” or the obstructed colon, liberated from its constricting loop “like a zeppelin escaping its hangar … boggy dark, and tense with fluid”. (By the way, Schama misquoted from the text, in that the business about maggots animating a corpse was about Aden!)

JC: When was the last visit that you made to Addis?

AV: Three years ago for an AIDS conference.

JC: One last question, Doctor. Are you planning to write more about Ethiopia?

AV: I am not consciously planning to do so, no. But when one sits down to write, one is never sure of where things will go.  It is the nature of writing, the utterly mysterious aspect of it.

JC: Thank you, Doctor, for taking time for this interview.

AV: It was my pleasure.