Cutting for Stone - Abraham Verghese [244]
By 1986 I had finished my year as Chief Resident, which was also my fifth year of training, and I stayed on as an assistant to Deepak as I prepared to take my board exam. Grudgingly, Id come to admire the long, arduous American system of surgical training; it was easier to admire when you were about done with it. I felt technically competent to do all the major operations of general surgery, and I knew my limits. There wasn't much I hadn't seen at Our Lady. More important, I was confident about caring for patients before and after surgery, and in the intensive care settings.
ALSO IN 1986, my brother became famous; it was Deepak who showed me the feature article in the New York Times. What a shock it was to see Shiva's picture, to see in it my reflection, but with shorter hair, almost a crew cut, and without the gray that had completely taken over my sideburns and temples. The image brought immediate bitterness, the recollection of the pain of betrayal. And yes, envy. Shiva had taken the first and only girl I loved and spoiled her for me. Now, he was making headlines in my backyard, in my newspaper. I'd followed all the rules, and tried to do the right thing while he ignored all the rules, and here we were. Could an equitable God have allowed such a thing? I confess, it was a while before I could read the article.
According to the Times, Shiva was the world's expert and the leading advocate for women with vaginal fistula. He was the genius behind a WHO fistula-prevention campaign that was a “far cry from the usual Western approach to these issues.” The Times reproduced the colorful “Five Failings That Lead to Fistula” poster: it showed a hand, the fingers splayed out. Peering at the photograph, I could see that it was Shiva's hand. In the palm was a seated woman in a posture of dejection—was the model the Staff Probationer?
The poster was distributed all over Africa and Asia and printed in forty languages. Village midwives were taught to count off on one hand the Five Failings. The first was being married off too young, child brides; the second was nonexistent prenatal care; the third was waiting too long to admit that labor had stalled (by which time the baby's head was jammed halfway down the birth passage and doing its damage) and a Cesarean section was needed; the fourth failing was too few and too distant health centers where a C-section could be done. Presuming the mother lived (the baby never did), the final failing was that of the husband and in-laws who cast out the woman because of the dribbling, odiferous fistula from bladder to vagina, or from rectum to vagina, or both. Suicide was a common ending to such a story.
“Somehow women with fistula find their way to Shiva Praise Stone,” the article said. “They come by bus, as far as they can before the other passengers kick them off. They come on foot, or by donkey. They come often with a piece of paper in their hand that simply says in Amharic, ‘MISSING’ or ‘FISTULA HOSPITAL’ or ‘CUTTING FOR STONE.’”
Shiva Stone was not a physician, “but a skilled layperson, initiated into this field by his gynecologist mother.”
When I next spoke to Hema, I asked her to congratulate Shiva for me. “Ma,” I said, “you should have gotten more recognition in that story. Without you, Shiva couldn't be doing what he does.”
“No, Marion. This is really all his doing. Fistula surgery wasn't something I relished. It suits someone as single-minded as Shiva. It needs constant attention, before, during, and after surgery. You should see the hours he spends thinking over each case, anticipating every problem. He can see the fistula in three dimensions.” Shiva had fashioned new instruments in his workshop and invented new techniques. The article had mentioned Matron's fund-raising