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560 pages, Paperback
First published January 1, 2009
“I'm ashamed of our human capacity to hurt and maim one another, to desecrate the body. Yet it allows me to see the cabalistic harmony of heart peeking out behind lung, of liver and spleen consulting each other under the dome of the diaphragm -- these things leave me speechless.”Oh, but I guess you also care about the story, and not just about my dithyrambs about the medical jargon? Okay, okay. Here is the brief synopsis of 600-plus pages:
“Wasn't that the definition of home? Not where you are from, but where you are wanted.”Twin boys Shiva and Marion (*) are born in a poor 'Missing' Hospital in Ethiopia to an Indian nun (who died in childbirth status post a horrific and vividly described Cesarean section) and a socially inept but talented British surgeon (who promptly exits the twins' lives mere minutes after their birth, having almost crushed their initially conjoined heads
(*) Marion is named after Marion Sims, the "father of American gynecology", who in the 19th century pioneered the operation for repair of vesicovaginal fistula (the abnormal communication between urethra and vagina with all the unpleasant and horrific consequences) - the operation that Shiva performs in this book.The boys are adopted and raised by an eccentric couple of Indian doctors at Missing - Hema and Ghosh, who in an adorable and sweet way 'renew' their marriage each year. We witness them growing up around the hospital, learning medicine from a very tender age, living through periods of Ethiopian civil unrest, and, of course, girl troubles (Genet - the tragic girl who always tragically plays the tragic role in the brothers' tragic lives). Both brothers decide to pursue medicine - self-taught Shiva is a gynecologist while Marion . More tragedy ensues, forever changing the lives of the twins, and everyone learns the value of love and family through much sadness. And it's both a bit cheesy and melodramatic and touching.
Marion Sims' work became a subject of much controversy in the 20th century since he practiced his craft without anesthesia on slave women, with unknown consent of his subjects on some of whom he operated about 30 times.
The past of medicine is very often a very scary and cruel place.
“What we are fighting isn't godlessness--this is the most godly country on earth. We aren't even fighting disease. Its poverty. Money for food, medicines... that helps. When we cannot cure or save a life, our patients can at least feel cared for. It should be a basic human right.”
“God will judge us, Mr. Harris, by--by what we did to relieve the suffering of our fellow human beings. I don't think God cares what doctrine we embrace.”
“Life, too, is like that. You live it forward, but understand it backward. It is only when you stop and look to the rear that you see the corpse caught under your wheel.”--------------------------------------------
“According to Shiva, life is in the end about fixing holes. Shiva didn't speak in metaphors. fixing holes is precisely what he did. Still, it's an apt metaphor for our profession. But there's another kind of hole, and that is the wound that divides family. Sometimes this wound occurs at the moment of birth, sometimes it happens later. We are all fixing what is broken. It is the task of a lifetime. We'll leave much unfinished for the next generation.”
"My brother, Shiva, and I came into the world in the late afternoon of the twentieth of September in the year of Grace 1954. We took our first breath in the thin air, 8 000 feet above sea level, of the capital city of Ethiopia, Addis Ababa."The twins, Drs. Marion , and Shiva Praise Stone, were born to a nun, Sister Mary Joseph Praise from the Carmalite Order of Madras, who were sent with Sister Anjali to darkest Africa to serve in hospitals. She would end up at the "Missing"(Mission) hospital of Addis Ababa, Ethiopia, via Aden in Yemen, with a dark secret she cold never share.
"Bound by birth, we were driven apart by bitter betrayal. No surgeon can heal the wound that divides two brothers. Where silk and steel fail, story must succeed."
"Sister Mary Joseph was a Malayali Christian. She could trace her faith back to St. Thomas's arrival in India from Damascus in A.D. 52. "Doubting" Thomas built his first churches in Karala well before St. Peter got to Rome."In the first 109 pages the background to the birth is introduced and when the birth finally takes place with high drama, I sighed with relief. Pardon my momental snarkyness, but I almost put down the book and moved on.
"To her parents' chagrin, my mother became a Carmalite none,abandoning the ancient Syrian Christian tradition of St. Thomas to embrace (in her parents view) this Johnny-come-lately, pope-worshipping sect... It was a good thing her parents didn't know that she was also a nurse, which to them would mean that she soiled her hands like an untouchable."
"I loved those Latin words for their dignity, their foreigness and that my tongue had to wrap around them. I felt that in learning the special language of a scholarly order, I was amassing a kind of force. This was the poor and noble side of the world, uncorrupted by secrets and trickery."Dr. Gosh was of the opinion that the language of love and medicine was the same "Take off your shirt. Open your mouth. Take a deep breath.".
"He invited me into a world that was not secret, but it was well hidden. You needed a guide. You had to know what to look for, but also how to look. You had to exert yourself to see this world. But if you did, if you had that kind of curiosity, if you had an innate interest in the welfare of your fellow human beings, and if you went through that door, a strange thing happened: you left your petty troubles on the threshold. It could be addictive."It is exactly the reason why I just could not put the bloody book down, for, believe me, bloody it was! Buckets full of it!
"There was three spaced knocks on the door of Matron's office. "Come in," Matron said,and with those words Missing was on a course different than anyone could have imagined. It was at the start of the rainy season, when Addis was stunned into wet submission."There are sweet anecdotal moments such as this: Dr. Marion Praise Stone, the narrator, recounts a moment in their childhood:
"In our household, you had to dive into the din and push to the front if you wanted to be heard. The foghorn voice was Ghosh's, echoing and tailing off into laughter. Hema was the songbird, but when provoked her voice was as sharp as Saladin's scimitar,which, according to my Richard the Lion Hearted and the Crusades, could divide a silk scarf allowed to float down onto the blade's edge. Almaz, our cook, may have been silent on the outside, but her lips moved constantly, whether in prayer or song,no one knew. Rosina took silence as a personal offense, and spoke into empty rooms and chattered into cupboards. Genet, almost six years old of age, was showing signs of taking after her mother, telling herself stories about herself in a singsong voice, creating her own mythology."Initially there is a deceitful tranquility present in the rhythm of the prose. The author used an ingenious method to pacify the reader while having an addictive mixture of tension and drama bubbling and boiling underneath.
P.184: "...the kitchen was alive. Steam rises in plumes as Almaz clangs lids on and off the pots. The silver weight on the pressure cooker jiggles and whistles. Almaze's sure hands chop onions, tomatoes, and fresh coriander, making hillocks that dwarf the tiny mounds of ginger and garlic. ... A mad alchemist she throws a pinch of this, a fistful of that, then wets her fingers and flings that moisture into the mortar. She pounds with the pestle, the wet, crunchy thunk thunk soon changes to the sound of stone on stone.This scene above acted as a metaphor for this book: so seemingly uncomplicated, innocent and serene on the surface, but exploding with energy under the lid! What was hidden in the mixture would ultimately add meaning and definition, like exquisite aromas from a pot-pourri of herbs and spices to the people's lives. The experience will be hot and penetrating; sweet and scrumptious, heavy and often "indigestably" cruel.
...Mustard seeds explode in the hot oil. She holds a lid over the pan to fend off the missiles. Rat-a-tat! like hail on the tin roof. She adds the cumin seeds, which sizzles, darken and crackle. A dry, fragrant smoke chases out the mustard scent. Only then are the onions added, handfuls of them, and now the sound is that of life being spawned in a primordial fire.
Rosina abruptly hands me over to Almaz... I whimper on Almaz's shoulder, perilously close to the bubbling cauldrons. Almaz puts down the laddle and shifts me to her hip. Reaching into her blouse, grunting with effort, she fishes out her breast.
"Here it is," she says, putting it in my hands for safekeeping...Almaz, who hardly speaks, resumes stirring, humming a tune. It is as if the breast no more belongs to her than does the laddle."
Medicine should be human-centric. Touch is an important part of connection. Docs should look their patients in the eye and spend time with them, hearing their stories. They can be as important as all those bright, shiny tests in diagnosis.
Family, both blood and chosen, is the core, the heart of life; it makes everything worthwhile.
We are the product of every single one of our experiences.
Absences are as real and powerful as the people, places, and incidences in life.