Cutting for Stone: Alternat Ending

The original owner and creator of the characters mentioned in the piece of writing is Abraham Verghese. This alternate ending of Cutting for Stone begins halfway through Chapter 51.

Cutting for Stone: Alternate Ending

         It was just after 2:00 in the afternoon when Hema and Deepak appeared at my door. Hema was panicking and weeping. I wanted to comfort her but I was too confused to do anything at that moment.
         “He is bleeding from an arteriovenous malformation, a cavernous tangle of blood vessels in the cortex,” Deepak said with fear and anxiety in his voice. “Two neurosurgeons are operating on him as we talk and Thomas Stone is assisting them in the ICU.”
         If the brain is an electrical circuit, where the neural pathways are wires and the polymeric coating of the wires represents the myelin-insulated neurons, then arteriovenous malformation, or AVM, is the short circuit that makes the current follow an unplanned path. AVM is an abnormal tangle of vessels in the brain in which one or more arteries are directly connected to one or more veins. Since arteries carry blood from the heart to the tissues and veins transport the blood back from the tissues to the heart, a direct connection between arteries and veins gives rise to several problems.
         The wrinkled outer surface of the brain is not at all like the smooth and shiny surface of the liver. The brain’s cerebral cortex is unique because of its distinct gray color and its uneven terrain. Due to the lack of insulation that provides other parts of the brain the color white, the cortex’s gray color is a contradiction of nature. The unattractive folds of the cerebral cortex allow a greater surface area in a relatively small space. If you took the cortex and ironed all the wrinkles, the length of the skull would have to be approximately three square feet to hold the neuron connections. The way neurosurgeons talk about the brain…its as if they are discussing a child’s puzzle. Pull these pieces apart and you’ll have small sections of the puzzle containing vital information that are useless alone.
         The cortex is divided into four lobes. Located at the front region of the cerebral cortex is the frontal lobe, which controls movement, decision-making, problem solving, and planning. The parietal lobe is located posterior to the frontal lobe, controlling cognition, information processing, sensation, spatial orientation, speech, and visual perception. Located inferior to the frontal lobe and parietal lobe, temporal lobe is in charge of organizing sensory input, auditory perception, language and speech production, and memory associate and formation. Position at the back region of the cerebral cortex, the occipital lobe plays an important role in visual perception and color recognition.
         Thomas Stone walked out of the Operating Theatre. Hema and Deepak looked at him with their red and puffy eyes. I stared at him, hoping he had brought some encouraging news. “It cannot be closed with endovascular embolization… Deepak is preparing to perform microsurgical resection.” Thomas Stone said. He went back to the Operating Theatre.
         Despite being a board certified surgeon, Thomas Stone shot a fusillade of questions on Deepak. “What is success rate of this surgery? What is the predicated length of the surgery? What is the anticipated length of hospital stay? Are you using staples or absorbable stitches for craniotomy? What type of incision? What is the exact location of incision? What are the recommended units of blood for transfusion? What are the potential complications?” Deepak was worried about Thomas Stone. He was not only distraught by this situation, but his behavior was also very unprofessional. Deepak wanted to comfort his senior partner, but he had a surgery waiting for him. Deepak escorted Thomas Stone out of the operating theatre and told him to wait patiently. The thought of performing an even more complicated surgery on his other son terrified Thomas Stone. The only words that came out of his mouth from that moment till Deepak finished the surgery were “Please take the time bomb out of my son’s head.”
         Deepak, standing on the left, examined the MRI, the CT, and the angiogram and had found the location of the arteriovenous malformation in the frontal lobe. While Deepak was solving the mystery of AVM’s position, the anesthesiologist was sedating Shiva to induce unconsciousness. Deepak made the initial incision. The first step was to remove part of Shiva’s bone from the skull to expose the brain. The bone flap is temporarily removed. He then turned his attention to the microscope in order to integrate the image with CT and MRI data in a stereotactic workstation. Deepak could view the delicate structures of the brain as he operated. The brain is arranged in a series of major and minor folds and Deepak was operating in these areas to gain access to the brain’s blood vessels, which course out of the folds of the brain. Looking for the abnormality inside the brain, neurosurgeons bear resemblance to teenagers handling game controllers, vigilantly, in order to find the enemies and shoot them dead. Deepak found the spider knot of arteries and vessels surrounded by other normal blood vessels. Deepak carefully removed a small amount of overlying cortex in order to expose the arteriovenous malformation and used a piece of surgicle, a hemostatic agent, to stop minor bleeding. When the AVM was finally exposed, he sealed it with metal clips. Before removing the AVM from the brain, Deepak inspected other vessels and arteries to make sure that blood was flowing smoothly. He then turned his attention back to the arteriovenous malformation. After reassuring the position of the metal clips, he removed the AVM from Shiva’ brain. Once the AVM is removed safely and the brain is examined thoroughly, the procedure is then completed by replacing the bone in position with small metal clips and sewing back the skin.
         Shiva was taken to the Intensive Care Unit where he was observed closely for three days. Those three days seemed like three years to me. Shiva’s prognosis was poor. He was given a paralytic drug on the first day in order to restrict his movements and lower his intracranial pressure. However, when one is suppressed by a paralytic drug, the muscles of the diaphragm are not able to move. Consequently, my brother was attached to a ventilator to breath for him. I felt so very tired. I could not think properly. All I could see was my brother attached to several different machines, each monitoring an internal aspect of his body: his heart rate, oxygen perfusion, blood pressure, and intracranial pressure. Every two hours, a nurse would walk in, check on all these factual data, make notes, and leave the room.
         Poor Hema. I should have tried to comfort her, but I was too pragmatic. Hema and I sat around Shiva’s bed. I was in my wheel chair and Hema kept weeping, bent over, resting her head on my thigh. At that moment, I said something very stupid and churlish to Hema. I told her, “It would have been better if you and Shive had buried me. You’d be on your way to Missing now with your favorite son.” I expected her to strike back, but she didn’t. She had reached that point where grief exceeds the human capacity to emote. She replied, “Marion, I have to apologize to you. I thought you were responsible for Genet being mutilated, circumcised, and all that followed. I held that against you. When we came here, Shiva told me everything. My son, I hope you can forgive me. I’m a stupid mother.”
         That night, I stayed in Shiva’s room. I lay next to him, resting my head next to his, feeling his chest rise and fall due to the ventilator. As I lay there, I thought about how things have changed and yet stayed the same. I thought of Ghosh. I thought of Genet. Many unanswerable questions¬ came into my mind that night. Would things be different if I hadn’t gone to America? Would I still be here if I hadn’t opened the door for Genet? I clung to Shiva as hard as I could. I remembered those times when Shiva and I used to wear matching clothes and look out for each other. I remember Shiva whispering things in my ear because he was too afraid, too shy to say it out loud. I loved my timid, introverted brother. I still do. Even though Shiva and I had parted and grew into two very different people, we were still ShivaMarion. Shiva and I were one being. Still, I was afraid to loose the physical presence of my brother in my life.
         As I held Shiva’s hands in mine, I felt his fingers move slightly. I felt movements on the bed, perhaps him trying to get more comfortable. As I observed him move, I felt a distinct burst of dopamine and endorphin, I felt a sudden rush of adrenaline in my body. I wanted to wake up Shiva and tell him how much I love him and how I am never going to abandon him again. I wanted to tell the world about the love, the bond two brothers share and how that bond could go through the phases of hatred, jealous, and wrath and yet remained unbroken.
         At a certain point in the life of an individual, he realizes that all he ever wanted was right in front of him; he just had to remove the veil of fake pride and societal burdens. As Shiva slowly opened his eyes, looked at me, and smiled, I knew I had reached that point.