This is a rich story, interweaving the lives of people working at a clinic in Addis Ababa run by a Christian mission (known as the Missing Clinic by the local people and everyone else) with the history of Ethiopia from the 1950s to the late 1970s.

Sister Mary Joseph Praise is a Carmelite nun from Kerala, who is sent to work in Africa by the Abbess of her convent. On the ship, she meets Dr. Thomas Stone, a surgeon, who is also going to work in Africa. They both end up working at Missing, with Sister Mary becoming the doctor’s indispensable right-hand person. They seem to have a professional relationship, so everyone—including the doctor—is stunned when Sister Mary goes into labour with twins. She had managed to keep her pregnancy secret from everyone.

The story is narrated by one of the twins, Marion (named after the famed gynaecologist, J. Marion Sims), who starts the story with his birth and that of his twin, Shiva. The birth is complicated—the twins are joined at the skull, and Sister Mary cannot push them out. The resident gynaecologist, Dr. Hema, being away, Dr. Stone is summoned to help. But faced with trying to save the life of the woman he loves, he loses his nerve. The twins survive, only thanks to the arrival of Dr. Hema, but she cannot save their mother. Shattered, Dr. Stone leaves the clinic and the country without acknowledging his children.

The boys are brought up by Hema and the man who becomes her lover and companion, Dr. Ghosh. The boys grow up at the clinic with Genet, the daughter of the maid, Rosina. Their childhood is relatively happy—Hema and Ghosh make good parents, and Marion-Shiva and Genet are inseparable. But adolescence shifts the dynamic between them, leading to a single action which impacts all their lives. Marion feels betrayed by Shiva, and the twins grow apart. Genet deals with her demons by joining the fight for Eritrean independence.

Politics is always present in the lives of the characters. Colonel Mebratu, who Ghosh’s patient, launches a coup d’état against Emperor Haile Selassie. The coup fails, and the Colonel and his driver, Zemui—Genet’s father—are taken into custody. Rosina goes looking for Zemui and disappears for days, and Ghosh is arrested and imprisoned. Then later, when Genet and a group of Eritreans hijack an Ethiopian Airways plane, a woman identifies Marion as Genet’s friend, which means that he has to leave the country. He goes to the United States to work in an inner-city hospital in Boston, which finally brings him face-to-face with his father.

The characters are rounded and nuanced—no one is purely good or bad. Addis is a character in its own right, and Abraham Verghese brings it to life. When Sister Mary goes into labour, the rainy season had just ended, “its rattle on the corrugated tin roofs of Missing ceasing abruptly like a chatterbox cut off in midsentence. Overnight, in that hushed silence, the meskel flowers bloomed, turning the hillsides of Addis Ababa into gold. In the meadows around Missing the sedge won its battle over mud and swept right up to the paved threshold of the hospital.”

Verghese is a medical doctor and so are most of the characters in this book, including the twins. There is a lot of medical detail about operations and diseases, which some readers may find a little overwhelming but I thought worked, given the context.

Verghese covers decades of Ethiopian history, from the remnants of Italian colonialism to the coups against Haile Sailasse and Eritrea’s fight for independence. But this is at heart a book about people and the messy, complicated relationships we all have. Cutting for Stone is a beautifully written book that you can easily lose yourself in.