Caitlin, on the other hand, lives part of the year with her wealthy mother Phoebe, who’s just moved to Albuquerque, and summers with her father Lamb, equally affluent, on the Vineyard. Victoria, or more commonly Vix, lives in a small house her brother has muscular dystrophy her mother is unhappy, and money is scarce. In sixth grade, when Victoria Weaver is asked by new girl Caitlin Somers to spend the summer with her on Martha’s Vineyard, her life changes forever. The years pass by at a fast and steamy clip in Blume’s latest adult novel (Wifey, not reviewed Smart Women, 1984) as two friends find loyalties and affections tested as they grow into young women. Once again a medical emergency defines the characters, though they are not large enough to fill the positively operatic roles Verghese has ordained for them. They become estranged over a girl, and eventually Marion leaves for America and an internship in the Bronx (the final, most suspenseful section). Shiva is an enigma, though it’s no surprise he’ll have a medical career, like his brother, though far less orthodox. The boys’ Ethiopian identity goes unexplored. The ambition is laudable, but too often accounts of operations-a bowel obstruction here, a vasectomy there-overwhelm the narrative. “Where but in medicine,” he asks, “might our conjoined, matricidal, patrifugal, twisted fate be explained?” The question is key, revealing Verghese’s intent: a family saga in the context of medicine.

Ghosh and Hema marry and make a happy family of four. Ghosh (another Indian) diagnoses his apnea again, a medical emergency throws two characters together. Hemalatha, the Indian gynecologist), who becomes their surrogate mother and names them Shiva and Marion. The emotionally repressed Stone never declared his love for her had they really done the deed? After the delivery, Stone rejects the babies and leaves Ethiopia. She then served as his assistant for seven years. The Indian nun, Sister Mary Joseph Praise, was a trained nurse who had met the British surgeon Thomas Stone on a sea voyage ministering to passengers dying of typhus. We are in Addis Ababa, Ethiopia, in 1954. The late-arriving OB-GYN takes charge, losing the mother but saving her babies, identical twins. The surgeon (is he also the father?) dithers. The nun is struggling to give birth in the hospital.

There’s a mystery, a coming-of-age, abundant melodrama and even more abundant medical lore in this idiosyncratic first novel from a doctor best known for the memoir My Own Country (1994).

Verghese cutting for stone