Opening
Personal awakenings collide with national upheaval as Marion Praise Stone discovers a calling in medicine just as a coup d’état engulfs Addis Ababa. Bonds tighten and fracture—between twins, mentors, and family—while violence outside exposes the limits of safety inside Missing Hospital.
What Happens
Chapter 21: Knowing What You Will Hear
After the pantry incident, Marion feels Rosina’s coolness and a new wall around Genet, who now gravitates toward Shiva Praise Stone. Shiva and Genet practice Bharatanatyam; Marion watches without jealousy, as if Shiva is his proxy, able to be near the girl he cannot approach. Marion continues to help Zemui with letters, noting that Genet refuses to assist her father. At a lively bridge party, Colonel Mebratu—soon to be Brigadier General—celebrates his promotion and extols Ethiopia’s military pride.
Sensing Marion’s loneliness, Dr. Abhi Ghosh ushers him into clinical life. In Casualty, he guides Marion’s fingers to a “water hammer pulse,” teaching the physiology of aortic regurgitation. The experience transforms Marion’s despair into purpose. He starts a notebook of observations, and Ghosh, delighted, gives him his own stethoscope—the first meaningful gift Marion has received that isn’t a pair—signaling a selfhood distinct from Shiva. Medicine becomes his refuge, and Ghosh the mentor who offers him a world where he belongs.
Chapter 22: The School of Suffering
“ShivaMarion” respond as one when a couple carries a lifeless child up Missing’s hill; the twins’ instinct to heal is immediate and shared. Marion recalls growing up inside the “School of Suffering”—white-robed patients streaming through wards, a woman bearing her cancerous breast in a basket, a child with cancrum oris—images that fix the fragility and stubbornness of life in his mind.
After Ghosh performs reconstructive surgery on the disfigured child, he speaks of Thomas Stone with reverence: Stone is a “real surgeon,” brilliant and unmatched. The praise deepens Marion’s fascination and confusion about the father who vanished. Later, the twins encounter a girl ostracized for a foul odor from a vesicovaginal fistula. While others recoil, Shiva locks eyes with her, takes her hand, and leads her to Dr. Kalpana Hemlatha (Hema). Marion recognizes the moment as fate: Shiva’s path cleaves toward healing society’s most shunned women, foreshadowing the twins’ divergent destinies.
Chapter 23: The Afterbird and Other Animals
Politics jolts the family when Brigadier General Mebratu, their friend, leads a coup against Emperor Haile Selassie. Zemui joins the uprising. School stops; tension saturates Missing. Ghosh returns from the palace after treating a prisoner, having seen Mebratu and carrying a St. Bridget’s cross from Zemui for Genet. Against warnings, Rosina leaves to find Zemui, vanishing into the sealed city as the Imperial Bodyguard patrols and the streets fall eerily mute.
Radio addresses track the shifting ground. The Crown Prince endorses the “bloodless revolution,” his tone thin and unsteady. Students march, but the army disperses them. Uneasy, Shiva persuades Hema to take the twins to her Version Clinic. There, he shines among pregnant women who embrace him, while Marion observes in awe. Hema demonstrates turning a breech baby and finally narrates parts of her craft. The twins latch onto her mysterious lexicon—“Delayed Afterbird,” among others—until Shiva’s blunt, body-first questions unsettle Hema and send the boys home.
Chapter 24: Loving the Dying
The “bloodless” coup erupts into gunfire. Jets scream. Explosions bloom over the city. The family huddles in the corridor while tracers rake the sky. Rosina returns breathless, reporting that the army, air force, and police fight the Imperial Bodyguard. To deter looters, Matron Hirst reveals a revolver tucked away.
Shiva retreats into prime numbers to order the chaos; Marion clings to the physical reality of his twin. From his bed, Marion overhears Matron and Ghosh in a whispered, intimate exchange. Matron confesses the terror of 1936, when Italians invaded Addis and looters ravaged the city. She tells of John Melly, a young missionary doctor she loved, and her guilt over his death amid the anarchy. Her faltering rendition of “Bunyan’s Hymn” trembles through the dark, transforming the iron matron into a figure of grief and endurance—another adult carrying a hidden, devastating past.
Chapter 25: Anger as a Form of Love
The coup collapses within days. The Emperor returns to cheering crowds, but Missing is pierced by grief. News arrives like shrapnel: the rebels are betrayed. Eskinder shoots General Mebratu in the face before killing himself. Zemui dies charging the police. Rosina’s quarters shake with hysterical mourning.
On the way to school, Ghosh and the twins are swept into a mob celebrating around public gallows where three conspirators hang. Ghosh keeps them safe by performing joy—clapping and smiling—teaching the boys a terrifying lesson in survival: sometimes you must pretend to live. The horror lingers. Then the worst blow: while the twins are at school, security forces arrest Ghosh at Missing. Phone lines die. Panic surges through Hema just as Almaz bursts in with a rumor that rebels poisoned the city’s water—moments after Hema has drunk a glass. She collapses with violent cramps, leaving the family leaderless at the most perilous hour.
Character Development
Marion’s vocation takes shape as his world falls apart. The stethoscope marks him as singular, not half of a pair, and medicine offers a moral order that his personal life cannot.
- Marion Stone: Finds identity and purpose in clinical practice; channels isolation into disciplined observation; steps onto a path diverging from his twin.
- Shiva Stone: Reveals an intuitive, tactile empathy, especially for women in pain; claims space in obstetrics and fistula care; appears most alive in the Version Clinic.
- Dr. Ghosh: Emerges as moral father and teacher; models courage and pragmatism in a deadly crowd; his arrest removes the family’s stabilizing force.
- Dr. Hema: Balances fierce protectiveness with surgical mastery; briefly opens her world to the twins; faces sudden vulnerability amid rumor and fear.
- Matron Hirst: Gains unexpected tenderness and tragedy; her love for John Melly and readiness to defend Missing complicate her iron exterior.
- Genet: Draws close to Shiva, distances from Zemui; becomes the silent center of grief through her father’s death and the cross he sends.
- Zemui and Mebratu: Their fates—betrayal, execution, and death—turn political abstraction into personal catastrophe.
Themes & Symbols
In these chapters, Medicine as a Calling and a Metaphor defines identity and resistance. For Marion, medicine is a sanctuary of clarity—a way to “know what you will hear” before the stethoscope touches skin. For Shiva, medicine is touch first, language second; his vocation grows from wordless recognition of suffering. Against the chaos of a coup, medical order becomes both bulwark and beacon.
Family, Identity, and Belonging fractures and reforms under pressure. The stethoscope marks Marion’s separateness; “ShivaMarion” becomes two names. The unit at Missing—Hema, Ghosh, Matron, the twins—confronts the limits of protection. The Weight of the Past and Secrets surfaces as Matron’s confession echoes the twins’ unknowable origins and Ghosh’s stories of Thomas Stone. And Exile and Homeland turns Ethiopia from beloved home into a landscape of betrayal and fear, binding the family to a nation that can no longer keep them safe.
Symbols that concentrate meaning:
- The Stethoscope: Ghosh’s gift inaugurates Marion’s independent self and his entry into a disciplined, interpretive art.
- The Girl with the Fistula: Emblem of the shunned; her silent bond with Shiva sets his life’s work.
- The “Delayed Afterbird”: A secret of birth and an echo of the twins’ own shrouded arrival.
- St. Bridget’s Cross: Zemui’s fragile thread of love to Genet, crossing battle lines to reach home.
- “ShivaMarion”: A name that is also a symbol—unity under pressure, then the beginning of division.
Key Quotes
“ShivaMarion”
The fused name captures the twins’ shared impulse to heal and the intimacy of their beginnings. Its repetition before their vocational split underscores the moment when one body becomes two paths.
“School of Suffering”
Marion’s title for Missing transforms the hospital into a classroom where mortality teaches first principles. It frames medicine as an education in humility and witness.
“Water hammer pulse”
This clinical phrase becomes initiation. Under Ghosh’s hand, Marion learns to translate touch into knowledge—an apprenticeship in listening that is also an apprenticeship in identity.
A “real surgeon”
Ghosh’s praise of Thomas Stone both sanctifies the absent father and deepens his mystery. The compliment is a standard Marion wants to meet and a shadow he cannot see through.
“Bloodless revolution”
The radio’s euphemism collapses when jets shriek and tracers light the night. The phrase exposes the distance between official language and lived terror.
“Delayed Afterbird”
Hema’s term fascinates the twins and gestures toward the hidden labor of birth—and the obscured truths surrounding their own origin story.
Why This Matters and Section Significance
This sequence is a hinge in the novel: a private coming-of-age collides with public catastrophe. The coup shatters the illusion that adults can shield the young, forcing Marion and Shiva to meet violence, betrayal, and death at close range. Zemui’s and Mebratu’s fall sears trauma into Genet’s life; Ghosh’s arrest removes the family’s anchor; Hema’s collapse leaves them exposed. The household at Missing, once sanctuary, becomes a bunker.
At the same time, the twins’ medical destinies clarify. Marion turns to the interpretive, cerebral craft modeled by Ghosh; Shiva moves toward tactile, stigmatized suffering and the women others refuse to touch. Medicine stands against the forces unmaking their world, even as it cannot stop them. The stage is set for separation and convergence—brothers defined by different forms of love, entering a future shaped by what they can heal and what they cannot.