The story is told by the protagonist, Marion Stone. He and his
conjoined twin Shiva are born at Mission Hospital (called "Missing" in accordance with the local pronunciation),
Addis Ababa, in September 1954. Their mother, Sister Mary Joseph Praise, an Indian
Carmelite nun, dies during childbirth. Their father, Thomas Stone, the English surgeon of Missing, abandons them and disappears. Orphaned at birth, the pair grow up in the household of two physicians of Missing, both from
Madras, the
obstetrician Kalpana Hemlatha (Hema) and Abhi Ghosh, who fall in love while caring for the infants. Hema names them Marion (after
J. Marion Sims) and Shiva (after the
Hindu deity). Ghosh teaches himself surgery to replace Stone. The tissue link between the twins has been separated at birth and the two grow up together being very close initially. Both twins are exposed to the changing political environment in
Ethiopia. There is an unsuccessful rebellion by
Haile Selassie's bodyguard, General Mebratu. Ghosh is imprisoned, then released, in the aftermath of the coup, due to his friendship with Mebratu. Through their parents, both boys are exposed to medical knowledge and taught medical procedures at the hospital. Over time, though, individual differences begin to become pronounced. When entering puberty their relationship to Genet, the daughter of Rosina, a domestic help, finally tears them apart. Marion is in love with Genet and intends to marry her, but it is Shiva who, interested in sexual pursuits, becomes her first lover. Marion feels betrayed. Rosina forces Genet to submit to
female genital mutilation, and Rosina commits suicide shortly thereafter. Genet later joins the
Eritrean liberation movement. While Marion goes to medical school, his brother stays at Missing. Focused on the repair of birth-related fistulas, he takes up his surgical training with Hema, eschewing a formal medical education. On his deathbed, Ghosh has three wishes for Marion – to get the best medical education, to find Stone, and to forgive his brother. When Genet and her comrades
hijack an
Ethiopian Airlines airplane in 1979, Marion's name is found in a list of her connections. To avoid arrest, he flees the country overnight to Kenya. He goes to
New York City where he finds a position at Our Lady of Perpetual Succour, a hospital in
the Bronx. There, he enters a surgical
residency. One day, while assisting his senior in a complicated trauma operation, an unknown surgeon enters and looks over their shoulders. It is Thomas Stone, by now a renowned liver surgeon from
Boston. Marion's encounter with his biological father redirects his life, leading to a painful reconciliation and reunion with his estranged brother. ==Medical topics==