It’s been five years since Verghese left eastern Tennessee, but his frustration with the limits of modern medicine is still raw. For now, he’s channeled it into a compelling new book, My Own Country (347 pages. Simon & Schuster. $23). Cast as the story of one doctor in the age of AIDS, the book is really a cautionary tale of what happens when the infinite hopes that doctors and patients pin on science collide with reality. “The most frustrating thing is to have a disease where all you can do is hold your patients’ hands,” he says. “But there is a salvation because you’re forced to confront what it is to be a doctor.”
Verghese, the Ethiopian-born son of a physicist and a teacher from India, came to the United States in 1980 after medical school. He took a succession of jobs as an orderly in cities like Newark and New York, then signed up to do his internship and residency in Johnson City, followed by a fellowship in Boston. When it came time to settle down, though, the Smoky Mountains-far from “urban rot,” he says-were irresistible. Since there were no AIDS cases in Johnson City in those days, the infectious-disease specialist began as an AIDS expert in name only. But in 1986, when his friend Essie Vines brought in her brother, who was gay and desperately ill, he had to become an expert for real.
Within a few years, almost all of Verghese’s patients were sick with AIDS. Most were gay; and many of them had left rural America to find their sexual identity only to return, in the end, to die. Others were like William and Bess Johnson. Will was a successful engineer and a pillar of his Kentucky community; he had suffered a massive heart attack in 1984 as he was driving away from his partner’s funeral. In the surgery that saved his life, he received enormous quantities of blood. But those were the days before blood was routinely tested for HIV, and Will not only wound up with the virus, but he infected his wife. In 1987 Verghese got a call from Johnson’s doctor asking him to take on the case. The only request was confidentiality-Johnson was so fearful of being found out that his Kentucky doctor said she kept his records at home, under lock and key.
Although Verghese faced his first cases optimistic that science would find a cure, no balm could soothe the realization that he and his patients were outsiders. Alienation became the doctor-patient bond, Verghese’s coffee-colored skin marking him as surely as the purple Kaposi’s sarcoma lesions marked many patients. “Perhaps they were willing to come to the ‘foreign doctor’ because if they went to someone who went to school with their father, they’d be inviting judgment.”
Many of the townspeople were quick to condemn. Verghese writes of nurses who never refused to care for a dying patient, “but the way they gloved, gowned, goggled and wore booties … as if they were going to the moon, reflected their disquiet.” Then there was “Doochie,” the funeral director who refused to bury Essie’s brother. These slights were small compared to the AIDS boycotts and bombings that pocked the nation at the time. But Verghese says, “I spent five years waiting for the other shoe to fall.”
It never did, not in the way he expected. But by 1989 the administrator of the Johnson City Medical Center-dubbed, ironically, the “Miracle Center"asked Verghese if he was the reason “we have so many AIDS patients.” It was time to move on. Besides, Verghese had become so involved with his AIDS patients that he needed some emotional space. With his wife and two sons, he headed to El Paso and became chief of infectious diseases at the Texas Tech Health Sciences Center. “We still cry, but we have a strong sense that what we’re doing is worthwhile.” Medicine still has no cure for AIDS, but Verghese isn’t afraid of the war.
