Born in Ethiopia to Indian parents, Abraham Verghese decided, after finishing his medical training, to settle in Johnson City, Tennessee, where he had been a resident a few years earlier. It was the mid-1980s, and Johnson City was seeing an influx of foreign doctors who were often the only people willing to work in rural communities because they were unable to find work in more desirable locations.
Verghese had completed a fellowship in Boston, and he was glad to come back to scenic and peaceful Tennessee, a place where he could imagine raising a family. He would be able to teach at East Tennessee State University, practice at the local VA Hospital and the Johnson City Medical Center, and continue his infectious disease research into pneumonia. At the time, he did not expect to become the area’s authority on HIV and AIDS.
In the 1980s, HIV was a new and mysterious ailment. Verghese had worked with AIDS patients in Boston and he understood how the disease spread—and how it didn’t. When he moved to Johnson City in 1985, the disease was still almost unknown in the area. Verghese was called in on some early cases, and he soon became to go-to physician for the many men and the handful of women with HIV. He began speaking in the community about AIDS prevention and testing, even presenting at the local gay bar when he realized there was no deliberate outreach to the gay community in the area.
Much of the book focuses on the stories of Verghese’s patients and his efforts to understand their stories so he could better offer the care they needed. Although certain common threads turn up in their stories, each one is different. Most of his patients are gay men who left Johnson City for a time, returning after they became sick. Several, however, lived in the area their whole lives. Risky sex was a common theme. One couple frequently drove out of town to meet men at a truck stop, and other men just took advantage of the freedom they had when they moved away to have sex with multiple partners without taking precautions (and, early on, without knowing what precautions to take). There were long-term couples and single men. One woman had been infected by her husband, who had also infected her sister. A man and wife became infected when he got a blood transfusion and passed the virus on to his wife.
At times, Verghese seems to treat his patients as oddities, asking questions that seemed less about their medical histories and more about his desire to figure out what it’s like to be gay. I think, though, that this tendency is more about his own curiosity than about seeing his patients as curiosities. And the desire to know the whole person, not just the disease, makes him an excellent physician and advocate for his patients. My unease at some of his descriptions was offset for the most part by his clear compassion and lack of judgment. What judgment he exhibits is focused on those in the medical community who fail in providing treatment.
The book’s main topic is Verghese’s work with people who have HIV, but the book also touches on life in rural communities in general and the life of immigrants in rural communities. It’s not unusual to see rural communities depicted as entirely backwards and intolerant, but Verghese shows how people’s attitudes and actions ran the spectrum. He does not pretend that it was easy—or even possible—to be openly gay and accepted in the wider community, but he reveals that many individuals were open-minded and welcoming or, at the very least, willing to live and let live. I grew up in a rural community, just a few hours from Johnson City, and his characterization of the people—both positive and negative—rang true to me.
As an immigrant, Verghese experiences some prejudice, but it’s not a constant drumbeat. Verghese speculates that his outsider status actually helps him with his patients because they’re more comfortable being open with him than they might with someone who looked like their church pastor. This aspect of the story fascinated me because the area where I grew up had few immigrants, certainly not a large community of them. The Indian community in Johnson City was large enough to draw a traveling sales team to make regular stops to sell lentils and Basmati rice out of the back of their truck. For Verghese, though, the Indian community doesn’t get a lot of his time and attention. His work becomes all-consuming.
Unfortunately, the multifaceted nature of the story, with the mix of cultures and personalities and multiple patient narratives makes the book feel overlong. Each piece was interesting, and I appreciated the descriptions of the countryside and the people’s mannerisms, but there were plenty of skimmable sections. Verghese’s personal struggles, for example, felt tedious in comparison to those of his patients.
Still, this was an interesting book about people who don’t get a lot of attention. I’m glad that they did receive attention, both in medical care and in writing, from someone as compassionate as Verghese.