My Own Country

by Abraham Verghese

  Route 36 changed its name to Roan Street immediately after a sign that said “Johnson City, Sister City to Guaranda, Ecuador.” Earth-moving machinery was clearing land for a Wal-Mart.

  Roan Street was the town’s main drag, running through it for four or five miles, eventually passing Allen’s gas station on the south side of town. The car dealers on the north end of Roan jockeyed for attention from both sides of the road. Pennants fluttered from antennae, and the Day-Glo lettering on the windshields stretched for blocks.

  Allen’s eyes flicked from one side of the road to the other, the cars speaking to him, his eyes never lingering on the BMWs or Mercedeses, but seeking out a car, an American car of a decade or two ago, about which he could say, “That there is a fine auto-mobile! Get you one of those, Doc.”

  Seven traffic lights later we left Roan and headed down John Exum where we saw signs with arrows pointing to MOUNTAIN HOME VA and to EAST TENNESSEE STATE UNIVERSITY. A quarter-mile past the Mountain Home VA entrance was State of Franklin Road on which sat the Johnson City Medical Center—the Miracle Center.

  We drove through the brick portals of the Mountain Home VA and I had an immediate sense of driving into an American past. The brick buildings with their baroque, French Renaissance architecture were built in 1901. I directed Allen past the cemetery, past the theater and the post office to the Engineering Building. The keys to my staff quarters were waiting for me.

  Allen and I drove to the house: a massive, two-story, white colonial with a full basement and attic. It dated back to the early 1920s and had wooden floors, high ceilings, a grand staircase, fireplaces that came up to your head, claw-footed tubs, a beautiful porch complete with swing, and acres of meticulously maintained VA lawn stretching in front of it.

  I couldn’t wait for Rajani to see this. She had made me haul her House & Garden back issues from Tennessee to Boston and now back. Rajani had done well at her job and had earned the respect of her coworkers in the professional world. But she had always looked forward to creating a home. Here was a house she would delight in furnishing and decorating; its quaintness would appeal to her. It was more house than we had ever had. The rent was nominal. All maintenance and utilities were taken care of by “engineering”—those ubiquitous men in green uniforms who seemed to be all over the campus, mowing, trimming, painting, weeding. The disadvantage might be that you were living on the VA campus: your work and your home were in the same place. But this was no disadvantage for me: I could walk over at lunchtime and play with the baby, I could go back into the office after dinner and work.

  “Son, you can throw one hellacious party here,” Allen said, looking around. “Unless them neighbors over there object,” he said pointing to where the hospital’s Chief of Geriatrics, an Egyptian married to an Englishwoman, lived.

  “Frankly, Allen,” I said, “I don’t give a damn.”

  JOHNSON CITY WAS NEW as far as cities went. Three railroads happened to cross in what became its downtown. First there was the East Tennessee & Virginia Railroad. And later came the East Tennessee & Western North Carolina Railroad. By 1900, the Carolina, Clinchfield & Ohio Railroad arrived.

  The railroads undoubtedly had much to do with the placement of the “National Home for Volunteer Soldiers” or “Mountain Home” in Johnson City. And that in turn fueled the growth of a tiny teachers training college into East Tennessee State University.

  The land that is east Tennessee is a long oval bowl that sits between the Clinch Mountain Range above, Lookout Mountain below, the Cumberland Mountains to the west and the Smoky Mountains to the east. The early settlers found this land around the Holston and Nolichucky and Watagua rivers to be theirs for the taking. The Cherokee had been rendered weak by their battles with the Chickasaw and were unwilling to engage this new enemy at once.

  Daniel Boone crisscrossed this area of land many a time on his way between Kentucky and North Carolina. It was on one such trip that he carved the words, “D. Boone cilled a bar,” on a tree that stood till 1920. Boone carried news of this territory to North Carolina and attracted new settlers.

  The “Wataguans” as the early settlers in east Tennessee were called, believed in the gun, in the Bible and in themselves. They were thrifty, hardworking, and eventually organized themselves as the Watagua Association in 1772.

  But at the Mountain Home VA, there was another discrete population we saw: veterans from the mining towns of southwest Virginia and Kentucky. Many were descendants of the original mountain men, men who were said to represent the second wave of emigration from Britain. The plantation owners of the New World came to England looking for cheap labor because the slave trade from Africa had trickled to a stop and could not provide the hands needed for the complex and labor-intensive task of harvesting tobacco. The British Parliament, with a series of bills, consigned the outcasts and orphans of London and England’s other big cities to the plantations of the New World. These unfortunates still owed the Crown for their perceived misdeeds. A seven-year period of indentured labor to the plantation owner seemed appropriate penance.

  Many of the new immigrants died under the whip of the plantation overseers. And others escaped out into the hinterland, pushing into the hills and hollows of the Cumberland region, becoming mountain men. (This story is to be found in Harry M. Caudill’s Night Comes to the Cumberlands.) They were joined later by men whose bonds had expired and who came searching for land of their own. To the great surprise of the Cherokee, these mountain men with their treasured Pennsylvania Dutch rifles fought with a savagery that matched that of their attackers, even taking scalps if the mood struck them. They had none of the scruples and qualms of the Puritan. They were hard-boiled, downtrodden people who were determined to give no ground.

  The only thing they lacked for was women of their own kind. Many made do with Choctaw and Cherokee squaws whom they kidnapped or bought outright. It was this intermingling, particularly with the Cherokee along the North Carolina border, that brought the high cheekbones and the dark looks that I saw in Claudia and in her son, and in so many others in east Tennessee.

  The Wataguans as well as their neighbors in the Cumberlands abhorred all forms of authority. In the American War of Independence, the Tennesseans readily formed a ragtag group of volunteers who marched off with Colonel John Sevier and engaged the disciplined, loyalist troops of Major Patrick Ferguson. These mountain men, who had honed their sharpshooting skills to an art from squirrel hunting, the men whom Major Ferguson had dismissed as mere “barbarians,” picked off and decimated the King’s troops and killed Major Ferguson.

  In every war to come these mountaineers and their descendants rushed to serve. They were killed in droves in the Civil War. Many more signed up and died in World Wars I and II and the Korean War. In Vietnam, so I was told by a veterans group in Tennessee, a disproportionate number of these good-ole-boys from east Tennessee and southwest Virginia had died. If a point man was called for and no one volunteered, a descendant of the early mountaineer was likely to say, “What the hell,” and step forward. His pride in his ancestry revolved around these qualities: skill with a rifle and a wiliness and cunning in the bush, even if it was the bush of southeast Asia. The license plate of every car in Tennessee announces this to be the Volunteer State, a term originating in the Mexican War when Tennessee overfilled the state’s quota for volunteer troops.

  When I justified to friends in the Northeast my decision to settle in the South, I found myself talking not about the natural beauty of the place, or its climate, or the mountains you could see in every direction, or the lakes, rivers and innumerable streams where you could fish. It was the people of east Tennessee and southwest Virginia that drew me.

  The descendants of the early pioneers had evolved from fighting with the Indians and feuding with each other to become folk who, as they told you themselves, would give you the shirt off their back—if you were their friend. They were, like the men Sevier had led to battle at King’s Mountain, still willing to die for their
country, be it in Grenada or Kuwait, because “that was just the way we were raised.” The people I met in Johnson City would, unlike those in a big city, trust a stranger almost to the point of stupidity.

  If a redneck was, as V. S. Naipaul narrates in A Turn in the South, someone who wore a ball cap, cowboy boots, was late on his trailer payments, someone who would rather drink ten beers and eat corn bread than converse with you, someone who was prone to say “shit” and “son-of-a-bitch” just about anytime he could, someone who was satisfied being who he was and wouldn’t care to change his world or try to improve his lot for no son-of-a-bitch, then the Johnson Citian was no redneck.

  Instead, to describe them, I found myself borrowing a term they frequently used themselves: “good ole boys.”

  “Good ole boy” was the highest compliment they could pay each other. It was the highest compliment they could pay me. This is how Allen would introduce me to some friend or other of his at the station: “What’s up, Doc?” (No one found his Bugs Bunny routine as funny as he did.) “Don’t mind me, Doc. I’m only joshing. I want you to meet Gus. Gus, this here is Doc. He’s a good ole boy.”

  Certainly, rednecks still abounded. In the little hollows one could see the trailer with no underpinning and dogs all around it and children playing under it. That world was food stamps and ignorance and rotted teeth and rheumatic fever and a suspicion of all strangers.

  But most people in the environs of Johnson City seemed to be gravitating to a gentrification of sorts. The flannel shirt, instead of hanging out over the jeans, was apt to be tucked in. The cowboy boots, if worn, were polished and smart. But a sports shirt with jeans and docksiders was also considered a desirable look.

  The younger generation that hung around the malls and in the mall parking lots were moving away from the ball cap to long hair, earrings and headbands. This was happening twenty years after Woodstock when this look had become passé in the rest of the country.

  Allen would not be caught dead in a baseball cap. There may have been a time when he wore one. But now, to dress neatly, to have a neat and orderly house, was extremely important to him. These were a measure of his evolution, a measure of his business and social success. Even if he could not read well or if the word “nigger” was much more natural to him than “black,” he was well aware of the world outside through TV and through living in Johnson City.

  And what he had become—someone who would give you the shirt off his back, someone who worked hard and aspired to a better life—gave him more pride and more satisfaction than if he had kicked back and waited on the food stamps and worked only when it suited him. Growing up, he had seen plenty of that.

  Country people had let me readily into their world. They may have been ignorant about lands like India or Africa that were outside their world. They may have been shy and reluctant to talk, but once they did, they gave me complete access.

  It was not difficult to qualify for the shirts off their backs.

  ON THE WARDS OF THE Mountain Home VA, I had always been conscious of being a foreign physician taking care of American veterans. As an intern, only two of my fellow interns were Americans: one was a graduate of the University of Kentucky and the other from Emory. The rest of us were from Nigeria, India, Haiti, Pakistan, the Philippines and Palestine.

  Now that I was back as a staff member, I noticed that the number of foreign residents and interns had decreased and we now had a few more Americans who had graduated from the offshore schools in the Caribbean.

  The patients on the old-fashioned open wards of Mountain Home seemed not to see the paradox in this situation: American veterans in one of the oldest VA facilities in the country, receiving most of their care from foreigners, the newest immigrants.

  The patients were mostly men in their fifties and sixties—World War II veterans. Many of the men had taken up smoking at the age of seven or eight, rolling their own in a state where tobacco was king. And though this habit had brought them their present problems—chronic bronchitis, emphysema, lung cancer—they still talked wistfully about smoking. Even when breathing was an effort, many continued to smoke. Each ward had a television room in which the smoke was so thick you could hardly see the television. A cigarette between one’s fingers was as much a part of Tennessee life as squirrel hunting or country music.

  Ward 2, the pulmonary ward, was where the effects of tobacco were most evident. When you looked down the ward, you saw a sea of chubby, moon faces staring at you from on top of bloated bodies—a side effect of the cortisone that the patients were taking to control their wheezing. And green mustaches—oxygen tubing—decorated almost every upper lip in the ward.

  At the very end of the ward was a chronic ventilator unit where six ventilators did the work of breathing for six patients. Some of the men in the unit had been on the machine for years. Their day consisted of sunshine coming through the window, the TV being turned on, watching the shifts change, being bathed and fed, afternoon turning to evening, the night shift arriving, and finally the TV being turned off. It was sad.

  At the emergency exit near Ward 2, it was common to see a cluster of men in brown-striped dressing gowns, their oxygen turned off and the green tubing now draped around them like a necklace, puffing on cigarettes and coughing. I was sympathetic to the dilemma of these men. They were hopelessly addicted to nicotine and to tobacco.

  Both on the pulmonary ward and on the other wards, the men slipped comfortably into the barracks-style existence. If they were not too sick, they joined in the camaraderie that sprang up when thirty veterans shared quarters. They looked out for each other. The open wards, antiquated though they were, had this advantage: A person who was recovering from a bleeding ulcer would take it on himself to help feed the patient with a stroke in the next bed. If a patient had a seizure there were six to seven men to witness it, summon a nurse, and then describe accurately how the seizure had begun in the left hand and marched up to the left side of the face before becoming generalized. The families that visited always brought enough food for the patients in adjacent beds.

  The occasional redneck, often young and belligerent, could disrupt things. Young veterans were typically Vietnam-era. Vietnam veterans were still few in number at the hospital; most of them were healthy and doing well in society, not at the age where they might be seen for problems like heart disease or lung disease. If they were in the hospital, it was often for alcohol abuse and its consequences, such as pancreatitis or cirrhosis. Or else for psychiatric problems. These patients were the most likely, particularly if there was a tussle over pain medication and drug-seeking behavior, to spit out a diatribe about, “Here I am, fought for my country. You foreigners just come here and make money off us. I’m going to write to my congressman . . .”

  The hospital staff—orderlies, clerks, nurses, technicians, telephone operators—who had to deal with foreign physicians every day, sometimes lost their patience. The problem was most often one of poor communication, coupled at times with an insensitivity on the part of the doctor. Most foreign doctors had come from countries where doctors were venerated, while nurses were not. Women who became nurses in India were frequently from poor circumstances and had an unfair reputation as women of little virtue. (Ironically, many nurses from India and the Philippines had immigrated to America to fill the tremendous inner-city nursing shortage of the sixties and seventies, a shortage that paralleled the physician shortage. Their circumstances were now considerably better than those of the people who had looked down on them. Some of the children of these nurses were medical students under my tutelage.)

  A Dr. Aziz, who was my second-year resident when I was an intern, typified the problems that could arise. He was a short, fair-skinned man in his twenties. He had a bristling mustache, thick lips and spiky, black hair. He hailed from a village outside Karachi. Despite going to medical school in the city, he had retained all his country ways. He was more of a redneck than any redneck one could unearth in the backwoods of Tennessee.

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p; He spoke with a thick guttural accent, pronouncing “system” as “shish-tem” and “thirty” as “durty” and “zero” as “jeero,” putting the burden of figuring out what he was saying onto the nurses. He felt no compunction to speak more clearly to them or attempt the intonations that would help make himself understood.

  When he ate in the cafeteria, it was with his mouth open and with loud smacking noises. Had he been approachable, someone might have instructed him on what was considered good manners in America.

  I once attempted to talk to him about why he was getting into so many conflicts with the ward nurses. But since he was a resident and I an intern, he did not take this well. Instead he was defensive, and even patronizing, lecturing me on the best way to “deal with these people.”

  Aziz was full of himself, too taken with the fact that he was a doctor. His personality, both public and private, revolved around this fact. He was abhorred by the nurses because of his curt and chauvinistic way of dealing with them. And so when they saw him in the cafeteria placing the chicken bones in a pile on the table beside his plate, or hawking and spitting into a wastepaper basket as he walked down a corridor, it made them connect his boorishness to his foreignness—they were one and the same thing.

  A nurse, stepping into a staff bathroom that Aziz had just emerged from, called after him and to everyone in earshot, “Did you never learn to raise the seat before you pee? Or at least wipe it clean? Were you brought up in a pig sty?”

  I cringed when I heard that. I was not from his world, nor was I his keeper, but to the degree that he generated these negative impressions it affected all the rest of us foreigners. Perhaps I consciously overachieved, worked hard to make up for Aziz, did everything to earn for myself the appellation “good ole boy.”

  But Aziz was long gone now, a mere memory.