My Own Country

by Abraham Verghese

  I remembered that even when I had been taking care of Rodney, there had been some concern about drug use. Hemophiliacs like Rodney were often in much pain from their bleeding into joints or into their muscles. Narcotics were often necessary to control this pain, and narcotic addiction was a very real hazard.

  “By early 1985, I guess he already had full-blown AIDS. But what brought him to the hospital was stuff related to his hemophilia. And his drug use.

  “He was weak and ill, but food services would bring him his tray and leave it near the door. There was no way that he could go and get it, so it would just sit there. And if he threw up, it wouldn’t get cleaned up. People would just walk right past. Well, I knew it wasn’t right. I said something. I kind of got into it with a few people.

  “To me, he was an old friend. I had to take care of him. There was no way I was going to walk away from him. So I did. I took complete care of him and it could not have made some of the other nurses happier. What I saw in them disturbed me. I had considered them my friends, I respected them as nurses. And I saw a side of them that I would never have seen in a million years, but for AIDS.”

  There it was: AIDS as the litmus test for nurses and physicians, a means of identifying who would and who wouldn’t. I had seen this before in Boston.

  I asked Eleanor why it was that I had not heard of his case before. How everyone always mentioned the young man from New York but nobody had mentioned Rodney Tester.

  “Two reasons. First, his drug problem was so bad that he was transferred at some point to a drug rehab hospital in Maryland. That’s where he finally died. But also, he was in and out just before or just around the time the AIDS test was discovered. It wasn’t like an official diagnosis till the end and then he wasn’t here that long.”

  “So,” I asked, “is this kind of stuff still going on now, with Gordon?”

  “Hell yes! Except they know who is and who is not willing to take care of a patient like Gordon. I am willing. Mary is willing. And quite a few others. But I don’t think they should take advantage of us for that reason. It’s convenient for them. Because if they bitch and moan and if they don’t take care of the patient right, then I feel like I have to step in. I can’t let that happen.”

  I must have looked stunned, because Eleanor went on:

  “You see, none of this gets back to you. If you hadn’t asked me, you wouldn’t know any of this.”

  My elation faded. As I left Eleanor, I could think only of Essie, her parents, and Gordon’s smile.

  6

  WEDNESDAY AFTERNOON was my time to see private, non-VA patients in the University Physicians Group office.

  Not long after Gordon’s admission to the hospital, I found myself in an exam room with Mrs. T, a prim and proper lady, belonging to what I thought of as the blue-hair and mink-stole society; she exuded the permanence of colonnades and war memorials. I often saw her type heading for church on Sunday mornings while I made my way to the Kiwanis Park tennis courts. Mrs. T was in her early fifties, handsome and slender; she kept her fur-collared jacket on during our interview.

  I blame the Chanel No. 5 she wore for lulling me into inattention, so much so that when she pulled out the envelope whose torn end was much folded over and held with a paper clip, and when she said there was something she wanted to show me, I almost let her spill the envelope’s contents onto the paper runway of the examining table before I cried:

  “Hold it, ma am! Do you mind if I peek into the envelope first?”

  When I looked within, all I saw were tiny brown particles. She had referred to them as “growths.” Growths that she had extracted from her pubic hair. But just as I feared, the little boogers were moving!

  “Take a look, ma’am,” I said. “Do you see how they are alive?”

  Mrs. T turned pale. She brought her glasses up from the chain on her neck and peered into the slit of the envelope with me. Now her hand came to her mouth.

  “I thought they were moving,” she said. “But then I thought it was my glasses, or that I was dizzy or something.”

  “Those are lice, crab lice, ma’am. Do you itch?”

  “I itch something awful.”

  Blood was now rushing to her face. I felt sorry for her embarrassment. My guess was that her husband had given it to her. I took a deep breath and asked: “Is your husband itching too?”

  “I doubt it,” Mrs. T said, lifting her head up, bravely looking me in the eye, a firmness and resolve coming to her face. I felt for her. “No. I’m the one that’s itching. I’m responsible for getting it.” Then, after a pause, she said, “If you would prescribe for me the appropriate treatment I would be very grateful.”

  There was a question I had to ask, a question that despite my several years now in infectious diseases I found myself embarrassed to ask this refined lady.

  “Uh, ma’am, is it your practice to use a condom with your . . . partner?”

  “Yes,” she said, almost in a whisper, turning red again, her eyes examining the back of her hands. She looked up now, a little sparkle in her eye: “But it didn’t help me, did it? What could I have done to prevent getting this? Worn a raincoat?” Her face broke into a wonderful smile and I had to laugh. The tension in the room was dissipated.

  “Think of it this way, ma’am. The condom did work; it may have prevented things like gonorrhea, syphilis, AIDS.”

  She turned pale when I said AIDS. “Oh, Lord!”

  “If you like, I can test you for those things . . . ?” She shook her head. “Then don’t worry,” I said. “The crab lice we shall take care of forthwith. Shall I prescribe a double dose? One for your partner?”

  “That won’t be necessary,” she said. “As far as I’m concerned, I hope they eat him alive.”

  She left without having removed a stitch of clothing, without my laying a hand on her body.

  When she was at the door, she asked me whether her husband could contract it or might already have contracted it from sleeping in the same bed with her.

  “Is there any sexual contact between you?”

  “None at all. Hasn’t been for years.”

  “Then probably not. If he seems to start itching, then we’ll need to do something about it.”

  I escorted Mrs. T to the door of the clinic personally; Carol, my nurse, raised her eyebrows at this special treatment. How was I to explain: This genteel southern lady had contracted a most ungenteel disease; the whole business had seemed to make her more human, exposed a vulnerability that touched me. I’m a sucker for that sort of thing.

  What if her husband had contracted it? It would probably destroy the marriage. I remembered a drug company representative, a handsome man-about-town who contracted gonorrhea from an extramarital affair. He bought tickets for a luxury cruise—a second honeymoon he told his wife—and presented them to her over dinner and champagne. He managed to convince her to come in to a doctor’s office for “shots” that they would need before the cruise. He had even found a doctor to go along with this deception. I was told this story by another pharmaceutical representative. I wondered what would have happened if the wife had a severe penicillin allergy—anaphylaxis and shock—and dropped dead in the doctor’s office?

  I returned to the exam room and stood the envelope open and took a photograph of it and its contents with my pocket camera before dispensing with the envelope. The photo would be a good prop in my next lecture on sexually transmitted diseases. Such oddities came our way in infectious diseases that an autofocus camera that fit into a coat pocket was well worth carrying.

  Thus far I had only one other photograph of something a patient produced from her body. It was a picture of a neurotic woman from Mountain City posing next to a table with a giant Winn-Dixie paper bag on it. The contents of the bag were displayed on the table beside her: There was a Mason jar full of foamy, white secretions that she claimed came from her sinuses but that I was convinced were spit. Every day for two weeks before her appointment with me, she had pooled this expe
ctoration into a jar, and allowed it to sit unrefrigerated. She had threatened to open the lid but I discouraged her—the ripe odor had already permeated the office building. She also had an assortment of blackheads and comedones she had pinched off her skin and placed in empty baby-food jars. And an envelope of nail clippings to show me subtle color changes in her nails that only she seemed to appreciate.

  “Look! Look!” she said. “You see those blue colors sparking out of it?” I saw nothing. And the last item on the table was a pile of four spiral bound notebooks containing a blow-by-blow of her symptoms for the last year, a catalogue of every twinge and throb that you and I write off daily, as well as a meticulous log of the color, quantity, odor and other subjective aspects of her stools and urine. In the photograph, she beams at the camera, displaying these goods with pride, the expression on her face being similar to la belle indifference of the patient with true hysteria.

  CAROL, THE NURSE who assisted me in the ID clinic, retrieved me from my daydreams. She directed me to another exam room. She handed me first one chart, “Ed Maupin,” she said. Then she placed another chart on top of the first. “And Bobby Keller. Enjoy!”

  I looked at Carol in puzzlement.

  “They wanted to be seen together,” Carol said. “I figured you wouldn’t mind. They want to be examined and they want an AIDS test.”

  This was a moment, this waiting on the threshold, that I would come to know well. One stepped into a limbus of time, a labium of space. This name on a new chart was like the title of a novel that you had just bought, the jacket cover still pristine, the book new. Or else it was the title of an apocalyptic short story from an anthology of stories. The first paragraph had just grabbed you and you could not put it down.

  Sometimes I would say the names out loud: Ed Maupin, Bobby Keller; Bobby Keller, Ed Maupin; Ed and Bobby; Bobby and Ed, rolling them around my tongue where they felt strange, sharp-edged, like freshly unwrapped candy. In time they would become the most familiar names in our clinic—Bobby in particular—like the names of ballplayers or movie stars, names one does not question. “I’m calling about Bobby Keller,” I would say to a consultant, or “Bobby Keller needs to be scheduled for . . .”—always using both first and last names, the singsong way they were linked bearing a relationship to the face, to the memory of what had transpired thus far in the personal AIDS drama, the anticipation of what would come next. But in that Zen moment of standing on the threshold, the name had no such connotation; it was just a name.

  Later, when Carol and I had forty or so persons with HIV that we were seeing repeatedly in our clinic, a new patient always created an excitement, an anticipation. Carol would go in to the room to get the blood pressure and temperature and pulse and settle them in. She would wind up tarrying there, putting them at ease and hearing the story of how this individual came to encounter the virus. And when Carol came out of the new patient’s room, I would do a strange dance to avoid her: I wanted my first impression to be unsullied, I wanted it to be pure like a well-struck note—I wanted to hear every quaver and intonation. My ear must not be biased.

  When I think back to some of those early patients, it is that first impression that lingers: what they wore, what words they used to tell their story, who was with them, the scent of the room, how the enlarged spleen felt rebounding off my fingers, how the smooth but distended liver slid under my hand. The writer Milan Kundera says that the first ten minutes between a man and woman are the most important in their subsequent history, a predictor of things to come. So it was with me: the first ten minutes were a determinant of how I would color that patient in my memory.

  I knocked and entered. The room smelled of lavender soap. The two seated men came to their feet. The butcher-blocklike examining table with its paper runway occupied one side of the room. It left us just enough space for three chairs. I introduced myself.

  Ed Maupin was in his early forties: he had gray hair, a receding chin and a short beard carefully sculpted to dip down on both cheeks in a sharp U and edged to outline his lips. His high cheekbones and Roman nose made him look rugged except for the fact that he had a tiny chin. He stood ramrod straight with his shoulders thrown back. If he had worn a robe he could have played a centurion in a biblical story. But despite this stately demeanor, his clothes were simple: his shirtsleeves were rolled up to his elbows, his shirttail not tucked into his pants; a cigarette packet was outlined in his breast pocket. He wore polyester pants with battered slip-on shoes whose heels were almost completely worn out on the outer edge so that if he took them off, they looked as if they would flop over. It was Ed who did all the talking, at least initially.

  His partner, Bobby Keller, was a roly-poly man with bulging, sad, moon eyes from which tears seemed on the verge of spilling. He was bald with a high peaked crown. When I looked at Bobby he seemed to cringe.

  Haltingly, Ed told me they had heard about me, seen me on TV and knew that I was an “AIDS doctor.” They had come to take “that blood test. To see if we got it.” They had driven down from Abingdon, Virginia, just for the test.

  I told them that we could do the test for them without their seeing me. Then they would not have to be billed for a doctor visit. Just for the test. If, in a week, the test was positive, I would be happy to see them.

  “Unless you are not feeling well right now?”

  “I just stay tired, Doc,” was Ed’s complaint. “I want that AIDS test. But I reckon I can wait to have you check me out after we get the test.”

  “In that case, well get the blood drawn and arrange to see you in a week when we have the results.”

  Ed and Bobby looked at each other; the plan suited them well and they both rose as if to leave.

  However, I said, since my time had already been blocked out, and since Carol was busy elsewhere, why didn’t they stay a few minutes and I would draw their blood myself and that would give us a little time to get acquainted.

  I went out and assembled my tubes and needles and tourniquet and returned to the room. Neither of them said a word.

  I told them I had driven up to Abingdon, their hometown, a year ago to have Sunday brunch at the historical Martha Washington Inn. Ed nodded but said nothing. Bobby Keller squirmed and studied the floor.

  Even more recently, I added, a group of us had been to the Barter Theatre to see a show that was definitely Broadway-bound. Before the show we had stumbled onto a new restaurant in Abingdon. The decor was nice; the food, I said, had been good. The highlight of the evening had been dessert: “Resurrection by Chocolate,” an inspired creation.

  Bobby, the bald one, piped in now: “I live for RBC—that’s what we call it. It’s the greatest.”

  “He does,” said Ed. “He could live on chocolate alone if I let him.”

  Their house, Ed said, was a mile down the road from the restaurant, just outside the town, on a couple of acres with its own pond. “Pretty, if you like country.”

  Ed told me he was a diesel truck mechanic and worked for a trucking company in Abingdon. Bobby worked as a salesperson in an Abingdon boutique.

  “We are gay, you know. That’s why we wanted the test. But we sure didn’t want to get it done in Abingdon.”

  I thought Bobby blushed when Ed volunteered this. I felt sorry that they had to drive sixty miles to a stranger’s office to get tested for HIV.

  I was curious about Abingdon, a town much bigger than Essie’s mining town, yet not as big as Johnson City or Kingsport. Did it have a significant gay population? Did it have a meeting place equivalent to the Connection?

  “Lord, no,” said Ed.

  “I wish!” said Bobby, showing some signs of life. They began to tell me about themselves.

  Ed had been married and had fathered three children who were all grown up now. Ed was not bisexual, but gay. The marriage had been an attempt to conform but after many years his instinct for a sexual relationship with men had won out. For the last ten years Ed had lived in a steady relationship with Bobby Keller.


  While Ed was manly, the strong, silent type, Bobby was extraordinarily effeminate. His voice was singsong with a trilling inflection that would have turned your head in the street if you overheard him. He tended to raise the pitch when he ended a sentence as if he was asking a question. It was a baroque touch that, together with the way he tossed his head, and the way his hands were held near his face, created the illusion that he was Salome wearing a diaphanous veil, not Bobby Keller, the salesperson.

  Bobby was a natural clown. To see Bobby Keller’s face, his expression halfway between confusion and confession, his Jonathan Winters–like seriousness, created an anticipation, a tension that at last you could stand no longer and you wanted to burst out laughing. His technique was the deadpan delivery. I was treated to flashes of it that morning, but there were times later when Bobby would have the waiting room—both HIV and non-HIV patients—in hysterics. On one of Bobby’s repeat visits, Carol reported to me how Bobby’s antics caused a lady in the waiting room to struggle up from her chair yelling, “Lord, I got to pee,” then dash past Carol for the restroom, where the Lord granted her her wish.

  On taking Bobby Keller’s history I was shocked when he told me that he had been married and had fathered two children. I had great difficulty imagining him married.

  My surprise must have shown on my face because he said, “Lord knows I tried to be straight. I was having sex with Ed when I was seven. But I kept telling myself it was wrong, wrong, wrong, and so I got married to make me straight. Well, all through my marriage I was tempted by men. Finally I just had to more or less admit to myself that there was no two ways about it. I was about as straight as a three-dollar bill!”

  I thought of a most incongruous couple I had met at a potluck dinner a few weeks before. She was grossly and dangerously obese: at five-foot-one she weighed close to 270 pounds. She puffed when she walked and had an unhealthy, cyanotic hue to her lips. He was a wisp of a man, a matchstick next to her. His blond hair and fastidious dress were accompanied by an effeminate manner that was only a little more subdued than Bobby Keller’s. What would have happened, I wondered, if he had been raised in New York City instead of rural Tennessee? Or if education or work had taken him out of the area in his youth? Would he have had the courage to come out and be gay, avoid marriage? In rural Tennessee, he probably had to stifle this secret part of himself. It was presumptuous of me to assume this, but it looked as if the man had married a needy woman whose appearance might allow him to slip by unnoticed. I wanted to ask Bobby Keller about his ex-wife. But I thought I should wait till I knew him better.