My Own Country

by Abraham Verghese

  Ed and Bobby had their first sexual experience with each other when they were small boys. For the longest time they had made the assumption that they were the only two gay people in town. Their relationship had continued through both their marriages. After they both divorced and began to live together, they had made one of their first trips down to the Connection in Johnson City. There, they ran into a high school classmate, a drag queen holding court at the bar, and through her learned of a regular clique of gay men in Abingdon.

  From time to time, Ed and Bobby would ride north on Interstate 81 till they came to a truck stop several hours away from their town. This spot was an important intersection where truckers heading down from the New York–Washington, D.C., area branched off in different directions. These expeditions, which always culminated in quick, anonymous sexual encounters—about eighteen in the last two years—were what now had them worried. “It was plain foolishness—we knew nothing about the men we were with. We were just crazy, is all I can say.”

  By probing gently, I established that most of what went on at the truck stop was oral sex. Anal receptive intercourse—the riskiest form of sexual activity for acquiring the AIDS virus—had been rare. But it had happened “ones’t or twice with me and a lot more with Bobby,” said Ed, looking at Bobby, who blushed deeply and whose shoulders began to shake as if suppressing an explosion within.

  “How much more?” I asked.

  “Just about every time with Bobby,” Ed answered as Bobby studied the ceiling with mock seriousness.

  At home, Bobby Keller was also largely the receptive partner. The sexual encounters they had with other men in Abingdon—mostly married men—involved mainly oral sex. They perceived their occasional partners in Abingdon as inherently safer than the men at the truck stop. At neither locale did they use a condom.

  By this time I had drawn the blood, labeled the tubes, taken off my gloves, and we were just sitting around “visiting,” as Carol would say.

  Ed and Bobby seemed more at ease than when they had first come.

  I told them I was curious about the truck stop sex. This was a potentially important method by which AIDS could arrive in the small towns of Tennessee and Virginia. I had pictured AIDS spreading out in concentric waves from the epicenters of New York and San Francisco. But what if it just zoomed down the interstates instead? And why truck stops?

  “You mean the pickle packers?” Bobby Keller said and giggled at his naughtiness. “The pecker picklers?” Bobby was loosening up, becoming almost chatty, riffing effortlessly off Ed who now played the straight man.

  Bobby said their sexual contacts at these truck stops were often people like themselves who had driven up from an hour or two away—not truckers at all, but people from Virginia or Kentucky and even Pennsylvania. But yes, the attraction was the truckers. The men from the big rigs parked caterpillarlike, in parallel to the interstate, the engines purring—this was the thrill.

  A few of the truckers were clearly gay, but others only wanted quick relief. And if a man could provide that, it was OK.

  Bobby had almost been beaten up by a burly Texan trucker because Bobby had made the mistake of conversing with him after the act, offering small talk and his name and an offer for him to visit on his next trip through. Those words had broken a spell. Conversation had changed the nature of the transaction from an anonymous quickie to a social exchange.

  The Texan became enraged. He needed to maintain the illusion that he was not gay. He needed to believe that he was using a man—a man that he had great contempt for, a man that in the height of his passion he called a “bitch”—to do what a woman wouldn’t do, or couldn’t do. The last thing he wanted was any attempt to get friendly. But for Ed’s intervention, the Texan would have hurt Bobby badly.

  Something puzzled me. Since there were women—hookers—turning tricks at these same places, why would the trucker not have gone with a woman, if that’s what he wanted?

  “But then he would have had to pay,” said Ed.

  “And Lord knows he wouldn’t have liked it half as much!” said Bobby.

  BOBBY AND ED LEFT my office with fistfuls of multicolored, multiflavored condoms, plenty of literature on safe sex, and little Band-Aids over the crooks of their elbows. I emphasized to them that they needed to practice safe sex at all times, not just in truck stops.

  I wondered after they left whether there was an element of relief on their part to discover that the doctor they had come to see was a foreigner, an outsider. Their sexual proclivities, if revealed, would have made them like Martians in their community. To come to a doctor’s office, even a distant doctor’s office, and tell their sexual secrets to a Caucasian face that could just as well have belonged to a preacher, a judge, or some other archetypal authority figure in their town, might have been difficult. I may have been flattering myself with these thoughts, but more than once I had the sense that a patient was opening up to me for this very reason, because of my foreignness. The preacher with penile, rectal and pharyngeal gonorrhea was a perfect example. He didn’t think I would pass judgment on him—perhaps he felt that as a foreigner I had no right to pass judgment on him. And so he came to see me regularly for new venereal problems that indicated to me he was not practicing safe sex; he was candid with his symptoms and very comfortable in my office. Would he have been as comfortable, as forthcoming, with the internists who practiced next door, all of whom were local boys, graduates of the University of Tennessee?

  Years later, a doctor I had trained in Johnson City, a native of the area, set up his shingle in a neighboring community. I sent him one of my AIDS patients who lived in his town. My thought was that the patient could get his routine blood work and simple follow-up with this doctor without driving all the way out to see me. The doctor said to the patient, “I don’t approve of your lifestyle and what it represents. It is ungodly in my view. But that doesn’t mean I won’t continue to take good care of you.”

  To which the patient replied, “Oh yes it does!”

  EVERY MORNING, before starting work at the VA, I would go and check on Gordon at the Miracle Center. His fever raged on and on, but the bronchoscopy did not reveal Pneumocystis carinii, tuberculosis or anything else for that matter. We gave him the benefit of the doubt and treated him for Pneumocystis. The spinal tap showed a mild abnormality consistent with poorly treated syphilis, and we added high-dose penicillin to his regimen. In search of an undiscovered infection that was causing his fever and drenching night sweats, I did a biopsy of his bone marrow—a common place for widespread infections to reveal themselves. I had gone over the slides of the bone marrow with the pathologist, looking for signs of infection with tuberculosis or with histoplasmosis—a fungus endemic to our region. But we had seen nothing. It was frustrating.

  Later, as I accumulated experience, it became clear that it was not uncommon to have fever persist for days in patients with AIDS without our being able to uncover a cause. I learned that infection with organisms like Mycobacterium avium intracellulare (MAI)—a tuberculosis-like organism commonly found in tap water and harmless to those of us with intact immune systems—was often preceded by prolonged fever. Yet the MAI infection was difficult to detect and easily missed by the lab unless special techniques were used. Some of these fevers were probably caused by the AIDS virus itself. The virus seemed quite capable of producing damage directly to different organ systems: AIDS dementia was an example of a condition produced directly by HIV. And Gordon’s lung disease—a stiffening of his lungs and an inability of the lungs to oxygenate his blood adequately—was another condition that, in retrospect, could have been caused directly by HIV, since we had found no other opportunistic infection in his lung.

  But at the time, I was convinced that Gordon had an opportunistic infection that I had somehow overlooked. Each day I would examine him from head to foot, looking carefully at his retinae, the back of his throat, examining his skin for a telltale rash. I would come out of the room and order more tests. I was f
ishing for a diagnosis. And each day when I picked up his chart, his fever curve would mock me. It stayed over 99° F and it swung up to 103° F with regularity.

  Three weeks into Gordon’s stay, when Essie’s mother was taking her turn to sleep in the hospital room with him, she awoke to see Gordon sitting on the edge of his bed, the light on, and a huge smile on his face. He said to his mother that he had seen Jesus Christ, clear as day, standing in the corner of the room. Gordon seemed so alert and so convinced of what he had seen that it had scared his mother, not sure whether this meant the end, not sure whether that was really Gordon sitting on the bed or some apparition.

  She called the nurse and also called Essie in Virginia. At two in the morning, Essie jumped into the car and drove down to Johnson City to be at Gordon’s side.

  When Essie arrived two hours later, Gordon was wide awake, animated and radiating a new optimism. He was sitting in the recliner, his dressing gown on, his legs crossed, looking better than he had ever looked in the hospital.

  “Essie, just like you are standing there right now, I saw Jesus Christ.”

  “All right . . . ,” Essie said, setting her purse down and catching her breath. It was not in her nature to be skeptical about matters of faith, religious visions. But she had enough medical experience to wonder if this was a hallucination or an illusion created by fever. “Tell me about it, Gordon.”

  “I woke up—I was having fever—I woke up and I saw this cloud around my bed and it felt like I couldn’t breathe—I wasn’t dreaming, mind you. I was wide awake. My eyes were open and I could see Mama laying there. Just then a voice spoke out from the cloud, just as clear as a bell ringing: ‘Everything will be all right; it’s all right, Gordon,’ and a hand reached out from this cloud and I knew it was Jesus and He held my hand!”

  Essie had been prepared to quiz Gordon on his vision, test its validity. But now she found herself dumbstruck by this account of a visit from Jesus, unable to dismiss it. She and her family had a strong faith. It was that faith, after all, that had brought Gordon, once lost, back to them. This vision could be of paramount importance. If God was trying to tell them something, the greatest sin was not to be listening, to dismiss it out of hand. Gordon had not dismissed it; it was as real as the plastic urinal that hung by its handle on his bedrail, it was as real as the television looking down on them with its blind eye from the wall.

  Essie led her mother out to the hallway. “Mama, did you see anything?”

  Essie’s mother had not. Evidently, she woke after Gordon’s vision was over. She sensed an aura in the room, but she experienced this aura as terror. She had been startled to see Gordon sitting bolt upright in the bed. The smile on his face had at first terrified her. As if at any moment he would leap out of the bed and come at her with a knife or his head spin around on his body. When she got over her fear, she too had been impressed with the clarity of Gordon’s vision.

  The women were led to two gratifying conclusions: First, that God was with Gordon and would indeed look after him. Second, that Gordon, who was brought up in the church but had wandered away spiritually, had had his faith renewed by this vision.

  A few hours later, when I made rounds, I found Essie and her mother in the hallway, waiting for me. I was apprised of the new development. There I was, in the bright fluorescent light, dressed in my white coat, clutching my patient list in my hand, hustling to finish rounds at the Miracle Center before I went to the VA, and being confronted with the appearance of Jesus Christ at my patient’s bedside.

  “How do you all feel about it?” I asked.

  Essie replied: “I’m happy for Gordon because it has obviously made a difference. Go on in and take a look-see. I think you’ll be surprised.”

  I found Gordon sitting up on the side of the bed looking more alert and interested in his surroundings than I had ever seen him. No longer passive, he was effusive and engaging. I got a sense of his old charisma. He did not tell me directly about his vision. He told me that he felt considerably better and was determined that he should go home. When I examined him, nothing had changed except that he no longer had fever.

  I looked at the fever curve. It had been up and down for days but the previous night it had come all the way down to 97 degrees Fahrenheit and stayed there. I had no assurance it would not shoot up again later that day, but I was still impressed. There were no more diagnostic tests that I could reasonably do in search of the cause of fever, short of taking a biopsy of every organ of his body. This seemed to be the right time to send him home. His fever had broken, whether by divine intervention or antibiotics. I arranged for home oxygen and a visiting nurse to administer his medications. I asked to see him in my clinic at the University Practice Group in two weeks.

  I LEFT THE DOCTORS’ parking lot, heading for my weekly clinic at the University Physicians Group. If I had been looking for justification for the time I spent lecturing about AIDS, preaching safe sex, I had it: I had just discharged Gordon, my first HIV patient. The results of Ed and Bobby’s blood tests for HIV would be in my box when I got to clinic. And, Carol told me, there were two new patients referred to me from the health department. Their problem was in all likelihood HIV-related, since the health department usually diagnosed and treated other common sexually transmitted diseases on their own.

  The University Physicians Group office was run just as any private practice office. The object was to make money, or at least stop running in the red, its history for most of its existence. Patients without private insurance or with Medicaid tended to come to our practice group. At times we found they had been sent to us by private physicians who could and would refuse to take patients that couldn’t guarantee them payment. There had been tensions between the private sector and the university physicians—“town-gown conflicts”—ever since the medical school had started in this area. We were viewed as competition. My specialty was perhaps the exception; there was no infectious diseases person in the private sector.

  Our practice office was just down the street from the VA. It was a dark and dingy place that we were occupying while a new building was being planned. It had a large waiting area that led to a reception window where patients registered and filled out the necessary forms. Behind that window were offices where three or more people worked full-time on processing billings and insurance forms, filing lab reports, updating charts. One or two people handled the phones, and the transcriptionist had her cubicle there as well. Behind the reception area, corridors led to two different patient areas, each with a nurses’ station, offices for us to dictate in, and examining rooms.

  Carol, the nurse who assisted me, worked primarily with cancer patients. She administered chemotherapy in the clinic. On Wednesday afternoons, she was assigned to assist me. I found out later that she volunteered for this assignment. Carol was in her thirties, a divorced mother of two. At five-foot-two, she was thin as a reed, with brown hair, vivid makeup, and boundless energy. She would have made Dale Carnegie proud: I never saw her with a negative thought. Sadness, yes; tears, yes. But she was determined—sometimes to the point where it was downright aggravating—to see a silver lining in every dark cloud. To be around her was to be peppered with little quotes written out on “Post-It” notes. Her coat displayed the “Smile” and “Have a Nice Day” variety of buttons that changed constantly. Invariably, there was some fattening cake or casserole that she brought in to be shared. I never saw her eat a bite of it. I think her energy and enthusiasm wore thin with some of the other nurses who would have preferred the more familiar bitch-and-moan mode. Before I got to know Carol well, I also had found the Zig Ziglarisms hard to take. Later, I realized that this was her method of survival; this was what had enabled her to get past a divorce and bring up two children—both now teenagers—on one income.

  When I had tested the flurry of men who came to our clinic after my talk at the Connection, Carol had put their test results in my box with exclamation marks and happy faces: the tests had always been negative for HIV
. But this time Carol had her quote for the day written out for me and clipped to Ed and Bobby’s test results: There is nothing either good or bad, but thinking makes it so. Shakespeare.

  The test results showed both Ed and Bobby had been infected with HIV.

  I called them and was pleased when an answering machine came on. I left a message for them to come and see me.

  I put on my white coat and went to the first exam room.

  I experienced a sense of déjà vu—there were two charts outside one exam room. Could Ed and Bobby have returned that quickly? But no, these were two new names: Fred Goodson and Otis Jackson. I held the two charts in my hand and paused before the closed door, rereading the names again and again, pronouncing them carefully.

  When I knocked and opened the door to the exam room, I saw two swarthy men in their late thirties, very different from Ed and Bobby, the couple from Abingdon.

  The little exam room was redolent with an earthy scent—partly the poor ventilation, partly the leather bomber jacket Fred wore, partly their jeans that looked comfortable but not recently washed, and partly the odor of tobacco that clung to their clothes. They both wore heavy cowboy boots.