My Own Country

by Abraham Verghese

  “It’s all up to the big man up there, ain’t it, Doc?” Ed said, raising his eyes skyward.

  “We need all the help we can get,” I said.

  I told them I needed to examine them, to see if there was any evidence the virus was doing anything more than just existing in the body.

  Ed Maupin stood up at once and took his shirt off. Bobby Keller was still weeping.

  Ed, with his shirt off, looked older than his forty-two years. He had no fever, and his pulse was normal. But he had striking lymph-node enlargement in his neck and armpits and also some yeast infection in his mouth. His blood pressure was raised but this was an old problem, unrelated to HIV infection. He had briefly taken blood pressure medications, but was not on any now. I found his heart to be mildly enlarged, probably a consequence of the high blood pressure. I elected not to treat the blood pressure until I had some laboratory tests back and could see what his kidney function was like. I would embark on treatment at the next visit.

  I coaxed Bobby Keller onto the exam table and had him remove his shirt. The tears were pouring uncontrollably off his cheeks, falling onto his breasts. He was, in contrast to Ed, quite normal except that he was overweight. Bobby now spoke the first words since I stepped into the room, sobbing them out in a manner that tugged at my heartstrings: “You don’t understand, Doc. I’m not worried about myself. I’m worried about Ed. He’s been real tired and at night he sometimes breaks out into a cold sweat and cries in his sleep. Take care of him, Doc. He’s my life and without him I wouldn’t want to live.” Ed came up to Bobby now, and Bobby laid his head on Ed’s chest and wailed so loud that I was sure it could be heard all through the clinic. Carol came into the room, and reflexively stood on the other side of Bobby, rubbing his back, hugging him, until gradually his cries turned to muffled sobs.

  I promised I would do my best for both of them. As soon as their CD4 count came back we would plot a strategy.

  When Carol left the room, I cautioned them again about safe sex. I expected them to tell me not to worry, that sex was the last thing on their minds. Instead, Ed looked at Bobby and said, “You hear what the Doc says, Bobby?” Bobby nodded his head without much conviction.

  Part of the excitement of sex for Ed and Bobby was the element of danger, the breaking of a taboo, the anonymity. It was not just chutzpah that made them go to church and greet the married men they were sleeping with and say “Hi” to the men’s wives and children and slyly make a date for a half-hour later. “Safe sex” was a cerebral concept that sounded good in my office. Yet, it was not the cerebrum, but some other part of the body that took over when a good-looking man cruised them in the grocery store and beckoned for them to follow in the direction of his car. Of course, this was far from a problem confined to gay men: No cerebral abstraction involving sex—whether it was the need for contraception, proscriptions against adultery, or the need for safe sex—had ever in human history fared well in the face of raw lust.

  When Ed and Bobby were finally ushered out, I checked the box where lab tests I had ordered would be kept. For the whole week after I saw Fred Goodson and Otis Jackson, I had been restless, waiting to get their CD4 count. It would tell me how they would do in the next few months and years. Were they early in their infection, or had the virus been chipping away at their immune system for some time now?

  When the tests came back, Fred’s count was 1,100. Over 1,000 was good; below 500 was bad. In later years, a count of 500 was the threshold at which we began AZT. Fewer than 200 CD4 cells and the patient became very prone to Pneumocystis and other infections. Fewer than 50 and we would begin to see Mycobacterium avium intracellulare (MAI) and other infections. Otis’s count was 30. His immune system was faltering badly.

  I called Fred and Otis on the phone. Fred picked up, for which I was pleased. I told Fred what the numbers were. I did not have to explain much to him; Fred had been boning up on AIDS. He had several excellent publications written on AIDS by gays. Fred understood the significance of Otis’s CD4 count. He promised to tell Otis. They had an appointment to see me in a few weeks.

  VICKIE CALLED IN THE afternoon and I drove over from the VA to the Miracle Center. Clyde was back to flipping channels on the TV. I took Vickie away to the hospital’s “quiet” room—the same room where I had talked to Gordon’s family. Vickie and I sat there and talked for an hour. I learned her story over the course of this and several other visits with her.

  Vickie grew up in the tough Greystone housing projects outside of Johnson City. Though she had food, clothing, shelter—“I was lucky compared to Clyde”—she had to use her fists to establish an identity in the projects, to keep herself and her younger sisters from being trampled over. Her father was an alcoholic and her mother had disappeared when Vickie was seventeen. Her decision to marry Clyde had as much to do with the promise of escaping the house as it did with her attraction to this brooding, silent man.

  Clyde’s father, also an alcoholic, had lived out in the country, scratching out an existence by raising corn and planting a huge garden. A tough, abusive man, he thought nothing of taking the hoe handle to the side of his son’s head, terrorizing him in the interest of “raising him right.” Clyde’s mother had worked third-shift all her life and never knew or cared to know what was going on. When she gave birth many years later to two girls, Clyde became the unpaid baby-sitter on top of all his other chores. Beneath his silence there lurked some deep scars that even Vickie never came close to finding out about. By the time he and Vickie tied the knot, Clyde had been married twice.

  During the first years of their marriage, Vickie and Clyde lived in Tester Hollow, surrounded by his kith and kin. They occupied a cinder block house out in a field in the back of Clyde’s mother’s house. It had no heat or running water and the outhouse was a good ways away, near the well. “At night we could look out through the cracks between the cinder blocks and see the stars; we just about froze to death every winter. I cooked on a little hot plate. If I wanted to bake bread or anything like that, I had to go use my mother-in-law’s oven.” As a construction worker, Clyde was bringing in just enough money for them to live on.

  After Danielle was born and when Vickie was pregnant with Clyde Junior she found out that Clyde was sleeping with her sister. “I almost left him, but I really couldn’t go anywhere. To go back to my father’s would have been terrible; he didn’t want me and I didn’t care to be around him. Besides, my sister—the one who slept with Clyde—was living with Pa; she never did marry. My other sisters had their hands full with their husbands and children. And I had no money to take off on my own. So I just stayed.

  “A part of me felt Clyde was oversexed, you know what I mean? And I hadn’t been able to give him what he needed, that was why he had slept with my sister. I fought with my sister something awful for that, but even then I didn’t hate her. She was heavier than me and not pretty, and I knew her life was tough living there with Pa. She got pregnant some years later, and I had a feeling it was Clyde’s but there was no way to tell. To tell you the truth, I didn’t care at that point. And Clyde’s attitude was kind of like that joke: ‘Who’re you going to believe, me or your lying eyes?’ Well, I chose to believe him; it was easier.

  “Clyde worked so many different jobs. But it seemed like we never was getting ahead. We lived in Tester Hollow—which I just hated—and it looked like we would be there forever. He’d been a short-order cook, a graveyard digger, a mover with a moving company, a sewer worker, a construction worker. The money was never enough, not when you had two young’uns and doctor’s bills and such like. Clyde was drinking pretty heavy then—I’d say he was an alcoholic—and even the cheapest liquor warn’t cheap, as much as he could put away.

  “One day Clyde says to me, ‘Vickie, I want to be a truck driver.’ He was as serious as a heart attack. He said where he’d seen this ad on TV and it had been playing in his mind. Now his heart was all set to study truck driving. Clyde talked so little that I knew it must have been building
up something fierce for him to string all them words together. He sent off for the forms and I helped him fill them out. I thought to myself that maybe this was it, maybe this would be our break.

  “He studied hard and I helped him—he had dropped out at seventh grade and could hardly read, see. I had done gone on almost to finish high school. Finally, in February, he went down to Florida for a week to do the driving part of the course. Well, when he came back, it took him till May to finally get a job, but when he did I thought, praise the Lord! Our life’s done turned around.

  “He was hauling produce to Florida and back and I mean to say he was working hard. He didn’t get paid unless he made those schedules and they were tough. I knew he was taking what they called ‘white crosses’ to stay awake, and God knows what else. That’s what I thought was wrong when he started to lose weight. And when he was home, the drinking was worse.

  “Then he began to hiccup. I thought it was the liquor. But then he never quit with the hiccups: he hiccuped for two weeks, night and day. It was driving me crazy. And he wasn’t right otherwise. He would just sit there on the sofa and watch TV, not even know when we came and left the room—I had to remind him to go to work. He became more and more tired, lost more weight and, meanwhile, the goddamn hiccups, every twenty seconds. They finally let him go at work; I don’t blame them.

  “That’s when I brought him to the doctors. And you know the rest.”

  When I left Vickie, I made an appointment for her to see me in the following Wednesday’s clinic. The Family Practice Group had already drawn her blood to be tested for HIV. The result would be out in the next day or so. I thought Vickie had a good chance of not being infected. If only because Clyde was too busy sleeping around with others.

  THOUGH I WAS PRIMARILY a Mountain Home VA employee, lived on the Mountain Home campus, did my research in the laboratories at the VA, my thoughts were very much on the HIV-infected persons I had seen at the Miracle Center and at the University Physicians Group office. For several weeks now—ever since Essie Vines had brought Gordon down to the emergency room—I had been going through the motions at the VA. Patients at the VA were interesting (though somewhat predictable), my research was going well, and I had my hands full with student and resident teaching.

  But I couldn’t stop fingering the index cards I now carried in my breast pocket: one each for Gordon, Ed and Bobby, Fred and Otis. One for Clyde McCray with Vickie’s name penciled in on the seventh card, awaiting the results of her test. I put a date on Fred and Otis’s cards and wrote their CD4 counts next to it. I spread the cards in my hand and wondered idly, How many cards I would be carrying next week? Next year?

  THAT EVENING, after Steven and Rajani had gone to sleep, I called Essie to ask how Gordon was doing. She was pleased to hear from me. If she thought it strange that the doctor should be calling at a late hour to inquire about his patient who had been discharged some time ago, she said nothing. Besides, who was to dictate what conventions applied to AIDS? With just seven cases under my complete care—not the surrogate care of a Boston City Hospital where ten other specialists and interns and residents were seeing the same patient—I was developing a patient-physician relationship unlike anything I had known.

  Essie said that Gordon’s temperature had remained normal with only a few spikes ever since his discharge. As soon as they got home, Gordon had wanted to be baptized before anything else was done. He talked of nothing else for that first day. His uncle was a lay preacher. Gordon asked his uncle if he would baptize him. He agreed.

  The next morning, the family took Gordon in a borrowed van to the church. The pastor had given Gordon’s uncle free rein to use the place. They walked Gordon into the vestry, one of them on either side. He was extremely short of breath but they helped him up the stairs to the baptismal tank and then down the stairs into the water. The process exhausted them all. They had to carry Gordon back to the van and later lift him like a baby into the house. But it was worth it: the expression on his face was priceless; he was at peace and greatly relieved.

  The baptism produced opposite effects on Gordon and his father. The father was sure that now Gordon was going to live. The father’s denial had taken on new heights. He talked about perhaps starting a business with Gordon. His speech was peppered with “when Gordon gets better . . .” It was not possible to reason with him about this.

  Gordon, on the other hand, Essie reported, was feeling a genuine peace, not the passivity with which he had dealt with his illness thus far. He told Essie he was ready to die, and that his Saviour was waiting for him. The Gordon who returned from Florida may have seemed like an impostor, but the impostor had been exorcised. Gordon was back. His major regret at this point was the burden he felt he was on his family.

  At one point Gordon felt well enough to sit out on the porch. When Essie had returned from work, she found Gordon there in his dressing gown. When she stepped out of the car he put on his Bugs Bunny voice: “Hello, dolling! What say you and I go rashmagooling, just you and me.” Essie had laughed till she cried.

  Gordon was trying to use the bathroom himself, but his legs were tiring out and sometimes he did not get there in time. They had convinced him to wear diapers at night. He was having frequent accidents, day and night.

  I asked Essie how the community was reacting to this. Did anyone know?

  “Oh, I think everybody knows.”

  “How?”

  “I told them. I don’t think we have anything to hide.”

  Essie had no time to waste on worrying about the reaction of her neighbors. If there was shame in her brother having AIDS, in his being gay, she did not feel it. If anyone else felt it, it was irrelevant. I remembered her saying when I had visited her house that “he was Gordo before he was anything else. Gay was what he did, not who he was.”

  “And have you had any negative reactions from anyone?”

  “Not really. Some women from our church have been coming by, bringing food—not that Gordo eats anything. If there is negative reaction, they sure better not come and say anything to me.”

  I was sorry I asked. It was as if I was digging for dirt. But it was something I wanted to know. The reactions to AIDS elsewhere in the country had not exactly been kind and understanding.

  Essie went on: “I think people are real scared of AIDS, if that’s what you mean. One time I was cleaning up Gordo when Jack, my friend from work, walked in. I’ll be honest with you: Jack never has married. I have heard tell that he might be gay—which don’t matter to me none, cause I love him to death. Well I had Gordo rolled over in bed and you know how skinny he is now. His back is just bones, a line of little marbles running down from his neck to his butt. And his buttocks—he don’t have buttocks anymore. His butt is as flat as a pancake. The skin sort of sags there like an old man’s. And his anus is one big hole in the middle of all this sagging flesh, bigger than all the rest of him. Well, I turned and I seen Jack looking. He was in shock, his mouth open. I don’t think it had really hit him till then how bad this disease does you. Well, I stopped what I was doing and just let him see that—I wanted him to see it. Gordo’s face was turned to the wall; he didn’t know Jack was watching.

  “Son, he just about froze there in the doorway. I thought he might faint. When I was done with Gordo and tucked him in good, I went out to find Jack. He was sitting on the porch, a-shaking and a-quivering like he was ready to have a fit. I sat next to him, tried to tell him how this was a bad, bad disease. To make sure that he understood everything about it, that he protect himself. Well, he up and bolted from there. I don’t think he can bear to look at Gordo again. And used to, he was here every day, chatting with Gordo, keeping him company—”

  “—because he wants Gordo’s box collection, that’s why,” Sabatha piped in on the phone. She must have been in the same room as Essie, overhearing her talk. She had spoken loudly, intending for me to hear.

  “Now hush about them boxes,” Essie said. “He said they’re going to be yours an
d that’s all there is to it.”

  I heard Sabatha’s voice say, “But I know Jack has his eye on them. Never mind that Gordo wants me to have them.”

  “Hush now.”

  VICKIE’S BLOOD TEST came back positive. Clyde had infected her.

  When Vickie found out she was positive, she told the family practice doctors that they needed to test her sister. Her sister’s test came back positive—she too was infected. None of the children—neither Vickie’s nor her sister’s—were infected.

  I had been talking to Vickie off and on by telephone: Visiting nurse services were arranged to help her care for Clyde. At home, Clyde had become a little child, just like his son, Clyde, Jr. He and Clyde, Jr., would roll around on the carpet together, would play elaborate games, lining up Junior’s Big-Foot trucks and racing them over the tops of his matchbox sedans. Danielle, who was twelve years old, began to help Vickie take care of Clyde. The family roles had been exchanged: Clyde had become the baby, Junior became the brother, Danielle was the mother and Vickie had become the provider and guardian.

  Vickie’s sister could not be convinced to come and see me and let me evaluate her. She had allowed herself to be tested, she had found out she had the virus, and that was it.

  When I talked to Vickie on the phone, I could tell that she was very stressed. She was taking Valium that I had prescribed, but she was still walking the edge of a mental breakdown. Word had got around her community that Clyde had AIDS. And that Vickie had it too. ‘I’m driving down the road and my neighbors look away. I stare at them, but they won’t look at me. I tell you what, I am keeping a list in my mind of the people who did that. They’ll get theirs one of these days.”

  I blocked out an hour and a half for Vickie’s visit with us at the clinic. When Vickie came in, Carol, my nurse, introduced herself and ushered Vickie into a room. When Carol came out, she said, “I’m going to get a suture set; you might have to do a little sewing!”