My Own Country

by Abraham Verghese

  In a few minutes there was no one in the room but an ICU nurse and myself. She was a night nurse I had seen around, but never worked with. She was picking up the debris from the code. She was dressed for a shuttle mission—gloves, gown, mask, goggles. This was not inappropriate, as during the Code Blue there was potential for splashing.

  I said to her, by way of small talk, “I’m surprised that his heart should have quit so quickly. I really thought I could cure the pneumonia, wean him off the respirator, get a few more meaningful months or even years of life for him.”

  She stopped what she was doing, looked at me and said, affecting nonchalance: “Well, they’re all going to die, aren’t they? There’s not much point to this.”

  She left the room before I could think of an appropriate reply.

  I was furious.

  I wanted to ask her what the “point” was in the ninety-year-old patients that they played with in the unit for days until they were brain dead, all the while running up a huge bill that we, the taxpayers, would pay? Right at that moment there was a patient in the ICU whom we were sending up for dialysis three times a week when there was no hope of any other organ in the body recovering.

  I wanted to ask her if she was in the same boat, would she like an extra year of life, or would she opt to leave the world right away? And for that matter, weren’t we ALL going to die one day? Did she think her job was to solely take care of immortals?

  I calmed myself. “Pick and choose your battles, Abe,” I said to myself. In a way she had been baiting me; anything I said back to her would have been a self-fulfilling prophecy for her. It would prove my lack of objectivity. Besides, I had failed in this instance. Ed’s corpse was proof of my failure.

  When I stepped out of the room, I saw her with some other nurses at the nurses’ station. She had surely finished telling them about our little encounter. I bade them all good night.

  BOBBY KELLER AND the Maupin family were in the quiet room. It was very difficult for me to go in there and tell them Ed had died. Bobby cried. His sobs were big and wrenching. Ed’s brothers covered their eyes or turned their heads away from me. The eldest came over and shook my hand and thanked me. Bobby came out with, “Praise the Lord, his suffering is over,” and walked alone toward the door.

  The next day the pathology report of the bronchial washing from Ed’s lung came back. The specimen had been loaded with the saucer-shaped, dark-staining Pneumocystis. At this point, of course, it hardly mattered. Ed was dead.

  I thought of funerals I had been to in Johnson City where the grieving widow was escorted to the memorial service by friends and family. Tears and hugs, happy memories, casseroles and condolences. Who would comfort Bobby Keller, I wondered.

  14

  IN THE WEEKS AFTER ED died, my life changed. Not in its circumstances but in its shades and colors. Now it seemed as if everything I witnessed was imbued with this sense of loss. I was a doctor, a scientist, trained in professional detachment, but all the usual postures seemed satirical in the face of AIDS. I felt these deaths. I was filled with a longing for home (whatever I conceived that to be) so strong that I sometimes wondered if I myself was dying and this feeling was foreboding, the bittersweet messenger.

  One Friday evening during this period I drove from the mall to downtown, heading to Cates Music Center on West Walnut. I was looking for guitar strings. The piano-and-organ store in the mall didn’t carry any.

  I negotiated my way to Cates: down Knob Creek, past Kiwanis Park, up Lamont, skirting the front of Mountain Home, then down Lamont past the Oak Hill Cemetery, emerging in downtown near the Diamond Cabs sign, pausing dutifully at the many railway crossings. Like a Seeing Eye dog, my Z knew the one-way streets and the dead ends; it left its master to his thoughts. Nothing on the radio had appealed to me and I drove in silence.

  The sagging wall on the side of the Majestic Theater on East Main Street caught my eye. The theater went belly-up years ago, but in its time it was the jewel of downtown, just a few yards away from Fountain Square and the railway station. On that patched-up wall, old brick and new brick formed an abstract pattern, an inadvertent chiaroscuro. I had seen the pattern for years, noted it, but it had never been more than that—a pattern. But that night the unwitting design became a symbol for me of my years in this town, of how I had changed. It spoke to me. It was much like the painting my mother has hanging in her dining room: an oil painting of an African woman with a baby strapped to her back; the painting affects me every time I visit my parents, every time I see this relic of my childhood hanging in yet another continent, yet another house. That painting is the one thing I want to inherit from my parents.

  I suppose this is when you know that a town has become your town: where others see brick, a broken window, a boarded up storefront, you feel either moved to tears or to joy. The map of the town becomes the map of your memories, the grid on which you play out your obsessions, on which you mark your great loves and your enmities; its geography becomes your destiny.

  That night, and for every night I lived in Johnson City, the town became the geography in which my dreams were set. Oh sure, I still dreamed I was in Africa, facing an anatomy exam, or in India, riding my trusted Jawa motorcycle through the streets of Madras. But even these dreams were framed by and happened within the larger dream of Mountain Home, the town within the town of Johnson City.

  Some nights, in that fugue state between dreaming and wakefulness, I would float down from my bedroom, drawn to the VA hospital, up the stairs to my old Ward 8, my sentimental favorite. The ward had its own scent—not the medicinal smell of Lysol and carbolic acid. It was a warm and familiar scent that lingered in the curtains between the beds, a scent that even the freshly washed green-striped dressing gowns and pajamas carried back from the laundry, a scent that even when temporarily tarnished by the smell of booze and blood, poop and pus, was still the dominant smell of the ward.

  I floated past the nurses’ station where the regulation federal calendar sat next to a picture of Reagan, and where the credenza that held the charts was full. I went on into the ward, down the aisle between the beds, the lights turned off now, the ward silent like a giant baby, only the snores and coughs and expectorations of old men to be heard. I was now near the smoking room at the end of the hall, a room yellowed with nicotine, the scent of many decades of tobacco having penetrated the brickwork, only to emerge richer and more refined.

  I loved the old men; I loved their sounds; I loved the way they let us take care of them and the way they and their wives bonded to us, seeking us out on every visit. And when finally oat-cell cancer of the lung or a fatal variceal bleed claimed them, I would hear from the wives for years: cards on Memorial Day, a surprise visit to my office with a present of a giant hug and homemade corn bread.

  I hovered near the ceiling in my astral voyage, watching over this pastoral scene, as if my vigil were protective. I watched the tiptoe of the nurses armed with flashlights as they went to and fro to get a late-night admission settled in without disturbing his neighbors. They released the curtain from the rubber thong that held it to the wall and drew it around the bed. They put on the night light. They summoned the on-call intern, and, after he came, they would traipse back and forth again down the ward to start the IV and administer the other medications, while all around the patient the veterans who could sleep slept.

  In the early morning the veterans would wake to find the newcomer in their midst. I stayed to watch this ritual: they would introduce themselves by name, then by disease, then by company and recitation of their army service, finally by their hometowns: Limestone, Knoxville, Oak Ridge or any one of the towns in a hundred and fifty mile radius from Johnson City. By first light they were all family.

  And this was the time when I headed back to my home, to my sleeping body.

  I cannot tell you whether my dreams were a true reflection of the spirit of Johnson City or whether they more accurately reflected my intense need at this time for home and communit
y. I cannot tell you whether Johnson City had truly made a place for me, a brown-skinned man, among its own or whether I, like some of my patients, was forever outside its real heart. I can only say that in these strange times when it seemed death was everywhere, I thought of this place as a kind of safe haven, and when I dreamed of falling, as I often did, there were gentle hands waiting to break my fall.

  15

  ONE EVENING during the late summer of 1987, I was strolling up and down the front porch with Jacob in my arms. He was wearing only a diaper; I held him facing me, so that his feet were curled up against my chest, his body resting on my forearms and his head in my cupped hands. His eyes focused on my mouth, watching in disbelief, as I sang “Teach Your Children.” His tiny hands with the gold bangles Rajani had put on them were dancing around his face. He showed no signs of sleep. Rajani had gone for her evening walk and I was holding down the fort.

  Steven came out and clambered to the porch rail, his attention riveted on the lawn, a Mason jar clutched between his hands. His head swiveled this way and that as he tried to spot the fireflies flaming against the dark lawn and the sunset’s last light.

  “Ping! Ping!” he called, in time with the soft flash of one firefly. “Ping, ping.” When the telephone trilled within the house, I thought for a moment that the noise was coming from Steven. I resented the sound of the telephone, resented its intrusion on an evening that belonged to my family. I hoped that it was not for me.

  DR. SARAH PRESNELL was a general internist near Pikeville, Kentucky. She sounded tired. I had never met Sarah, but I had spoken to her on the phone more than once to discuss a patient of hers with a knotty infectious disease problem. Twice I had admitted Sarah’s patients to work up an FUO: fever of unknown origin. One old man with fever and recurrent phlebitis had an occult cancer of the pancreas show up at exploratory laparotomy, an operation we undertook when all other tests had failed. The other patient, a man in his forties who worked in a doctor’s office, had fever that I could never find the cause of. The fever diminished in the hospital and did not recur when he went home. I wondered about self-induced fever but could never prove it.

  Sarah had always impressed me with her soft-spokenness, her precise diction and her wry sense of humor. The case summaries she sent with her patients were lucid and clear and her diagnostic workups thorough. I guessed we were the same age and had gone through training in the same era.

  “I’m sorry to bother you at home, Abraham. I have a sad, sad situation here. A couple I know, the Johnsons, are both infected with HIV. They are pillars of our community; nobody but me—and now you—knows they are infected.”

  I was not sure what Sarah was after. Did she want advice over the phone? Was she asking me to see the patients in my clinic?

  “He contracted HIV by a blood transfusion when he underwent emergency coronary artery bypass surgery at Duke University Medical Center. He had a massive heart attack and was airlifted to Duke. The surgery was complicated by enormous bleeding. He recovered from surgery but had lymphadenopathy and weight loss and vague fevers. I was racking my brains, trying to figure out what he had. I finally ordered an HIV test and it came back positive; it’s the first case I have ever seen. I tested his wife, and she is positive as well.”

  “When did he have his bypass?”

  “A few weeks before the blood test came out. A few weeks before they were screening all blood for HIV. Such bad luck.”

  Will Johnson must have become infected just prior to March of 1985 when the blood test first became available. He was now in his second year of infection.

  “They are such a wonderful couple. You can’t imagine: incredible human beings. It’s breaking my heart to go through this with them.” Sarah was more emotional than I had ever known her to be, and I sensed that there were tears she was holding back as she talked.

  “And before I tell you anything else, I have to tell you that their primary concern is confidentiality. It’s the reason that I can’t admit him and treat him here. I’m quite willing to, but everybody knows him here. Everybody. It would knock this town for a loop. Even his son and daughter don’t know what he has. I can’t send him to the University of Kentucky. I think at one time he was even on the board of directors there; he never misses a home basketball game. He chairs one of their foundations. I have even been going to his house to draw blood; I keep his medical records at my house under lock and key.

  “He has told everyone that he has a form of lymph cancer. He is such a charismatic, convincing person that no one questions him. You’ll see when you meet him.”

  “When are you sending him over?” I asked. I hoped it would not be till the morning.

  “Tonight, if it’s OK with you. For the last week he has been complaining of severe difficulty swallowing. He’s not able to swallow a drop of water.”

  Steven was signaling to me excitedly that he had caught a firefly in his jar. I gave him the thumbs-up sign.

  Sarah went on: “But I have to tell you something else. Years ago he set up the health insurance for his own firm. When he is admitted, he doesn’t want AIDS listed as the diagnosis. Otherwise, in no time everyone at his company will know. You’ll have to list something else. Can you do that?”

  I grunted in agreement.

  Sarah went on: “I’ve been scheduling him at the end of the day because his visits take so long. I’ve just finished seeing him. It’s not that he’s long-winded. He’s just a meticulous observer of every minute symptom. He wants to participate completely in each decision we make. He wants to be in control. It’s his nature. That’s not a problem with me because I like him, and I’m drawn to him—particularly now. I give them all the time they need. I’m telling you all this to prepare you.”

  I was faintly irritated: all these proscriptions before I even saw the patient.

  “How soon can you send them?”

  “They have their bags packed and the car tanked up. He’s waiting for me to call him and tell him. He told me it will take him two hours and twenty minutes to drive down.”

  “Send him on to the Miracle Center.”

  “Where?”

  “I’m sorry: the Johnson City Medical Center. It’s an inside joke.”

  I HELPED RAJANI coax Steven into the house and upstairs for his bath. She accepted without comment that I had to go back to the hospital. Steven sat at one end of the tub while his baby brother looked on from a port-a-seat that Rajani had parked in the bathroom. Steven’s brown body was iridescent with water and his little shoulders were so perfect.

  I wanted to freeze this scene, seal the sounds of the water splashing and Steven’s yips and yells; I wanted to bottle the puppylike scent of Steven’s hair, never let my little boy and his baby brother grow up. Now that Steven was mobile and free to roam, I worried about him, worried that he might hurt himself as he probed the world around him, pushing gravity and his body to the limit.

  At some peril, I leaned into the tub and kissed Steven good-night: there was firefly glow on his hair and his hands were sticky. I knelt to kiss Jacob, saw him blink as my dark head loomed over him, felt his petal-soft cheek against my lips, smelled the milk on his breath.

  I DECIDED I WOULD walk to the Miracle Center. The dogwood trees near the Intermediate Care Building were in bloom; the petals all looked faintly gray. In the moonlight I could not tell the pink-petaled Cherokee Chief from the White Cloud variety. I picked up the ticklish, ripe scent that told me the pine trees and perhaps the redbud or magnolias on the campus were flowering. By morning a fine yellow coat of pollen would be visible on the hood of our cars.

  The two-story domiciliary buildings, symmetrically placed, barracks-style, on either side of the road—eight of them altogether—shone like images on a daguerreotype. Along the upstairs balconies of each building, I saw the glow of cigarettes, the faint outlines of figures looking down on me. When these buildings were first built at the turn of the century, each had a special function: one was for “restive” TB cases, another f
or “cripples,” another for “nervous” disorders. Each time I walked by, I tried to picture which was which. I tried to feel the anima that each building gave out. From which building had the coughs emanated all night: short, sharp coughs like nails rattling in a paper bag? And which of these buildings had held captive the men who talked to themselves, who tried to escape from imagined voices from which there was no relief in those pre-Thorazine days?

  I walked parallel to the north fence that separated the Mountain Home campus from a string of Johnson City row houses. An old veteran once told me that in the days when the campus was an Old Soldiers’ Home, “women of a certain kind” from Johnson City would line up against this fence on the first of each month, the day the checks came in. That image lingered in my mind whenever I walked here.

  The VA police pulled up alongside me in their squad car. They doubled as a transport service, driving the staff to the outlying buildings, particularly if the weather was poor. A pretty ward secretary was riding in the back seat; I had known her from the time I was an intern. Over the years, she had told me the saga of her love life: a divorce, remarriage and very recently another divorce. It was she who called out now, “Hey, Abraham! Need a ride?”

  “Thanks, but no. I’m going to the Miracle Center. I’ll walk.”

  “Well,” she said pouting, “I reckon some people’s too good to be riding with us!” All of them had cigarettes going and streams of smoke slipped out of the windows.

  “Now you know that isn’t true,” I said. “I’d ride with you anytime. But it looks like you got two good men with you already.” The policeman in the passenger seat winked at me.

  “Tell her, Doc. She don’t know how good.”