My Own Country

by Abraham Verghese

  Part of the explanation, then, for our high patient numbers was the large catchment area for our medical practice.

  Next, I traced out the outline of the entire United States, leaving out all the detail within. I titled this map “Acquisition.” I was after something different on this map: I wanted to locate the places where each patient used to live between 1979 and 1985. This was the period in time when most of them had contracted infection with the AIDS virus. I culled all the stories I had been told to try to arrive at this information. The sentinel patient, for example, the young man who had driven down from New York and come to the Miracle Center and died, he had almost certainly contracted his infection in New York City. I placed a dot there for him. Gordon, the prodigal son, brother of Essie, had come back from a prolonged residence in Florida; I placed his dot in Jacksonville. Otis Jackson had lived in San Francisco in the Castro district before returning . . .

  As I neared the end, I could see a distinct pattern of dots emerging on this larger map of the USA. All evening I had been on the threshold of seeing. Now I fully understood. The paradigm was revealed.

  I took the completed maps to the porch. I was proud of my handiwork. I poured myself a scotch and sat on the porch swing, staring at the two maps while moths swarmed around the porch light and threw shadows on the paper.

  The dots on the larger map, the “Acquisition” map, were no longer confined to the rectangle of Tennessee and its neighboring states as they had been on the “Domicile” map. Instead they seemed to circle the periphery of the United States, they seemed to wink at me like lights ringing a roadside sign. Here was a tight cluster around New York City. Below that, a few dots around Washington, D.C., and then scattered dots on the eastern seaboard down to Florida, where a clump of dots outlined Miami, and single dots pointed to Fort Pierce, Orlando, Jacksonville and Tallahassee. The middle of the country—the heartland—was bare except for three dots in Chicago. There were isolated dots over Houston and San Antonio and Denver and Salt Lake. But on the western seaboard the dots were clustered again in two spots: San Francisco and Los Angeles.

  The numbers were small, but the two maps unequivocally confirmed what individual stories of Otis, Gordon and so many others had suggested: infection with HIV in rural Tennessee was largely an imported disease. Imported to the country from the city. Imported by native sons who had left long ago and were now returning because of HIV infection.

  But if AIDS was a disease imported to east Tennessee, I needed to explain the dots that were clumped around Johnson City on both maps. These were patients who lived in the Tri-Cities and acquired their infection in the Tri-Cities—the “local-locals,” as we came to refer to them.

  The first name I wrote down—Rodney Tester—provided the clue to the “local-locals”: he was a hemophiliac. Rodney Tester was the recipient of tainted factor VIII that, courtesy of an efficient manufacturing and distributing system, had been delivered to his doorstep in rural Appalachia as soon as it was available anywhere else in the country.

  But there were still more “local-locals”—persons whose dots occupied the same position on both maps. There were blood transfusion recipients—persons other than the Johnsons—infected by a batch of tainted blood that had found its way into the blood bank of a regional hospital.

  The remaining “local-locals” were partners of infected patients—Vickie McCray was in this group. There were also gay men like Raleigh, Ed Maupin and Bobby Keller who had not resided out of the area but had made frequent trips to big cities (or to highway rest-stops where they had met people from the big cities) and engaged in unprotected and high-risk sexual encounters. Finally, there were a few men like Vickie’s husband, Clyde, and Jewell, who did not fit into any category. They may have contracted their HIV infection in Johnson City. Or else they were not entirely forthcoming about their travel and risk factors.

  IT WAS AFTER midnight but I was still on the porch. I was too wired to contemplate sleeping. Here in our little corner of rural America, my patients, trickling in over the past several years in ones and twos, had revealed a pattern to me. Their collective story spoke of an elaborate migration. Did this paradigm hold true for rural Iowa or rural Texas just as it did for rural Tennessee?

  The first step in this circuitous migration was a disappearance from home, a departure from the country. When I thought of departure, I thought of Hobart Carter. One of Hobart Carter’s earliest memories was that of his brother telling him not to “walk like that.” By the time I saw him, Hobart was in his late twenties, with a large head and an owl-like face. He carried himself very upright, almost tilting backward, making him appear taller than his six foot two. His protruding lower jaw only exaggerated his peculiar hip-swinging carriage. If that was not enough to make him different, he had started to lose his hair at the age of fifteen.

  Was it any surprise that when Hobart Carter realized he was gay, he left home for the city at the first opportunity? Yes, the leaving could be construed as a search for a better job, a better education, a space apart from the family just like any heterosexual male might want. But clearly, his desire to leave had much to do with his awakening sexuality.

  At home, his opportunities to meet other gay men would be limited and there would have been his parents to deal with: their knowledge, their attitude. His greatest fear was that he might embarrass them, bring them shame. Perhaps he needed distance from them to really understand if he was gay; to live independently was the only way to define himself. He had to separate, despite the part of him that might have wanted to stay.

  The opportunity came when his uncle in California became sick. Hobart, who was eighteen by then and quite close to his uncle, volunteered to move there and take care of him. Hobart’s father, a fireman and church deacon, recalls: “While he was in California, Hobart was working in a beer-and-sandwich joint called ‘Thirteen Buttons.’ I asked him on the phone one time, I said, ‘Son, what does thirteen buttons mean? When I was in the Navy, thirteen buttons was a kind of coat navy men wore. Does it have something to do with sailors?’ And he said, ‘Yes, Father, it has something to do with sailors.’ But even then, I didn’t make the connection.”

  After two years, Hobart decided to move to San Francisco. He had a friend there and pretty soon he got a job as a night clerk in a very prestigious hotel in San Francisco. He worked that job for a long time and was happy with it, proud of doing what he did and doing it well. He sent his parents a picture of the hotel and a picture of himself working behind the counter. In it he was wearing a black tuxedo and a bow tie, together with an expression that seemed to say he had found not just a job but a city where he could be himself. He had arrived in Mecca.

  San Francisco was perhaps the most comfortable place in America in the 1970s to live an openly gay life. On his days off, Hobart strolled up and down the Castro, shopped at the All American Boy or went for a drink in one of the bars. If he ate in a restaurant, he was surrounded by gay men. The “Castro-cut” which was popular then, exaggerated the natural male-pattern recession on either side of the widow’s peak. It was, at least in part, a rebellion against effeminacy. Hobart’s baldness, which had embarrassed him in Tennessee, now seemed desirable. It fit into the “clone” look (Levi’s 501s, flannel shirts or Izods, lace-up boots) that most gay men seemed to be espousing at that time. Adopting the clone look of that town and that era—and gay men have continued to reinvent the look—seemed a way to signal a union with a community after years of alienation from the rituals and even the dress of the larger community. Hobart was no exception.

  There was a point in the paradigm that I was constructing when parents became fully aware that their son was gay. With Hobart it happened years before he got sick. His father recalls:

  “Hobart came home one vacation in 1977 and he and I were driving down this bypass just about a mile from the house and Hobart turns to me and says, ‘Daddy, I want to tell you something that has been eating me up inside. I’m gay. I’ve had these feelings in me ever sin
ce I can remember, since the age of four or five.’ Well, it hit me like a ton of bricks, for him to tell me that. Then Hobart says to me, ‘Daddy, if you want to stop the car, I’ll be happy to get out now.’ I said, ‘Why would I want to do that? I don’t love homosexuality but I love you and I would never tell you to get out of my house.’ We just kept a-driving and a-driving, and I was thinking about it and he was studying me. He asked me whether he should tell his mother and I said no, I better be the one to tell her ’cause you know how Mother is.

  “I remember telling Hobart as we were driving around that I had known or suspected this for some time, even if I had never formed the words ‘homosexual’ or ‘gay’ in my brain. Hobart says to me, ‘Why in God’s name did you not say something to me if you knew, Daddy? I’ve been living with this burden for years and years, from the time I was a small boy. I wish you had said something to me.’ I said, ‘What would I say to you? And if you were not gay and I had suggested you might be, it would only have hurt you.’

  “When we got home, we were at peace with each other. Like I said, it hit me like a ton of bricks, but all the same I felt like I understood my son and that his pain had been eased by telling me. I prayed for guidance on it. When I told Mother, it hit her like a ton of bricks, too. Even though she had suspected the same thing beforehand. Hobart called up his brother and told him as well. Jake and Hobart were never really very close, and after that it seemed as if they were even more distant.”

  For Hobart, this period of independence and self-definition in California coincided with what was the first period of true gay liberation in the seventies. Hobart was discovering and creating his sexual self and adult identity at a moment when gay men and women across the country were learning for the first time to accept themselves and celebrate this sexuality. For the men, particularly, the search for psychological liberation was combined with a period of sexual revolution, a period of rampant sexuality and exhilaration. The gay community had watched the straights experience the sexual revolution of the sixties. For years before that, they had waited in the closets, often sexually inactive. Now finally it seemed there was freedom, exuberance, fraternity. At this moment, sexual freedom was more than just an expression of lust, it was a celebration of all that had not been previously available.

  But no one knew of the existence of the HIV virus, least of all Hobart in San Francisco. By the time he was aware there was a virus, it was already in him, subverting his immune system.

  Hobart kept in touch with his parents irregularly. Before Hobart returned, before he fell ill, the Carters had a great desire to go west to San Francisco, a part of the country that they had not seen. Mr. Carter collected travel brochures and used to sit in the evenings studying pictures of the Golden Gate Bridge, Embarcadero, Fisherman’s Wharf and imagining how it would be. Every time they made plans, Hobart waved them off. For one reason or another their visit at that time was not convenient. When Mr. Carter related this to me, he did so with sadness and deep disappointment. He and his wife had a hard life with very little variety. The prospect of visiting San Francisco was indescribably exciting.

  “I sure would have loved to see that Golden Gate Bridge,” Mr. Carter told me. His longing has stayed with me as a symbol of all the pleasures denied by barriers of sexuality and misunderstanding, barriers between parents and their own children. When I think now of the losses caused by AIDS, I am also haunted by the earlier losses, the times that might have been, the communication and sharing that for many will never be possible. I can picture Mr. Carter on his porch, years after his son’s death, still fingering brochures and studying pictures of the Golden Gate Bridge.

  THE FIRST TWO STEPS of the paradigm—leaving home and then the period of urban living—were followed by the long voyage back. Four months before I first saw Hobart in clinic, he was admitted to San Francisco General Hospital for an acute attack of shingles, and while there was found to be HIV-positive. When he recovered, the hotel job was gone, his rent was in arrears, and there were no friends willing to take him in.

  He called his parents to say he was sick, he had lost his job, and he planned to come home. He told his parents over the phone that he had “the virus that causes AIDS.”

  To his parents this must have seemed terribly unfair: Mr. Carter had just had diverticulitis and bowel surgery. Mrs. Carter was not herself because of her own medical problems. Now, Hobart, who had never once invited them to San Francisco, was coming home with AIDS.

  Hobart’s mother was a stern woman. If her husband’s face was expressive and warm, hers was an inscrutable mask, and only the wild expression in her eyes revealed her underlying torment. When I met her at her son’s bedside, I worried that she was going to explode from all the tension: a husband just weeks out of surgery, a son with AIDS.

  If the move back was hard on his parents, it was hell for Hobart. He was once again in the same family environment, the same town that he had once felt imprisoned by. The boyhood room where he had once dreamed of a different life now held him again within its walls. The crucifixes in every room, the framed needlepoint verses in the bathroom and kitchen, the giant, somewhat gaudy rendering of Christ at Gethsemane that dominated the living room harked back to a childhood that had been difficult. His apartment in San Francisco had been like his vision of the world: his art objects, his framed and signed Mapplethorpe print, his color scheme and furnishing. All these affirmations of his own identity sat in a box in a friend’s basement in San Francisco, a friend who was also sick and might have to vacate soon.

  A few months after returning from San Francisco, Hobart had tried to live in an apartment away from his parents. Rents in Johnson City were so much cheaper than in San Francisco; he was able to use his disability check, food stamps and wages from a part-time accounting job to exist on his own for a while. But his worsening illness made him abandon the apartment and move back with his parents.

  THE PARADIGM—the circuitous voyage, the migration and return—ended in death. The last time Hobart came to my office, he looked anxious and apprehensive in addition to being wasted and thin. I knew from his conversation that he feared death greatly. I had no idea how to approach this but I felt reckless, willing to try. I sat him down and asked him a series of questions: Where did he want to die? At home or in the hospital? Who did he want with him at his deathbed? What did he want done with his body? What did he want to do with his remaining possessions? What sort of help could I offer him to alleviate his symptoms near death? What symptom did he fear most? Choking? Gagging? Being wide awake? Thinking of Norman Sanger and his death, I told Hobart how I might prescribe morphine and how it would make him feel. Did he want cremation? Did he want an autopsy performed? What sort of service did he want? What music did he want played? Did he want his father to speak? Anyone else?

  He had pondered each question at length, and I was convinced that he had avoided these thoughts before. As he answered I served as his scribe, jotting down his replies on a yellow legal pad. At the end I handed him the sheet of paper. We had addressed all those issues about his death over which he had some control. He left my office helped not so much by the paper, but by the sense of having faced his worst fear and talked about it, walked past it. I resolved after that to discuss death with all my patients when it was appropriate. In many families I noticed it was the last entry on the long list of things not discussed with their sons.

  A few weeks after Hobart and I had our talk, Mr. Carter visited me to tell me that his son was fading rapidly. He picked up a prescription for morphine solution to help Hobart rest. Hobart would ask his father to come and lie down with him and hug him just as when he was a little boy. They would stay that way for hours. He said to his father, “Daddy, I love you. I hope you never grow old and die.”

  Mr. Carter replied: “If I die today, I don’t mind. Because of my belief in the Lord I feel I will never die. What about you, Hobart? Is everything all right with you and the Lord?”

  “Daddy, it was not for the longe
st time. But now it is.”

  It was at this point that he called his brother Jake in Germany and asked him for forgiveness. Jake was puzzled. “Forgiveness for what?” Hobart replied, “Forgiveness for everything I have done to you.” He had made a similar phone call to me, to ask me to excuse him for any grief he had caused me. I assured him he had caused me none. I thought guiltily about the yellow piece of paper—had that been too much?

  He told his father that he wanted his body cremated. He wanted his ashes thrown over the pond at a farm that his friends owned, a farm where he had house-sat for a few weeks.

  On a Saturday morning, I was on the tennis court when the call came that Hobart had died. I went over to the hospital and picked up some “Tru-Cut” biopsy needles and small bottles of formalin. This was his idea. In death he had wanted to give me some clues as to what had gone on from an infectious disease point of view.

  I drove to the apartment complex in Bristol where the Carters lived, a thirty-minute drive. For financial reasons, the Carters had sold the family home and moved into an apartment. Outside the building, children were playing. They paused to watch me enter the Carters’ flat on the ground floor. Did they know a death had taken place? Did they know a child like them had attempted an escape, tried to create a new life, but after just a few years had it cut short?

  The apartment was neatly furnished, with a gleaming white sofa in the living room and pictures of Hobart and Jake on the coffee table. Mr. Carter rose to greet me, gracious as ever. “Praise the Lord, Doctor, he is out of his misery,” he said to me. Mrs. Carter sat heavily on the couch; she looked up at me but said nothing. Mr. Carter went back to ministering to her.