My Own Country

by Abraham Verghese

  She had asked that the sermon be from John 11, verses 25–27: “. . . I am the resurrection and the life: he that believeth in me, though he were dead, yet shall he live. And whosoever liveth and believeth in me shall never die.”

  After the reading of Psalm 23, the service ended with the hymn, “All Hail the Power.”

  Will Junior and his sister, orphaned by this terrible virus, made the trip to the cemetery once more. They took turns scooping the ashes into the ground. Once again Will Junior kissed the ash off his fingers.

  VICKIE MCCRAY HAD started going to church, a different church than the one her cousins attended.

  For a while she liked the preacher. She had confided to him about her infection, and he had taken the news well and was full of sympathy. Then, a few weeks later, he called her and asked her if she was willing to stand up at church and tell the congregation that she had AIDS.

  He said to her, “Let us carry your burden for you. It will also allow us to introduce this topic to the church.”

  Vickie had answered him, “And why would you want to use me as a specimen?” Danielle begged her not to even dream of it because so many of her classmates went to the same church. Vickie told the preacher, “What I would like to do is keep coming to your church and get to know the people and tell them when I’m ready.”

  The preacher persisted: “I feel like my congregation would support you. I know my congregation. I know what they will do.”

  “Oh no you don’t. ’Cause you just done lost one member of your congregation.”

  Meanwhile Vickie was more and more active with TAP—Tri-City AIDS Project. She was crisscrossing the county, going up to see Bobby Keller every other day, taking care of Jacko. Jacko was deteriorating, losing more toes, having the KS lesions growing both without and within, squeezing out his life.

  She said to me, “I’m beginning to believe that I was given this disease for a reason. I was just this everyday, typical housewife, taking care of the children, cooking meals for everyone, and waiting for my husband to come home after each evening’s work. I didn’t get the chance to go out much. I didn’t go to bars. I didn’t meet very many new people. My life just revolved around my family. We never had vacations, though we did go camping quite a lot. We went to big places where we could fish and swim, and we had a good time. But as I look back on my life and compare it to the way it was then and now, I say, ‘Wow!’ ”

  It was indeed a TV movie sort of transformation. Vickie’s hair had grown back fully. With Clyde’s insurance money, she had bought a four-year-old Camaro and was applying for a housing loan to move away from Tester Hollow to a subdivision of Kingsport. She was creating a new self.

  “I feel like a bear that’s been in hibernation, you know what I mean? I have become a person I didn’t know existed inside of me. I know I can make friends. I know I’m respected after people get to know me. And my heart is so full of love to give to them who need it. I’m so active in every organization I join. I’m now on the board of TAP! Can you believe it? An old country hick like me? I’m living my life to the fullest and thanking God for each day that I’m here. Life is so precious, Abraham, and there’s so many people that don’t realize it. So if anything, this disease has made me take a long look at how things were before I got it and afterward. I’m more of a complete person than I ever was.” Here she pounded her right fist into her cupped left hand. “I set goals for myself that I’m determined to fulfill. I am somebody. I’m happier now than I’ve been in a long time. I enjoy life more now.”

  I couldn’t believe what Vickie was telling me. There was something a little desperate here, a measure of denial. But the new life she had created was one she was justifiably proud of. So was I. I just had a hard time getting the future—her future—out of my mind.

  Vickie read my thoughts. “But I’m also realistic. I know that what I have is like a time bomb waiting to blow up in me and cause this terrible AIDS to begin. But I can’t let it rule my life, get into my train of thought all the time and take away the best fight that my body possesses, and that is ‘positive thinking.’ I’m going to fight this disease with lots of laughter on account of, you know, it will boost my immune system.”

  I nodded. I believed laughter did a lot more than most things I prescribed.

  She went on: “I’ve had a lot of sad times and probably a lot more to get through. But it helps having very special friends to talk to. I appreciate Carol at your office and I appreciate you. But my friends in support group are even more special to me because they know what I’m going through. They’ve been through it themselves. But I tell you what, Doc, there’s much more to life than sitting around waiting to die. There’s so many people with this disease that I’ve seen just give up on life, give in to this disease, and let it take over their lives.

  “After I lost Clyde in that most horrible way, how much more horrible could anything else in my life be? I’m not scared of death one bit. And when it comes, I’ll deal with it. I’ve made arrangements for my kids—I have a cousin what is well off and wants them both. Meanwhile, Doc, guess what: I have just enrolled in nursing school!”

  I gave Vickie a big hug. I was so proud of her. I had watched her transition from housewife to household head to widow and now to nursing student. I told Vickie that I would come from the end of the earth for her graduation.

  “Why? Won’t you be here?”

  “I might not, Vickie. I might not.”

  She shook her head as if she did not want to think about it.

  I asked Vickie the question that had always nagged me: How was it that she managed to retain so much love for Clyde? In her journals, her poems, which she shared with me, and in the pictures on the wall, she had memorialized him. Yet this was the man who had cheated on her constantly with both women and men. He had had an affair with her own sister. This was a man who gave her a disease that might take away her life, make her children orphans.

  Vickie’s face took on that same teary-eyed, somewhat shamed expression as when she had exposed her scalp to me in clinic three years before.

  “I don’t know. I can’t explain it. You know, when I caught him with my sister, what I had done is drive out to the store and then before I got there, I turned around and coasted home, cutting the engine off so they couldn’t hear. And sure enough, her car was right there. I just bust in there and let them both have it. I remember I took my ring and threw it at him. It was the worst moment of my life.

  “And then no more than two weeks later we’re back together and he’s sleeping with me. And I was thinking, ‘How does this man have the nerve to sleep with me again when he knows I can just slice it off with my knife and hand it back to him and say that’s what you get for sleeping around?’

  “See, Abraham, I don’t understand how he was able to attract those women, how I even forgave him. Why, he hardly spoke a word—he was backward, to tell you the truth. And I don’t know why I still love him, but I do.

  “It’s almost like I’m still looking for him. I’ll be driving and I’ll see a dark-haired man with a mustache and my head will spin, as if it might be him. It’s the strangest thing, Abraham.”

  30

  I LIE AWAKE AT NIGHT, the household fast asleep around me.

  I am now plotting the unimaginable, the sacrilegious. No: not the Little Black Dress. Worse than that: I am thinking of how I will leave my Mountain Home, leave Tennessee. Steve Berk has suggested I take a leave of absence rather than quit. I have been looking for a research or scholarly project to pursue outside Johnson City. I have told my patients and they have accepted it quietly. But I worry that they think I have betrayed them.

  It was a crazy day: Roly-poly, jolly Bobby Keller died.

  And Luther Hines is in the hospital refusing to die.

  And Jacko is at home, near death. Vickie reports that one by one his toes are falling off. I have a notion that one toe—perhaps the last one—is attached to a guy wire that holds up his viscera. When the last toe falls
, everything within will collapse. The lungs and heart will crash through the diaphragm onto the liver, breaking it free from its ligaments, carrying the spleen in its fall, and the whole lot go crashing to the pelvic floor.

  Fred the bear and Vickie McCray—I think of them as the brave generals who lead the battle charge and will never admit defeat—are doing well. They report the casualties to me.

  The “infection” dream is so frequent that many mornings I wake up and, even when I have shaved and showered, I am still having to convince myself that I am uninfected. Perhaps my insomnia of the last six months is an attempt to avoid the infection dream.

  Idly, in the silence of the night, unable to sleep, I percuss my body, map out my organs, take an internal poll: liver, spleen, heart, lung—how do you feel? Do we leave or not, guys? I think of Hobart Carter and how I went to his house to biopsy his organs. I had percussed his Christ-like corpse just as I am percussing myself now to find my liver. Did his liver in death sound different from mine in life?

  I was taught how to percuss the body so long ago: it was the first day of June 1972. That night, like tonight, lying flat on my back, the sheets pulled away and the lights off, I percussed my liver. I started just above my right lung, high, at the level of my nipple, pressing the middle finger of my left hand against my skin. I cocked my right wrist and let the fingertips fall like piano hammers: thoom, thoom.

  “Resonance!” I said to myself, picturing the air vibrating in a million air sacs, a million tiny tambours.

  I moved down an inch: thoom, thoom. Farther down and farther still, and then suddenly, thunk! thunk!—dullness. I had reached my liver, airless and solid.

  I returned to my nipple: thoom, thoom, thoom, thoom, and then thunk! I lightened my stroke: there was no longer any sound but there was still a vibration in my stationary finger—the pleximeter finger—which told me where the air sacs ended and where, high under my rib cage, under the domed diaphragm, my liver began.

  I traversed my liver, following its dull note into the belly until the thunk! thunk! was replaced by a sharp and high-pitched tup! tup!—“tympany!” It was the air that had been trapped in the loops of my bowel. No longer confined to little sacs, it was free to vibrate like the air in a conga drum—tup! tup!

  As a young medical student, I percussed everything in the joy of discovery. I percussed table tops, to find the stony dull circle where the leg joined the underside. I percussed plaster walls, looking for studs. I percussed tins of rice flour and the sides of filing cabinets. But in the dark, just as tonight, it was my own body that I percussed. As I drifted to sleep I saw myself as if transparent, my viscera, both hollow and solid, shining through my skin.

  But tonight, unlike those medical student days, sleep hovers far away and I continue sounding my body. I think of my hero, Charles Leithead, who taught me percussion. He was professor of medicine at the Princess Tsahai Hospital in Addis Ababa, Ethiopia. I was a third-year medical student. It was only a few years before Haile Selassie was deposed and the country came unglued.

  Professor Leithead, who favored dark, pin-striped suits and Edinburgh ties, was bald except for a fringe of gray-white hair that hung long over his collar. Half-moon, tortoise-shell glasses were perched on the very tip of his nose.

  At the time that I came under his preceptorship, I harbored secret fantasies of specializing in heroic neurosurgery, high-risk perinatology, surgery of the open-heart-and-transplant kind—as did my two fellow students, Tom and Arsalon. We were convinced that it was only by specializing in these fields that we could achieve the Dr. Kildare-ish charisma that we all secretly sought. As it turned out, most of us who met Charles Leithead found a higher calling than surgery or perinatology: we became internists.

  We met Leithead in the hospital every other afternoon for a bedside tutorial. Leithead was about six-two but had a way of slumping his shoulders and bending his knees when first introduced to the patient, as though trying to make himself more human. After introductions, he would sit by the bed and hunch forward, crossing his legs English style, and then—as if that had not been enough—would hook a foot behind the calf of the other leg so that he was now double-twisted, vinelike, a seated caduceus. The spectacles would come off and he would bend over as if studying the tile pattern on the floor. The professor’s command of Amharic was good enough, we suspected, for him to understand most of what transpired, but we translated for him nevertheless. The corners of his mouth would twitch or his chin draw up as though he was going to cry as we gravely described the case before us.

  One case I remember was that of Woizero Almaz. I described to the professor how her symptoms unfolded. Almaz, having squatted beside the market road to pee, noticed that her water was taking a dangerous course. Emerging from the perimeter of her skirts, the narrow groundstream had crept toward a nearby coil of rusty, evil-looking barbed wire. Ever since her water had touched the wire, Almaz had suffered pain in her hips, night sweats, fever. I asked more questions, but Woizero Almaz looked only at the bald pate while answering. Her gaze remained rooted on the Great White One. When I finished my history, we all looked at each other while our preceptor continued staring at the floor. Finally he spoke.

  “Ask Woizero Almaz for me, would you, if . . .” And the questions, in a strange Yorkshire accent, would then emanate from this twisted vine, each piercing some protected enclave that the patient—her eyes bugging out—had not thought fit to share with us. Now, terrified at the clairvoyance of this foreigner with the white mane and the black serpent of a stethoscope coiled in his hand, she spewed out reams of history, well beyond the tales of barbed wire and bad humors and evil miasma that we had heard thus far. Other patients had been known to throw in cries for forgiveness.

  Leithead rose to examine the patient, bringing his head close to inspect her skin and her bony landmarks, then stepping to the foot of the bed and squatting to “sight” down her body to see if both sides of the chest rose and fell equally, only then probing with his fingers. He percussed smoothly, rhythmically and rapidly: quick strokes—thoom-oom-ooom—before moving on, each triplet melodic and crisp, mapping out the borders of the lung, the edges of viscera, a silhouette of the heart. Finally, almost as an afterthought, he put his stethoscope on her skin. All this was done with great economy of time and motion, as if this was not an examination but some sort of bloodless surgery. Now, having understood the case, he would demonstrate each of his findings to us, letting us see and feel and hear what he had experienced, leading us in Socratic fashion to a diagnosis. “Never forget,” he would say, “inspection, then palpation, then percussion, finally auscultation.” He would look at us curiously and ask: “Which is the least important instrument in our armamentarium?”

  “The stethoscope, sir!” we would bark out.

  “And why is that, pray?”

  “Because, sir,” we would chant, “by the time you have looked, felt and percussed, you should know what you will hear!”

  I LEAVE THE HOUSE AT 5:30 a.m. I pick the Press off the front porch and scan the first page before placing the paper back on the doormat where Steven will discover it in an hour or so and take it up to his mother.

  A fine mist is in the air creating halos around the street lamps and making every tree look ghostly, as if a shrouded figure stands behind it. In a few weeks there will be frost to scrape off the windshield, gloves to be worn.

  Under the streetlight, I see the silky tracks left by the snails on the pavement, a slimy carpet they roll in front of themselves. The snails seem unaware that warm weather is over. I study the paths of their wanderings, their drunken meandering out of the hedges, up the footpath and then looping back. They crisscross each other and I bend low to see if I can tell which traveler has gone most recently. I wonder if there is an order to this confusion of interweaving lines. Is there a set of rules that snails the world over follow, a code that if broken reveals an intricate pattern underneath this chaos?

  I stop at the vending area next to the VA domici
liary canteen; I am starting so early that the Miracle Center’s coffee and doughnuts will not be out. For a quarter, I get coffee and the bonus of my horoscope printed on the paper cup.

  I see the shadowy figure that I know to be old Bill Mulrooney standing by the door to the mess hall. He wears a tasseled, broad-beamed hat. In the morning mist he can pass for Lee at Appomattox waiting to surrender to Grant. When I come closer, I notice he is sniffling in the cold.

  Bill’s goal in life is to be first in the chow line. For years he has had no competition. Recently another old veteran, Edward Harless, a transfer from the Murfreesboro VA, has started to compete with him. On one or two mornings I have seen them race-walking and then finally running flat-out to the door while the rest of the VA sleeps.

  Bill Mulrooney is a Bible nut. This morning he calls out to me: “Hey, Doc. You know the shortest verse in the Bible?”

  “Jesus wept, Bill. Jesus wept.”

  THE VENDING MACHINE ROOM this morning smells strongly of stale cigarettes. In two hours the smoke will be so thick that you cannot see the far wall. If they ever tear the building down, the smoke will be found to have penetrated the heart of each brick. A few insomniacs and a few of the early risers who need that first cup of coffee to get their bowels going are seated in the booths. By midmorning, there will be no place to sit, as a dozen men will be stretched out on the seat cushions, their legs jutting out of the booth, sometimes snoring loudly.

  I look for and find Red sitting in his favorite corner booth. He sits attentively, his hands on the edge of the table, as if at any moment someone is going to put a test paper and a No. 2 pencil before him and tell him to begin.

  My guess is that Red is only in his late thirties—very young by VA standards—with a baby face and yet with hair that has turned completely white. If you ever ask him why he is called Red, he will say, “Well, I tell you. Back when I was younger, I used to work for the CIA, I had red hair and they used to call me Red.”