My Own Country: A Doctor's Story
Abraham Verghese, 1994
Knopf Doubleday
448 pp.
ISBN-13: 9780679752929
Summary
Nestled in the Smoky Mountains of eastern Tennessee, the town of Johnson City had always seemed exempt from the anxieties of modern American life. But on August 11, 1985, the local hospital treated its first AIDS patient, and, before long, a crisis that had once seemed an "urban problem" had arrived in the town to stay.
Working in Johnson City was Abraham Verghese, a young Indian doctor specializing in infectious diseases. Of necessity, he became the local AIDS expert, soon besieged by a shocking number of male and female patients whose stories come to occupy his mind, and even take over his life. Verghese brought a singular perspective to Johnson City: as a doctor unique in his abilities; as an outsider who could talk to people suspicious of local practitioners; above all, as a writer of grace and compassion who saw that what was happening in this conservative community was both a medical and a spiritual emergency.
Out of his experience comes a startling but ultimately uplifting portrait of the American heartland as it confronts—and surmounts—its deepest prejudices and fears. (From the publisher.)
Author Bio
Abraham Verghese is Professor and Senior Associate Chair for the Theory and Practice of Medicine at the Stanford University School of Medicine. He was the founding director of the Center for Medical Humanities & Ethics at the University of Texas Health Science Center, San Antonio, where he is now an adjunct professor. He is the author, most recently, of Cutting for Stone (2009), as well as The Tennis Partner, a New York Times Notable Book. My Own Country was a 1994 NBCC Finalist and a Time Best Book of the Year, A graduate of the Iowa Writers' Workshop, he has published essays and short stories that have appeared in The New Yorker, the New York Times, the Atlantic Monthly, and Granta. He lives in Palo Alto, California. (From the publisher.)
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is the Professor for the Theory and Practice of Medicine at the Stanford University School of Medicine and Senior Associate Chair of the Department of Internal Medicine. He was born in Ethiopia to parents from Kerala in south India who, along with hundreds of Keralites, worked as teachers.
Dr. Verghese began his medical training in Ethiopia, but his education was interrupted during the civil unrest there when the Emperor Haile Selassie was deposed and a military government took over. He came to America with his parents and two brothers (his elder brother George Verghese is now an engineering professor at MIT) and worked as an orderly for a year before going to India where he completed his medical studies at Madras Medical College in Madras, now Chennai.
In his written work, he refers to his time working as an orderly in a hospital in America as an experience that confirmed his desire to finish his medical training; the experience had given him a first-hand view of patients' experience in the hospital with its varying levels of treatment and care. He has said the insights he gained from this work helped him "imagine the suffering of patients," which became a motto for some of his later work.
After finishing his medical degree from Madras University in 1979, he came to the U.S. as one of hundreds of foreign medical graduates, or FMGs, from India seeking open residency positions here. As he described it in a New Yorker article, "The Cowpath to America," many FMGs often had to work in the less popular hospitals and communities, and frequently in inner cities. He opted for a residency in a brand-new program in Johnson City, Tennessee affiliated with East Tennessee State University. He was a resident there from 1980 to 1983, and then secured a coveted fellowship at Boston University School of Medicine in 1983, where he worked for two years at Boston City Hospital and where he saw the early signs of the urban epidemic of HIV in that city.
Returning to Johnson City in 1985 as assistant professor of medicine (he later became a tenured associate professor there), he encountered the first signs of a second epidemic, that of rural AIDS. His work with the patients he cared for and his insights into his personal transformation from being "homoignorant," as he describes it, to having a understanding of his patients resulted a few years later in his first book.
Exhausted from the strain of his work with his patients, with his first marriage under strain and having by then begun to write seriously, he decided to take a break and applied to and was accepted to the prestigious Iowa Writers Workshop at the University of Iowa, where he earned a Master of Fine Arts degree in 1991. He had cashed in his retirement plan and his tenured position to go to Iowa City with his young family.
After Iowa, he accepted a position as Professor of Medicine and Chief of the Division of Infectious Diseases at Texas Tech Health Sciences Center in El Paso, Texas, where he lived for the next 11 years. Despite his title, he was the sole infectious disease physician for a busy county hospital—Thomason Hospital—for many years. His skills and commitment to patient care resulted in his being awarded the Grover E. Murray Distinguished Professorship of Medicine at the Texas Tech School of Medicine.
During these years in El Paso, he also wrote and published his first bestselling book, My Own Country: A Doctor's Story, about his experiences in East Tennessee, but also pondering themes of displacement, Diaspora, responses to foreignness and the many individuals and families affected by the AIDS epidemic. This book was one of five chosen as Best Book of the Year by Time magazine and it was later made into a movie by Mira Nair with TV Lost series star Naveen Andrews playing his role.
His second book, The Tennis Partner: A Story of Friendship and Loss, also written during his time in El Paso, is another eloquently written personal story, this time about his friend and tennis partner, a medical resident in recovery from drug addiction. The story deals with the ultimate death of his friend and explores the issue and prevalence of physician drug abuse. It also concludes the account of the breakdown of his first marriage, an integral part of the narrative in both My Own Country and The Tennis Partner.
In 2002, Dr. Verghese went to San Antonio, Texas as founding Director of the Center for Medical Humanities & Ethics at the University of Texas Health Science Center at San Antonio, where he focused on medical humanities as a way to preserve the innate empathy and sensitivity that brings students to medical school but which is frequently repressed through the rigors of their training. In San Antonio, besides developing a formal humanities and ethics curriculum that was integrated into in all four years of study, he invited medical students to accompany him on bedside rounds as a way of demonstrating his conviction about the value of the physical examination in diagnosing patients and in developing a caring, two-way patient-doctor relationship that provides benefits not only to patients and their families but to the physician, as well. At San Antonio, he held the Joaquin Cigarroa Chair and the Marvin Forland Distinguished Professorship.
His deep interest in bedside medicine and his reputation as a clinician, teacher and writer led to his being recruited to Stanford University in 2007 as a tenured professor.
In 2009, Dr. Verghese published his first novel, Cutting for Stone.
His writing and work continue to explore the importance of bedside medicine, the ritual of the physical examination in the era of advanced technology, where as he notes frequently in his writing, the patient in the bed is often ignored in favor of the patient data in the computer. He is renowned at Stanford for his weekly bedside rounds, where he insists on examining patients without knowledge of their diagnosis to demonstrate the wealth of information available from the physical exam.
Dr. Verghese has three children, two grown sons by his first marriage and a third by his second marriage. (From Wikipedia.)
Book Reviews
The greatest strength of this eloquently written book is its ability to weave together all those separate strands. It is at once a previously untold story of AIDS in America, a story of the South, a story of the modern-day immigrant experience in America and a story of a personal journey within the medical profession. Dr. Verghese illumines a number of landscapes here, and does it with more than a touch of the poet. He writes, for example, about the life inside the hospital—but not just any hospital. His greatest affection is reserved for the patients and staff of the Veteran's Administration Hospital, that perennial poor relation of the medical system; perhaps never has a V.A. hospital been written about with such glowing lyricism.
Perri Klass - New York Times Book Review
This extraordinary book is ostensibly "about" a doctor caring for persons with HIV/AIDS. That it is, but it is also a book containing multiple texts. It is a doctor's personal journey toward understanding the multiple meanings of HIV/AIDS for those who have it and those who care for them. It is the story of a physician, an Indian, born in Ethiopia to Christian expatriate teachers, [who has been] in America since 1980... trying to determine the meaning of "home." It is, at the same time, a glorious pastoral account of practicing medicine in Tennessee—here making a house call to Vicki and Clyde, whose trailer is perched on the side of a mountain, now traveling through the Cumberland Gap to a cinder-block house to see Gordon, another native son who has come home to die. On still another level it is the story of a man trying to understand what it is like to be gay; a man trying to integrate his passion for his work with his life at home; a man trying to explain to his wife (and sadly, even some of his peers) his commitment to caring for persons infected with the virus.
Literature, Arts and Medicine Database
When infectious-disease specialist Verghese, the Ethiopian-born son of Indian schoolteachers, emigrated to the U.S. and settled in Johnson City, Tenn., in the mid-1980s, he finally felt at peace "in my own country'' at last. But his work at the Johnson City Medical Center soon led him into a shadow world of Bible-belt AIDS, often without the support of his colleagues. Verghese discovered a local gay community that was then untested for the HIV virus. If revealed, these people's closeted relationships would have, writes Verghese, made them stand out "like Martians.'' The author tells the stories of several patients, including the gay man who must reconcile with his father and the "innocent'' man who has contracted AIDS through a contaminated blood transfusion but who, concerned about society's response to his plight, keeps his disease a secret even though he believes that "this thing, this virus, is from hell, from the devil himself.'' Verghese reveals his own confusions about homosexuality, immigrant identity and his wife's fears about his health. Writing with an outsider's empathy and insight, casting his chronicle in graceful prose, he offers a memorable tale that both captures and transcends time and place.
Publishers Weekly
In fall 1985 Verghese—who was born in Ethiopia of Indian parents—returned with his wife and newborn son to Johnson City, Tennessee, where he had done his internship and residence. As he watched AIDS infect the small town, he and the community learned many things from one another, including the power of compassion. An AIDS expert who initially had no patients, Verghese describes meeting gay men and then eventually others struggling with this new disease. Verghese's patients include a factory worker confronting her husband's AIDS, bisexuality, and her own HIV status and a religious couple infected via a blood transfusion attempting to keep their disease secret from their church and their children. This novelistic account, occasionally overly detailed, provides a heartfelt perspective on the American response to the spread of AIDS. —James E. Van Buskirk, San Francisco P . L .
Library Journal
Discussion Questions
1. Verghese describes the early eighties, before AIDS had spun out of control, as "a time of unreal and unparalleled confidence, bordering on conceit, in the Western medical world, " [p. 24] in which doctors felt they had achieved "mastery over the human body"[p. 25]. How does the reality of AIDS undermine this ultra-modern, technological ideal of medicine? How does Verghese's idea of the doctor's role change during the course of the narrative? Do you believe that his turning back toward the older ideal of treating the whole patient, body and soul, might be a harbinger of a general medical trend?
2. When Verghese arrives in Johnson City, he says, "I knew no openly gay men. I only knew the stereotype" [p. 23]. What changes does his attitude toward homosexual men undergo during his years at the Miracle Center? How does Verghese's initial perception of himself as an outsider in Johnson City make him especially sensitive to his patients' problems with their families and community?
3. Johnson City in the mid-eighties is "a place where Jerry Falwell's pronouncement that homosexuals would 'one day be utterly annihilated and there will be a celebration in heaven' was taken as a self-evident truth" [p. 56]. Yet when AIDS strikes people they love, many inhabitants of Johnson City prove remarkably supportive. How does their personal contact with the disease work to falsify the "gay" stereotype they previously held? Does Verghese, simultaneously, succeed in breaking stereotypes about "Falwell country" that readers themselves might hold? What other stereotypes does Verghese undermine in his story?
4. Verghese's story indicates that to feel part of a group is vitalto human survival and well-being. How do the various groups Verghese describes—the gay community, the TAP support group, the church, the medical fraternity, the expatriate Indian community—nourish and strengthen their members? Are they always nurturing, or do they also put up barriers between their members and the outside world? Is Verghese himself fully a member of, fully at home in, any of these groups?
5. How do the different members of Gordon's family react to his homosexuality and illness? How does each, in his or her different way, cope with Gordon's condition? In what way does Gordon typify the "generation of young men, raised to self-hatred" and their collective "voyage, the breakaway, the attempt to create places where they could live with pride" [pp. 402-403]?
6. "I heard different but strangely similar versions of this story from families of gay men: There was always the God-given talent that accompanied their God-given sexuality, always the special creativity and humor" [p. 92]. Verghese speculates on two possibilities: these qualities might be as biologically determined as sexuality, or they might be developed to compensate for the men's essential difference. What do you think of these ideas?
7. What is Verghese's reaction to Gordon's and Will's visions of Jesus? How does religion affect the way these patients deal with their disease? Does it help them to fight? Does it help them to come to terms with defeat? Does it ever hinder them from facing their problems truthfully?
8. Verghese comes to see AIDS "as the litmus test for nurses and physicians, a means of identifying who would and who wouldn't" [p. 105] provide treatment and, in so doing, risk their own health. Is there an excuse for the hostile attitude of nurses who don't want to treat AIDS patients? Should people who have committed themselves to careers as doctors or nurses be morally obligated to treat any and every patient? In Johnson City, just how deeply does the hospital staff's attitude towards AIDS change over the course of the four years Verghese describes?
9. When Ethan Nidiffer explains why he didn't alert his dentist to the fact that he was HIV-positive, Verghese admits that he "could certainly see his point of view" [p. 306]. What is your point of view on this issue? How much responsibility lies with the patient, and how much with the dentist? Should patients always be obliged to inform their doctors that they are HIV-positive, even if that means they may not find treatment?
10. How do Gordon, Fred, Ethan, and Raleigh differ in their visions of themselves as gay men and as part of a larger gay community? Can you see any parallels with Verghese and his own search for a community, a home?
11. Will and Bess Johnson see themselves as "innocent victims" of the disease—as opposed, by implication, to the gay men who also suffer from it. How might you explain Verghese's complex reaction to this notion? Do the Johnsons strike you as essentially more "innocent" than the gay men in the narrative? This issue relates to the way the cancer patients at the VA hospital are perceived as dying with honor, while so many HIV patients harbor feelings of shame. How are the concepts of honor and shame, innocence and guilt, addressed by the TAP members? By the Johnsons? By Rajani? By Verghese himself? Do these attitudes reflect those of the larger American culture?
12. Do you agree with Bess and Will's decision that secrecy about their HIV infection was vital? Why were they so overwhelmingly concerned with secrecy? What makes them able to draw comfort from their church even while assuming that their fellow church-goers would not stand by them in their illness? Do you blame Bess and Will for not speaking out and trying to help others who suffer from the disease, or do you think that they had every right to their privacy?
13. Because of his work, Verghese comes to believe that "our moments of true safety are rare." Is such a knowledge a handicap, or can it bring increased strength? How does the enormous change in Vickie McCray's life and character relate to this knowledge?
14. Do you believe that the situation Verghese describes in Johnson City accurately represents the situation for AIDS sufferers in the United States as a whole? If you have any experience with the disease, do you find that patients feel isolated, feel the need to keep their condition a secret? In your own community, does compassion outweigh prejudice? Are there adequate support resources for the HIV-positive? How do different members of the local and national government treat this volatile issue?
15. At the end of the book, Verghese states that AIDS work will always be his vocation. How does Verghese's powerful sense of mission and his unselfish giving of himself affect his family life? Is the sort of schedule he has undertaken necessarily incompatible with a full family life? How might a busy doctor's wife and children share in his professional life?
16. When Verghese arrives in Johnson City, he feels he has found a home, his "own country" [p. 46]. Does he still see it in this way at the end of the book? If so, why does he leave? How does the Malcolm Cowley poem placed at the beginning of the narrative apply to Verghese's personal quest?
(Questions issued by publisher.)
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