Abraham Verghese has written a novel set in Ethiopia called Cutting for Stone with a focus on medical conditions in Addis Ababa that I liked very much. My Own Country was written earlier, in the mid-90s and is Verghese's account of his time as a doctor in Johnson City, Tennessee in the mid to late 80s, just as victims of AIDS were turning up in the rural area. First I should say what fun it is to read about an area that I know pretty well, having lived in Knoxville in the 60s and having married a man from Upper East Tennessee, a term odd only to those who have not lived there.
Verghese's parents left Kerala, India for Ethiopia before he was born; he was in medical school in Addis Ababa when upheaval came and he finished school in India. He moved to the U.S. for a residency in Johnson City, and did a fellowship in Boston before returning to work in East Tennessee.
During his fellowship in Boston, he worked with AIDS patients, so when they began to appear in East Tennessee after his arrival there, he was already knowledgable about the disease. There he worked as a part of a team who saw these patients; in Tennessee he became their primary doctor. In this book he describes these patients: their personal lives, their symptoms, the treatment and the trajectory of the disease. Thus we come to know intimate details of Vickie whose husband slept with her sister as well as men she did not know, two men who had been lovers since childhood who traveled to truck stops together for an evening of anonymous encounters, a pillar of a community in Kentucky who received tainted blood from Duke and then infected his wife, and many more. Verghese was apparently tireless in giving them time for treatment and drawing out their stories.
One theme is the fear among the medical community and the community at large to have any contact with the sick. Even the couple infected by tainted blood kept their illness a secret from everyone including their grown children. Verghese was able to relate to their feelings of alienation, given that all his life he lived as a foreigner.
Although it seems churlish to have a reservation about such a wrenching account by a devoted caretaker, I was put off a time or two. One evening he describes begins with the reference to a late summer evening and later in the evening refers to dogwood trees in bloom. Need I mention that dogwoods bloom very early in spring? And I was put off by his characterizations of East Tennesseans in broad terms early in the book.
More than once he makes references to the unfortunate system for payment of doctors in this country; payment "by the procedure" influences medical students to go into the lucrative fields of medicine and encourages unnecessary procedures. Infectious disease doctors have few "procedures" and thus are at the bottom of the heap.
I am so glad my friend Sue in Sweden who also lived in East Tennessee in the 60s described this book as one of her favorites. It was engrossing and very touching.
Abraham Verghese, My Own Country: A Doctor's Story, Vintage Books, 432 pages.