Book Review

My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS

N Engl J Med 1994; 331:1100October 20, 1994

Article

My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS
By Abraham Verghese. Approximately 347 pp. New York, Simon and Schuster, 1994. $23. ISBN: 0-671-78514-1

In late 1985, Dr. Abraham Verghese, freshly licensed infectious-disease specialist, arrived in Johnson City, Tennessee, to begin his practice. The number of AIDS cases was beginning to rise in the urban centers of the East and West Coasts. Dr. Verghese's decision to leave Boston and return to rural Tennessee, the site of his residency, meant leaving this new and troubling epidemic behind. Or so he thought.

A few months before Dr. Verghese's arrival in Johnson City, a young man who had left Tennessee years earlier for New York City arrived in the emergency room of the Johnson City Medical Center in extremis. He was successfully resuscitated but died three weeks later, after a bronchoscopy had confirmed the unthinkable: Pneumocystis carinii pneumonia. The patient had AIDS. When Dr. Verghese landed in Johnson City, hospital staff were still debating what to do with the young man's respirator. There were more than a few votes for burial or incineration.

The simultaneous arrival of the young physician and the dread inner-city disease of gay men and drug users in the backwoods of the American South forms the story of My Own Country. This is rural America in the age of AIDS, and through the author's eyes we see a region reluctantly come of age in the face of a changing reality. Even as the author's practice grows from 1 to a dozen to 80 patients with AIDS, the townspeople go about their business, shopping at the Piggly Wiggly and drinking in the local taverns, utterly unconscious of the possibility that the person next to them might be infected with the human immunodeficiency virus (HIV). The town's oblivion simply heightened Dr. Verghese's concern about the expanding epidemic. He writes:

I saw AIDS everywhere in the fabric of the town; I wanted to pick up a megaphone as I stood in a checkout line, say, ”ATTENTION K-MART SHOPPERS: JOHNSON CITY IS A PART OF AMERICA AND, YES, WE DO HAVE AIDS HERE.”

The book begins breathlessly, with the author's staccato description of the emergency room resuscitation of Johnson City's first patient with AIDS. But the reader expecting a high-speed chase will be disappointed. Instead, we are taken on a leisurely stroll down a shaded country lane, the bright glare of the AIDS epidemic at times illuminating and at times casting new shadows on the people and culture of the rural South. Most of the characters we meet -- from the gay men with AIDS returning to their families to die after years away, to the man with hemophilia who tenaciously battled his joint deformities only to lose the battle against HIV, to the devoutly religious company president and his wife who kept the fact of their HIV infection from town, company, and family for years -- are described with considerable sympathy and poignancy. Some of the themes, such as the strain Dr. Verghese's devotion to his patients puts on his marriage, are tantalizing but incompletely explored. Other details -- differences in pay between surgeons and internists, arranged marriages in Indian culture, nuances of the physical examination -- are disconnected ruminations that fail to enlighten the reader. Brisker editing would have helped.

Dr. Verghese has a keen ear for dialogue and writes in clear, uncluttered prose. From time to time the writing is even inspired, as when he describes how he might have used large doses of morphine to hasten the death of a suffering patient:

Morphine disconnects the head from the body, makes the isthmus of a neck vanish, diminishes the awareness of suffering. It is like a magic trick: the head on the pillow, at peace, while the chest toils away.

The book is one of the first to describe the experience of the care giver in the age of AIDS. Despite its flaws, it captures the maelstrom of excitement, fatigue, tragedy, and ultimate gratification that AIDS care givers feel. Dr. Verghese is a man who gives much of himself -- driving miles to visit a patient's family “to get a clearer picture of this strange man,” scrubbing to watch the surgery on one of his patients, helping form a local support network when he perceived one was needed. That he finishes his five-year sojourn in Johnson City with his basic decency and optimism intact is a tribute to his strength of character. That the tale ends with Dr. Verghese packing up with his family to move to Iowa, emotionally and physically drained, his marriage at risk, is poignant evidence that the AIDS epidemic has claimed more victims than simply the patients.

Robert M. Wachter, M.D.
University of California, San Francisco, San Francisco, CA 94143