Unsteadily Marching on the U.S. South Motion

AAVV

• Publisher: Publicacions de la Universitat de València
• Year: 2017
• ISBN:
  9788491341482
• Edition: 1
• Topic: Languages & Linguistics
• Subtopic: Linguistics
• Index: Languages & Linguistics

This collection includes a rich variety of approaches to Southerners' complex understandings of change and developments reflected in the literature, history, and culture of this distinctive region. Contributors from both sides of the Atlantic address introspective journeys of literary pilgrimage, shed new light on the history of the civil rights movement as well as its reflection in literature, analyse transactions from literature to film, trace religious pilgrimages in both history and film, and follow a host of authors and literary figures on their journeys through the South or their forced or voluntary flight from it, in search of other places where they might find refuge or where they might sow the seeds of a new beginning.

VI

INROADS AND OUTROADS

Once Upon a Doctor’s Life:
Abraham Verghese’s Coming of Age
in East Tennessee in the Era of AIDS

Nahem Yousaf

In 2010 oncologist Siddhartha Mukherjee observed in his Pulitzer Prize-winning study of cancer that, “Medicine . . . begins with storytelling. Patients tell stories to describe illness; doctors tell stories to understand it” (390). Abraham Verghese has been telling medical stories for some two decades and his first book which recounts how he came to understand the medical and social effects of HIV-AIDS in the 1980s also chronicles how he came to terms with a new life in the U. S. South where he became the resident medical expert on whom a particular southern community came to depend and rely.

The immigrant figure who acclimatizes to a region defined so particularly in the cultural imagination as the U. S. South is receiving progressively more scholarly attention as a result of the emphasis on the global South in the New Southern Studies.¹ But some of the tales immigrants tell are more complicated than stories about lonely migration and painful acculturation to the South because of their context, as with the southern community battling the onset of AIDS as told by Verghese in his 1994 memoir My Own Country: A Doctor’s Story of a Town and Its People in the Age of AIDS. Set in Appalachia from 1985 to 1989, it details his experience as an Ethiopia-born Indian immigrant arriving in Johnson City, East Tennessee via India with experience only of Boston in the urban North. As the local hospital doctor, he is inculcated into a community-within-a-community living with HIV-AIDs as if on “a small island in a sea of fear.”² It traces how Verghese finds a homeplace in “another country,” the same beautiful setting at the foot of the Smoky Mountains close to the Appalachian Trail that many of his AIDS patients were quick to escape but to which they return to die. In Dr Verghese’s memoir the sense of belonging he achieves is learned in the tough context of the changing epidemiology of infectious disease medicine. He describes the pressure common to his particular “generation” of physicians who were “coming of age in the era of AIDS” (226). As HIV-AIDS becomes embedded in this community, Verghese’s response to the emergency creates a writer out of the doctor; initially entranced by the place and its people, he is later transfixed by the crisis that affects the patients in his care.

In My Own Country, the story of the ways in which HIV-AIDS travelled to the small-town and rural South is made more significant than Verghese’s own “perennial migrations” (427) from Ethiopia and India to the U. S. His sense of allegiance to the U. S. as the natural home for his family is at least as palpable as the traditional leitmotifs of the immigrant memoir—exile, alienation, acculturation and nostalgia—which are given an unexpected twist. Quickly and succinctly, the memoir details how welcome he feels in Appalachia, a region too often represented in popular culture as unwelcoming and isolated when it is much more diverse than such depictions suggest. Verghese lives in Johnson City where he is coached in what he calls the “Appalachian folk lexicon” or “talking country” and discovers he is “a quick study.” He loves southern foodways and celebrates the “incredible hospitality” he receives (21). He and his wife Rajani move easily between meals with other Indian families in East Tennessee and line dancing and blues clubs (23). He realizes immediately that watching television repeats of The Beverly Hillbillies in India was inadequate preparation for migration to the South (31) and soon discovers that a larger effect of the move is his facility for recognizing stereotypes, as when he decides that the typecasting of gay men is as “untrue as the stereotype of the southerner, the redneck” (23). Verghese sets himself against V. S. Naipaul’s description of southern “rednecks” in A Turn in the South (1990) to force his point home (41). He reads Appalachian history and explores local culture, including country music and squirrel hunting; his closest friend, gas station owner Allen, thinks of him as “a good ole boy” and Verghese thinks that is “the highest compliment” he could be paid by a local; he believes the house he rents on the campus of the Mountain Home VA Hospital, “a massive two-story, white colonial,” is an indubitably southern home. Throughout the memoir there are descriptions of the beauty of isolated valleys and mountains, as when he visits patients in Tester Hollow, Tennessee and in Wise County, Virginia and a cemetery at the centre of Powell Valley that is so beautiful that he imagines being buried there (153).

Nevertheless, Verghese finds that he must justify to his friends in the Northeast his decision to move South: “I found myself not talking about the natural beauty of the place, or its climate, or the mountains you could see in every direction, or the lakes, rivers and innumerable streams where you could fish. It was the people of east Tennessee and southwest Virginia that drew me” (41). He disarms a reader expecting that his immigrant status should be his proper, primary and, indeed, most appropriate subject matter, when he confides that he felt more of a “culture shock” moving between Boston and Tennessee than emigrating from India to Tennessee (31-2). When he dwells on his own foreignness it is to wonder whether it makes him a safer repository for his patients’ confidences when they fear their sexual proclivities could mark them out as aliens in the larger community. As their doctor, he wonders whether they feel safer confiding in “another whose face is not like their own—or whether they simply care less about a foreigner’s possible prejudices” (116-7).

In one of few critical readings of the book, Rajini Srikanth focuses on the ethnicity of the physician and his outsider status while acting as a “privileged insider” for AIDS patients. She does a good job of locating Verghese with and against other foreign doctors with whom he comes into contact in the memoir but expects Verghese to conform to certain expectations of a minority writer when she judges that, “He does not address sufficiently the privilege that being a doctor gives him over immigrants in other types of endeavors, motel ownership or grocery store retailing” and when she feels that he “could probably have done more” to complicate and “particularize” ethnicity and that he “glosses over” his Christian heritage and Biblical first name (Srikanth 439, 441, 444-45). While in her conclusions Srikanth acknowledges the creative expectations placed on Asian American writers in terms of pursuing racially and ethnically-identifiable themes and finds them regrettable, the critical yardsticks she erects in relation to this text by a South Asian writer take less account of the book’s subtitle, A Doctor’s Story of a Town and Its People in the Age of AIDS.

In my reading, Verghese’s story recalls Werner Sollors’s idea posited in the year that Verghese arrived in Tennessee that the traditional US settler-frontier story would be revised by new immigrants. Verghese intends to settle in Tennessee and to put down roots. He becomes a naturalized citizen during his first year in the region. “Johnson City was going to be my town,” he declares, “I felt at peace in this corner of east Tennessee. Finally, this was my own country” (46). His personal affinity with the region soon develops into a community sense of belonging but that feeling is dominated by professional anxiety once “our little town” (392) and “our little corner of rural America” (395) loses its pre-AIDS age of innocence. In this sense, he is susceptible initially to the myth of the small-town South as protected and, in particular, to the idea of an isolated Appalachia. However, by 1989 Verghese is forced to come to terms with the seemingly surreal situation that his new home in the South, Johnson City with a population of 50,000, is suffering a disproportionate number of cases of HIV-AIDS: some 100 cases in the tri-cities area of Johnson City, Bristol and Kingsport.

The story of the individual immigrant is burdened with the weight of collective representation, as if to know one immigrant’s story provides access to an ethnic group in a single horizontal movement. This assumption still underpins some of Srikanth’s expectations that Verghese should provide a larger and more connected picture of his place within an ethnic group. In my reading of My Own Country, Verghese’s epidemiological approach to unraveling “the plot” of HIV-AIDS succeeds in opening up a connection to many others whose stories are more compelling in that time and place than that of the ethnic outsider. Chronicling gay culture in Mississippi specifically, and the South more generally, John Howard closes his study in 1985 precisely because it was in that year when “queer lives and queer networks were irrevocably altered—as were, of course, all lives and cultures, though in different ways” (299). At his most beleaguered, and indeed in an uncharacteristically melodramatic aside, Verghese begins to feel like “a death camp inmate in this setting” (392), his own life changed forever by his encounter with AIDs.

He embarks on a pioneering demographic study that will chart the path of the epidemic and in this sense he may be read as a settler battling on an AIDS frontier. Such metaphors are not unusual in discussion of HIV-AIDS, of course, with Marita Sturken describing doctors tackling an immune system under attack by the syndrome as “a frontier site for exploration and conquest” (238). My Own Country may also be read as a precursor to sustained social histories of the impact of AIDs in the South, such as Stephen J. Inrig’s case study North Carolina and the Problem of AIDS (2011). Such studies have taken a long time to catch up with Verghese’s. He published his first short story about AIDS in 1991, his memoir in 1994, and the film adaptation of the memoir was released in 1998. Only since 2005 when it became apparent that half of the national deaths from AIDS occurred in the region, and as federal and private funds to support its treatment dried up, would reports including “Southern States Manifesto” on HIV-AIDS, released in 2002 and updated in 2008, analyze why the disease should take a disproportionate toll on the U.S. South and precisely in the kinds of rural areas that Verghese described, with 65% of all AIDS cases among rural populations occurring in the South by 2008.³

In order to tackle the problem of an infectious disease with no cure in sight in the 1980s, Verghese has to begin to understand the enemy, a virus that migrates to the South and multiplies there. He turns to the map his eldest son has tacked to his bedroom wall because he is fascinated by geography and particularly those places that resonate for him personally: “He knew India, Ethiopia, Boston, Tennessee, all the places that were significant in his life or that of his parents” (393). Similarly, the cartography that Verghese plots is intensely personal to his patients, underpinned by an idea that acts as a leitmotif throughout the book: that geography is destiny.⁴ When he first muses on the map in his son’s bedroom it is to wonder, “Was there some place in this country where I could walk around anonymously, where I could blend in completely with a community, be undistinguished by appearance, accent or speech?” (309). But slowly this feeling shifts as he realizes that when he feels alienated it is less the result of his ethnicity or foreignness and more because of his work with HIV-AIDS:

“[H]ow alienated I felt from other physicians, from friends, and even from my wife. By God, if what I was doing was noble, why did it feel like something… something shameful?

….

I seemed to be living in a separate world which those who have not been touched by the disease could not enter. I felt alone at my own table, alone and unclean… (168)

When Verghese returns to the map, it is not wistfully in search of utopia but as a responsible physician whose own emotional vulnerability recedes in the face of the larger problem to solve, the problem that he would describe again with hindsight in 2011 as a “mystery” to explain and communicate (Rees). He plots the places where his patients live and then creates a larger map of “acquisition” by returning to the journal in which he has been recording “the stories behind the medical facts” (393), life stories as told to him by his gay patients that include enjoying a loving childhood in the region until a sense of being different leads them to follow the Appalachian Regional Highways out of the region to those cities where they can identify with a wider gay culture. They stay in the Castro area of San Francisco, or in New York City, or in Atlanta, until a partner dies or they become ill and then they return home along the same highways and byways to families who will care for them as in childhood. Like a cultural geographer, Verghese creates a map of what he calls “the circuitous voyage of migration and return” (400). This terminal migration within the domestic U.S. is traced according to a North–South axis, or from West to East, with the disease imported from city to country.

Verghese uses medical geography to solve the mystery of why the region should suffer disproportionately from HIV-AIDS. As an epidemiologist he has been trained to map an outbreak by person, place and time but, by extension, his chart also acts as a chronicle of his own memories. The hospital registrations and deaths of his patients are his temporal markers in coming to terms with this disease in this time and place. So, for example, when one patient dies he feels that

my life changed. Not in its circumstances but in its shades and colors. Now it seemed as if everything I witnessed was imbued with this sense of loss. I was a doctor, a scientist, trained in professional detachment, but all the usual postures seemed satirical in the face of AIDS. I felt these deaths. I was filled with a longing for home (whatever I conceived that to be) so strong that I sometimes wondered if I myself was dying and this feeling was foreboding, the bittersweet messenger. (229)

Even in a memoir whose confiding tone is everywhere, this opening to a short and intensely meditative Chapter 14, situated at the midpoint of the book, is striking for its momentary emphasis on mourning because mourning is not a determining metaphor in My Own Country. Verghese understands mourning as a solitary experience and therefore not fitting to dwell upon in a book conceived, as its subtitle states, as the story of a place and its people. In “Mourning and Melancholia” (1917), Freud described mourning as leaving no time or space for other pursuits and Verghese seems to think similarly; little time is spent mourning in this book even though it contains so many deaths. Rather, Verghese finds his métier caring for those suffering from HIV or AIDS. Even when he leaves the region to study to be a writer at the Iowa Writers’ Workshop it is because he feels he must leave or risk losing that purpose. Verghese burns out after having been hands-on and on-call for five years. He finds he is losing sight of his wife and children who do not need his help but rather his time. He risks losing the necessary sense of distance and detachment from his patients as the result of the intensely personal web of connections he has made; he feels one patient is “like a sister,” to another he feels like a helpless son, and many others are described as his brothers or, indeed, avatars.

Chapter 14 also stands out because it is addressed directly to the reader in an effort to balance what Verghese describes as “my intense need for home and community” with the sense of ambivalence that may derive initially from his immigrant peripatetic experience but that, in the pressurized timeframe of the memoir, derives more intensely from his inability to stem the tide of cruel deaths breaking over the small-town South (231). Without forcing the analogy, he compares his feelings of difference and marginalization with the experiences of those of his patients who are gay:

I cannot tell you whether Johnson City had truly made a place for me, a brown-skinned man, among its own or whether I, like some of my patients, was forever outside its real heart. I can only say that in these strange times when it seemed death was everywhere, I thought of this place as a kind of safe haven, and when I dreamed of falling, as I often did, there were gentle hands waiting to break my fall. (231)

My Own Country is framed by the image of a Tennessee country road with the framing device an analogue of context. In the opening scene, a “young man” presented as the region’s “sentinel patient” (394) drives home through a landscape that Verghese has since come to know. The young man is shaking and shivering with a fever that is the prologue to the discovery made in Johnson City’s Medical Center that he is dying of AIDS. The final scene closes the five-year window Verghese has held open on the disease and through which he chronicles its taking hold in southern places. On New Year’s Eve 1989, he drives his family out of Tennessee and away from the place in which he has felt most intimately connected to others. That connection is underlined by the conflation of the dying young man driving home to “his own country” (6) with the immigrant doctor so suffused with nostalgia for his newfound homeplace that even before he reaches Iowa, he is struck viscerally by the feeling of leaving behind “my own country, my beloved Tennessee” (427). In this memoir the road is a literary chronotope, “the primary means for materializing time in space … proving the ground essential for the showing forth, the representability of events” in the...