Ray pointed out that he had had no time to get a history: perhaps they could give him some information. Had their son been healthy in the past year and in the days preceding the trip? Lord, yes! (The father did all the answering.) Did he ever use intravenous drugs? Lord, no! And to their knowledge had he ever had a blood transfusion?
No.
Was he married?
No.
Did he live alone? No, he had a friend in New York.
A male friend? Yes . . . they had never met him.
“Oh Lord! Is that what you’re saying? Is that how he got it? Is my son a queer?”
Ray just stood there, unable to respond to the father’s words.
The father turned to his wife and said, “Mother, do you hear this? Do you hear this?”
She gazed at the floor, nodding slowly, confirming finally what she had always known.
THE MOTHER NEVER LEFT THE ICU or her son’s side. And in a day or so, the father also rallied around his son, spending long hours with him, holding his hand, talking to him. Behind the glass one could watch as the father bent over his son, his lips moving soundlessly.
He balked when his son’s buddies flew down from New York. He was angry, on the verge of a violent outburst. This was all too much. This nightmare, these city boys, this new world that had suddenly engulfed his family.
Ray tried to mediate. But only when it seemed his boy’s death was inevitable did the father relent and allow the New Yorkers near him. He guarded the space around his son, marshaling his protection.
The two visitors were men with closely cut hair. One had a pierced ear, purple suede boots, tight jeans and what the ICU ward clerk, Jennie, described to me as a “New York attitude—know what I mean?”
Jennie said the other friend, clearly the patient’s lover, was dressed more conservatively and was in his early forties. She thought he was “a computer person.” She remembers the tears that trickled continuously down his cheeks and the handkerchief squeezed in his hand. Jennie thought the mother wanted to talk to her son’s lover. He, in turn, needed badly to talk to anyone. But in the presence of the father there was no chance for them to speak.
Three weeks after his arrival, the young man died.
The New Yorkers left before the funeral.
The respirator was unhooked and rolled back to the respiratory therapy department. A heated debate ensued as to what to do with it. There were, of course, published and simple recommendations for disinfecting it. But that was not the point. The machine that had sustained the young man had come to symbolize AIDS in Johnson City.
Some favored burying the respirator, deep-sixing it in the swampy land at the back of the hospital. Others were for incinerating it. As a compromise, the machine was opened up, its innards gutted and most replaceable parts changed. It was then gas disinfected several times. Even so, it was a long time before it was put back into circulation.
ABOUT TWO MONTHS AFTER the young man died, I returned to Johnson City. I had previously worked there as an intern and resident in internal medicine and I was now coming back after completing my training in infectious diseases in Boston. People who knew me from my residency days stopped me and told me the sad story of this young man’s homecoming.
But it was not always recounted as a sad story. “Did you hear what happened to Ray?” a doctor asked me. He proceeded to tell me how a young man had dropped into the emergency room looking like he had pneumonia but turning out to be “a homo from New York with AIDS.” The humor resided in what had happened to the unsuspecting Ray, the pie-in-your-face nature of the patient’s diagnosis.
Some of the veteran ICU nurses, perhaps because this case broke through their I’ve-seen-it-all-and-more-honey attitudes, astonished me with their indignation. In their opinion, this “homo-sex-shual” with AIDS clearly had no right to expect to be taken care of in our state-of-the-art, computerized ICU.
When I heard the story, the shock waves in the hospital had already subsided. Everyone thought it had been a freak accident, a one-time thing in Johnson City. This was a small town in the country, a town of clean-living, good country people. AIDS was clearly a big city problem. It was something that happened in other kinds of lives.
2
I HAD ARRIVED in America as a rookie doctor in 1980.
At about the same time, HIV, the virus that causes AIDS, landed in the port cities of the United States: New York, San Francisco and Los Angeles. The virus arrived from Africa (perhaps via Haiti) carried in the bloodstream of one or more unsuspecting people who had then passed it on by sharing needles or through sexual intercourse. Like recipients of a biological chain letter, the numbers of carriers mushroomed. Quickly, but without commotion, the virus took root in the immune system of thousands of urban individuals.
It was not in its nature to kill at once. Instead, in the first months of infection, the virus quietly undermined the immune system, latching on to and then destroying the CD4 lymphocyte, the conductor of the immune orchestra. Months and often years would pass before bizarre, fulminant infections by other microorganisms—like Pneumocystis carinii—revealed the extent to which the immune orchestra had been decimated.
I FIRST CAME TO America from Africa in 1973. War and political unrest had interrupted my medical education in Ethiopia, the land where I was born and where my parents had worked for thirty-five years as expatriate teachers. After a hiatus spent working as an orderly in a succession of hospitals and nursing homes in New Jersey during my first period of American citizenship, I had eventually completed medical school in India and by 1980 had passed all the necessary exams to come back to the United States as a doctor. I considered myself lucky.
My father and mother were born in Kerala, in the south of India, to Christian families that trace their religion back to the apostle Thomas. After Christ’s death, “Doubting” Thomas traveled east and arrived on the Malabar coast of India. There, long before St. Peter arrived in Rome, long before Christianity had taken any sort of hold outside of Palestine, “Mar Thoma” converted the south Indian Brahmins he encountered to Christianity. They named their children with Christian names. My surname, Verghese, has the same derivation as Geórgios or George.
The Christianity of my parents was a rigorous and demanding rite with daily prayer, fasting, and church services that became all-day marathons on Good Friday or Christmas.
When my father, George Verghese, graduated from Wilson College in India with a master’s degree in physics, he wrote to the Ethiopian Education Ministry inquiring about teaching positions. “I had heard from someone—a relative or friend, I forget—that teachers were being recruited to Ethiopia.” In reply he received a letter of appointment; he was to cable his acceptance and prepare to leave within ten days.
Meanwhile, unbeknownst to him, his future bride, Miriam Abraham, had received a letter of appointment to teach in a girls’ school in Addis Ababa, the capital city of Ethiopia. She was also a recent physics graduate.
She says: “I wanted to go, but your grandfather had grave misgivings. A single woman going to Africa to work! Just imagine! He consulted lots of people. Finally he wrote to Thomas Uncle who was in Nairobi for many years running a tire-retreading business. He asked him about the wisdom of sending an unmarried girl to Ethiopia. Now see how God works: Thomas Uncle wrote back promptly: not only was Addis Ababa a safe place and the job offer good, but he even knew a family—Terese Auntie’s family as it turns out—who had moved to Ethiopia from Kenya. Not only that, but he had already written to them about my situation. Soon a letter came from Terese Auntie saying I could stay with them and my father need not worry. All was arranged.”
The letter from Terese Auntie went on to say, to my grandfather’s satisfaction, that Ethiopia was an ancient Christian country with a Coptic Orthodox faith and a tradition very much like his own.
My mother and father arrived in Addis Ababa a week apart. They were among four hundred other Indian teachers—most of them Christians from Kerala—who would spread
out over Ethiopia and teach math, physics, biology or English in the newly built high schools in Ethiopia. Why were all these teachers recruited from one state in India? Emperor Haile Selassie of Ethiopia, shortly after his country was liberated from Mussolini’s hold, went on a state visit to India. He traveled to the south of India to see the churches of St. Thomas. He had seen in the early morning, as you can still see today, legions of schoolboys and schoolgirls in uniform making their way to classes. Kerala was then and still is the state with the highest literacy rate in India. This sight had impressed the emperor so much that he had decided to hire teachers from this Christian state to man the new schools he was starting across his country.
On the matter of how my parents met, how they courted, I dare not ask my father. And my mother, though seemingly willing, parts with no significant details. My brothers and I always thought it had something to do with physics.
When my parents tell me the story of their arrival in Ethiopia—the tough times in India, the struggle to get a college education, the word of mouth from friends about jobs overseas, the letters of inquiry to “relatives” abroad, the establishment of a base, the accumulation of a nest egg, the consolidation of resources by marriage, the help and support extended to their younger cousins and more distant “relatives” who wrote asking for advice—I understand the migration of Indians to South Africa, Uganda, Kenya, Tanzania, Mozambique, Mauritius, Aden, Ethiopia. And the next wave on to Birmingham, Bradford, Bristol, London and Toronto. And to Flushing, Jersey City, Chicago, San Jose, Houston and even Johnson City, Tennessee.
In their herald migration, my parents individually and then together reenacted the peregrination of an entire race. Like ontogeny repeating phylogeny—the gills and one-chamber heart of a human fetus in the first trimester reenacting man’s evolution from amphibians—they presaged their own subsequent wanderings and those of their children.
DURING THE HIATUS IN my medical education, while I worked as an orderly in America and before I went to India to finish medical school, I had seen from the vantage of a hospital worker the signs of urban rot in Newark, Elizabeth, Jersey City, Trenton and New York. The (insured) middle class continued to flee farther out to the suburbs where chic, glass-fronted hospitals complete with birthing suites and nouvelle cuisine popped up on the freeway like Scandinavian furniture franchises.
Meanwhile, the once grand county hospitals were sliding inexorably, like the cities themselves, into critical states. Understaffing, underfunding, the old stories. Their patients had become the uninsured and indigent whose problems revolved around drug addiction and trauma. In the emergency rooms of these fading institutions, bodies were pressed together like so many sheep. Old people languished on stretchers shunted into hallways and corridors while beleaguered nurses attempted some form of triage.
An inevitable accompaniment to this scene of a city hospital under siege was the sight of foreign physicians. The names of these doctors—names like Srivastava, Patel, Khan, Iqbal, Hussein, Venkateswara, Menon—bore no resemblance to those of the patients being served or the physicians who supervised them.
City and county hospitals were the traditional postgraduate training grounds for foreign medical graduates: hospitals like Cook County Hospital in Chicago, Nassau County and Kings County in New York and dozens of others across the country counted on foreign interns and residents for manpower, particularly in internal medicine.
By the time I completed medical school in India and returned stateside, a few of my seniors from my medical school in India had begun internships at county hospitals across America. Through them and through their friends and their friends’ friends, an employment network extended across the country. With a few phone calls, I could establish for any city which hospital to apply to, which hospital to not bother with because they never took foreign graduates, and which hospital took foreign graduates for the first year, used them for scut work, but never promoted them to the second year—the infamous “pyramid” residencies. And the network invariably provided me with the name of someone to stay with.
At hospitals that took foreign physicians the work was grueling, the conditions appalling—but only by American standards—and the supervision and teaching often minimal because of the sheer volume of work. This was particularly true in hospitals that were not university-affiliated. The scut work—wheeling the patient down to x-ray, drawing blood, starting intravenous drips, putting in Foley catheters, doing ECGs—was endless and the every-other-night-call schedule was brutal.
As I crisscrossed the country, in search of a residency slot, by way of Greyhound, sleeping on friends’ couches (or on their beds if they were on call), I was amazed by the number and variety of foreign interns and residents I met in these hospitals. I overheard snatches of Urdu, Tagalog, Hindi, Tamil, Spanish, Portuguese, Farsi and Arabic. Some hospitals were largely Indian in flavor, others largely Filipino. Still others were predominantly Latin or East European.
In the cafeteria of a hospital in a less-desirable section of Los Angeles, a hospital at which I was interviewing, I took my tray over to a table where an Indian physician sat. She had the handsome Aryan features of a Parsi or a Kashmiri. I thought she might be from Bombay or Chandigarh or Delhi—the other end of the country from where my parents were born. But when she spoke I was bowled over: from her lips emerged the purest Birmingham cockney! (I recognized this accent easily: as a ten-year-old I had spent a year in Birmingham while my father was there on sabbatical.)
She told me her family had fled Uganda and settled in Britain when she was a young girl. She had never seen India, neither had her parents. Her family had been in Uganda for two generations. She had gone to medical school in Leeds and then come to the States. When I told her I was born in Ethiopia, she tried her Swahili on me and I my Amharic on her. Neither of us got very far with that and so we retreated to English.
The England she reminisced about was vastly different from my memory of it. The Asians, she said, now had pubs of their own in Asian strongholds like Wembley and Southall. These hybrid establishments served tandoori chicken, pakodas and samoosas to be washed down with pints of the finest British bitter. And the music and dance were likely to be “bhangara-disco”—an electronic rendering of Punjabi and Gujarati folk music. The youth, most of whom, like her, had never been to India, had taken up the music of Lata Mangeshkar, Mukesh or Mohammed Rafi—old playback singers for Hindi movies.
Before she left to return to the wards, she paged a fellow intern, a Zachariah Mathen. From his name I knew he was a Christian-Indian like me. Zachariah took me around the hospital and as a matter of course offered me his apartment and car keys. “Make my home your home! Explore the City of Angels,” he said.
SOME HOSPITALS, like Coney Island Hospital in New York, sent contracts to graduating medical students in India who had been recommended by their seniors. Come July, the seniors were dispatched to Kennedy to pick up the new blood fresh off Air-India, bring them to Coney Island and orient them. The cultural adjustment was simple: the reassuring scents of green chili and frying papads wafted down the corridor of the house-staff quarters. Indian sari stores, Indian restaurants and Indian grocery stores abounded—some even delivered. The latest Hindi blockbuster starring Amitabh or Dimple could be rented in Queens on bootleg video within days of its debut in Delhi or Poona. And the faces of the physicians on the wards were those that one might have seen on the platform in Victoria Station, Bombay.
The few American interns and residents I saw in the various hospitals I visited were graduates of the “offshore” or Caribbean schools in places like Antigua, St. Lucia, Montserrat or Grenada. These schools existed solely for Americans who could not make it into U.S. medical schools.
NOW THAT I HAD RETURNED to America with my medical degree, a certain perverseness and contrariness made me want to buck this system. What was the point in coming to America to train if I wound up in a little Bombay or a little Manila? In India I had met Rajani Chacko, a lovely, sloe-eyed accou
nt executive working for a leading advertising agency. After a whirlwind courtship, we were now newlyweds. I was loath to bring her to an urban war zone, to an apartment where she would have to be alone for long periods of time while I worked as an intern.
Through a relative who was on the faculty, I heard of a new medical school: East Tennessee State University. It had started a residency program in internal medicine. As residents we would rotate through the Mountain Home Veterans Administration Medical Center (the “VA”)—a veritable town within the town of Johnson City—as well as the adjacent Johnson City Medical Center (the “Miracle Center”), a community hospital. This rural setting in the foothills of the Smoky Mountains, in the shadow of the Appalachian Trail, seemed a beautiful place to bring my bride.
DURING MY INTERNSHIP AND residency in Johnson City, I moonlighted on free weekends in small emergency rooms (ERs) on the Tennessee-Virginia border. I pulled sixty-hour shifts—Friday evening to Monday morning—in places like Mountain City, Tazewell, Grundy, Norton, Pound, Lebanon and the Lonesome Pine Hospital in Big Stone Gap, Virginia. These hospitals had anywhere from twenty to forty beds, two-bed intensive care units, and the ambience of a mom-and-pop grocery store.
The ER nurses were on a first-name basis with every patient that came in. The ambulance drivers rarely resorted to the “forty-three-year-old-white-male-with-chest-pain-unrelieved-by-nitroglycerin” jargon. One was more apt to hear on the scanner that “Louise Tipton over on Choctaw Hollow says Old Freddy’s smothering something awful and we better get over there right away, cause it’s worse than the last time when he came in and Doc Patel put him on the breathing machine.”
If I was lucky, no more than eighteen to thirty patients came through the ER in twenty-four hours. The drive up through the mountains was breathtaking, the staff exceptionally friendly, and the cafeteria food free and plentiful.