My Own Country: A Doctor's Story Paperback – April 25, 1995

Abraham Verghese is a physician, a specialist in internal medicine and infectious diseases. His medical training was in Ethiopia and India. He came to the United States as an FMG (foreign medical graduate). After finishing his residency and a fellowship, he settled in Johnson City, Tennessee in 1985. Because of his work in Boston, he was the most knowledgeable doctor in the Johnson City area about AIDS, but AIDS was not yet present when he arrived. Four years later, when he left Johnson City, there had been dozens of deaths from AIDS and he had over eighty HIV-infected persons under his care. Johnson City, with its 50,000 residents, had a hundred-fold more cases than the CDC would have predicted for it. MY OWN COUNTRY is Verghese's account of his four years in Johnson City, Tennessee, fighting an ever-mushrooming battle with AIDS and coming to love a corner of Appalachia.Two subjects predominate. One, of course, is AIDS. The book is studded with case studies, as Verghese sees a wide array of the insidious ways in which AIDS manifests itself and kills. Most of his patients had obtained HIV elsewhere and had moved back to the Johnson City area once they became ill. Acquisition for most was via unprotected homosexual contact, but for a few it was through tainted blood or plasma or via heterosexual intercourse. The disease was hellish in and of itself, but often the social ripple effects were also dreadful -- from contempt and rejection on the part of family members and community, to refusals to treat by doctors and dentists, to boycotting by undertakers. As Verghese writes, "I was improvising constantly to deal with the moral, ethical and social subtleties that were so much a part of this disease."The second principal subject involves medical practice in general in this country. When Verghese chose to specialize in infectious diseases, he relegated himself to second-tier status among his physician colleagues, especially financially. Medicine was transforming itself into a get-rich business, and the big money was in conducting processes and performing procedures, as opposed to diagnosing patients and being their primary care physician. As Verghese came to realize, proper treatment often required a holistic approach, which in turn required an understanding of the dynamics of the patient's relationships with family, friends, and community. In the thirty years since, the economics of medicine has gotten more out-of-control, and the quality of medical care has decreased. Even in 1985, many of the doctors and medical staff in rural hospitals and in urban public hospitals were foreign-trained, working in the U.S. with visas. If the U.S. continues to insulate itself from the world at large, how will these roles be filled in the future?Verghese, however, does not harp on these and other social/medical policy issues or become preachy. Foremost, MY OWN COUNTRY contains umpteen different tales of human suffering and endurance, surprisingly often heroic and dignified in nature. For every incident of contempt and rejection, there is one of care and compassion. Two heroes in particular stand out -- Essie Vines, who cared and advocated for her brother Gordon, and Fred Goodson, who did likewise for his partner Otis Jackson and also was the principal organizer and force behind the local AIDS-support group. Anecdotally, there are a handful of intriguing "human interest" stories, such as "John Doe", a debilitated old man with a stroke, diabetes and pneumonia who had been left at the emergency room entrance while the family went to "park the car" and were never seen again; or Vickie McCray, who got HIV from her husband, who unbeknownst to her often had had sex with a male friend from his youth and then went on to give the virus to Vickie's sister as well (Vickie told Verghese that "ever since I found out he has AIDS, I've been feeling too sorry for him to be angry with him. No one deserves to be sick lik'at. No one deserves to lose their mind lik'at.").MY OWN COUNTRY is not a perfect book. At times, Verghese goes too far down rabbit trails of marginal relevancy (especially when he describes geography and the routes from one place to another); the book is a tad manipulative; occasionally Verghese, although a truly remarkable person, comes across as a little holier-than-thou; and the sentimental reference to "my own country" seems a wee bit hypocritical given that Verghese left the Johnson City area after four years, never to live there again.That said, and even though the book now is over twenty years old, MY OWN COUNTRY deserves to be read. It is interesting throughout, it is very readable, and reading it will surely broaden almost everyone's horizons of humanity.

Stories about HIV and AIDS fascinate me. They speak of our common humanity and our tragically all-too-common inhumanity towards each other. In fear, so many in power sought to sweep this disease and its victims under the rug, yet it pervaded to impact human life in almost every sphere. When AZT first showed promise and HAART later showed effectiveness, many breathed sighs of collective relief. Today, we live in an era of PEPFAR, where the US financially supports AIDS relief for Africa, and PrEP treatment, where prophylactic monthly shots can prevent the spread of HIV. The battle continues, but early casualties, as infectious disease physician Abraham Verghese reminds us, need their legacies to be preserved. They must tell us of their suffering and of our own physical and moral frailty. HIV is a deeply human disease.This book is deeply moving and provocative. Verghese is honest with his own shortcomings and with his emotional attachment to those impacted by this disease. He tells stories of his patients and of his close involvement in their lives. This book contains both a personal memoir and short biographies of the patients that led him to devote his career to managing this disease. The story entices readers from the first page and eloquently leads them to its conclusion.In the late 1980s, the era discussed in this book, no one knew how to handle AIDS, especially in rural settings. President Reagan was so frightened by the disease that he didn’t mention the word until 1987. This silence prevented Americans from processing their fears together. Only isolated situations, like that of Verghese’s patients when they formed a social group around the disease, provided hope and support. Big American cities, especially on the oceans, represented the sites of the most transmission and assistance, but Verghese illustrates that AIDS impacted even small towns like Johnson City. The viewpoint of small-town America in the late 1980s provides this book’s unique visage.This book’s topic drew me in because I volunteer around HIV vaccine efforts in Tennessee. I was curious about how the disease evolved in my state of residence. My Own Country was a best-seller in its day, and I hope that it won’t become lost to history. It tells of a common public health history that cannot be forgotten. Certainly, students at East Tennessee State University can continue to study public health impacts of disease, and Verghese’s local account can inform about their local history. In a time when a urban-rural divide haunts our politics, this book reminds us that our lives in America – our fears and our fates – are intertwined more than we might suspect.

After reading "Cutting for Stone", I wanted to know more about this author and this book is an autobiography. I like his writing style and found the book quite interesting, since I lived in Appalachia many years ago. He talks of medical school and beginning his practice as well as the lives of the people living in the hills of Tennessee and south western Virginia. No one expected AIDS to get to that isolated place, yet there it was.This book was hard to put down as it carries you into his young life, family, and community.