Foreign Medical Graduate

From Verghese, My Own Country

"I had once tried to reach Dr. Patel, a cardiologist, to see a tough old lady in the E.R. whose heart failure was not yielding to my diuretics and cardiotonics. I called his house and his wife told me he was at 'Urology Patel's' house, and when I called there I learned he and 'Pulmonary Patel' had gone to 'Gastroenterology Patel's' house. Gastroenterology Patel's teen-age daughter, a first-generation Indian-American, told me in a perfect Appalachian accent that she 'reckoned they're over at the Mehtas' playing rummy,' which they were."

An Indian traveling salesman explains how to find a place to eat in a strange town: Count the number of Patels in the phone book and multiply by 60. "That will tell you size of Indian community. . . . Take my word: less than 10 Patels means no Indian restaurant. If more than 10, you call, say you are from India, ask them where to go to eat."

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As Dr. Verghese traces the spread of the [HIV] infection, he also examines its effects on his own attitudes, and on his relationships with his patients. He identifies the less-than-lofty, self-congratulatory "front-rank soldier" pride of doctors who treated AIDS patients in the early days of the epidemic, before the mechanisms of transmission were better understood. As he considers his patients in Tennessee and their willingness to confide in him, he wonders how much it has to do with their relief at finding a doctor who is a foreigner, an outsider. "To come to a doctor's office, even a distant doctor's office, and tell their sexual secrets to a Caucasian face that could just as well have belonged to a preacher, a judge or some other archetypal authority figure in their town, might have been difficult." He is also direct and straightforward about the toll that his involvement with his patients takes on his wife and young children -- and ultimately on him as well, as the patients, one by one, begin to die, as he dreams repeatedly of his own infection and death.

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The story of all these people -- brothers and sisters, parents and children, doctors and patients -- is the story of a small city whose departed sons begin returning, one by one, sick with an infection that even the medical professionals of Johnson City had assumed would never hit close to home. Thus the doctor who sought security and a better life in the American South finds himself treating some of the sons of that South who had fled, searching for safety, acceptance and a fuller, freer life.

It was, as Dr. Verghese ultimately chronicled it for a medical journal, "the story of how a generation of young men, raised to self-hatred, had risen above the definitions that their society and upbringings had used to define them. It was the story of the hard and sometimes lonely journeys they took far from home into a world more complicated than they imagined and far more dangerous than anyone could have known."