Do It and Die

Richard Horton

  • Soundings by Abraham Verghese
    Phoenix, 347 pp, £18.99, May 1994, ISBN 1 897580 26 6

Evening, 10 May 1987. Thousands of American fingers flick their television remotes to Old Time Gospel Hour. The Reverend Jerry Falwell steps forward to address an adoring audience, worn Bibles in hand, blessed suppers of body and blood recently consumed. His message is a comforting one for this gathering. ‘They are scared to walk near one of their own kind right now. And what we have been unable to do with our preaching, a God who hates sin has stopped dead in its tracks by saying, “Do it and die. Do it and die.” ’ Falwell wrote later that year: ‘Aids is a lethal judgment of God on America for endorsing this vulgar, perverted and reprobate lifestyle.’ His words emerged from the sun-beat soul of the American South and did not, as you might imagine, solely reflect his desire to fill the coffers of televangelism. Two years earlier, the residents of an unprepossessing Southern town were asked their views about Aids. Half of those polled believed that the law should prevent people with HIV from working in close contact with others. Forty per cent thought that children with Aids should be excluded from schools. Intolerance is institutionalised; it is the ordinary language of Christian fundamentalists, and fundamentalists are the human infrastructure of the southern United States. Or so it seems at first blush.

Tennessee is a small state with an ignominious past. In 1860, one quarter of its population were slaves and the slave-trade was its most successful business. This uneasy history, combined with an ardent religious fervour and tough rural living, still defines life east of the Mississippi. Even today, in the tourist brochures of Johnson City (the location for Verghese’s story), the percentage of the population who are non-white is listed to reassure prospective visitors (7.2 per cent, for the record). Tourism trades happily on this humiliating past. Henning, the birthplace of Alex Haley; the Lorraine Motel, Memphis, where Martin Luther King was assassinated on 3 April 1968; Dayton, where John Scopes was convicted in 1925 for teaching evolution to his biology class. Tennessee still stumbles under the burden of being a Civil War battleground (the East was loyal to the Union while the Midwest supported the Confederacy) and the state government works hard to overcome this legacy of poverty (the Jack Daniel’s distillery helps). In Tennessee, throughout the Eighties, homosexuality was a felony. Into this inhospitable setting came Dr Abraham Verghese.

Abraham Verghese’s story has to do with migration: his own in search of a peaceful settlement and that of his patients with Aids. Verghese’s journey had taken him to Johnson City in East Tennessee, a small town of about 50,000 people, which nestles in the forest highlands of the Chickasaw, Choctaw and Cherokee. Johnson City boasts two distinctions: according to a 1993 survey, it is the 34th most desirable place to live in the US, and it exports 165,000 Bibles a year. Verghese trained as a specialist in infectious diseases and expected the usual run of pneumonias, septicaemias and infectious diarrhoeas. Yet by 1989, he was caring for 81 people with HIV infection, 68 of whom were gay men, injecting drug-users or both – an astonishingly high number for a rural enclave. He discovered the solution to this epidemiological conundrum in the journeys made by his fellow migrants. When he traced a map of the US from his four-year-old son’s wall chart and marked the cities from where his patients had come, a pattern began to emerge. Large, urban centres on the country’s edge – New York City, San Francisco, Los Angeles, Miami – were the common points of departure. He described what he saw as the ‘return of the native’ and concluded that this ‘was not an exodus but a conclusion of a journey that began years ago and that has returned the patient to his birthplace’.

As sons discovered a sophisticated urban gay culture, the families of these adolescent men were soon left behind. Strangely, news dried up. Telephone calls were not answered; letters were returned to sender. Often years passed. Finally, there would be a telephone call, disclosing a history of hospital visits and asphyxiating human isolation, which had reduced the callers to cadaverous mannequins. Verghese is especially powerful in his physical descriptions of their return home. Here is Luther Hines:

His lips were horribly crusted and fissured. There were angry sores at the corners of his mouth. From where I stood I could see the Candida growing in his mouth like cheesy curd that threatened to spill out. His face was covered with a swathe of fluid-filled vesicles ... one of them hung down from the point of his chin and made him look like an old shrew. His shoulders resembled wire coathangers that propped up his shirt. His nails were long and pale and seemed to hang down like a parrot’s beak.

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