Instead of Robbins’ Basic Path, I am reading My Own Country: A Doctor’s Story, by Abraham Verghese. He spoke at my White Coat Ceremony, just over a year ago, and my parents were so impressed by him that they bought his autobiographical account of doctoring in a small Tennessee town through the AIDS epidemic. As I was leaving for school this summer, my mom handed me the book with glowing praise.
Mostly, Verghese recounts clinical experiences he had with AIDS patients in the early days. He analyzes them with remarkable insight into the metaphors of AIDS (see also: Susan Sontag), especially the way AIDS was instantly associated with gay people, and from there into deeper social obsessions with sexuality and morality. I’m very impressed by his honesty in depicting not only others’ reactions but also his own. At one point, he is asked to speak about safe sex at the town’s open-secret gay bar, and he recounts his fear of being seen and mistakenly “outed.” And then he realizes that’s the same fear many of his patients live with every day. Unlike Paul Farmer, who manages to make even semi-permanent separation from his wife and child into a virtue, Verghese is honest about his flaws even as he strives to overcome them.
But the real insight, for me at least, came in an off-hand little remark after Verghese sees two gay men who have driven 60 miles across state lines to get tested for HIV.
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. I may have been flattering myself with these thoughts, but more than once I had the sense that a patient was opening up to me for this very reason, because of my foreignness.
That’s an interesting thought. Last year, they gave us more than a few “cultural competency” and “health disparities” lectures, and the basic theme was always the same: patients are more comfortable with providers when they share a common culture. To hear that difference doesn’t matter — that it may actually be a positive rather than a negative trait — is intriguing. I like intriguing.