“We must hang up in the belfry where the bats and moonlight laugh
We must stare into a crystal ball and only see the past”
- Bright Eyes, “At the Bottom of Everything”

 

John Green’s second foray into nonfiction, Everything is Tuberculosis, begins with the story of a great-uncle Stokes Goodrich who contracted tuberculosis. The rest of the book goes on to tell the entrenched legacy of humanity’s deadliest infection. It is a testament to the disease’s intractability that I have also encountered the shadow of M. tuberculosis in my family history. Here it is: there has never been a medical degree in my family tree, but we have always practiced medicine.
   My mom’s mom dedicated her life as the sole medical practitioner in a small Chinese village, a role that loosely translates to “healer.” But she didn’t always work as a healer. When my grandfather fell ill with tuberculosis and had to abandon school, my grandmother assumed the role of his caregiver, setting her on an unexpected medical path. One day my grandfather fell severely ill and the two embarked on a desperate trip to Beijing to be treated by a doctor. Following a night and an initial antibiotic treatment, the doctors insisted on extended hospitalization, but they warned that without sufficient funds, my grandparents would be sent back home.
   “How will he get the treatment if we go back?” my grandmother asked. 
   “You can’t. If you leave here, he won’t survive this bout of sickness.”
I had heard versions of this story throughout my life; as motivation to study hard in school since my grandpa didn’t have the same opportunities, as justification for wearing an extra sweater and scarf in the winter, as explanation for our numerous home remedies for sickness. Family stories have a way of becoming parable or mythology as each situation dictates. The strength of John Green’s Everything is Tuberculosis is his ability to demystify parable, mythology, history. As I read the book I could connect my grandfather’s life to a universal human story of disease and cure.
     Perhaps unsurprisingly. Green takes a narrative storytelling approach to nonfiction. The high points of the book come in the movingly-told story of Henry Reider, a young Sierra Leonean man whose battle with TB stole much of his childhood, education, and nearly his life. His story, from contraction to hospitalization and from lost hope to miracle workers, is the common emotional thread through which Green deftly weaves the history of disease, Sierra Leone, and TB (which, as the title suggests, seems to be in everything). Storytelling is not limited to this throughline, however. Perhaps the greatest strength of Everything is Tuberculosis is its ability to tell a story in a paragraph or two: the romanticization of illnesses like OCD, the poetic resonance of John Keats’ death, Shreya Tripathi’s indomitable fight for access to drugs that would have saved her life.
     These narrative histories were also how I found my own family history to be woven through that of TB. Despite the global reach of Everything is Tuberculosis, the book does not directly discuss TB’s history in China. Still, as Green writes about the rise of the disease following the rapid industrialization of Britain, I saw the timelines mirrored in the industrialization of China. The chapters that describe the global health priority of “directly observed treatment” — an attempt at minimizing multi drug-resistant TB (MDR-TB) — undergirded the attitudes of the Beijing doctors who mandated an expensive hospitalization. And as Green praises the strength of Henry Reider’s mother and familial support, I read echoes of my grandmother’s unyielding resolve.
    Every story in Everything is Tuberculosis is a small baited hook. Maybe you don’t have a grandfather who was sick with TB but you wear stetson hats, rock a clean-shaven face, live in New Mexico. The magic that John Green works into the book are the countless narrative opportunities to find a personal connection to the world’s deadliest curable infection. Because when you realize that something is tuberculosis, suddenly everything really does feel like tuberculosis; for better, and for worse.

 

Love in the Time of Tuberculosis

 

“We must take all of the medicines too expensive now to sell
Set fire to the preacher who is promising us hell”
- Bright Eyes, “At the Bottom of Everything”
 

      Everything is Tuberculosis is also a desperate book. Towards the latter half, John Green describes a poignant call and response underscored by his powerlessness.
     “I’m a novelist, not a historian of medicine. TB is rare where I live. It doesn’t affect me. And that’s all true. But I hear Shreya, and Henry, and so many others calling to me: Marco, Marco, Marco.”
Perhaps the lay, non-medical audience that seems to be the focus of this book is meant to see themselves in these lines. Reading through the chapters, I was struck by the patiently-explained scientific concepts; the physiology of the lung, the membrane of a bacterial cell. And yet, even confident in the basic sciences, I feel no less powerless in the face of the problems laid out by Everything is Tuberculosis. I’m a medical student, not a doctor. Or even if I will be a doctor, not an infectious disease expert. Or if I will be an infectious disease expert, not a global health expert. Or if I will be a global health expert, not a Sierra Leonean history expert. I won’t know Henry Rider, or Shreya Tripathi, or Great-uncle Stokes. Honestly, I do not know my maternal grandfather very well either. If we can’t hope to achieve the level of attention as John Green, and even he feels disempowered, then perhaps the best hope Everything is Tuberculosis offers is that “Marco, Marco, Marco” galvanizes me into calling back, “Polo!”
     Hope does not permeate throughout the book but neither is it absent. In the personal history of Henry, the final chapters document his recovery in their titles: Vicious Cycles, Hail Mary, Like Magic, Virtuous Cycles. Throughout those chapters, the story of systematic progress is also detailed through the declining cost of treating one case of MDR-TB from $15,000 to $1,500 to $300. The heroic efforts of individual doctors like Dr. Girum and organizations like Partners in Health show that patient-by-patient and system-by-system, we are not powerless to turn vicious cycles into virtuous ones. These are not the stories that make the news, but that is why it is so important that they are the stories told towards the end of Everything is Tuberculosis. Still, one leaves the book with a deep sense of the work left to be done.
     The two patterned end-papers of the hardcover for Everything is Tuberculosis hold a secret message. The front end-paper, the very first images when opening the cover, is an artist's rendering of M. tuberculosis: green pathogens floating haphazard in space. The rear end-papers, the last page before closing the book, is a neat array of little green pills. Everything is Tuberculosis begins with a disease and ends with a cure and the pages between is what is keeping them apart, and what is holding them together. This is also the tragedy of that in-between. Since the publication of the book, the United States has shredded USAID, gutted the CDC, and turned a blind eye to the inevitable wave of MDR-TB. Future editions of Everything is Tuberculosis will invariably include reference to these disasters. Be it through forewords, authors notes, or a new chapter; the page count is likely to grow. In other words, the gap between the end-papers — between disease and cure — will only widen.
     The gap between treatment and patient continues the same one that turned my grandmother away from a hospitalization they could not afford. Despite this, she nursed my grandfather back to health borrowing methods and imitating the actions of the city doctors and nurses she had observed. As his health improved, she became a sought-after healer in the community, all while continuing to work in the crop fields. My grandmother's healing knowledge, though essential, wasn’t lucrative. Nevertheless, she passed down her hard-earned lessons to my mother, who, upon coming to America, imparted them to me.