strategy for dealing with the AIDS pandemic. Deo was supposed to be collecting data and reviewing the
scholarly literature for Joia, but he routinely became incensed at the papers arguing against treatment
and would send Joia long diatribes, backed up not just with facts, but also with material from the
websites of conspiracy theorists. She’d say to him, “Let’s think of concrete ways to make our argument,
for the world, and make it less sort of swirling.” He listened, and with her help figured out how to
identify reliable websites and journals. When she put him to work on the pharmaceutical industry, much
the same thing happened. To Joia, the problem wasn’t that Deo got upset at the way patents on drugs, for
instance, left the indigent sick of black Africa bereft of modern medicine. These things upset Joia, too.
And it wasn’t as if Deo didn’t seem to realize that anger and indignation were no substitute for fact and
reasoned argument. Rather, anger and indignation seemed to take control of him, at least for a while.
“Offensive things are so offensive to him. Understandably,” Joia said. “It’s just like he has no skin.
Everything just penetrates so much.”
When she was alone with him and there was time to talk, it seemed as though he was compelled to tell
her about the genocide, and to recite parts of his own story. There seemed to be no end to this. It was as
though he were trying to purge himself of his story, again and again. Joia asked him several times if he
would like to see a psychiatrist. He would politely decline, or change the subject, not mentioning that
he’d tried that once.
“It was not because I wanted to get out of listening to him,” Joia told me. “But I just was very worried
about him. It seemed like he never slept, it seemed like the genocide was such a part of his every day.
Not that any of this defied understanding, of course, but I didn’t know how a person could possibly cope
with it.” She thought about her own father: she grew up knowing that he had narrowly survived the
massacres during the partition of India, events just as cruel and bloody as most other ethnic and religious
wars, and for body count even bloodier than the Rwandan genocide. But her father had never talked
about his experiences. His way of dealing with his memories had seemed to be hypochondria. Joia told
me: “He had been sick and dying my entire childhood, and I always thought that he was just strange
until I met Deo, and when I saw how much pain Deo had incorporated into his every day, I thought,
‘What are your options if you see that kind of tragedy?’ Your options are pretty much to let it spew out
all the time like Deo, or try to suppress it, which is what my dad did, and I think it came out in his
hypochondriasis, thinking he was dying all the time.”
Paul Farmer was the only other person to whom Deo told his story in detail. And, as he did with Joia, he
told it to Farmer repeatedly. “The first time we spoke privately, he broke like a distressed dam,” Farmer
remembered. “I was worried about him, but I never recommended that he see a shrink. It was hard to
imagine an American psychiatrist medicating him for having survived genocide in two countries.”
Farmer soon came to think of Deo not as a patient or charity case, but as a friend and colleague in
lingering distress. And the best remedy for Deo, he thought, would be a return to medicine.
Deo vividly remembered the hospice in New York where he had worked. That had been a place, of
course, where everyone was dying. He had sat beside the patients and talked with them. In his mind, he
placed himself in their deathbeds, remembering times when he was fleeing and had felt as they must
now: “I probably have maybe a minute for the rest of my life, to be alive, and then I’ll be gone.” He’d sit
down beside a patient’s bed and say, “Tell me about your life. Tell me something you enjoyed.” Talking
to them so that they could die the good death, he imagined. Many burst into tears. Mostly, they said they
felt guilty, for having accomplished nothing compared with what they had planned, or for getting
divorced, something they regretted now when they could no longer even try to repair the break.
After that time of hearing deathbed stories, to walk into the offices of PIH felt like one of those
transitions he’d read about in Greek myth, when the mortal consigned to the underworld is granted a
parole to return to the light. And it also felt, as one said in Burundi to describe a feeling of special
warmth and liberty, “like going to Grandmom’s.” Deo said, “Walking into that building was like a whole
world opening for me. It was like opening my own house and just right there. I had such an unusual
feeling. A great feeling. You enter, you know that you are not just going to work. It’s like you’re going
home, and everyone there is so nice and friendly.” Sometimes he stayed all night with the other young
PIH-ers, assembling documents and facts for papers that the higher-ups had to present within days in
Geneva, in Barcelona, in Moscow. They’d buy pizza and beers, put on some music, and work until
dawn. “Oh, my God. It was great,” Deo said. “I actually loved those days.” He liked to go to the
meetings where the director of PIH, Ophelia Dahl, and her staff would talk about what PIH was
accomplishing in Haiti, a place that Deo imagined to be very like Burundi. In Haiti PIH was building
houses and schools for the poorest families and cleaning up water supplies and bringing in doctors to do
heart surgeries and constructing new clinics. He would glance around the conference room. It looked so
small and organized compared with all the big and messy work PIH was doing outside those walls. “It’s
a really tiny place that is changing a great big environment,” he remembered thinking. Then he’d
exclaim in his mind, “No group of people is really too small to change the situation!”
He loved all of it, from going to the airport to pick up a jar that contained a Haitian patient’s severed
breast and taking it for a biopsy at one of the Harvard teaching hospitals, to pounding computer keys all
night so that Farmer or Joia or Jim Kim, another big figure in the organization, would be fully supplied
with ammunition to argue the rights and needs of poor patients at high-level meetings that week.
“To be part of that meant a lot, a lot, to me, and made me feel that I was really being productive and
participating in the good cause,” he told me. Sometimes he would look up from his computer and around
his little janitor’s closet of an office and wonder, “Am I really here?” He remembered thinking, “Finally,
finally, this is who I am. This kind of work is not just work. It’s part of me, my life, me. There is no way
of separating that and me. It feels so good!”
After some months at PIH, Deo was invited to give the weekly lunchtime talk to the office staff. He had
not yet told these colleagues his story in full. He hadn’t tried to do this with anyone except abortively
with the psychiatrist and with Paul and Joia. As he began to speak, he felt tears well up—
embarrassingly, then not. He couldn’t have dissected all he felt, one feeling from another. Maybe relief
was uppermost. It was as if something in him had to compensate for the years of silence. Deo talked on
and on, long after the lunch hour, long after the time when everyone had to get back to work. But PIH
was the right place for this to happen. Ophelia Dahl remembered sitting there, watching Deo and
thinking, “If anyone gets up and walks out now, I’m going to kill ’em.” No one did.
He had been lucky again. He’d found a group of people equipped and willing to understand him, and
models for himself, and a vision. He’d made many new friends, including a girlfriend, a medical student.
She had since become just a friend, but a close one. James O’Malley had finally got him permanent
residency in the United States. And, with a lot of help from Paul Farmer, he’d enrolled in medical school
at last, at Dartmouth.
I was once introduced to an old, dying man who had spent his late adolescence at Auschwitz and had
refused to speak about it afterward, for nearly forty years. If an acquaintance happened to ask about the
provenance of the pale blue numerals tattooed on his forearm, the survivor would say, “I’ve always had
great difficulty remembering my phone number.” In old age, though, he had finally begun to tell his
story. He told me, “The problem is, once you start talking it’s very difficult to stop. It’s almost
impossible to stop.”
By the time I met Deo, he had told pieces of his story to various people and he had been telling all of it
repeatedly to Farmer and Joia for about two years. I think he had gone through most of his time of
finding it impossible to stop. When I next saw him, two years after we first met, he had grown much
more reticent. His story wasn’t pleasant. “It isn’t time for tea. It is not,” he would say. He didn’t want to
burden his friends with it anymore. Once, I listened to Deo deliver a rather scholarly public-health talk
about Rwanda, and a person in the audience asked him what had happened to him during the genocide.
Deo took a deep breath, then delivered a three-minute précis of his escape. By the time he finished, the
room was hushed. Deo made a small, pained smile and said to the gathering, “Maybe you are
wondering, ‘Why did I ask?’”
Now and then one friend or another would urge him again to visit a psychiatrist. I asked him why he
continued to refuse. He said, “It’s true that I really had, I still do have all these problems. There’s no way
that they will go away from me. But I deal with them the way I can.” He lifted his chin. “And I’m very
happy with the way I deal with them.”
Chapter ELEVEN
New York City,
I felt uncomfortable at times, during the two years or so when I was asking Deo my questions.
Sometimes I felt that to remind him of the past was to traumatize him all over again. On several
occasions, I offered to stop my search for his story and let his memories die, if they would. Once or
twice, I hoped he would accept my offer. But he always declined. He’d say, “No, it’s all right.” In
retrospect, I feel as though we went on a journey together, moving backward through his past,
sometimes on tiptoes, as it were. I don’t know what useful purpose, if any, this trip served for him. For
me, Deo was the attraction, Deo and his story. First of all, there was New York.
A young man arrives in the big city with two hundred dollars in his pocket, no English at all, and
memories of horror so fresh that he sometimes confuses past and present. When Deo first told me about
his beginnings in New York, I had a simple thought: “I would not have survived.” And then, two years
later, he enrolls in an Ivy League university. How did this happen? Where did he find the strength, and
how had he won the beneficence of strangers? How had it felt to be him? I asked him to show me some
of his New York.
We started in Harlem. Deo hadn’t been there in five years, and as we walked up Malcolm X Boulevard
past rank after rank of renovated brownstones and gutted brownstones covered with scaffolding and
clusters of new chain stores and banks, he made exclamations. “Look at these buildings! They used to
have wood on their windows. This is unbelievable! This used to be the worst place here, people peeing,
yelling. Gosh, that building is brand-new.” He wondered what had become of his old neighbors. He said,
“This is not good news for the poor.”
He’d never seen joggers in Harlem before, he said, let alone white joggers. Actually, back when he lived
here, the only white people he saw were cops, always angry because—so he surmised—always scared.
The pay phones, once his only way back to Burundi, were gone. By the time we reached 124th Street, it
wasn’t changes in the landscape but the sight of something familiar that astonished him. “Oh my God!
Look! ‘PEN’!” The windows and doorways of the abandoned tenement were bricked up, but the graffito
was still there, high on a wall. “This was a door right here. There were many entrances. And people used
to hang around on these fire escapes.”
Out front there was a bent metal awning with this written on it: “All Cure Health Variety Patties, Natural
Juice, Newspaper, Magazine And Lot More.” The awning must have been there back then, already a
relic of a defunct store, but Deo said he didn’t remember it. “You know there are a lot of things that I
didn’t even look at, things I don’t remember.” What he seemed to recall most clearly from his month or
so in this place was his state of mind. He had escaped physical danger. Here the problem had been to
escape the torment of memory.
As he looked around, he was laughing one moment, pensive the next. I wondered whether he was
feeling a touch of perverse nostalgia for a place where he’d known so much pain and confusion. He
pointed at the staircase for the 125th Street subway station. “This is where I tried to bargain for a token,
for less.”
“Oh, you tried to bargain for tokens?” I said. “You didn’t succeed.”
“No.”
I laughed. “You actually tried to bargain for tokens?”
“Yes,” he said, rather stiffly.
It hadn’t occurred to me that he might be annoyed by my laughing over what an innocent he’d been a
decade ago. Hoping that I would seem to be laughing at someone else, I told him I was thinking of my
grandmother, who once managed to pay a New York City bus driver with postage stamps. He chuckled
politely. I had the feeling that to Deo my grandmother’s behavior wasn’t all that peculiar either.
We descended to the subway station, the same from which Deo had departed on his long, long ride of
years ago. We went to the end of the line in the Bronx, then all the way to the other end in Brooklyn.
One round trip took about two hours, and he had made several round trips on that day twelve years ago.
As we rode along, Deo remembered how, worry overcoming pride, he had attempted to ask other riders
for help, in French. “Some people would walk away, some would curse at me.” After he’d stopped
asking, he had begun to sense, in the background of his loneliness, changes in the human landscape of
the cars. When the trains had passed through what he now knew to be Midtown, he had been struck by
the whiteness and the purposeful haste of the riders, their fancy dress, the perfume of the women. Then
