Tuberculosis

by Zary Fekete

I have tuberculosis.

Odd to hear the doctor say a word like that. It sounds so old…connected to an earlier age. The first time I recall hearing about people with this disease was in children’s history books like the Laura Ingalls Wilder series, when she talked about her family gradually making their way across the Midwestern plains of America. Laura grew up in Wisconsin, not far from where I live in central Minnesota. In the 19th century, Minnesota had more than one sanatorium devoted to TB care, not surprising for a northern land where much of the year has positively alpine weather: cold and dry. In St. Cloud, just 30 miles north of my home, Jane Grey Swisshelm, who founded The St. Cloud Visitor newspaper in 1850, devoted substantial pages of the publication to highlighting the need for TB cures. Her father and daughter both died of the disease. The illness is tricky and sneaky and thus has been around awhile. Hippocrates said it was the most common disease of his time. It stalked George Orwell through most of his life, eventually requiring his doctors to paralyze one of the nerves on his left lung so that the vessel could be artificially inflated in order to heal properly. It never did, and he died of a burst blood vessel in his chest just when 1984 was becoming popular.

It is a rare disease in the United States now. In 2024, there were only 195 cases in Minnesota, most considered latent. Most people with active TB in modern America caught it when traveling abroad. My doctor, a Mexican man who has treated lung patients in Minneapolis for the past 20 years, said it was common in his childhood village in central Mexico for doctors to inoculate children with a strain of TB so that they wouldn’t catch it in its full form as adults. He winked and thumped his chest when he told me this.

“Been anywhere recently?” he asked.

I nodded. My tuberculosis did not start in America. My doctor is almost one hundred percent sure I contracted it during a trip I took to Bangladesh and India in February earlier in the year. I was on a two-week work trip with my son, an opportunity for a father/son reconnection after the first several months of his freshman year. I booked the tickets, and we waited for the day of departure, exchanging text messages on the state of air pollution in Dhaka and the average temperatures for February in Bangalore.

When our flight finally took off from Chicago, it was already clear to us that we were entering a different world. Air India #1121 was filled with people heading home to their hometowns across India. Our first stop was Delhi, on our way to the destination in Dhaka. The chair monitor on my son’s seat didn’t work, and he spent the entire 17-hour flight watching downloaded Simpsons episodes on his phone and occasionally trying to nap.

Eventually, he struck up a conversation with the lady sitting next to him on her way home to southern China. My son practiced his Mandarin with her and helped her retrieve things from the overhead bin. Sometimes it was pre-packed ramen. Other times she just needed more hot water from the flight attendants, who were busy tending to a flight half-filled with families and half with businessmen heading back to meetings. The carpet in the aisles was frayed and coming undone. I woke from my half-nap every time the flight attendants pushed the cart by because each time a single drop of hot tea flicked from the passing thermos and landed on my hand. Every time it happened, I looked down at the brown liquid spattered on my skin and thought about tea…how the dry leaves infuse through the hot water and color the entirety of the cup’s contents. That flight felt like seventeen hours of humans infusing one another with their essences in the hot, dry atmosphere 30000 feet above the earth.

When we finally arrived in Dhaka, we collapsed at the hotel and slept fitfully through the first night. I woke at one in the morning and finally dragged myself to my feet at 5AM for an early morning jog. Looking back on it, it was probably this first jog that introduced the tuberculosis pathogen into my system.

Our hotel was in the diplomatic sector of the city, but I quickly left the leafy side streets in search of something larger and more encompassing, finally finding a sluggish river, its banks clogged with makeshift dwellings for the fishermen who plied its waters. I jogged along the wet banks of the slow stream, glancing across the water at the sun rising on the far side. The river reminded me of a canal near where we used to live in northern Beijing. The smell was the same too, thick and green.

I crossed the river a few times using small pedestrian bridges. At one point, I jogged around a peninsula jutting out into the water where four or five huts clung to the muddy banks. Elderly women leaned back and forth over wet boards where they cleaned the fresh-caught fish. Insects skimmed across the top of the slow water, while a mutty dog ignored me as I jogged by, his attention focused on a one-eyed cat perched above him in a smooth-barked tree.

I arrived back at the hotel feeling energized and remembering something my father said many years ago: “Start a trip with a jog.” He believed it was the best way to orient yourself to a new neighborhood. The clear memories of that first morning run through Dhaka show me the truth of that advice.

Our family has lived a very international existence during the past twenty years, spending the first ten years of our sons’ lives in Eastern Europe and the second ten in East Asia. Before that, I grew up as a third culture kid in Hungary in the 1980s. I took many “first” jogs in over 40 different countries, eventually visiting almost everyone in Europe and a few in Asia. Some of our East Asia travels brought us through a section of Southeast Asia, where my doctor later suggested also could also have been where I was infected. But after hearing about our trip to Bangladesh this year, he is fairly confident that the particular strand of TB I inherited was infused into me, like tea, when I jogged along the banks of the river in Dhaka that first morning.

It’s strange to think of that moment now. I set out to discover a new city. And I did. Something new entered me along with the sites and smells and sounds that morning. Something new and very old. Something I inhaled. You imagine illness arriving with a cough or a fever, something dramatic. But this came quietly. I’ll never know the moment I began to carry it. I felt strong that morning. My shoes were well-laced. My muscles felt tight and sharp. I jogged with a rhythm I learned back in high school: three breaths in…one out. Quick. Crisp. 1,2,3, out. 1,2,3, out. Again and again, I breathed as I took in the new world. Somewhere that morning the disease slipped in through a breath, but it didn’t leave. It was 1,2,3…home.

In the 19th century, tuberculosis was thought of poetically. It informed one’s character. It had a personality: delicate and slow burning. The “romantic disease.” They called it: consumption…a word I remember from childhood readings of Heidi and The Secret Garden and A Little Princess. It was associated with writing by candlelight and frail heroines, pallid beauty, tragic endings. People believed it arose from sadness and broken hearts. Thin blood and weak nerves. The literature of the time is filled with beautiful people wasting away with hands lightly draped across their foreheads. A slow death…spiritual. People who suffered were “melancholy angels.” People wrote about TB in ways that made it sound almost aspirational. Helen Burns says to Jane Eyre, “By dying young I shall escape great sufferings. I am not in the least afraid. I have faith: I am going to God…How comfortable I am! That last fit of coughing has tired me a little; I feel as if I could sleep, but don’t leave me, Jane; I like to have you near me.”

There were sanatoriums established all over the world in cold climates. An entire novel by Thomas Mann takes place in a tuberculosis clinic in the Alps, the location where the author set The Magic Mountain, his satire on Europe and World War I. The hero of the story, Hans Castorp, visits the clinic to spend three weeks with his cousin who is recovering from the illness, but Hans decides to stay longer once he develops an infatuation with a young Russian woman, Clawdia Chauchat. Hans alludes to the tea-like infusive nature of the disease when he finally declares his love to Clawdia, “Let me take in the exhalation of your pores and brush the down—oh, my human image made of water and protein, destined for the contours of the grave, let me perish, my lips against yours!" Effectively beating director Brandon Cronenberg to the turn by over 100 years, Mann describes love as something closer than caution. People in love will choose to inhale one another’s essence just to be close to them, something Cronenberg explored in his disease thriller Antiviral in 2012.

Back in the 19th century, across the Atlantic, more sanatoriums were established in the upper Midwest and southern Canada, built on the premise that cold air and pine trees could breathe the disease out of you. Ontario, Manitoba and parts of northern Michigan became destinations for the weak-lunged. The largest sanatorium in Canada, the Muskoka Cottage Sanatorium, was founded in 1897 on the shores of Lake Muskoka, where tuberculosis patients were given fresh air, porridge, and long hours of rest on open verandas...just like in Mann’s novel. There are photographs of patients wrapped in wool blankets on snow-covered balconies, an odd sight, but perfectly aligned with the prevailing belief that climate, not medicine, was the key to survival. Doctor’s prescribed afternoon naps in subzero temperatures, certain that the cold would chase away the illness from the warmth of moist, fetid lungs.

The sanatorium movement was as much about silence as it was about science. There were whole communities where people barely spoke. Nurses wore crepe-soled shoes to keep their footfalls quiet. Talking was discouraged. Laughing was discouraged. The lungs needed peace. The patients needed to forget their city lives. Even the meals were simple, bland, predictable…boiled potatoes, white bread, thin soup. The world had to be quieted so the body could be still. This austerity is one thing that was different from Mann’s descriptions of the Swiss clinic where patients dined on gorgeous multi-course meals and drank libations to their hearts’ content. But this was also true to the nature of the land, as well. People in Europe were old hands at dealing (or attempting to deal) with tuberculosis. In the 19th century of the New World, cold weather clinics were still something new and hopeful. Never mind that very few people were ultimately cured.

The patients wrote letters and journals, and many of them drew or painted. There are watercolors preserved in archives that show soft hills, black spruce, birds in flight. Sometimes the writing is hopeful. Sometimes not. There’s one journal entry I came across once where a patient simply wrote, “I think I will miss the quiet.”

Here on the farm in central Minnesota, I’m beginning to understand that.

Tuberculosis is a patient traveler. It lodges itself in the lungs and collects to itself a host of antibodies that the body throws at it in hopes of dislodging it. When the initial rounds of battle result in a kind of stalemate, the body is content to keep tuberculosis holed up wherever it happens to be. Often, it isn’t until later that the real infectious stages begin to develop. Some people carry around this patient guest in their bodies for years before the disease decides to announce itself. Unlike the sumptuous meals in Mann’s Swiss clinic, the environs for the TB virus are more like the stubborn austerity of the upper Midwest with their dry bread and unsalted soups. It is an uncomplaining illness, rarely announcing itself if it doesn’t need to.

That’s what makes TB so haunting. It waits.

It waited in me. Throughout the rest of our trip in Bangladesh and India, it passed through airports and hotel rooms and taxis. It shared space with other travelers. It napped with me through time zones. It followed me home and sat quietly in the corner of my lungs. It didn’t ask for anything. It watched, patiently, for an opportunity.

And then, in March, it awakened. I had been feeling an ongoing pain in between my ribs for a few days. Being a jogger, I thought nothing of it…maybe it was just a twisted nerve. But then I woke up one morning feeling miserable. My mother drove me to the emergency room and an X-ray confirmed there was definitely something in my lungs that looked off. The doctor thought it was pneumonia. After a few rounds of antibiotics with no improvement, I was referred to a pneumologist. I told her my travel stories, and, when she heard the word “Bangladesh,” she sat upright.

“Oh,” she said. Her eyes darted back and forth while she read her computer screen. She turned back to me. “We’ll need to do a TB test.” We did and it came back quickly. The rest of the plan came together quickly, too: No travel. No contact with anyone, if possible. Masks if I need to go anywhere. And at least a month of seclusion in my house.

What kind of TB I have is yet to be determined. But because the doctors need to exercise the greatest possible amount of caution, especially after the COVID experience of the last few years, the month of July is going to be entirely confined to our family’s house on the farm plains of middle Minnesota, which is where I sit down to write this now.

A sample culture from my lungs will be sent off to a lab somewhere, and until the results come back, I am supposed to be “off-line.” Not just from work and travel, but from the daily rhythms of shared breath. I wear a mask when people come near me, though mostly they don’t. My wife and two sons are in Thailand for two months, part of a summer project organized by our mission organization. I was meant to be on the trip, too, before my diagnosis.

Instead, I am now here, waking up every morning with plenty of time and lots of empty rooms to haunt.

The body doesn’t feel sick, but the mind does odd things. There’s a disconnect between the diagnosis and the way my limbs still want to move, the way my lungs still rise and fall without effort. That’s part of the quiet cruelty of TB. You don’t feel it until much later. And by then, you may have already passed it on.

My days now begin with the soft clink of cat bowls, the low creak of floorboards. I make coffee, feed the animals, and open the windows. The house still breathes, even if I’m asked to hold mine back. There’s no fever. No pain. But the awareness of being a host, of carrying something ancient and tireless, is its own kind of strange ache.

I read again about the old poets who died of TB. I think of Keats, coughing blood into a handkerchief. I think of Chopin, his thin fingers trembling, scared of being buried alive, certain his body was full of something and longing to have himself cut open and freed. I think of all the women misdiagnosed with hysteria when their lungs were quietly collapsing. And I think of myself, jogging by the river in Dhaka, watching the morning mist on the river along with the fishermen, picking up a silent visitor somewhere along the way.

I had no idea.

That moment seems distant now, but also somehow sharpened. I remember the children crouched beside the water pump. The curve of the cat’s back in the tree. The smell of fish and silt, the sun on leaves. I remember it so clearly it feels almost holy. That’s the paradox: the moment I may have been infected is also a moment I hold onto with strange gratitude. I was present. I was there.

TB is not a metaphor. But it has always lent itself to metaphor. Waiting. Watching. The slow battle between body and breath. And now here I am, in the stillness of a summer I didn’t choose, listening for what it might mean to heal, not just physically, but with attention. With patience. With a quiet that isn’t forced, but given.

It’s a strange kind of gift. Not the kind you wrap or share. But the kind you sit with. The kind you name slowly.

BIO: Zary Fekete grew up in Hungary. He has a debut novella Words on the Page out with DarkWinter Lit Press and a short story collection To Accept the Things I Cannot Change: Writing My Way Out of Addiction out with Creative Texts. He enjoys books, podcasts, and many many many films. Twitter and Instagram: @ZaryFekete Bluesky:zaryfekete.bsky.social