Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection

“To me, it was a disease of history—something that killed depressive nineteenth-century poets, not present-tense humans. But as a friend once told me, ‘Nothing is so privileged as thinking history belongs to the past.’”

The quote reframes privilege not simply as material access but as a way of seeing—a lens that can obscure present suffering when history is imagined as distant or resolved. Green offers his previous misconception of TB, which underscores the fact of his privileged access to healthcare services as an American. This supports his thesis that the way illness is imagined shapes one’s priorities; by imagining TB as an illness of the past, he did not yet see the urgency around the global TB crisis.

“In Henry’s short, beautifully written memoir, he referenced hunger many times. He called Lakka ‘a place where hope and despair intertwined…I found myself in a world where food was scarce, water was rationed, and clothing was inadequate for the chilly nights.’”

Green frequently refers to Henry’s writing to let him speak about his own experience as a person with TB. This passage provides insight into Lakka that Green cannot give because he was only a visitor, whereas Henry had become intimately acquainted with the emotions that followed life and death at the facility. It also subtly challenges the “savior” narrative by placing narrative authority in Henry’s hands, reinforcing The Need for Empathetic Thinking through shared authorship.

“Looking at history through any single lens creates distortions, because history is too complex for any one way of looking to suffice.”

Green cautions the reader against reductive thinking as early as Chapter 2. He dispels the notion that his book should be seen as a collection of “fun facts” about TB because this distorts the experience of people who have the illness today. Instead, he urges the reader to take a more nuanced view of TB, which will help them recognize the urgency of the crisis. This drives the need for empathetic thinking as a theme.

“And unlike the medical system, traditional healers treated Henry and his father like people. Henry was not viewed as an infectious case to be feared, but as a human child to be healed.”

While explaining Henry’s father’s reluctance to trust in the healthcare system, Green also points to two ways of imagining patients, which will recur in his discussion of sanatoria and the DOTS strategy. Henry’s father saw the healthcare system as a mechanism for control, rather than care. This moment foreshadows how systemic trust—or its absence—can profoundly shape patient outcomes, regardless of medical capability.

“But he also desperately wanted a normal life. Most of all, he wanted to be able to sit for his exams to get into secondary school. He knew education was the key to a successful life, a life where he might be able to travel and work, a life where he could be ‘a person in society,’ as he once wrote. But his reemergent, rampaging tuberculosis threatened to deny him those opportunities.”

Green depicts Henry not only through his experience of illness but through his aspirations in the midst of that experience. This helps to define Henry as being more than a person with an illness; it also shows how illness interrupts the normal course of life, causing people with illnesses to long for a return to life’s normal rhythms. More than anything, Henry wanted to go back to school. Green emphasizes that aspirations are not erased by illness; instead, they become a measure of what unjust systems steal.

“These illness narratives are often not just a strategy for conceptualizing the pain of others, but also a way of reassuring ourselves that we’ll never feel that pain.

The way we symbolize disease ends up shaping the way we experience and respond to disease.”

This passage is crucial to Green’s thesis, as it shows how people are naturally inclined to construct meaning around illness as a way to make sense of it. This creates room for Bias as an Illness of the Spirit since it distances people from the experience of those who are sick. Sick people are quietly placed in a category of “otherness.” This also highlights how illness narratives can serve the emotional needs of the well rather than the lived realities of the unwell.

“Imagining someone as more than human does much the same work as imagining them as less than human: Either way, the ill are treated as fundamentally other because the social order is frightened by what their frailty reveals about everyone else’s.”

Green warns the reader against romanticizing disease, arguing that it is a strategy that complements stigmatization by placing sick people in a category of otherness. This once again drives the theme of bias as an illness of the spirit since it underlines the social order’s fear of empathizing with those they cannot identify with.

“Acknowledging that consumption was common among enslaved, colonized, and marginalized people would have undermined not just a theory of disease, but also the project of colonialism itself.”

The refusal to diagnose TB in marginalized communities weaponized illness into a tool for colonialist control. In this passage, Green argues that had the colonial powers acknowledged that TB could spread among a population regardless of their identity, it would have been a sign of their common humanity and the shared right to adequate healthcare. Green’s insight shows how denial of diagnosis becomes a political act, reinforcing dominance by erasing both disease and the humanity of the colonized.

“This was the world in which Black people lived with tuberculosis in the U.S.—one where they were told by the medical establishment that their illness was caused by weaknesses and susceptibilities inherent to their race, or else by freedom and citizenship itself. And so even after we understood that TB was an infection, we continued to blame it on the sufferer, but with a radically racialized and stigmatic lens that caused more harm to the ill than even previous forms of stigma.”

The racism discussed in the previous passage continued even after the true nature of TB as a bacterial infection was discovered. Despite this shift in understanding, illness was further weaponized to advance the project of racism, explicitly viewing Black communities as being racially “weaker” than white ones. This is one of the strongest demonstrations of Green’s argument that systems of control advance the spread and growth of TB more strongly than the microorganism does.

“Stigma is a way of saying, ‘You deserved to have this happen,’ but implied within the stigma is also, ‘And I don’t deserve it, so I don’t need to worry about it happening to me.’ This can become a kind of double burden for the sick: In addition to living with the physical and psychological challenges of illness, there is the additional challenge of having one’s humanity discounted.”

Green explores the psychology behind stigmatization in this passage. By stigmatizing illness, one views infection as a consequence for moral failure. To stigmatize a person is to ignore the science that explains that infection occurs regardless of one’s moral compass. This speaks volumes about the person who stigmatizes, rather than the one who is stigmatized. The passage critiques not only public attitudes but also the internalized shame that stigma imposes on those with illnesses, adding emotional labor to physical suffering.

“I find it interesting that even here, in the supposedly pure world of science, we feel the weight of historical forces pressing in upon discovery. Our desire to create outsiders, the competition for resources among communities that would be better off cooperating, and our long history of warfare all come together in this moment of discovery.”

Green provides this aside while discussing the feud between Koch and Pasteur in the search for a cure for TB. This observation shows how the psychological mechanisms that lead to bias and exclusion are also the same mechanisms that drive conflict. This highlights the challenge of working together to overcome a crisis like TB.

“Before the germ theory of disease, we did not know that around half the cells in my body do not, in fact, belong to my body—they are bacteria and other microscopic organisms colonizing me. And to one degree or another, these microorganisms can also control the body—shaping the body’s contours by making it gain or lose weight, sickening the body, killing the body.”

In this passage, Green discusses the germ theory of disease in a way that transforms it into an apt metaphor for the systems of control and marginalization that have existed throughout history. Key to this analogy is Green’s use of the word “colonizing” to describe the proliferation of foreign microorganisms in the body. This evokes the history of colonization, in which imperial powers have enforced control over the communities they colonized.

“Why must we treat what are obviously systemic problems as failures of individual morality? […] This is often not an environment patients are excited to return to—and yet somehow we always seem to blame the patient for noncompliance, rather than blaming the structures of the social order that make compliance more difficult.”

In this passage, Green uses a rhetorical question to criticize the view of illness as a consequence of moral failure. Applied in the context of healthcare systems and treatment, he adds how this view discourages patients from seeking treatment, which is counterproductive to the endeavor of healthcare. Green reframes patient noncompliance not as failure but as a rational response to structural neglect and social punishment.

“When markets tell companies it’s more valuable to develop drugs that lengthen eyelashes than to develop drugs that treat malaria or tuberculosis, something is clearly wrong with the incentive structure.”

In the present day, the TB crisis escalates because the companies that produce the cures are primarily motivated by profit rather than care. This passage shows that they see the death of millions to TB as being a cost-effective consequence that enables them to pursue the creation of drugs that bring in more profit. It’s a sharp critique of global priorities, where beauty products are more profitable—and therefore more researched—than life-saving medication.

“People often ask me why I’m obsessed with tuberculosis. 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.”

Although Green has refrained from discussing his own experience as a novelist, it becomes relevant in the context of this chapter when notes that Shreya was a fan of his work before she died. Green sees the loneliness she experienced as someone fighting to survive and connects it to the loneliness he felt as he was trying to get work that he really believed in out into the world. This drives the need for empathetic thinking as a theme by underscoring empathy as the force that motivated Green to study TB. Green’s use of “Marco” turns a game of isolation into a metaphor for connection, underscoring how empathy bridges the gap between story and survival.

“Dr. Girum told me about another great frustration: knowing what needs to be done and being unable to do it. ‘When you know the drugs they need, but you do not have the drugs available, it is very difficult. In western countries, they can stop a hemorrhage, but we do not have the tools.’ And so many times, Dr. Girum has watched patients die from a lung hemorrhage that he knew how to treat, or for want of drugs that he could safely dispense.”

As Green relays, Dr. Girum expounded on the irony of being a doctor in a middle- or low-income country. Although he came to Sierra Leone to impact the TB crisis, he found himself unable to do his work because the tools and drugs required to treat the illness were too expensive to actually procure. This rendered his medical skills completely useless.

“To Henry, Thompson was not only a friend and mentor but also, as Henry once called him, ‘a ghost of my future.’”

This passage explains the impact that Thompson’s death had on Henry. Aside from losing one of the biggest elements of his support system, Henry was left to feel as though there was no hope for him once Thompson died. This echoes the experiences of Gale and Angie in Chapter 11.

“Dr. Girum later told me, ‘Yes, I know, it’s just one patient. There are so many patients, and Henry is just one. Why should we move mountains to save one patient? Because he is one person. A person, you understand? And anyway, what if he can be the first of many?’”

Dr. Girum elaborated on his reasons for aggressively pursuing Henry’s case. Despite the limitations of the system in which he operated, he wanted to prove that Henry’s life was worth saving because he believed in Henry’s inherent dignity. He also expressed the hope that Henry’s recovery could offer a case study to save others at Lakka, driving The Cumulative Power of Virtuous Cycles as a theme.

“I would never accept a world where Hank might be told, ‘I’m sorry, but while your cancer has a 92 percent cure rate when treated properly, there just aren’t adequate resources in the world to make that treatment available to you.’ That world would be so obviously and unacceptably unjust. So how can I live in a world where Henry and his family are told that? How can I accept a world where over a million people will die this year for want of a cure that has existed for nearly a century?”

Green imagines how it would make him feel if the same obstacles that hindered Henry’s treatment were applied in the cancer treatment of his brother, Hank. The rhetorical questions he supplies at the end of this passage underscore his argument that such systemic failures, no matter where they manifest, are forms of injustice. This parallel exposes the moral inconsistency at the heart of global health inequality, forcing the reader to confront their complicity in a two-tiered world.

“Tuberculosis is so often, and in so many ways, a disease of vicious cycles: It’s an illness of poverty that worsens poverty. It’s an illness that worsens other illnesses—from HIV to diabetes. It’s an illness of weak healthcare systems that weakens healthcare systems. It’s an illness of malnutrition that worsens malnutrition. And it’s an illness of the stigmatized that worsens stigmatization. In the face of all this, it’s easy to despair. TB doesn’t just flow through the meandering river of injustice; TB broadens and deepens that river.”

In this passage, Green uses the term “vicious cycle” to describe the factors that allow the global TB crisis to persist. These factors are not medical in nature but social ones, proving Green’s thesis that epidemics are the result of injustice on a broad scale. Green’s metaphor of the river deepens the theme by portraying TB not as an isolated tragedy but as a social current shaped by human decisions.

“We live in between what we choose and what is chosen for us. Henry was acted upon by historical forces, but he was also a historical force unto himself—as we all are. He made choices. And as one of those choices, he chose to stay at Lakka, to believe in Dr. Girum, to trust a medical system that had done so little to earn his trust.”

Henry refused to accept that the system that hindered him from receiving treatment was more powerful than his choice to trust in the healthcare system. This became Henry’s way of contributing to the cumulative power of virtuous cycles, as his resignation from treatment would have undone all of Dr. Girum and Lakka’s work with him. This also reframes heroism: Henry’s choice to trust was itself an act of resistance against fatalism and structural abandonment.

“And so the work of TB caregivers, survivors, and activists in Peru in the 1990s helped Phumeza Tisile survive TB, and her work in turn lowered the price of bedaquiline, which will help many others survive TB.”

In this passage, Green shows the cumulative power of virtuous cycles in action. While the vicious cycles that allow TB to persist succeed in spreading more resilient forms of illness in a given community, the outcomes of a virtuous cycle can help others beyond community borders. Virtuous cycles are effectively sustainable solutions. The passage also reminds the reader that the benefits of care are cumulative and contagious—proof that investment in one life can ripple outward to many.

“We can do and be so much for each other—but only when we see one another in our full humanity, not as statistics or problems, but as people who deserve to be alive in the world.”

Green ends his discussion of virtuous cycles by echoing Dr. Girum’s motivation to save Henry. It is only by valuing the inherent dignity of each individual person that one can adopt the mindset that leads to the creation of more virtuous cycles. Vicious cycles, by contrast, do not see people as people but as data points and problems to be resolved or ignored outright. The quote reframes empathy as both the origin and the engine of structural change, aligning emotional insight with political possibility.