“America is a sick country.”

This is the refrain Porochista Khakpour recalls hearing from her Iranian immigrant relatives, spoken “in every meaning of the sentence possible.”

In her new book Sick: A Memoir, Khakpour dives deep into her experience as an Iranian-American author living with late-stage Lyme disease, which she contracts from a tick bite. While the memoir is a straightforward account of her illness, Khakpour weaves in commentary on America’s politics, healthcare system, and structural shortcomings.

Throughout the book, Khakpour grapples with the ebbs and flows of Islamophobia in America. After a harrowing car accident in late 2015, a time when the Paris attacks were at the forefront of people’s minds and the racialized 2016 election cycle was kicking up, Khakpour finds herself in a tow truck. She recalls of her interaction with the driver, “Eventually we got into it: Iran and Muslims and 9/11 and the Paris attacks, and after I realized this man wasn’t going to hit on me, I was so focused on not letting him hurl anything racist at me that I barely remembered the accident.” She faces this grim reality: that in the light of a potentially fatal car accident, she must play defense due to her background, her gender, and her name. How can a person focus on wellness when she is constantly forced into a place of vulnerability? In a time when studies are revealing the health implications of racism, Khakpour’s experience reads as supporting evidence. People of color, subject to “day to day indignities,” tend to have worse health outcomes. This is not a coincidence.

This type of racial and location-based trauma started long before her adulthood. As a child, she faced a dramatic move from Iran to Los Angeles. Her childhood experience sets up her lifelong feeling that she does not have a true home. Her father reinforces this thought, repeating about Los Angeles, “This isn’t your home…We’ll be going home again one day soon.” Throughout the book, Khakpour is constantly on the move, with sections of her narrative in Baltimore, Chicago, Santa Fe, Pennsylvania, and New York. With each move, it seems she picks up little pieces of home, but she never quite finds one to settle into. Rather, she ends up with deep and painful uncertainty: “I sometimes wonder if I would have been less sick if I had had a home.” How does feeling whole, comfortable, and welcomed in a place contribute directly to wellness? She does not claim to have the answer.

Khakpour’s story is riddled with medical bias. When initial symptoms of Lyme manifest in various ways – with insomnia as her first major indicator that something is wrong – doctors jump first to mental health diagnoses: hypomania, depression, bipolar disorder, etc. Almost every symptom comes with its own medication. Some drugs are prescribed to temper the side effects of others. Many lead to dependence and addiction. Throughout her treatment, healthcare professionals dismiss her when she suggests her symptoms may have an underlying physical cause. Many of the experts she sees believe their course of care will be the solution for Khakpour. Most of them are wrong. This experience is not specific to her story but serve as an example of systemic bias against female patients. “Women suffer the most from Lyme,” Khakpour writes. “As doctors often treat them as psychiatric cases first… Women simply aren’t allowed to be physically sick until they are mentally sick, too.”

When she finally receives the official, CDC-level, Lyme diagnosis, she continues to face skepticism from the medical community. After a car accident, an ER doctor smiles weakly when she mentions that she has Lyme. She recalls, “I’d tried to avoid this hostile world of hospital rooms and doctors’ offices for years, but it haunted me…It amazed me…that I could still be in this position – helpless, crazy-seeming, confusing, inconvenient, out of their norm, a problem.” With the diagnosis, it is expected that there may be hope for an end to the condescension and skepticism. Instead, she realizes that to many she is an inconvenience, that some patients are to be questioned not comforted, and that there is little she can control, despite being the person who knows her own body best.

Sick is, in a word, overwhelming. In breaking down the lines between the physical, mental, and structural components of health, Khakpour uncovers the enormity of what it might mean to make someone truly well. Physical illness cannot be reduced to a moment of contraction or diagnosis. Instead, it is the thousands and thousands of dollars paid to determine, after nearly a decade, an underlying cause. It is the emotional toll this amount of money takes on those paying it, on a family whose hopes for life in America were wrapped up in “health and wealth.” It is the complexity of family relationships and the dependence on romantic ones. It is the yearning for home in a relationship and the heartbreak that comes from being “the brown girl rejected by the white prince.” It is the emotional burden that drums up physical illness, the insomnia that spurs addiction, the helplessness that leads to suicidal ideation. It is the doctor’s dismissive doubts and the patient’s worst fears.

Khakpour’s account is not one of undying hope. It is not an inspirational tale of ultimate triumph after great adversity. In the end of the book, which she emphasizes is actually the middle of her journey, she struggles with a Lyme relapse. She does not hide the truth – that illness cannot be separated from identity, from financial situation, or from place and global events. America is a sick country, full of many sick people. All we can do is try to understand what it might mean to be well.