Nursing Book Club
Everything Is Tuberculosis by John Green
The History and Persistence of Our Deadliest Infection
John Green is best known as the author of six novels, including The Fault in Our Stars. His newest book is a nonfiction deep dive into tuberculosis, a disease that he says reveals “the folly and brilliance and cruelty and compassion of humans.”
Green’s interest in this subject began with his great uncle Stokes, who died of tuberculosis in 1930, at the age of 29. At that time, the best of care was basically supportive: good nutrition served in mountain locations. In 2019, while visiting a hospital in Sierra Leone in support of the nonprofit Partners In Health, Green met a young tuberculosis patient named Henry Reider, whose condition wasn’t improving with treatment. Physician K.J. Sueng explained to Green that with access to proper medical care, no one in the world would ever die of TB today. That became the core idea of this new book.
A Nonfiction Narrative
Everything Is Tuberculosis isn’t a standard history or science book. Rather, it’s a nonfiction narrative tracing what we know about tuberculosis and how we’ve learned it, going back to ancient Egypt. Tuberculosis, also called phtysis or consumption, is the main character; the plot is the journey to eradicate it.
It took centuries to discover and understand the elusive tuberculosis bacillus. Some people with TB can harbor the disease in latent form for years without problems, while others become very sick with “active” disease, which can be fatal.
A tuberculosis vaccine for children, BCG, has been available for over a century. Starting in the 1940s, it also became possible to treat TB with streptomycin. Chest X-rays can detect the disease before it becomes symptomatic, and there’s even been some interesting work on using rats to detect TB. In other words, tuberculosis is now preventable, detectable, and broadly curable. Yet, since the ‘40s, another 150 million people have died of the disease.
In 2023, there were almost a million cases worldwide, including 9,633 in the U.S. There are still many barriers to TB prevention and treatment, including the stigma of chronic disease; the ease with which it can spread in crowded environments; limited access to care; the reluctance of Big Pharma to invest in this area; and insurance companies’ reluctance to pay for it.
Treating TB with antibiotics involves a lengthy, complicated schedule of three drugs, which have unpleasant side effects. Directly observed therapy is often used to enforce adherence, since the tuberculosis bacillus can otherwise mutate into a multiple drug resistant strain.
Disease from a Dickens Novel
As a public health nurse, I once had to stop at a TB patient’s house every morning to watch him take his medication and then deliver his sputum samples to the lab at the county hospital. His antibiotic regimen actually took a year and a half, but I only observed him for two weeks. From then on, he was on his own to get his prescriptions refilled and lab specimens filed on time. It was a dodgy, precarious situation.
We often think of TB as an anachronism — a disease that characters die of in Dickens stories. If you don’t work in public health, you might assume it was cleared up long ago. It should have been, which is exactly the point of this compelling book: Unless we do the collective work to finally eradicate tuberculosis, we will continue to have pockets of this deadly but preventable disease.
Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection by John Green (Crash Course Books, 2025)
CHRISTINE CONTILLO, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics. She enjoys volunteering for medical missions.
In this Article: historical epidemics, Public Health, Tuberculosis
