The rest of the paragraph isn't literal, so I assume this isn't.

I wondering which part you felt was not literal. I am fairly sure that

The man is a licensed doctor and an American citizen

is the case. It is really hard to lose citizenship, and if he is not a doctor he certainly sounds like one.

he could have moved to any town in this continent-sized country

I think you might have a point here, as "continent-sized country" seems like an exaggeration, as the US is only as big as the smallest continent, but this seems like a quibble.

married a big-tittied nurse

Doctors marry nurses a lot.

bought a house,

This is probably achievable in every town in America, outside the biggest of big cities, for a local doctor.

Am I missing something?