Gentlemen. My name is Kevin Hampton and im the curator of history at the Wisconsin Veterans Museum here in madison. Thank you for joining us today. At this wisconsin book festival event featuring jon kerr setter and his new book, crossing. Id like to thank the madison public library, the foundation, and all of our sponsors for helping make this incredible celebration possible. Before we begin, please take a moment to silence all mobile devices so not to interrupt the presentation this afternoon. As you attend the wisconsin book festival event this year, please help us spread the word about the wonderful opportunities with others by sharing your experience using the wi bookfest. And mr. Kerstetter will be signing copies of his become. Copies are available for purchase outside the auditoryup. Its my pleasure today to introduce to you, author john kerstetter, dr. Kerstetter received his medical degree from Mayo Medical School in rochester, minnesota, and his fma degree with from Ashland University in ohio. He served as a combat physician and Flight Surgeon for the u. S. Army and completed three combat tours in iraq. His writing has appeared in the best american essays, river teeth and other literary journals. His most recent work crossings a memoir of an improbable by powerfully drawn life that been in poverty on the denied that rays sir Oneida Reservation but encompasseses a medical practices. He is thirst for intensity led item to volunteer in war torn rwanda, kosovo and bosnia and to join the Army National guard. Dishis tours in iraq he was involved in everything from saves soldiers lives to organizing the joint u. S. Iraqi Forensic Team tasked with identifying the body of saddam husseins son. Suffering a stroke upon returning from iraq, john spent years recovering, impeded by near unbearable tame and complicated be tpsd. The hospital that we set up. Right after a series of attacks in baghdad. We walk from the icu down to this triage room one patient lay in the bed a young soldier the private first class. He have a ballistic head injury. His elbows were flexed tightly drying his forearms. To his chest. His hands made stone like this and his fingers quelled together as if grabbing an imaginary ropein he have no oxygen mask and intravenous online sent us line set so low drip of a painkiller he was what was known in military medicinein has expectant. Some of his fellow soldiers gathered at the foot of his bed except for the captain they were all a young like the patient late teens early 20s. A few of them had sustained injuries in the same attack and have already been treated and managed in the emergency room. One soldier have all bit of body salt. One wept one prayed another quietly said jesus, over and over. Breaking his shaking his have from side to side. The other had no expression at all. A young surgeon hands shaking stammered as he tried to explain what have happened. The captain in charge of the expectant soldiers unit told him that this was the first soldier killed but then he corrected himself and said this was the first soldier in their unit to be assigned to triage. The soldier was a good show soldier. The room was suddenly quiet. And then they laid the hand on the expectant soldiers leg. The leg whose strength imagine was drifting moving against the dark sky. Retreating into the time before he carried a young soldier into war. Back into the womb of his mother. Drifting towards a time when the leg was not a leg. A body not a body. A time when a the soldier was only the lasting between two young lovers who could never imagine that a leg, body and man and soldier would one day lie expectant. And that that soldier would be their son. As i watched the soldiers at the foot of the bed i know there trembling mounts. The eyes i watch them watch this shallow breathing. And the unnatural gray of expected skin. I took clinical notes in my mind. I did this when i needed to emotionally separate myself. I noted that the soldiers and the patient. All of the things that needed. The tiles of the ceiling and the dullness of the overhead light. I noticed the taught draw with the shiny polished metal. A single ceiling fan rotated slowly. There were no windows. The floor was spotless. A drab green blanket covered each bed. In the absence of teams of doctors opening wounds and calling out orders there was an absence of the hurried sounds. One floor down. Nobodybo called for the chaplain they did not gather dressing. They did not arrive with soldiers. The emergency surgery for in the treatment based on severity. Assignment to the expectant categoryan based on the single calculation. On the surface the ultimate cost of that decision was a soldiers life. One decision, one life there are other costs not so easily calculated. Where the psychological toll on soldiers who make that triage decision. They react to the demands of making a tree has decisions. No chapter instructs combat. There are chapters on my tree has triage decisions must be made. However what to do next after making the decision is never covered and that vacuum of knowledge knowledge leads to that. In the process of making notes about the expectant patient i paused and moved closer to the bed i put my hand on the patients leg just as the general have done. I let it linger i stared directly into the expectant soldiers face. Alongside breath followed by the absence of movement. I matched his breathing with my own. I timed the slowing pattern with my watch and once again i know the quiet in this room and the whiteness of the walls i noted at the empty beds b in the ceiling in the antiseptic smell. Oblivious to all of my watching. In i stood at the triage bed that if this is my son i would want soldiers together in his room and they will break strides from the rope war routines. And if he called out for his dadd i would want one of them to become a father to my son simply that nothing more nothing less procedures not written in department. I finally moved to the have of the bed. My hand rested there with barely any moment. They give them an acknowledgment with the slight upturned person. And then looked away. I lifted my hand at the patients right shoulder. Ft has of trying to hold him gently in place i had nailed and half bent and closed the distance between our bodies i noted the fabric of his skullcap dressing in the blood that tainted the white cotton edges. I whispered so only he could hear you are good soldier. Your finish here its okay to go home. I saw the faces of my own son in his and i was glad they were not soldiers i finished, stood up and walked to the foot of the bed. One of the soldiers ask me ifnt there was something i could do. I said no i meant no. I want my answer to be yes. I faced the captain and put my have on his shoulder and said we are finished and that his soldier did not feel any pain. The tone of my voice was neither comforting no nor encouraging. It was as i remember military and professional. The captain said yes sir to the things i said in the way i said them. In the things i said have their own pace and rhythm they float like the movement of the triage itself shaped by the need of survivors. After a few moments of silenced they quietly left the triage room in the hospital. I remember that expectant patient so often after the hospital visit. I knew i have seen his name and hospital chart or was told his name by his commander. I did not take the name the time to write it down and that bothered me. It bothered me because as the weeks and months went by he remained nameless like some the other soldier patients i encountered. In that nameless nest seemed like a form of abandonment for which i felt personally responsible. Oror that is triage. It provided the accent to medical efficiency. The theory quickly eroded when confronted with the raw Human Emotion of sorting through wounded patients into signing and assigning them to triage categories. In my mind the theoretical and the practical waged a constant battle so that whenever i participated in a part of me said yes and part of me said no. Will, we move on from the hospital. I move on for my first to her. I did two more tours of duty in iraq. Many stories of the same nature. They are all orthopedic injuries. With a year full of recuperative surgery. At the tail and we get the Fourth Mission assignment. Before we can marshal up enough recovery to go. It is discovered i have a brain aneurysm. A it is big enough to be worrisome but small enough except for the urgency of returning to battle. M the commander in charge of me said what would you do with a similarr patient. R we choose the least invasive and safest route to get into the brain. Hopefully that causes that. There is no chance of rupture there was a vascular accident. Enter a turn of events it was decided it could be put on hold now. As you might imagine. The medical knowledge about 15 minutes along 20 if you push it. And the right guy for if you need that for 15 minute dr. What is the term dash the amount of time. When i went to medical school i trained under this old paradigm that said this we do physical and speech rehab theres not a whole lot of other things we can do for cognition. And the patients we are told this very thing. About one year outut from the initial incident of the stroke we are not going to gain much more. If one year. That was told me. I will never sink again. And i certainly can be a medical officer. It was personal resilience that i learned from my mother that learned it for my grandfather. You have to push. They were not that i was can go to college. In order n to do that was education and skill. When that was taken away from me all i could think was have got a fight back somehow. Ive the right scope team in terms of the university of iowa a in the va and early on they said outpatient therapy is not really working. All of the therapy you can get. I went off to st. Lukes. They specialize in acquired brain injury. They do all of the recovery work there. Off we went. After the stroke i had fallen several times some of the battle injuries. And reinjured my cell. And then i will invite some cure. Q a. I difficulty with ongoing painn sometimes it hit me like the sudden rip of thunder just a frightening boom and a shaking of the earth. Other times it started like a dandelion seed or shooting down on a puff of wind its weight no more than the head to heft of the childhood memory. It felt like the tiny barbs of the road leaf. They tried to choke it off but usually i let it fly. If it started like a seat it was tolerable at first. The pain festered and bruce. Just after lunch i therapy assistant knocked on the door. No access smalltalk this is the beginning i think i respond to her with a single word okay, she helps me to the wheelchair and off we go. As we roll the hall we grow. Like a scene from alice in wonderland. Im off to my first therapy session and in my head im a perfect storm of anxiety. I hope that my therapy will provide exactly what i need to get i fear it will provide nothing at all. I noticed the doors of the patients room as we pass them. I joke that i need oil and i laugh just a bit. She chuckles in return. Fifty i think. But the number is certainly if you are. Its over half the room. The other half is covered with parallel bars. She parked me just inside the room next to the other patients. Her skin is pale. She is an obvious head injury. Maybe a beehive. In near the opposite. She refuses to get out of her wheelchair. The patient lets out a string of curses. And tells a screamer that the screamer that she can cool down. The therapist said nesting and walks away. They went to get me. Helps me take the table where we sit and we go over my schedule of exercises for the day. Im ready to go. Anxious to get started. Yet also intimidated. May the layer and the imaginary wolves. She instructs her therapy assistant to grab a gait belt. I dont need one. She said i do ifer i want to do therapy. I can tell she takes no prisoners. Gait belt on my waist they help me to my feet. Just a short walk and tighten your stance and look up. Breathe. We need you to relax. I bring my feet together and i take control of my body. At the end of itsg at the end of its they each take hold of my belt. I take one step i make a wild gyration. Lets try again. I make a concerted effort to watch my feetth and think of every step cindy puts two figures under my chin and pushes up. Look up she says. No nowhere to go. I need to watch my feet and counter. I think she is using trust my feet. Who ever heard of that. We start again and i managed to walk maybe 20 feet with the therapist holding on i weve ends that are step as she encourages me to keep my had up. And breathe. I turned to look across the room and crash. Concentrate cindy says. All of the activity going on around me on that drilling have injury patient. The layer, the high. Ive never seen anything like it. More screamers emerge who i have not noticed at first. They are more reserved in polite but still in and getting over giddy over something and there therapy. An other patients like me walk to the rhythm of theirs their pest. M some do quite well. Others not so much. One patient cannot walk a single step. Another is hooked up to a computerized treadmill. He has one prosthetic leg i think he might be a soldier also. But i dont ask. The therapist look like they dont take crap. They keep pushing they might pause but they dont stop. And as i take my first walk in my first hour of therapy at st. Lukes i wonder about the kind of patient i will become. Y the therapist knows my room number. With a set of orange cones just as the previous how patient has done. And then on along. Up and down and practiced with the stairs. Over and around the tiny obstacle on the floor. A piece of paper as bill of water. I wobble and weave up and down. I walk until i think walking is overrated after 30 minutes cindy says its time for some balance routines. That was gait chain training. Balance is different. I fall again. Its like being drunk without the booze. Ci it doesnt help. I graduate to the balance beam and gymnast balance beam six of the floor. Am i supposed to walk on it. Were here to hold you up. Your left foot first and then youre right. As close as i can get them. My left foot goes first. That is good cindy says. Tried again this time remember to breathe. When i am ready im supposed to lift my right foot onto the beam. They start putting pressure on my belts. Ge that is a sign. The pressure its time to move. Im not ready i protest. She is not stern just clinically pushy. I raise my right foot onto the beam and all of my weight is there. She gets a three and halfde before i fall in the country. After one more she has me practice the balance beam. Its easier for my balance but not nearly as threatening as the beam. I watch the other patients. The screamer has done back to her room. Im glad. I want to redo. And when i am finished with the days and weeks before me i shall walk out the store of this hospital and onto the thin mantle of the tenuous life. Let me just read one more to follow section and then we will turn to q a. I did not make the functional gains i expected. I made chris clinical progress and it was visible and meaningful but it also established that my recovery still remained a work in progress. Hospital based therapy had mproved. Force me to confront those deficits in the real invitations that they exposed. During my speech i have come out to realize that my patterns of thinking were not just impaired they were broken. And no amount of inpatient therapy was going to repair that damage. That was my greatest lesson in my greatest disappointment the double edge sword of inpatient therapy it made me clinically and emotionally aware of exactly who i have become. Y. In a few short days would go home from st. Lukes not as that imagine patient with his dr. Skills are fully fully intact and his mind sharpened as the real person his fears have become concrete i would notso emerge from therapy with all of the recovery i dreamed yet i was not a therapeutic failure. I was simply and profoundly a stroke survivor. So, that was about a year into the st. Lukes nine months after my stroke. As i said i would onto vocational rehab to learn how to write. I started the writing of this book while in my studies that was seven and half years ago. The summer. So in the first two years the writing as you can imagine was something i was not used to. Used to make this flaw. I wanted to write meaningful profound things so i did. And they were terrible for those of you who right here is a freebie he said could train right meeting write sentences. Closure essay and put it down. And tell us of the episode. Toss what happens. I would describe the triage episode. And it brought everybody to their knees. Its like the teenagers i dont know. I did learn. And i hearkened back into the tree and have a medical school. You observe, interpret imply. What does the nurse do to the patient. You tap, you touch you feel. You listen to their story. And in all of that youve gathered data and information you observe the finite and the smallest details of human pathology and when you are done with that and only when youre done with thatfo do you make the step called diagnosis or meaning what does it mean. What does the color of the lesion mean. When i applied the same thing to writing i could describe the color of the sand the sound of the wind and my own i used to write more in my first blocks i was able to spend 15 minutes no more. By the end of the seven year time i was able to spend over four hours it was phenomenal. What were doing today is we are trying to look at what happened in that kind of therapy here is what we surmised in and then it will turn it over to you. What does an injured brain need more than anything else. What is the brain do. It thinks, it sends signals. In the thinking brain needs to do exactly that. But what does writing too. It requires the patient to think. Over and over. And that is what transpired over that time and at the va when we measured my reading diility it went from two or 3 to 4 in one year. Then it went up about the third year in we measured my reading capacity again. I went to grade level 5. 3. And now we just measured the summer and about 70 on some of my tests 30 on others. Im only 30 on that scale. I will entertain your questions go ahead. Jump right up there and use the mic. I am halfway through your book and i am just blown away by your life. When did you realize that you had ptsd. And how do that when did i know i had ptsd. When i deployed i was almost there a year. We did not do a lot of testing in the military at that time. We did it quite a number of soldiers who have some civil incidents. By the second tour we screened everybody. It was at that time that i said yes you test positive for it. Any but it goes to war and spends any amount of time there is can be positive. When i started my stroke therapy and then i went to st. Lukes. And that va took it over. Ed there was a neuropsychologist there who said it we understand your screen drug i revolted against that diagnosis. I did not understand it as a physician. I will give you the military paradigm. Thats what soldiers think. They dont want to be branded. You say that to a soldier that has a connotation to it. Is not true of course. But it still has a connotation. And believe it or not there are careers that are ended over that diagnosis. Into their credit at the va they work with me and said okay. But lets just go to some therapy sessions which we did and overtime in about a year i finally came to agreement that yes i agree. I do write about that in the book. And the one thing i have to confront which was very difficult for me and i will tell you briefly. I would have these nightmares. Ill get tangled up in the sheets. , i thought i was fighting someone. I would turn over and i would pummel my wife with my fist. Is difficult to say. She understood it i did not. As a clinician i did. But there is a difference between havinghe in a clinician in the patient. I denied that i have a stroke even though they would show me the evidence. And they would say things like put your finger on the brain lesion. My heart would swing sink. I knew that was me in there. , and on up to the mic and go ahead. My husband have a minor stroke about a year and a half ago. And he was told that what you have after you. Theyre still telling us that. If it were i would not be here. You bring up something out something very important. And here it is. Im i do discusses in the book. Thats obviously not true in my case. I would walk like this. Hes to take a stance like that. I didnt have any balance. My muscle went all the way down the bone. If you try to have a conversation me ten years ago you would not get much. He would say whats wrong with this guy. Now those things we challenge through therapy and hard rigorous therapy. What we have discovered in my own caseer and now is making this leap and say it must apply to other cases. As much as you can get. Right away in you have to use the brain over and over again. And then you see the changes. Now, heres one here is one of the issues at the va will bring up. In the army. Theys. Wrote a check to st. Lukes. Up i probably had 90 tank 99 times more therapy than youll ever get. How much therapy do you get on medicare. Its pretty short. Its not years. Its literally weeks and months. So you fight that kind of battle. Yit therapeutic plateaus simply meet this. You reached your plateau and youre done. What happens if you go from three to 4 . An i think i can read faster. Lets keep going. Lets do more therapy then. I ask for more and i pushed for more. Th and you wobble. Do you really overdid it. Youre up to 4 on your reading. Theres no more. The alternative for me as a dr. In the survivor and someone who pushes boundaries and makes a lot of these crossings was this. Im either can sit in the chair and drool like so my patients i have seen i have to get on the horse and keep writing. N i know idea that i would be here today talking about a book that i wrote. That was not predicted at all. The only thing that was predictedth was every time i showed a gain got to be two years and three years and four yearss only until last year did i get to 60 and 70 percentile on some of my brain function. Now, every year for ten years weve had a therapeutic plateau. It does not mean that son some wines are not hard. I cant think fast i used to practice Critical Care medicine. Could i maybe do it really is not good enough. H. That when you are the have of the table and someones life depends on whether your memory works or doesnt work. There are hard lines. When a soldier uses loses two legs in combat. I will say i can dig you some prosthetic ones. But there are some limitations. Can you talk a little bit about that character traits that you have. T it comes down to one basic one and thats resilience. Somehow in some way she was able to see i cannot quit because if i quit there is no survival. My mother was a depression agent teenager. Now if they quit what happens. Its either quit trying or die. She ended up workingng for indian school. The only job she could get off the reservation. She works worked for 75 cents an hour. And then she scrubbed the floors and mopped kitchens on the weekends. We used to live in that gas station house. I would peer out the window when i got up at 630 or 730 in the morning. And she would be out there. There is a big patch of weeds out there. She harvested. I saw that when i was little and it kind of have an imprint and it said you got to keep going. Eve got to try. You got to work. If it wasnt for her. Even though he got kicked out of carlisle. He could farm he could lumberjack. He did anything and everything to keep his family is solid and surviving. And as a history of our tribe. An i think it is that in the nutshell. We may have one more quick question. Come to the micic i will be hanging out around outside. While i was waiting downstairs. I wonder how that affected your care of trauma patients in the military. If you went back to that time and use it at all. Ou on the reservation. And then they said there are two words this will be fun. I climb on a board and he pushes it around. Of course he runs into a stick and the thing stops and i go unflying. I stick my hand down in the blades. I got the scar rate right here to prove it. The next thing i remember im there and im bleeding. I will look at it. This is not good. The next thing i know my motherod has got me in the house and she rushes me off to green bay. And the surgeon repaired the arm. And it made another imprint. N a weve got to do that all i remember was he was very good and is very kind. I will type this one little story. We went around. And she took me to a healer. Not because i was sick but just to visit. W he motioned me to come over. B i want to be a dr. He pulls the medicine bag out of his pocket. And grabbed some tobacco and rubbed on his hands. And we leave. I asked my mom he was praying that your hands would do good. Man, im a dr. I remember that. My graduation day. I pray that your hands would do good. And i said to myself they will. [applause]. The journalist daniel golden. The National Security agencys established espionage