Good afternoon ladies and gentlemen. My maim is kechi hample ton cure ray tosser history at the Wisconsin Veteran museum in madison. Thank you for joinings us today. As this wisconsin book festival Event Features author john and hiss new book crossing. I would like to thank the Madison Public LibraryMadison Public Library foundation and all of our responseses for helping make this incredible celebration possible. Before we begin, please take a moment to silence our mobile devices not to interrupt the presentation this afternoon. As you attend book festival events spread the word about wonderful opportunities with otherses by sharing your experience using the hashtag wi book fest in your social media post. Also following this afternoons talk mr. Will be signing copies of his book copies are available for purchase at the vend or tables just outside thed a auditorium he received his medical degree from mayor medical school in rochester, minnesota and mfa degree from Ashland University in ohio. He served as combat physician and flight surgery for u. S. Army and completed three combat tours in iraq. His writing has appeared in the best american essays, river chief, and other literary journals. His most recent work crossings, is a memoir of an improbably powerful drawn live in poverty on united reservation in wisconsin that grew by force of will to encompass a medical practice rainers and emergency physician his this for intensity led him to volunteer in war torn bosnia, and to join the Army National guard. During his tours in iraq, he was involved with everything from saving soldiers lives to organizing the joint u. S. Iraqi forensic teams packed with identifying the bodies of saddams sons. Suffering a stroke upon returning from iraq, john spent years recovering impeded by near unbearable pain and overcoming limit of his body and mind john repaneled his own capacity for renewal and change and found healing in his writing. Wisconsin veteran museum is the states memorial dedicated to preserving and sharing the stories all of the men and women are from wisconsin who served in armed forces the opportunity to hear the stories directly from the veterans themselves is especially powerful. Is therefore a special pleasure for me to welcome forward Wisconsin Veteran john. [applause] thanks so much for thanks for coming and i want to thank had the book festival for inviting me every author who pans one of these books look for an outlet to tell their story. And i appreciate it. I really do. Well, im john, im a medical doctor. And im a retired u. S. Army flight surgeon. Im going to take you bag a little ways my story began in in a preface in 1885. You say whats that got to do request today . Everything. My grandfathers name is levi elm he had what i consider the First Crossing in our family in our native american family. He was assigned to the Carlisle IndianIndustrial School in 1885 he used to be there five years. He didnt last but one year. And he was discharming haded and im reading from official discharge dt of the Carlisle Indian school. June 23rd, 1886, he was assigned to become a brick yard worker. This was his First Contact request sphan i Indian Education when they discharged him theres a discharge notice here and theres a word in that box the reason for discharge is the word worthless. My grandfather was deemed worthless thats the First Crossing. His First Encounter with a nonindian counterpart. I go forward some 30 years to my mothers encounter with same educational institutions not at carlisle but at the bethany end in mission a school in wisconsin in whittenburg in 1921 at the age of four year old she was taken from her parents to that school. And if you you can look this up on goggle on the roster that school the first two nails in 1921 were march imret and Lewis Margaret that was her First Crossing in a nonIndian Education. She went through about the 6th grade six or sefnght grade equivalent that she came away with skills of a house worker a domestic cleaner, a dishwasher, a person who could vacuum and take care of households. She used to grab me by lapels when i was in junior high and high school and she would say johnny youve got to get an education. And i would say yes, mom. I had in mind that i would become a doctor at a very young age. But what she meant by becoming educated was going to the army and gaining the skill like so many other people in the 50s did. So when i did graduate from high school i was the first in our family to make that crossing right there into again, yet another encounter with nonIndian Education. And if youll look at the roster from the graduation roles of the male medical school in 1988, there youll find my name so we go from grandfather to mother to son all making these individual crossings. And only reason are i bring that up is kind of put this into cultural perspective. Its often that we we think of our lives in terms of our history. And ive had an opportunity to do that so much. And i appreciate those early crossings those early frontiers if you will that my relatives made. So lets move forward. I become a doctor. I join the it army i go to traig i become a flight surgeon. I go to iraq, i serve three tours there. And i have the opportunity to encounter war at the most details i also encounter opportunity to save lives, i do get injured. I come home and during that process is when i have my stroke. Im ten years removed from the onset of that troak so im a tenure stroke survivor. This summer the book i wrote actually was written it started as an experiment at the Veterans Administration rehab program. Vocational rehab they werent so sure what minor rehabilitation should look like as a senior officer in the military because they never had that many Senior Officers with a debilitating career changing injury. They said well lets think about this it was very clear i couldnt go back to medicine. But it was clear i had to do something i was only 57 years old at the time. So they said, well lets try writing. I said well wait a minute at the time my neurologically tested reading, speed comprehension was at the 30 so 90 of the age match read better and faster than i did. I came from reading ability of a doctor of aingses. And i practiced dr medicine so everything i read and did had had to be very quick all the way down to rd percentile i struggled with books like charlottes web. I did read that and first tile i read it after my stroke was very confusing for me. Well the v. A. Said no mind lets use your army spirit. [laughter] and your willingness to overcome obstacles and lets try it. I said yes lets try it. Why not . Im game. And i went off to get an mfa in writing. It was difficult. First day i felt like, you know, this senior on skis on the ski slope and all of the kids are going arranged me and flipping uturns and skiing backwards there was Educational Frontier i did not cross and did not know what to do with. So what i want to do is take you through two or three small readings to have plenty of time to deal request questions first im going to take you to war and what i do as a physician there and im going to bring you to the brink of stroke. Im going to read a piece called triage and this was published in best american essay in 2013. Im with a twostar general john eddy a marine general, and were visiting the hospital in bgdz its an Army Hospital that we set up and its right after a series of ied attacks in baghdad and theres a number of injured people there. We walk from the icu down the hallway to the triage room. Onefacient lay in a bed, a young soldier a private first class he had a ballistic head injury elbows were flexed tightly in spastic tension drawing fore articles to his chest. His hands made stone like fists and his fingers coiled together o as if grabbing an imaginary rope attached to his sternum he breathed in a slow pattern he had no oxygen mask. And intervenous line fed saline and painkiller he was what is known in military medicine as expectant. Some of his fellow soldiers gatheredded a foot of his bed except for the captain they were all young with like the patient late teens early 20ss. A tough they will had sustained injuries in same ied attack and already been treated and bandaged in emergency room. They stood watch over the expectant patient. One soldier had a white body salt edging the collar of his uniform. One wept, one prayed. Another quietly said jesus other and over shakes his head yet another had no exregulation at all and stared into empty space above the expectant patients head a young start handshaking stammered as he tried to explain what had happened. The captain in charge of the expectant soldiers unit told the general and me that this was their first soldier killed but then he corrected himself and said this was the first soldier if this their unit to be assigned to triage. He told us that the soldier was a good soldier. The generalled toed in agreement and the room was suddenly quiet. Then the general laid his hand on the expectant sol jr. S leg the leg who strength i imagine was drifting like a shape shiftings cloud moving against the dark lumber sky treaty into the time before he carried a young soldier into war. And i watched the drifting of a man back into the womb of his mother drifting toward a time when a leg was not a leg. A body not a body. To a time when a soldier was only the laughing between two young lovers who could never imagine that a leg, body, man soldier would one day lie expectant in that soldier would be their son. As i watch the soldiers at the foot of the bed i noted their worn faces hallow stare, eyes i watched them watch the shallow breathing the spasm of seizure limbs. And the unnatural gray of expectant skin. I took clinical notes in my mind, i did this when i needed to separate myself from the emotional impact of seeing the critically wounded. I noted the soldiers noted the patient, i know the all of the things that need to be noted. The size of the triage room, the trail of the bed, tile the ceiling the dullness of the overheadlight. Noticed the draw of the white linen seats in the shiny polish melts of the hospital fixtures. The single ceiling fan rotated slowly. The walls were offwhite there were no windows. The floor was spotless the smell an septic wool army blanket covered each bed. Three beds lay empty. I noted the absence of noise, the absence of nurses rushing to prepare a surgical instrument and absence of teams of doctors openly wounds and calling out orders. There was an absence of the hurry sounds and hustle of soldier in combat emergency room one ploor down. Nobody yelled medic or dock, nobody called for the chaplain. Medics did not cut off clothing or gatter dressings, ambulances and medevac helicopters did not arrive with bleeding soldiers. The book emergency war surgery, the militarys bible of war medicine defined tree i can of assignment patients to four based on severity. Minimal, delayed immediate, expectant. The assignment to the category meanses soldier has no livelihood of survival. And based on a single indication a physician has decided to withhold medical treatment. On the surface the ultimate cost of that decision is a soldiers life. One decision, one life. Perhaps even several lives but there are other costs not too easily calculated like emotional cost of survivors or the psychological tole on soldier who is make that triage decision textbook slengt on how they prepare for, react to, the demand of making triage decisions. No chapter in a military textbook instructs combat doctors in the multidimensional complexity of that decision. There are chapters on why triage decision must be made and chapter house to apply establish criteria in making those decisions, however, however, what to do next after making the decision is never covered. And that vacuum of knowledge leads to exposure and vulnerable neither tolerated or wore. In the process of making notes about the expected patient i paused to move closer to the bed. I put my hand own patients leg as general had done. I laid it there. Let it linger from what i stood i directly into the expectant soldier face and i watched his breathing. Along side breath followed by the absence of movement followed by three to four shallow breaths i matched his breathing with my own. I climbed slowing pattern with my watch, i made mental calculations and then looked away once again i noticed quietness and whiteness of the walls. I noted the empty beds and the ceiling in the antiseptic smell. Begun i watched the expectant soldier who was oblivious to all of my watching i stood at the triage bed thinking if this were my son, i would want sol jr. S to gather in his room and listen to his breathing. I want them to break strides perhaps to e weep perhaps to pray, and if he called out for his dad i would want one of them to become a father to my son. Simply that nothing more. Nothing less, procedure not written in defense man yule or war near rei class or triage exercises. A finally moved to head of the bed to place my right hand on his had chest my hand rested there with barely any movement. I turned to the other soldiers and gave them an acknowledgement with a slight upturn purse of my lips and then looked away. I lifted my hand to the patients right shoulder, let my weight shift as if trying to hold him gently in place. I half kneeled the half bent, closed the distance between our bodies. I noted the fabric of his skull cap dressing and the blood that tainted this white cotton ins, i prayed for god to take him in that very instance i wise whispered so he would hear youre finished here youre a good soldier. Its okay to go home. I saw face of my own son in his and i was glad they were not soldiers. I finished stood up, walked to the foot of the bed, and one of the soldiers asked me if there wasnt something i could do. I said no i meant no. I want my answer to be yes. I face the captain and put my hand on his shoulder. Told him that we were finished. That his soldier did not feel any pain. That he would be gone soon, and that had everybody had had done o everything they could. The tone of my voice was neither comforting nor encouraging. Neither sorrowful nor hopeful it was as i remember military and professional the captain said yes, sir to the things i said. And the way i said them things i said had their pace and rhythm they flow Like Movement of triage itself shaped by the needs of survivors after a few moments of silence the general and i quietly left the triage room in the hospital. I remember that expectant patient so often after our hospital visit. I knew i would see his name in a chop the chart or told his name by his commander. I didnt take time to write it down anywhere and that bothered me e it bothered me because as weeks and months went by he had remained nameless like so many other o soldier patients i encountered. And that namelessness seemed like a form of abandonment for which i felt personally responsible. I understand a professional sense that the patient was not abandoned. That his triage was purposeful that it provided accent to medical efficiency which ultimately saved other soldiers lives. But i also understood that the theory of triage quickly eroded confronted with the raw, Human Emotion of sorting through wounded patients and assigning them to triage categories in my mind, the theoretical and practical waged a constant battle. So that whatever i participated in a triage decision part of me said yes. And part of me said no. Well we move on from the hospital i move on from my first tour. I do two more tours of duty in iraq. And i see many more images and voices like this many stories of the same nature. I get injured somewhere in my third tour, and their all or injuries from a missile that went off nearby. Medevaced home and i have a year full of recuperative srming and 1 srngs in 14 months something is like that and at the tail end, i i get my Fourth Mission assignment to afghanistan but before we can marshal up enough recovery to go, its discovered i have a brain aneurysm at base of my brain. And its big enough to be worrisome, a small enough that we didnt have to operate needsly except for the urgency of returning to battle. So we have to make a decision, and the commander in charming of me, my medical officer says what would you do with a similar patient . I said well i would have to say youve got to get the thing fixed. So we choose the least invasive safest rout to get into the brain its i understood Vascular Surgery put a coil up in aneurysm and hopefully that causes clot and scar and theres no chance of rupture. That has to be done before you go to the field. Well did that and there was air bubbles interested in the catheter system from the top of my brain to the brain stem so when i woke up i didnt know who i was and i couldnt feel my right side, and through a turn of events, of course, then and followups over the ensuing weeks, it was decided that my fourth put on hold now [laughter] and my medical career was put on hold. I was a bit of an adjustment as you all might panel. Imagine we went to Stroke School as i call it stroke therapy now im an er doctor. My span of er knowledge in medical engine about 15 minutes long. 20 if you push it. Im the the right guy, im the right doctor if you need that 15 minute doctor. Which the span of time in terms stroke rehab years and years and years. When i went to medical school i trained under this old who said this when you get your stroke, we do physical and speech re. Rehabs theres not a lot of other things we can do for cognition. And patients were told this very thing that about one year out from the initial incident of the stroke whatever you have is function is basically what you have. Youre not going to gain much more so you have one year. Now that was told to me when i had my stroke and own army doctor said ill never use any arm again ill never think again. And i certainly cant be a medical officer in the military or a doctor anymore. And this was at the one manyyer point and i said that doesnt sound very hopeful but rather dismal and something inside me and ill call it this ill call it personal resilience that i learned from my mother who learned it fr