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 from my grandfather. That you have to push. You have to survive. Now the survival mantra of my mother in the 20s to the 50s was what . Work, work, work, work. Hers was not ive got to go to college. Mine became in order to survive the new currency of survival was education and skill. And i took it and i grabbed it and i grabbed every bit of it and when this was taken away all i could think of is i have to fight back somehow. And i had the right team of stroke team in the in terms of the university of iowa and the v. A. And early on they said well look how patient therapy is not really work but we want inpatient experience, the front end load all of the therapy we can get so i went off the st. Lukes which is a smaller hospital in cedar rapids iowa that specialize in traumatic brain injury and acquired brain youre stroke and trauma and they do it awe of the recovery work there, and off we went. And after the stroke i had fallen several tiles and i reoccurred some of the battle injury and reinjured myself so i had a lot of pain. So im going to take you on a trip to st. Lukes hospital and have shoredder reading and then invite some q and a. At st. Lukes during florida therapy i had difficulty with ongoing pain. Sometimes it hit me like a sudden rip of thund mother warning just a frightening boom and shaking of the earth. Other times it started like a dandelion seed parachuting down on a puff of wind. Itself weight no more than a childhood memory. It felt like the tiny rose leaf drawn across any skin, and when pain came hard and fast, scream bubbled from my throat i tried to choke it off but usually i let it fly like the screeching kaw of a crow. If it started line a seed it would tolerable at first maybe two or three on a pain scale of 10 either way thunder ore o dandelion pain festered and grew so in the end it felt like i was being tortured or drawn through a key hole. My pills did not work. I bit the back of my hand or cupped my ears and i was cursed by the witchcraft of pain. Just after lunch a therapy . Angt knocked on my door when i left happen open. Im here to get you for therapy she said she was matter of fact yet pleasant no con goaling no excess small talk. This was the beginning i think i respond to her with a single word okay she helps me to wheelchair and off we go rolling down a well lit hallway through the therapy bay and it grows and elongates lying a scene from alice in wonder land. Im of a to my first therapy session and in my head im the the perfect storm of anxiety and anticipation bewilderment and excitement. I hope that hospital therapy will provide exactly what i need yet i fear it will provide nothing at all i notice the doors of the patients rule as we pass them. Most are painted tan. Fists are tight and her arms contracted. He has an obvious head injury. A car accident i assume. I studied the room, maybe a beehive, near the opposite wall screaming at her therapist. She refuses to get out of her wheelchair. The therapist is working at getting her to stand, a string of curses, the therapist stopped, that wont be tolerated. The therapist rolled her over i me and my drooling companion until the screamer she can cool down. The screamer yells you are a core. The therapist is nothing and walked away. Cindy comes to get me as the screamer calm down. She introduces herself and tells me she is going to be my therapy team leader, rolled me through the room and helped me take a table where we sit and she goes over my schedule of exercises for the day. We start with shoulder work and finish speech and language therapy. I am ready to go, i say, anxious to get started and intimidated by all i see, the layer and its imaginary holes. Cindy instructor therapy assistant, i dont need one. She says i do if i want to do therapy. I can tell she takes no prisoners. Around my waist they help me to my feet. Lets take a short walk down the hall, cindy says. Tighten your stance, look up, breathe, you are tensing up, we need you to relax. I bring my feet together in gyrations, state control of my body. I am a wobbling toy top. The therapist and assistant take hold of my health. I take one step. I make wild gyration that twists me 45 off center. That is okay, cindy offers, lets try it again. I make a concerted effort to watch my feet and think of every step. Cindy puts two fingers under my chin and pushes up. Lookup, she says, your feet nowhere to go. I need to watch my feet, i counter. You need to trust your feet she countered back. I think she is using a cute mantra she learned in physical therapy, trust my feet. Who ever heard of that . We start again and i managed to walk 20 feet, therapist holding onto. I stutter step as cindy encourages me to keep my head up and breathe. I turned to look across the room and crash but my gate belt saved me. Concentrate, cindy says. I am concentrating, but all the activity going on around me on the screen, between patient and therapist on the head injury, on the others working their limbs and hands, the hive, the therapists, i have never seen anything like it. More screamers emerge i hadnt noticed at first. They are more reserved, polite but in agony over something in their therapy. Other patients like me walk to the rhythm of their therapists. Some do quite well. Others not so much. One patient cannot walk a single step. Another is hooked to a computerized treadmill with one prosthetic leg. I think he might be a soldier too but i dont ask. The therapists look like they dont take crap. They keep pushing, they might pause but they dont stop, as i take my first walk in my first hour of therapy i wonder about the kind of patient i will become as i crashed to the floor, scream at my therapist week in shame. Will i fail therapy . Will it fail me . I sense i want to run or hide but i cannot, the therapist knows my room number, my case file, my name. Cindy walks me through a set of orange cones on the floor as the previous outpatient therapist had done. We walk slowly, then fast, in a circle and on a line, on linoleum, up and down. I walk with and without my cane, a line, a crack, over and around a tiny obstacle on the floor. The shoe, piece of paper, wobble and weave like a boxer on the ropes, walk until i think walking is overrated. After 30 minutes, cindy says it is time for some balance routines. I thought we were doing balance, i say, slightly puzzled. That was gate training, balance is different, we do 5 minutes on a blue exercise ball, fall to the side and cindy catches me and we repeat, it is like being drunk without the booze. I say more than necessary. It doesnt help. From the ball i graduated the balance beam fixed to the floor with a double set of mats on either side. No way i can walk on the balance beam, no way. Am i supposed to walk on that, i squeal, my voice up an octave. We use it for balance, dont worry, we are here to hold you up. We start with one step. Your left foot first, then youre right. She has me stand on the right side of the beam with my feet together as close as i can get them. She and her assistant bold me, my left foot goes first, my good foot, they tighten their grip on my belt and lift as quick as i am on, i am off. That is good, cindy says, try it again, this time remember to breathe. I start again by standing, breathing, when i am ready i am supposed to lift my right foot on the beam. I will never be ready, never. Ipod longer than is apparently allowed. Cindy and her assistant start putting pressure on my belt. That is the sign, pressure. It is time to move. Im not ready, i protest. Raise your right leg to the beam, let it rest cindy insists. She is not stern, just clinically pushy. I raise my right foot on the beam and let it rest and all my weight is there. Cindy and an assistant guide me with pressure on the belt. Im on the beam and cindy holds me steady, gets to 31 2 before i fall and they catch me and after one more trial, asks me to practice with the balance beam on the floor, easier for my balance but not as threatening as the beam. Cindy finishes the balance session and walked me to my wheelchair. My next session start in ten minutes, i drink water and watch the other patients, screamers, gone back to her room. She made me nervous. I am nervous. I think my gait and balance training have gone poorly and i want to redo but i cant have one. I feel like a temporary interruption with the mass of machinery on therapy and what im finished with days and weeks before me i will walk out this door of this hospital and onto the in mantle of tenuous life. Let me read just one small section and we will turn to q and a. I didnt make the functional gains of inpatient therapy. I was not cured as i expected, i made clinical progress. It was visible and meaningful but also established my recovery remains a work in progress, hospitalbased therapy, had improvements in physical defects. Equally important, to confront deficits and real invitations they impose, especially true of my cognizance, and sessions they realize the patterns of thinking work were not just impaired but broken. No amount of inpatient therapy crammed into four short weeks was going to repair that damage. That was my greatest lesson and greatest disappointment, doubleedged sword of inpatient therapy. Made me clinically and emotionally aware of exactly who i had become. That was the person who in a few short days we go home from saint lukes not as the imagined patient with doctor skills fully intact and his mind sharpens but as the real person whose fears had become concrete which i would not emerge from therapy that i dreamed possible yet i was not a therapeutic failure. I was simply and profoundly a survivor. That was about a year into nine months after my stroke. As i said i went to vocational rehab, learn how to write. I started writing this book while in my studies, master of fine arts, 71 2 years ago this summer. In the first two years of writing, as you can imagine, something i was not used to, i used to make this fatal flaw. I wanted to write meaningful profound things so i did and they are terrible and for those of you who right, there is a freebie that i will pass along from one of my professors, i t triage episode and brought everybody to their knees, why didnt you write them that way, i dont know. I did learn and harkens back to training, three things to observe and interpret, what is the physician for the patient, what does a nurse due to the patient, observe, observe, observe, your stethoscope, you touch, you feel and listen to their story, and gather data and information, observe the finite smallest details of human pathology, 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, the dressing on the patient and my own failures and frustrations in therapy. So we did and i started and i used to write my first blocks, i was able to spend 15 minutes, no more, the amount of concentration i had by the end of the 7year period, i was able to what we were doing, trying to look at what happened in that therapy and here is what we surmise, what does an injured brain need more than anything else . What does the brain do . It thinks, creates, makes pathways, receives signals, a thinking brain needs to do that. What does right requires the patient to, to think, to think over and over and over. And what transpired over that time, at the va measuring my cognitive abilities my reading one from 3 to 4 and it went up two notches to 5 . The third year in, we measured my reading capacity again. And this summer, 70 on some of my test, 30 others, verbal listening, you dont listen to me. I will entertain your questions, what do you have . Anything at all. Jump right up there, use the mic. I am halfway through your book and blown away by your life. When did you realize you had ptsd, were you diagnosed and how did it affect your recovery from stroke . That is a good question. Did everybody here . When did i have ptsd . When i employed 2003 i came back, didnt do a lot of ptsd testing in the military. We had a number of soldiers who had several incidents some of which including violent incidents with their family. The second tour we screened everybody for ptsd and at times, you test positive for it, one of the difficulties with that diagnosis, everybody goes to war and spends time there it will be positive. When i started my stroke therapy i started at the university immediately after the stroke and went to saint lukes, and we understand your stroke and indications, and against this diagnosis. And the military paradigm, ptsd is a sign of weakness. And emotionally, cognitively week. And that connotation to it. And the connotation, and careers that are ended the diagnosis. To their credit, and going to therapy sessions over time, over a period of time i finally came to agreement that i agree, i write about that in the book and one thing i had to confront which was difficult for me, after three tours of war, i get tangled up in the sheets and i thought i was attacking, somebody getting me, pummeled my wife with my fist and wake up screaming of course. That is difficult to say, she understood it. And there was a difference between being a clinician and the patient, and didnt want to make a crossing as a patient, i vehemently denied i had a stroke, showed the evidence, say things like put your finger on the brain lesion and i do it. My heart would sink. Come up to the mic. My husband had a minor stroke a year and a half ago and was told what you have is what you are stuck with. They are telling us that. It is not true . It is not true. I can go home and tell him that. You better tell him that. You bring out something very important and here it is. I do discuss this in the book. Therapeutic plateaus. And what you have is done and finished. That is not true in my case, i will show you. I walk like this. Take Something Like that. I didnt have any balance. I couldnt feel my right side, you could feel the tubercles. If you try to have conversation with me ten years ago, like i was drunk. What is wrong with this guy . Those things, you challenged through therapy, hard, rigorous therapy. What we have discovered, making this leap to other cases, therapy, has to be lots of it, massive amounts every day and frontloaded so as much as you can get right away and you have to use the brain over and over and over again and you see the changes. Heres one of the issues that the va will bring up. In the army they wrote a check to saint lukes, take care, fix them. I probably have 90 time more therapy than you will ever get. Some of it, when you get carnage, medicare, how much therapy do you get on medicare . It is pretty short, pretty short, it is not years. It is literally, weeks, months, you fight that kind of battle. Therapeutic plateau simply means this, you reach the plateau and you are done. What happens if you go like i did from 3 to 4 , that is a 1 increase. It is not. I think i can read faster. Lets keep going, do more therapy. I asked for more and pushed for more. And in the corner, for hours at a time, and you wobble, going to the gym and all that stuff. The second year, you really overdid it at two years, 4 on your reading and that is it, no more. Okay, you know . The alternative for me as a doctor and a survivor and somebody that pushes boundaries and makes a lot of these crossings was this. I will sit in the chair and rule like patients i had seen or get on the horse and keep riding, got to keep moving, so i did. I had no idea i would be here today talking about a book that i wrote. That was not in the stars, that was predicted at all. The only thing that was predicted is every time i showed a gain, lets keep going. Then it got to be two years, then three years, four years, 6 years. Only last year that i get to the 60 , 70 on some of my recovered brain function. Memory is not one of them. Every year for ten years we had a therapeutic plateau. It doesnt mean some lines arent hard. I will not going back to be doctor. I cant think fast. I use to practice Critical Care medicine in the battlefield. For me it becomes an ethical thing. Cut i may be do it . Maybe is not good enough when you are the head of the table and someones life depends on whether your memory works or doesnt work. There are hard lines. When a soldier loses two legs in combat i cant tell him i will give your natural legs back to you. I will get you some prosthetic ones. That is the question. Come to the mic please. Talk about the character traits you share with your mother, grandfather and other people in the family. It comes down to one basic one, resilience our personal resilience that my mother had that somehow someway she was able to see this, i cannot quit. If i quit there is no survival, there was a diversion aged teenager, not a lot of money and less on reservations. If they quit what happens . Keep trying or die. I can tell you, she ended up working off of the reservation, in wisconsin she moved the entire family out west, . 75 an hour, records in a shoebox, and mopped kitchens on the weekends. When you got up, we lived in a gas station house, ip route the window, 6 30 or 7 00, she would be out there. Lets take it back, she harvested and cultivated at 4 30 or 5 00 in the morning. I saw that when i was little, you got to try, got to push, got to work. I told stories about my grandfather who got kicked out of carlisle, he was assigned to the second grade at 18 years old. He became more. He could farm, he could lumberjack, to keep his family solid and surviving and that is the history of the tribe. That is it in a nutshell, resilience. One more quick question, then go for books. We will find books out there. I will be hanging around. I read the first few pages of your book while i was waiting downstairs. You had a major trauma when you were 4 years old on your lawnmower ride. I was wondering how that affected your care of trauma patients in the military, if you went back to that time and use that at all. My brother offered to give me a ride on a wooden lower bar lawnmower and he said two words, hey, this will be fun. Okay, what do i know . I am 4 years old. He pushes it around and runs into a stick and the thing stops and i go flying. As i am flying i stick my hand down in the blades and got a car right here to prove it. The next thing i remember, he runs, he is out in the woods and gone. I am there and bleeding and look at it and go this is good. Next thing i know my mother has got me in the house, she rushes me to green bay, she didnt drive and the surgeon repaired my arm, put a cast on it. There was another imprint, i got to do that and i got to do it like country doctor did it. He was very good and very kind. I will tell you one little story. When my mother took us back to the reservation in sixth grade, we went around to see people before they died, she took me to a healer, not that i was sick but just to visit. He motioned me to come over and my mother says tell them what you want to be. I want to be a doctor. He pulls a medicine bag out of his pocket and grabs tobacco and rubs it on my hands and prays and we leave and i ask my mom what he said, he was praying that your hands would do good. Man im a doctor. 12 years old, Something Like that. On my Graduation Day my mom sat in the front row and i remember that, my grandfather, my mother and that healer saying i pray that your hand do good. I said to myself they will. Thank you very much, i will see you up front. [applause] go outside. [inaudible conversations] next up from the wisconsin book festival, pulitzer prizewinning journalist Daniel Golden with his report on foreign and Domestic National security agencies, established espionage rings at american universities. Good afternoon, welcome. I am a friend of the book festival and it is my pleasure to welcome you today to Daniel Goldens presentation on his new book spy schools, how the cia, fbi and foreign intelligence equally exploit americas universities. If they had any more room on the book jacket they would have added and