>> [inaudible conversations] >> good afternoon, ladies and gentlemen. my name is kevin had and the curator history of the wisconsin veterans museum here in madison. thank you for joining us today. featuring author jon kerstetter and his new book "crossings." i'd like to think the medicine public library, the madison public library foundation at all of our sponsors for helping make this incredible celebration possible. before we begin please take a moment to silence all mobile devices so as to not interrupt the presentation this afternoon. as you attend wisconsin book special events this year please help us spread the word about these wonderful opportunities with others by sharing your experience using the hashtag wi muckfest in your social media post. also followed this afternoon talk mr. kerstetter will be signing copies of his book your copies are available for purchase at the vendor tables just outside the auditorium. it is my pleasure to introduce to you author jon kerstetter. dr. kerstetter received his medical degree from mayo medical school in rochester minnesota and is msa degree 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 chief, , and other literary journals because most recent work "crossings" is a memoir of an improbable powerfully drawn life, and the begin in poverty on united reservation -- oneida reservation in wisconsin but grew to encompass of medical practice. trained as emergency position dr. kerstetter thirst for intensity led them to volunteer in war-torn rwanda, kosovo and 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 team tasked with identifying the bodies of saddam hussein's sons. suffering a stroke upon returning from iraq, jon spent usually covering, impeded by near unbearable pain and complicated by ptsd. overcoming the perceived limits of his body and mind, jon reimagined his own capacity for renewal and change, and found healing in his writings. the wisconsin veterans museum is a statesman was dedicated to preserving and sharing the stories of all the men and women from wisconsin that have served in the armed forces. the opportunity to hear the stories directly from the veterans themselves is especially powerful. it is therefore special pleasure for me to welcome forward wisconsin veteran jon kerstetter. [applause] >> well, thanks much. thanks a coming. and i want to thank the book festival for inviting me. every author who pins one of these books looks for an outlet to tell their story, and i appreciate it. i really do. well, i am jon kerstetter. i am a medical doctor and i'm retired u.s. army flight surgeon. i'm going to take you back a little ways. my story begins in a preface in 1885. you say what's that got to do with today? everything. my grandfathers name is levi elma. levi elim have what i consider the first crossing in our family, in her native american family. he was assigned to the carlisle indian industrial school in 1885. he was to be there five years. it didn't last but one year, and he was discharged, , and i'm reading from the official discharge document of the carlisle indian school. june 23, 1886, he was assigned to become a brickyard worker. this is his first contact with non-indian education. and when the discharged him, there's a discharge notice here and there there's a word in th, the reason for discharge is the word worthless. my grandfather was deemed worthless. that's the first crossing. his first encounter with the non-indian counterpart. i go forward some 30 years to my mothers encounter with the same educational institutions, not at carlisle but at the bethany indian mission which is a school in wisconsin in wittenberg, used to be in wittenberg, in 1921 at the age of four years old she was taken from her parents to that school. you can look this up on google. on the roster of that school the first two names in 1921 margaret ann louise. that was her first crossing any non-indian education. she went through about the sixth grade, 6% of grade equivalent. equivalent. then she came away with skills of housework, a domestic, a cleaner, a dishwasher, a person who could vacuum and take care of households. she used to grab me by the lapels when i was in junior high and high school, and she would say johnny, you've got to get an education. and i would say yes, mom. and they 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 skillsl like so many other people in the '50s did. so when i did go to college, when i did graduate from high school i was the first in our family to make that crossing writer into, again, yet another encounter with non-indian education. and if you look at the roster for the graduation rolls of the mayo medical school in 1988, there you will find my name. so we go from grandfather to mother to son all making these individual crossings. the only reason i bring that up is to kind up with this intercultural perspective. it's often that we think of our lives in terms of our history, and i've 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 let's move forward. i become a doctor. i join the army. i go to training. i become a flight surgeon. i go to iraq. i served three tours they are. i have the opportunity to encounter war at the most dirtiest of details. i also encounter the opportunity to save lives. i do get injured. i come home and during the process is when i have my stroke. i'm ten years removed from the onset of stroke, so i'm a ten year stroke survivor this summer. the book i wrote, "crossings" was actually written, it started as an experiment at the veterans administration rehab program, vocational rehab. they were not so sure what my rehabilitation should look like as a physician, is a senior officer in the military because they never had that many senior officers with a debilitating career changing injury. they said let's think about this. it was very clear i couldn't go back to medicine. but it was glad to do something. i was only 57 at the time. so they said well, let's try writing. i said wait a minute. at the time my neurologically tested reading, speed comprehension was at the third percentile. the 97% of the people in the u.s. of my age matched peers with faster and better than i did. i came from the reading ability of a doctor, a physician, and a practice medicine is everything a red had to be very, very quick all the way down to the third percentile. i struggle with books like charlottes web. i did read charlottes web, and the first time i read after my stroke was very confusing for me. well, the va said, no mind, let's use your army spirit and your willingness to overcome obstacles and let's try. i suggest, let's try. why not? i'm game. and i went off to get an msa in writing. it's difficult. first it felt like, the senior ones the ski slope and all the kids are going around the and flipping u-turns and skiing backwards and all this kind of stuff. it was frightening for me. there's an educational front you i've not yet crossed and did not know what to do with. so what i want to do is take you through two or three small readings and then we left plenty of time to deal with questions. first i'm going to take you to war and what i do is a position there, and that i'm going to bring it to the brink of stroke. i'm going to read a piece called triage, and this was published in the best american essays 2013. i'm with a two star general, a marine general, and were visiting the hospital in baghdad. it's an army hospital that we set up, and it's right after series of ied attacks in baghdad and there's a number of injured people there. we walk from the icu down the hallway to the triage room. one patient lay in the bed, a young soldier, a private first class. he had a ballistic head injury. his elbows were flexed title in spastic tension drawing his forearms to his chest. his hands made stone like this, and his thinkers coiled together as if grabbing an imaginary rope attached to his turn. he breathed in a slow sporadic pattern. yet no oxygen mask. an intravenous line that is slow drip of saline and painkiller. he was what is known in the military medicine as expected. some of his fellow soldiers gathered at the foot of his bed, except for the captain. they were all young like the patient, late teens, early 20s. a few of them existing energies in the same ied attack and/or been treated and bandaged in an emergency room -- injuries. they stood watch of expectant patient one soldier had body soap edging the color of his uniform. one wept, one braid, another quietly said jesus, over and over. shaking his head from side to side, yet another had no expression at all. he simply scared a blank stare into the empty space above the expectant patients had. a young sergeant, hands shaking, stammered as he tried to explain what had happened. the captain in charge of expectant soldiers unit told the general and the 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. he told was that the soldier was a good soldier. the general nodded in agreement, and the room was suddenly quiet. then the general laid his hand unexpected soldiers leg. the leg strength imagine was drifting like a shape shifting cloud moving against a dark amber sky, retreating into the time before he entered a young soldier into war. and i watched the drifting of the man back into the world of his mother, drifting toward the time when a leg was not a leg, a body that the body. to a time when a soldier was only the laughing between two young lovers who could never imagine that a leg, oddy, man, soldier would one day life expectant, and that that soldier would be their son. as i watched the soldiers at the foot of the bed i noted their worn faces, or jumping mouse and their hollow stare, ice. i watched the watch of the shallow breathing, the intermittent spasm of seizure limbs and the unnatural rate of expectant skin. i took clinical notes in my mind. i did this when i needed to separate myself from the emotional impact of seen the critically wounded. i noted the soldiers noted the patient. i noted all the things that needed to be noted, the size of the triage room, the frame of the bed, the tiles of the ceiling, the dullness of the overhead light. i noticed the top drawer of the white linen sheets and the shiny polished metal of the hospital fixtures. a single ceiling fan rotated slowly. the walls were off-white. there were no windows. the floor was spotless. the smell and the septic, the drab army blanket covered each bed. three beds late empty. i noted the absence of noise, the absence of nurses rushing to prepare surgical instruments and absence of teams of doctors urgently opening blooms and calling out orders. there was an absence of the hurried sound and hassle of soldiers in the combat emergency room one floor down. nobody yelled medic. nobody called for the chaplain. medics did not cut off clothing or gather dressings. ambulances and medevac helicopters did not arrive with bleeding soldiers. the book emergency or surgery, the military bible for medicine, defines triage as the assignment of patients to four categories of treatment based on severity. minimal delayed, immediate, expected. the assignment to the expectant category means that a soldier has no likelihood of survival. and based on a single calculation, 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 stabilize but there are other costs not so easily calculated like emotional cost to survivors or the psychological toll on soldiers who make that triage decision. textbook definitions are silent on how military physicians prepare for, react to, the demands 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 decisions must be made and chapters on how to play establish criteria in making those decisions. however, what to do next after making the decision is never covered. that vacuum of knowledge leads to a feeling of exposure and folded building neither of which can be tolerated in war. in the process of making notes about the expectant patient, i paused and move closer to the bed. i put my hand on the patient's leg just as the general had done. i laid it there, let it linger. from where i stood eyster directly into the expectant soldiers face i watched his breathing, a long side breath followed by the absence of movement, followed by three to four shallow breaths. i matched his breathing with my own. i kind of slowing pattern with my watch. i made mental calculations and looked away. what to get i noted the quiet of the room and the whiteness of the walls. i noted the empty beds and the ceiling and the antiseptic smell. again, watched the expectant soldier, was oblivious to all of my watching. i stood at the triage bed thinking if this were my son i would want soldiers to gather in his room and listen to his breathing. i would want them to break stride from their war routines, perhaps we, perhaps to pray. and if he called out for his bad, i would want one of them to become the father to my son. simply that. nothing more, nothing less. procedures not written in department of defense manuals or war three classes or triage exercises. i finally moved to the head of the bed and placed my right hand on his chest. my hand rested there with barely any movement. i turned to the other soldiers and gave them an acknowledgment with a slight upturn curse of my lips, and then looked away. i lifted my hand to the patient's right shoulder, let my weight shift as if trying to hold and gently in place. i half kneeled, half bent, closed the distance between our bodies. i noted the fabric of his skullcap dressing, and the blood that tainted his white cotton edges. i pray for god to take it in the every instant. i whispered, the only he could hear, you're a good soldier, you are finished year. it's okay to go home. i saw the faces of my own sons in his, and i was glad they were not soldiers. i finished, stood up, walked to the foot of the bed. one of the soldiers asked me if there wasn't something i could do. i said no, i meant no. of what 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 do not feel any pain. that he would be gone soon and that everybody had done 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. and the things i said had their own pace and rhythm. they flowed like the movement of triage itself, shaped by the needs of survivors. after a few moments of silence a general and i quietly left the triage room and the hospital. i remember that expectant patients often after our hospital visit. i knew i'd seen his name in hospital chart or was told his name by his commander. i didn't take the time to write it down anywhere, and that bothered me. it bothered me because as the weeks and months went by, he remained nameless eczema and other soldier patients i encountered. and that nameless does seems like a form of abandonment for which i felt personally responsible. i understand any professional since the patient was not abandoned. that is triage was purposeful, data provided the accent to medical efficiency which old was saved other soldiers lives. but it also understood that the theory of triage quickly eroded when confronted with the raw, human emotion of sorting through winded patients and assigned them to triage categories. in my mind, the theoretical and the practical wage 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 visions like this, many stories of the same nature. i i get injured someone in my third tour, and they are all peripheral orthopedic injuries am a missile that went off nearby. i got medevac tome. i come back and have year full of recuperative surgery, ten surgeries in about 12, 14 months, something like that. and at the tail end i get my fourth mission assignment to afghanistan, but before we can marshal up enough recovery to go, it's discovered i have a brain aneurysm right at the base of my brain. and it's big enough to be worrisome but small enough that we didn't have to operate immediately, except for the urgency of returning to battle. so we have to make a decision, and the commander in charge of me, my medical officer, says what would you do with a similar patient? i said, well, i would have to say you've got to get the thing fixed. so we choose the least invasive, safest route to get into the brain. it's an endovascular surgery. put a call up in the aneurysm and hopefully that causes a clot and a scar and there's no chance of rupture. that has to be done before you go to the field. we did that and it was a vascular accident. they were and are bubbles introduced in the catheter system that went from the top of my brain to the brainstem so i woke up. i did know who i was, where i was. i couldn't feel my right side. through a turn of events, of course then and follow-ups over the ensuing weeks, it was decided that my fourth obvious he would be put on hold now, and my medical career was put on hold. that was a bit of an adjustment as you might well imagine. we went to stroke school as i call it, stroke therapy. now, i'm an er doctor. my span of er knowledge and medical knowledge about 15 minutes long, 20 if you push it. i'm the right guy. i'm the right doctor if you need that 15 minutes doctor, what's the span of time in terms of stroke rehab, years and years and years. when i went to medical school, i trained under this old paradigm that said this. when you get your stroke, we do physical and speech rehab. there's not a whole lot of other things we can do for cognition. and patients were told of this very thing, that about one year out from the initial incident of the stroke, whatever you have as function is basically what you have. you are not going to gain much more. so you've got one year. now, that was told to me when i had my stroke. my own army doctor said i will never use my arm again, i will never think again. and i certainly can't beat a medical officer in the military, or a doctor, anymore. this was at the one year time frame, and i said that doesn't sound very hopeful. in fact, that sounds rather dismal. something inside me, and i will call it this, i will call it personal resilience that i learned from my mother who learned from my grandfather. that you have to push, you have to survive. the survival mantra, my mother in the 20s to the '50s was what? work work work work work. hers was not i 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. when that was taken away from me, all i could think was i've got to fight back somehow. i had the right team of stroke gene in terms of the university of iowa and the va. early on they said well look, outpatient therapy is not really working. we want to have an inpatient experience. the front end load, all the therapy we can get. so i went off to st. luke's which is a small hospital in cedar rapids iowa and they specialize in traumatic brain injury and acquired brain injury. stroke and trauma. they do all the recovery work there, and off we went. after the stroke i had fallen several times and reoccurred some of the battle injuries, reinjured myself. so i had a lot of pain. i'm going to take out a little trip to st. luke's hospital and was a short reading and then i'm going to invite some q&a. at st. luke's, after surgery and doing physical therapy eye difficulty with ongoing pain. sometimes it took me like a sudden writ of thunder, no warning, just a frightening boom and the shaking of the earth. other times it started like a dandelion seed parachuting down on a puff of wind. it's wait no more than the heft of a childhood memory. it felt like a tiny barbs of rows leapt on across my skin,, and when painting hard and fast, a scream bubbled from my throat. i tried to choke it off but usually i let it fly like a screeching cause of a crow. if it started like a seed it was tolerable at first, maybe two or three on a pain scale of ten. either way, found or dandelion, the pain festered and crew so in the end it felt like i was being tortured or drawn through a keyhole. 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 of therapy assistant knocked on my door, which i left half open. i'm here to get you for therapy, she said. she was matter-of-fact yet pleasant. no cajoling, access smalltalk. this is the beginning, i think. i i respond to her with a single word, okay. she helps me to the wiltshire and off we go rolling to a well lit hallway toward the therapy bay. as we roll the hallway grows and elongates like a scene from alice in wonderland. i am off to my first therapy session, and in my head i am the perfect storm of anxiety and anticipation, the wilderness -- bewilderment and excitement. i hope that hospital therapy tul provide exactly what i need, yet i feel provide nothing at all. i noticed the doors of the patient's rooms as we pass them. most are painted tan, some have bright colors. my wiltshire has a will that squeaks, and i joke that i need oil, and i laughed just a bit. she chuckles in return, and as we come into the open therapy room, i am surprised that it's filled with so many patients and therapists work 50 i think, but the number is certainly fewer. large brown therapy mats, blue covers on tables, over half the room. the other half is covered with parallel bars and exercise equipment, and a mock kitchen. she parks me just inside the room next to the other patients, tells me that my therapist cindy will be with me shortly. the patient waiting by me is drooling. her skin is pale. her fists are tight and her arms contracted. she has an obvious head injury, a car accident i assume. i study the room. it's a layer, maybe a beehive. the patient near the opposite wall is screaming at her therapist. she refused to get out of her wheelchair. the therapist is working at getting her to stand. the patient lets out a string of curses and the therapist says stop, that won't be tolerated. in the therapist rolls over by me and my drooling companion and tells the screamer that she can cool down. the screamer yells, you're a horror. the therapist says nothing, and walks away. cindy comes to get me just as the screamer calms down. she introduces yourself and tells me she's going to be my therapy team leader. she rolls me halfway through the room and helped me take a table where we sit and she goes over my schedule of exercises for the day. we will start with gait and balance and to some shoulder work and finish with speech and language therapy. i'm ready to go, i say, anxious to get started and also intimidated by all i see by the layer and its imaginary walls. cindy -- i tell you i don't need one. she says, i do if i want to do therapy. i can tell she takes no prisoners hear gait belt on my waist they help me to my feet. okay, let's just take a short walk down the hall, cindy says. tighten your stance, look up, read, you're tensing up. we need you to relax. i bring my feet together and take control of my body. i'm a wobbly toy taught at the end of its pinprick the therapist and assisting each take hold of my belt. i take one step. i make wild gyrations to twist a 45 degrees off-center. that's okay, cindy offers. let's try again. i make a concerted effort to watch my feet and think of every step. cindy puts to thinkers under my chin and pushes up. look up, she says. your feet nowhere to go. i need to watch my feet, i counter. you need to trust your feet, she counters back. i think she's using a cute little mantra she learned in physical therapy school, 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 weep and stutter step that cindy encourages me to keep my head up. and to breathe. i i turned to look across the rm and crash, , but my gait belt saves me, concentrate, cindy says. i am concentrating. with all the activity going on around me, the screening patient and a therapist, on the truly head injury patient come on the others limbs and their hands, the therapists. i've never seen anything like it. more screamers emerge who i had not noticed at first. they are more reserved, polite but still 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. when patient with a attack she cannot walk a single step or another is sucked up to a computerized treadmill. he has one prosthetic leg. i think you might be a soldier, too. but i don't ask. the therapist looked like it don't take crap. they keep pushing. they might cause, but they don't stop. and as i take my first walk in my first hour therapy at st. luke's, i wonder about the kind of patient i will become. while i crashed to the floor? yell at my therapist? will i fail therapy? will it fail me? i sense of what to run or hide but i cannot get the therapist knows my room number, my case file, my name. cindy walks me through a a setf orange cones on the floor just as the previous outpatient service attended we walked slowly, and fats come in a circle, then an online, on carpet, linoleum, up, down, practice tears. i walk with and without making. i step over a few fake curbs, align, a crack, over and around tiny obstacle on the floor. i shoe, a piece of paper, a spill of water. i wobble and we've up and down a ramp like a box the ropes. i walked into my think walking is overrated. after 30 minutes, cindy says, it's time for some balance routines. i thought we were doing balance, i say. slightly puzzled. that was gait training. balance is different. we do find minutes on a large blue exercise ball and i fall to the side and cindy catches me. we repeat. i fall again. it's like being drunk without the booze. i say shit more than is necessary. it doesn't help. from the ball i graduate to the balance being, a gymnast balance being only affixed to the door with a double set of maps 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 note an octave? we use for balance. don't worry, we're here to hold you up. we're going to start with one step. your left foot first, then you're right. she has missed out on the right side of the being with my feet together as close as i can get them. she and her assistant holding with a gait belt belt. my left foot goes first. it's my good foot. they tighten their grip on my belt and lift, and as quick as i mom, i am off. that's good, cindy says there tried again. this time remember to breathe. i start again by standing in briefing. when i'm ready i'm supposed to lift my right foot onto the beam. i'll never be ready. never. i pause longer than is apparently allowed your cindy and her assistant start putting pressure on my belt. that's the sign. pressure. it's time to move. i'm not ready, i protest. raise your right leg to the beam, , let it rest there, cindy insists. she's not stern, just clinically pushy. i raise my right foot onto the being and let it rest, , and all my weight is there. cindy and assistant guide me with pressure on the belt. i'm on the beam and cindy holds the study, starts to count. she gets to three and a half before i fall, and they catch me. after one more trial just me practice the balance beam routine on the line on the floor. it's easier for my balance, but not nearly as threatening as the beam. cindy finishes my gait balance session, walks me back to my wheelchair. my next session starts in about ten minutes. i drink water and watch the other patients. the screamer has gone back to her room. i'm glad. she made me nervous. i am nervous. i think my gait and balance training have gone poorly, and i want to redo, but i can't have one. i feel like a temporary interruption in the mass of machinery of therapy. when i'm finished with the days and weeks before me, i shall walk out this door of this hospital and onto the thin mantle of tenuous life. let me read just one little small section and then we returned to q&a. i didn't make the functional gains i expected of inpatient therapy. i was not cured as i expected. i make clinical progress, and he was visible and meaningful, but also established that my recovery still remains a work in progress. hospital-based therapy have propelled improvements in physical defects, equally important, however, it forced me to confront those deficits and the real limitations imposed because especially true of my cognitive defects. during my speech and cognitive therapy, sessions i'd come out to realize that my patterns of thinking were not just impaired, they were broken. and no amount of inpatient therapy crammed into four short weeks is going to repair that damage. that was my greatest lesson and my greatest disappointment, a double-edged sword of inpatient therapy. maybe clinically and emotionally aware of exactly who i had become. and that was a person who finish a few short days would go home from st. luke's, not as they imagine patient with his doctor skills fully intact and his mind sharp and, but as the real person whose fears had become concrete. i would not emerge from therapy with all the recovery i dreamed possible. yet i was not a therapeutic failure. i was simply and profoundly a stroke survivor so, that was about a year into the st. luke's, that was about nine months after my stroke. as i said i would onto vocational rehab, learned how to write. i started the writing of this book while in my studies, master of fine arts. that was seven and a half years ago this summer. so in the first two years of the writing, as you can imagine, something else that used to so is horrendous. i used to make this fatal flaw. i wanted to write meaningful, profound things, so i did. they were terrible. and for those of you who write, here's a free be, i will pass it on from one of my professors. she said, quit trying to write meaning. write sentences. what? she said close your essay, put it down. now tell us the episode. tell us what happened, and i would tell my cohorts of six or seven students, now describe what the triage episode. and it brought everybody to their knees. she said why didn't you write that that why? i said, i don't know. it's like teenagers, i don't know. well, i did learn, and i hearken back to training i had in medical school, three things, you observe and you interpret and you apply. what does the physician do with the patient? what does the nurse do with the patient? observe, observe, observe. usually eyes, ears, stethoscope, you tap, , you touch, you feel, you listen to the story. and in all of that you gather data and information to you observe a finite, smallest details of human pathology, and when you are done with that and only when you're done with that do you make the step called diagnosis or meaning. what does the data 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 skullcap dressing on a 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. that was not of concentration i had. i into this seven year times i was able to spend four hours, the phenomenal. what we're doing today at the va, we're trying to look at what happened in that kind of therapy, and usually surmised and then i will turn it over to you here what does an injured brain need more than anything else? what does the brain do? it thinks, creates, , makes pathways. it sends signals and receive signals. a thinking brain needs to do exactly that. what does writing to? what does art do? what does music do? and requires a patient to think, to think, to think over and over and over and over. and that's what transpired over that time, and at the va when we measured my cognitive abilities, my reading went from two or 3% to 4% one year, then it went up two notches to about 5%. and about the third year in, we measured my reading capacity. i went to the grade level 5.3. and now we just measured this summer, i'm about 70% on some of my tests, 30% others. verbal, listening, my wife says you don't listen to me. i have an excuse. i'm only 30% on that scale. i'll entertain your questions. go ahead. what do you have? anything at all. [inaudible] >> if you could use the microphone in the middle of the room. >> please. jump right up there and use the mic. i will entertain anything you want. >> i'm halfway through your book and i'm just blown away by your life. >> thank you. >> when did you realize you at ptsd? were you diagnosed, and added that affect your recovery from the stroke? >> that's a good question. did everybody here it? when did i know i have ptsd. well, when i deployed in 2003 i was there almost you, came back. we didn't do a lot of ptsd detesting in military at the time. we had quite a number of soldiers who have some incidents can some which including violent incidents with her family. my second tour we screened everybody for ptsd and it was at that time actually that i was green and said that, you test positive for it. one of the difficulties with that diagnosis, so brodkin anybody who goes to when spent anytime there will be positive. well, when i started my stroke therapy go for sister at the university immediately after the stroke and then went to st. luke's and then the va took it over. i had a brilliant neuropsychologist there who said we understand your stroke but you've also got some indications your ptsd. i revolted against that diagnosis. i didn't like it. i didn't understand as a physician, and i'll give you the military paradigm. ptsd is a sign of weakness. that's what soldiers think. they don't want to be branded with somebody saying you are emotionally, cognitively week, psychologically weak. you say that you soldier that has that connotation to it. now, it isn't true of course but it still has that connotation. and believe it or not there are careers that have ended over that diagnosis. so i balked at it. i said no, not me. and to their credit at the va, they were to me and said okay, but let's just go to some therapy sessions, which we did, and i, over time, over about a year, a whole year, i finally came to agreement that, yes, i agree. now, i do write about that in the book, and one thing i had to confront which is very difficult for me, not just a briefly, and when i i came back from after three tours of war, i would have these nightmares. i get tangled up in the sheets and i thought i was fighting somebody, attacking, somebody was getting me. so i would turn over and i would pummel my wife with my fist and she would wake up screaming, of course. now, you know, that's difficult to say when she is sitting right there. she understood it. i did not. yes, as a clinician i did, but there's a difference between being a clinician and patient. i made that, started making the crossing edited need want to make the crossing as a patient. for a year i vehemently denied that i had a stroke and even though they which it was evident and say things like put your finger on the brain lesion on the mri and i would do. as soon as i touched that, my heart would sink because i knew that was me in there. another question. come on up to the mic, go-ahead. >> my husband had a minor stroke about a year and half ago, and he was told that what you're after a year year is what you're stuck with. they are still telling us that. that's not true? >> no, it's not true. if it were i would not be here. >> okay, i can go home and tell them that? >> you better go home and tell them that. >> thank you. >> you bring up something very, very, very important and here it is. i do discuss this in the book. it's called therapeutic plateau. now, the old paradigm was when you get to one year that's what you got, you're done, you're finished well, that's obviously doctored my case because if that were, i'll show you. i can do this. and i walk like this. i used to take a stance like that. why? because internet any balance. i had a huge brain -- i couldn't get my right side. my muscle with all the way down to the bone. you could feel. if you tried to have conversation with me ten years ago he wouldn't get much. you would get a blank stare like i was drunk or on drugs or something. they would say what's one with this guy? now, those things we challenged through therapy, through hard, rigorous therapy. and i'll give you another freebie. what we discovered in my own case and now are making this leap to say that it certainly must apply 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 and over. and then you see the changes. now, here's one of the issues that the va will bring up. and the army. they wrote a check to st. luke's and whoever said take care of him, fix them. i probably have 99 times more therapy than you will ever get. and some of it is because, well, when you get our age, yet medicare, right? how much therapy to get on medicare? it's pretty short, pretty short. it's not years. it's literally weeks, months. so you fight that kind of battle. but therapeutic plateau simply means this. you've a plateau, you are done. well, what happens if you go like i did from three to 4%? that's a 1% increase. they go that's a statistical error. no, it's not. i think i can read faster. okay, let's keep going, let's do more therapy then. and i did and asked for more and i pushed more at the did more. my wife helping with a lot of therapy and balance. i do stand in the corner and she help me stand in the corner for hours at a time. you know, you wobble. in going to the gym and all that stuff. the second year well, okay, now you would over did it, you are at two years, up to 4% 4% by reading, that's it, there's no more. okay, but you know. the alternative for me as a doctor and a survivor and somebody that pushes boundaries and makes a lot of these crossings is this. i'm either going to sit in a chair and drool like some of my patients i had seen, or i've got to get on the horse and keep writing. i've got to keep moving. so i did. i had no idea that i would be here today talking about a book that i wrote. that was not in the stars. that was not predicted at all. the only thing that was predicted was every time i showed a gain, well, let's keep going. and then he got to be two years and three years and four years and five years and six years. only until last year did i get to the 60, 70 percentile on some of my recovered brain function. memory is not one of them. now, every year for ten years without a therapeutic plateau. it doesn't mean some lines are not hard. i will not ever go back to being a doctor, and here's why. i can't think fast. that is, i used to practice critical care medicine in the er in the battlefield. and then for me becomes an ethical thing. could i may be doing? maybe it's not good enough. not when you're at the head of the table and someone's life depends on whether your memory works or doesn't work. see what i mean? so there are hard lines. when a soldier loses two lakes in combat, i can't tell him i will give your natural legs back to you. i can say i will get you some prosthetic ones, but there are some limitations. that's a good question. yes, please. [inaudible] >> , to the mic, please. thank you dick. >> could you talk about the character traits you share with your mother and grandfather and some people in your family? >> character traits, it comes down to one basic one, resilience. it's personal resilience that my mother had, that somehow someway she was able to see this, i cannot quit here because if i quit, there is no survival. my mother was a depression age teenager. not a lot of money to get even less on indian reservations. if they quit, what happens? they just die. if you keep trying or die. i can tell you this. she ended up working for a bureau of indian affairs indian school called in intermountain indian school in wisconsin. it's the only job she could get off the reservation. we were in wisconsin. she moved the entire family at west. fiction work for 75 cents an hour. i have all the records in shoebox, and then she scrubbed floors and mopped kitchens on the weekend. why did she do that? you know, when we got up, we used to live in a gas station house, it's in the book. i peered out the window when i got up ticks 30, 7:00 in the morning. she would be out there. there's a big patch of weeds, about a city block. she said if you guys don't want it, that's my land, i'll take it back. she harvested it. she cultivated. she would be out there for 30, 5:00 in the morning. i saw that when i was little and it had an indelible imprint and said you got to keep going, you got to try, you've got to work. and i think if it weren't for her, then later she told the stories about my grandfather, even though he got kicked out of carlisle, by the way he was assigned to the second grade when he was 18, illinois kicked out and told he was worthless, he became more because he could far. he could lumberjack. he did anything and everything to keep his family solid and surviving. and that's kind of the history of our tribe pic so i think that's it in a nutshell, resilience. we might have one more quick question and then we would go for books. we're going to sign books out there. yes. come to the mic, please. thank you. i'll be hanging around outside, too, after. >> i read the first few pages of your book while i was waiting downstairs. you had a a major trauma when u were four years old on your lawnmower ride. i'm wondering how that affected your care of trauma patients in the military, if you went back to the time and use that at all? >> i think it did. well, my brother offered to give me a ride on a wooden lawnmower in the backyard on the indian reservation to andy said there's two words, hey, this will be fun. okay, what do i know? on four years old. i climb on a board and he pushes it around. of course she went into stick and thing stops and i go flying. as i'm flying i stick my hand down in the blades and they cut the scar right here to prove it. annexing a member, of course he runs. he's out in the woods now. he's gone. i'm there i'm there and i'm bleeding and a look at it and i go this isn't good. annexing i know, my mother has got me in the house, she has a good old pat and she rushed not to green bay. she didn't try. the surgeon repaired my arm, put a castle. it made an imprint where you go i got to do that, and i got to do it like the country doctor did it. all i remember, he was very good and he was very kind. and i'll tell you this, one little store and i will quit. my mother took us back to the reservation when i was in the sixth grade. we went around to see all the old oneida people before the doctor she took me to heal her. not i was sick that just to visit. and he motioned me to come over and my mother says, tell them what you want to be. i said i want to a doctor. he pulls a medicine bag out of his pocket and he grabs some tobacco and erupted on my hands and he prays -- and he rubs it on my hands and he prays. i asked my mom what he said. she said he was praying your hands would do good. man, you know? yeah, i'm a doctor. i'm 12 years old, something like that. i remember that. on my graduation day my mom sitting in the front row, and i remember that, i remember my grandfather and my mother and that healer saying i prayed that your hands would do good. and i said to myself, they will. thank you very much. i'll see you out front. [applause] [inaudible conversations] >> what is this about? >> it's about a unit that was in berlin germany from 1956-1990. no one knew it was there. and it was basically there to cause problems for the russians if and when they ever attacked. >> so when were the stories unclassified? >> when i wrote the book. i had to submit them to the department of defense who submitted them to about 12 different agencies. it took about 16 months to get cleared. and after that they became open but before that -- [inaudible] >> what are some of the actions that the army special forces participated in? >> actually there was a mission of preparedness come to be ready for the -- [inaudible] but probably one of the most prominent, well-known was the siege in terror ran which had nothing to do with berlin. the unit and participated in that, one of the part of the rescue force, along with the better-known delta force from fort bragg, and it's quite a gripping story. so i tell that in the book. >> so what would your you to topic? >> i was a member of the unit, the unit got together and decided that we needed a history and i was told to write it. no, it was a labor of passion. i have written other things on military history, and so it fell right in to my proverbial. >> booktv offers programming focus on nonfiction authors and books. keep watching for more here on c-span2 and watch in of our past programs online at booktv.org. >> you are watching booktv on c-span2 with top nonfiction books and authors every weekend. booktv, television for serious readers. >> up next "the communicators" with matthew price, ceo of cloudflare. .. >> in 1979, c-span was created as a public service by america's cable television companies and is brought to you today by your cable or satellite provider. >> host: and this week on "the communicators," we want to introduce you to matthew prince. he is the