Crossings

by Jon Kerstetter

  Meeting with Dr. Hall was always interesting. He had an edgy yet professional demeanor and he would always laugh with me when I poked fun at my progress or at psychology. We often laughed at the twists and oddities of cognitive recovery. During most sessions we talked about therapy issues and he usually filled me in on the latest developments in mental health for soldiers. Those sessions tended to lean toward the serious end of a continuum. At the other end was a light-hearted treatment of all things clinical as if we were more like friends than patient and doctor, though I knew that was a relationship that held firm and couldn’t be changed. One of the interns who sat in on our sessions asked me a zany question in her first interview with me.

  “So, how’s your disability?” she asked.

  “Well, kind of disabling,” I shot back. And I laughed until I was breathless.

  Dr. Hall loved that anecdote, because it showed how both he and I could muster a sense of humor and laugh at our own circumstances. I joked about VA administrators and cognitive tests and exercises. “How can you tell how many administrators are on duty in the hospital?” I asked him. Answer: “You roll a donut down the hall.” Laughter therapy.

  At other times, when I told him I had felt less than properly treated in a situation involving a VA staff member, he would go to bat for me and get on the phone to resolve any care issues. He was tenacious on behalf of patients.

  He addressed me as “Dr. Kerstetter” and frequently reminded me that my professional education and experiences gave me an advantage in therapy. On days when he reviewed my cognitive tests, he always put the results in the context of recovery. He would take a particularly poor testing result like reading speed and ask me to focus on a strategy for improvement rather than a test number. “Don’t focus on the numbers,” he would say rather forcefully. “Focus on recovery.” And as I listened to him, his counsel made perfect clinical sense. Move patients forward rather than let them linger on what they had lost. That was his talent. And he made sure I felt clinically relevant in that movement forward.

  I felt like he understood the gravity of treating a patient who equated losing a career with losing a leg. To him, I was more than a patient who had lost clusters of brain cells. That loss had caused a rift in my identity as a physician and a soldier, but he didn’t spend much time in session pondering the weight of it. Instead, he created a therapeutic climate that stressed healing and the need to keep pushing forward to explore new boundaries. He and Gina were alike in that regard. Their encouraging interventional styles, coupled with my proclivities for challenging boundaries, formed a perfect therapeutic triangulation—self-motivation, cognitive training, and directed encouragement. That didn’t necessarily translate into quick results, but there was something happening in my recovery that was certainly rare and special. When Dr. Hall spoke about the extent of my recovery, he always noted how high-functioning I had become and how some patients with less demonstrable brain injury did not recover to the same degree. In part, I thought of my recovery as motivated by the fear of becoming nothing, a person who would live only in the shell of a former life, devoid of the joys of professional identity. Yes, I had my family, my wife, my children and grandchildren. I had love and meaning as a father and husband. I had far more recovery than many stroke survivors. Added together, it all meant that I enjoyed a full measure of personal and family significance, but that wasn’t enough. Love for my family and the love of my family were not the same as love for my profession. Simply put, I missed my life as a doctor and soldier.

  Dr. Hall encouraged me to look beyond the loss of my career. As I did, I found that the core of my passion for medicine was an unquenchable desire for knowledge. It had driven me and pushed me since my childhood. So when he told me in the first few minutes of our therapy session that we needed to explore my vocational options, it didn’t totally surprise me, although I didn’t completely understand the gist of his conversation. I thought he had opened a channel for exploring a reentry into medicine, but I knew that topic had been closed for some time.

  “I can’t practice medicine,” I reminded him. “I can’t retrain in another specialty. I still have gait and balance issues. I still can’t think worth crap. I don’t think I have any vocational options.”

  “If you did, what would you like to do?” he asked.

  “I don’t know. Learn to read more books, maybe.”

  “Have you ever thought about writing? It has the potential of becoming a natural outgrowth of your reading. The MFA program here is interested in helping veterans.”

  I was thinking in a vacuum when he said that. Writing had given me fits. Did he think I could learn to write?

  “I can’t write and I can’t go back to school. I can barely read at the sixth-grade level. I think you have to read and write in an MFA program.”

  “Dr. Kerstetter, our progress has not stalled out. You have the intellect and the motivation to learn more. What if we tried it for a semester?” He was serious about it. And he was talking in the fast-paced voice that he used when he was excited.

  “I don’t think it works that way,” I said. “I can’t just sign up for classes.”

  “Wait a minute,” he said. “Don’t jump to conclusions yet. Let’s think about it for a week and see how you feel about the idea.”

  How I felt was bewildered. I couldn’t imagine myself in grad school again.

  “I just don’t think it would work,” I concluded.

  I did think about my future in the days that followed. I saw it as foggy. I could no longer work as a physician. There were absolutely no prospects of returning to anything related to the field of medical science, and writing seemed far-fetched. I could imagine myself as a burger flipper, a library assistant, or an artist, but not as a writer. Writing never held any vocational interest for me. I had taken a poetry class once at the Iowa Summer Writing Festival, but that was a one-week fling with words that didn’t even add up to fully formed sentences. Dr. Hall and Heather were both inclined toward writing as therapy, and I had done some therapeutic journaling, but doing so as an author strained the limits of therapeutic feasibility. At the very least, it demanded sustained attention that I did not possess.

  Yet there it was, the idea that I could learn to write. Dr. Hall had spoken the words, released the idea like a falconer releasing a bird. He let the idea take flight, and my mind followed. Could I accomplish such a complex task? What would writing mean to me? To others? What if I could not learn fast enough? What if I could? The possible answers frightened me. I conjured up excuses why I should not go to graduate school. Age: at fifty-nine years old, I felt a bit out of my prime for going back to school. Reading ability: grade level 5.3 worked for reading young adult novels. It would not suffice for graduate-level reading. Rehab: I was still in rehab. Would I put my therapy on hold? What would happen to my brain if I did? Speed: I wasn’t very fast at anything: reading, thinking, walking, planning. Graduate school required speed. I would have to keep up a fast pace with a slow brain.

  The whole idea seemed to me nothing more than delusional happy talk and therapeutic silliness, an exercise in positive mental attitudes encountering impenetrable negative forces. But Dr. Hall thought I could do more. I wanted to do more. Therapy had paid off. I was actually making significant cognitive gains. I surpassed a clinical plateau about every six months. When I passed one plateau, we defined a new limit, and then another, and then one more. With each crossing, we wondered if that might become the final boundary, my true limit of recovery. It made me question the legitimacy of clinical plateaus. What was the limit of stroke recovery? Were limits real or therapeutic constructs? If they were real, how would I know when I arrived at a point beyond which no further gains were possible or practical? There was no answer.

  My entire life had been about redefining limits and pushing against boundaries. In two years of cognitive therapy, I had learned to read and think well beyond my abilities in the immediate aftermath of my stroke. Dr. Hall tested my gains, showed m
e the results, and said I could learn more. And just as air bubbles had floated into my brain and changed my life two years earlier, an idea surfaced that carried the same potential for change: I could learn to write. It was a nutty idea, intangible, unrealistic—a dream. It was undeniably beyond reach, but it was there. So I grabbed hold of every damn crazy notion and cognitive nuance of what writing could mean and what it promised. With every firing neuron in my brain, I calculated how and why and if I could learn to write, and then I decided to cross that line separating all things possible from all things unknown.

  As a way of validating my decision, I reread some of the stories in my short story anthology and restarted the Hunger Games book. One thing grabbed me immediately; good literature pulled me into the fabric of the story. It made me relate to myself on a deeper level, made me think about thinking and about divergent perspectives. It left me wanting more, just as it had when I was in high school reading J. D. Salinger and in college studying Shakespeare. If I could learn to write, that would be the metacognitive coup of a lifetime—not a vocational milestone, but a therapeutic crossing that would challenge the presumptive limitations of clinical plateaus. Writing at a graduate level would mean going well beyond the limits of therapeutic writing and cognitive brain exercises.

  When I met with Dr. Hall again, I told him I might like going back to school but was unsure how it would work. I was less bewildered than when he first mentioned the idea, but it still seemed so outrageous. He had already consulted with the vocational rehabilitation counselors, who said that their department would pay for my training and, if necessary, provide tutoring if I were accepted into a writing program. It didn’t have to be an MFA program, but it did have to meet their educational requirements of college or trade school education. Initially, I was excited about the idea, but I still wondered if I could perform at a graduate level of education. I had my level: 5.3. I felt it dictated my ability for reading and, by extension, learning. Dr. Hall suggested an informal interview with the staff of the MFA program at Iowa as a way forward. I agreed. Within two weeks I had three informal meetings with the director and two professors in the program. I met with several faculty in casual meetings. They told me about the demands of the program and asked if I had done any writing.

  “I’ve been writing about my stroke a bit,” I said.

  They all asked about my publications.

  “I have three academic papers in medical journals,” I replied. When asked about my stroke writing, I told them the nutshell version.

  In the end, the faculty were gracious but blunt. They didn’t think I would be able to sustain the workload of reading and writing to successfully complete the program, even if I were to gain admission. That level of graduate education was highly competitive and academically rigorous. They were right. I did not have the attention and focus to sit in a classroom and listen to lectures or read numerous hours a day.

  When Dr. Hall and I discussed the meetings afterward, we were both disappointed, but he said there were alternative, distance education programs. I concluded he meant correspondence courses like the ones offered when I was in college. He told me that distance education had changed and that numerous schools offered their MFA programs entirely through distance education and short residencies.

  In June, I dedicated myself to contacting MFA programs with low-residency distance education curricula. Most told me to send in writing samples, fill in the application, and wait for an answer. But Ashland University in Ashland, Ohio, was different. Theirs was a relatively new program, and the director, Stephen Haven, and the program administrator, Sarah Wells, both talked to me on the phone and encouraged me to apply. They both promised that I would receive any individual attention required. I was a little suspicious, so I asked for an in-person interview. At their request, I sent them my required writing sample. I hadn’t written anything except therapeutic journal entries since my stroke, so I sent them a short critical essay I had written before I went to Iraq.

  During my campus visit, Sarah, who in person was even more excited than on the phone, talked with a wide smile and expressive hand gestures as she gave me a tour and answered all my technical questions relating to an Ashland MFA. She had graduated from Ashland in their undergraduate writing program and had also written poetry. Her knowledge about MFA programs and the needs of graduate students I thought remarkable. When I asked her if my stroke might create issues, she reassured me that the school could make any adjustments necessary to help me.

  Professor Stephen Haven was a soft-spoken mid-career academic with numerous publications and experience teaching in China. He had published several volumes of poetry and a memoir about his boyhood among the Mohawk in New York. That caught my attention; the Mohawks and Oneidas were both part of the Iroquois Nation. I had lunch with him and we talked about my goals and cognitive deficits. He had a welcoming and collegial personality, and his refined manner and casual speech gave him the aura of a professor who was completely in touch and relevant to students. He reminded me of Dr. Hall. When Professor Haven asked about my situation and why I wanted to write, I told him about my career as a military doctor and my stroke rehab. I thought he would be put off, but he wasn’t. Instead, he asked me to tell him a short vignette about being a doctor in Iraq. I told him about my medevac flight home and he listened intently. He said if I could learn to write with the same passion and intensity, I could make an impact with my writing. I had never heard that idea before, that my writing could possibly make an impact. I understood that was the purpose of literature, but not specifically of literature I might create. He sounded serious. I believed him. That was enough.

  Before I left campus that afternoon, Sarah gave me a letter of acceptance into their creative writing MFA program. I would start in late July with the first of three annual two-week residencies. Excited, I called Collin at home. “I’m in! I’m in! They actually accepted me into the program.” We both laughed and cheered on the phone. On the drive home I wondered what I had done.

  —

  In the first week of my summer residency, I felt sure that I had suffered a cognitive relapse. If it were possible to beam me to a Colorado ski slope, I would have been the old man tangled in the rope tow or sliding down the hill on his ass. My fellow students were scary-smart. They seemed to know everything and possessed skills in literature and writing that made mine look paltry at best, critically anemic at worst. I sat next to two English majors who taught English in high school. I didn’t dare ask them questions for fear of revealing my stupidity. Could I ask where commas were supposed to go in a sentence? What did the lecturer mean by narrative arc? What was the precise difference between an essay and a memoir? I made a quick ally of Dave MacWilliams, a college professor with a PhD in English who specialized in grammar. Grammar! I could hardly tell the difference between a comma and a colon, except that one could get cancer the other could not. There was a contingent of poets in the class who dissected words as if they were literary surgeons. They even found meaning in the shapes of the white spaces around words and lines. The faculty had all written books and several of them had even written books on how to write books. To be sure, I felt inadequate and unqualified to have been counted as a student in their program, but there were threads of enlightenment that wove through the lectures and the workshops and the student interactions. As in medical school, I told myself that I would keep going to class as long as they didn’t start cutting me and making me bleed.

  I didn’t learn quickly, but I did learn. Lessons that other students finished in hours, I finished in days or weeks. Speed was not my forte; persistence was. I had time and I had tenacity, so that’s what I used for my writing exercises. My instructors gave me no special exemptions from lessons or requirements and I didn’t want any. I wanted to learn. They wanted to teach. The combination proved valuable.

  In my earliest attempts at short combat essays, I tried to write something profound. My instructors told me to just write sentences. “Tell us what you see, w
hat you did, and how you did it. Don’t jump to meanings first; don’t censor your experiences; give us the full monty,” they said. Author Sonya Huber, while critiquing my first combat essay, asked me to read a paragraph to our group. When I finished, she said, “Now put the essay down and tell us what you saw and what you felt during your first day in combat. Tell us only what you saw and felt. Don’t interpret anything. Make it raw.” I did. I told the group of five other students exactly what I saw. I described the frightening sounds and insufferable desert heat and the smell of blood. I told them I acted boldly but was fearful deep inside. And when I was done telling my story, Sonya said the words had power and then she asked why I had not said the same things in my essay. That was my first lesson: be real—be clear—make sentences. Let the meaning flow from what I observed. That turned out to be something I could do. As a physician, I had been trained to observe with my eyes and fingers and ears as I evaluated a patient. “Observe first, diagnose second, prescribe last” became my investigative clinical paradigm. I taught it to medical students and interns on rotation through my emergency room. I adapted it to writing. Write what I see, I told myself. Tell them exactly what you saw. And so I did. One summer residency to the next, one week at a time, one assignment after another. I put words on paper, in a semi-logical array, in a scatterbrained sequence, first in one version, then in another.

  At times my hands and eyes and brain tangled with each other. When my brain didn’t cooperate, I sat for hours doing a free-writing exercise, trying to remember stories of war and childhood, or medical school and therapy. I wrote words and connected them with lines. I scratched out sentences and crumpled up pages. I went outside to take breaks and sometimes I cussed at my brain; then I came back into the house and faced my computer and worked on lessons and exercises and sent them to my group. My instructors and cohorts pushed me and taught me. They told me to read this or that and to rewrite my stories. And I tried. God how I tried.