A Physician’s View of the Drug Epidemic Ravaging Rural America

Headshot of Will Cooke and Canary in the Coal Mine book cover.
Will Cooke, BA’94, MS’95, MD’01, published Canary in Coal Mine in 2021. Photo courtesy of Will Cooke. Book cover image courtesy of Tyndale House Publishers, a Division of Tyndale House Ministries. Design by Kendra Kay Creative.

Will Cooke, BA’94, MS’95, MD’01, had no idea what he was in for when he moved back home to southern Indiana after completing his medical residency in Muncie, Ind.

In 2015, Austin, Ind., a mining town of 4,000 people, had been pervaded by the worst drug-related HIV outbreak in rural America. As the only physician in Austin, Cooke and his clinic were pushed to create solutions and provide residents with access to social services and medical resources when drug use ravaged the town.

“My job is to heal, to keep people healthy, and to allow them to have as much access to life as possible,” says Cooke, medical director at Foundations Family Medicine in Austin. “It’s those vital community factors—feeling safe, having your basic needs met, transportation, livable wage, lifelong learning, humane housing—that define how much access to life someone’s going to have.”

When Cooke decided to write a book from his viewpoint of the crisis, finding a publisher that was comfortable with the subject matter proved challenging. He wanted the book to focus on the people of Austin, and not to portray himself as a hero.

“We’re talking about people who are often overlooked in society that people don’t want to acknowledge,” says Cooke.

In the following Q&A, Cooke discusses the experience of writing Canary in the Coal Mine: A Forgotten Rural Community, a Hidden Epidemic, and a Lone Doctor Battling for the Life, Health, and Soul of the People—a book propelled by the vulnerability of his patients and himself, and what Austin looks like post-outbreak.

At what point did you know that you wanted to write a book?
Will Cooke: I’ve always enjoyed writing, so the idea of writing a book has always been in the back of my mind.

I started writing this book once we got on the other side of the [HIV] outbreak [in 2020]. I started feeling like we had developed a system of care for the people we needed to care for and started seeing some success.

The book tells the stories of actual patients at your clinic. Did you have any concerns about interviewing them?
WC: As a physician, it’s kind of weird writing about your patients, so I talked to [contributor Laura Ungar] about how comfortable she felt with being the one who interviewed the patients. That way, she’s getting information and reporting it back. Then I could pull together a[n] [illustrative, non-identifying] patient from the interviews conducted and build the narrative and the story.

You’re honest about your personal and professional missteps in the book, like dismissing a patient who was abusing drugs rather than helping her find resources. Was it difficult to share these moments?
WC: I had to be vulnerable because one of the messages of the book is vulnerability—being allowed to say that we failed, that we’re not OK, and that we need help. If that’s going to be the message of the book, then I needed to be willing to show the places where I have personally failed and that it’s not on us to become heroic.

What has changed in your practice since the book was published?
WC: I’ve converted the clinic into a federally qualified health center. We merged with an organization called Well Care Community Health, which gives us more resources and infrastructure to do what we do better. That’s a significant change that ensures that the clinic will be there long after me.

Carolyn Cooke and Will Cooke, Will Cooke Sr. and Will Cooke Jr., Will Cooke.
Image top left, Will Cooke with his mother, Carolyn Cooke, BGS’92, MS’95. Image bottom, Cooke with his father, Will Cooke Sr., BA’80. Image right, Cooke speaking about his partnership with the Aids Healthcare Foundation. Photos courtesy of Will Cooke. Design by Kendra Kay Creative.

What is Austin, Ind. like today?
WC: Many of the same social issues still exist and we’re working to figure out ways to help people. We started a nonprofit, Refresh, [when the book was published] to work alongside the clinic to meet social needs. Through Refresh we have community health workers, case managers, and care specialists, who go out into the community, connect with people, and link them back to care.

What advice do you have for people in communities struggling with drug and health crises?
WC: If you acknowledge and fix the toxic conditions, then everybody can live a healthier life.

When I talk to other communities, I talk about how places like Austin are the canary in the coal mine. There are toxic conditions that are killing people [everywhere]. Just like the coal miners bringing the canaries into the coal mines to warn them of toxic conditions, if you ignore that, more people are at risk.

You mention in the book how valuable it is to have resources nearby. As a graduate of two regional campuses—IU Southeast and IUPUI—how helpful was it to have an IU campus in your community?
WC: We didn’t have many resources growing up, and I think it would have been difficult for me to have gone off to college. [IU Southeast] allowed me to live at home and commute to college. The fact that [my parents] went to [IU Southeast] while I was growing up was impactful, too, because I got to see and be around that environment.

Rapid Fire with Dr. Cooke

Where was your favorite writing spot while working on your book?
WC: I would put my headphones on, play music, and sit in my recliner and write.

When you’re not at work, what occupies your time?
WC: We have four [kids] in college and two in high school, so time is spent traveling to visit [them]. I enjoy being active: exercising, riding a bike, getting outside for walks with my wife, and spending time with my parents. Also, I write poetry and short essays, and I’ve done a couple of op-eds.

Do you have plans to write another book?
WC: I’m moving toward writing another book. It would probably be on poverty and vital community factors. Knowing how she grew up and has overcome poverty, my mom might be the focus of that story.

What books do you often recommend?
WC: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk.

Tattoos on the Heart: The Power of Boundless Compassion by Greg Boyle.

In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Maté.

Read an excerpt from Canary in the Coal Mine.

This story is part of our IU alumni author series, Novel Ideas.

Written By
Autumn Simone Monaghan
Autumn Monaghan, MA'14, is a graduate of IUPUI’s Sports Capital Journalism Program and a content specialist at the IU Alumni Association.