Excerpt: Canary in the Coal Mine by Will Cooke

When Will Cooke, BA’94, MS’95, MD’01, an idealistic young physician just out of medical training, set up practice in the small rural community of Austin, Ind., he had no idea that much of the town was being torn apart by poverty, addiction, and life-threatening illnesses. But he soon found himself at the crossroads of two unprecedented health care disasters: a national opioid epidemic and the worst drug-fueled HIV outbreak ever seen in rural America.

Confronted with Austin’s hidden secrets, Cooke decided he had to do something about them. In taking up the fight for Austin’s people, he would have to battle some unanticipated foes: prejudice, political resistance, an entrenched bureaucracy―and the dark despair that threatened to overwhelm his own soul. Canary in the Coal Mine is a gripping account of the transformation of a man and his adopted community, a compelling and ultimately hopeful read.

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Just over six months after the first cluster of HIV cases was uncovered in Austin, but less than ninety days after Governor Pence signed the emergency order, everyone involved in the state-led emergency response had packed up and gone home. Their jobs were done. Meanwhile, our work—the work of daily caring for and providing support and resources to the underserved people of Austin—continued. Although the immediate crisis had abated, we needed to develop a community-wide model to combat stigma and remove the barriers to accessing care faced by people struggling with poverty and substance use disorder.

Those battling substance use disorder in Austin still faced seemingly insurmountable obstacles to recovery. Many families struggled to pay for necessities like rent, food, and utilities, and one in three children in Scout County lived below the poverty line. The criminalization of drug use compromised people’s willingness to seek help. If arrested, they would lose their Medicaid insurance coverage. If convicted, they would be qualified as felons, which would only make it nearly impossible to find jobs. Locking people away only made their return to society more difficult and second chances nearly impossible. In fact, studies show that many caught up in compulsive drug use overdose within the first two weeks of release.

My bout with depression had taught me the simple act of getting out of bed could become a herculean task. For people living with substance use disorder, or PTSD, seeking treatment was nearly impossible. Not only that, but there weren’t many mental health resources available to people with substance use disorder. All this kept local families lost in the shadows of poverty and despair.

Despite these obstacles, I knew people would participate in recovery if given an opportunity that felt safe. If we could develop a secure bridge to help patients overcome their substance use disorder and make a fresh start, I was convinced people in recovery would actively maintain and expand that bridge for others.

The lunch hour crowd was dwindling in the small café facing the Scottsburg town square. Carolyn King and I were finishing our meal with Tom Cox (representing the Great Lakes Addiction Training and Transfer Center) and Stephanie Spoolstra (deputy director of the state’s Department of Mental Health and Addiction), along with the director of the IU Addiction Medicine fellowship and a federal representative from the Substance Abuse and Mental Health Services Administration. Carolyn and I felt we needed help resurrecting out county’s spirit of collaboration.

“We lack resources,” I told the group, “which makes it critical that we find ways to collaborate.” Our server laid down our bill and began to quietly clear our table.

I nodded to Carolyn, who was sitting next to me. “Carolyn is the one who proved how successful Scott County can be when partnerships are built.” Together, she and I began explaining how more than twenty-five years before, Scott County had been nationally recognized for the collaborative program Kids Place.

“Over the past few years,” Carolyn added, furrowing her brow, “with the economic downturn, we lost grants and programs that addressed things like childcare, domestic violence, teen pregnancy, and workforce development. Even the Kids Place closed. All of this has strained our collective system, and yet the spirit of teamwork prevails.”

“An example of that,” I added, “has been the work we’ve accomplished through the Scott County Partnership. That includes the Get Healthy Scott County coalition, representing agencies from every sector in the county, which is focused specifically on improving health indicators such as drug prevention, education, and poverty.”

“Somehow,” Carolyn picked back up, “Governor Pence’s Incident Command Center missed our strong history of collaboration. The administration seemed to listen more closely to political influences that were not inclined to invest in social services.”

Everyone nodded.

“It’s not unusual for chaos to reign in a crisis,” Carolyn continued. “I saw this happen when I took over the federal recovery efforts after the tornadoes that devastated Henryville, Indiana, in 2012. Various groups try to assume leadership. People worry that no one is in charge. However, once the chaos receded, we brought local partnerships together, and calm was restored. Now that the emergency response has ended, we believe Scott County is ready.”

Our group began discussing ways for the entire community to get behind helping those battling substance use disorder. Stephanie pledged the support of Indiana’s Division of Mental Health and Addiction (DMHA), and the representative from the Substance Abuse and Mental Health Services Administration (SAMHSA) agreed to hire a nationally recognized, professional facilitator she knew to help the splintered factions spread across the county reunite around a common purpose.

As we wrapped up, I looked at everyone around the table and smiled. “Thank you for hearing out concerns. Carolyn and I believe our community deserves the opportunity to develop our own way forward.”

A few weeks later we held a successful two-day leadership summit at Scott Memorial Hospital. By the end, we had developed a countywide consensus to focus on recovery by working through the Scott County Partnership.

Carolyn, Stephanie, and I smiled as we found each other after the last meeting. We exchanged hugs, and Carolyn told Stephanie, “Thank you for not buying into the chaos narrative. We are grateful that you believe in us and are helping us pull this off!”

Stephanie replied, “This whole mess has taught me how vitally important it is to invest in and empower local coalitions and resources long before a crisis strikes. I’m not willing to play politics with people’s lives.”

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If you’d like to learn more about Austin, Ind., check out our Q&A with Will Cooke or purchase his book.

Adapted from Canary in the Coal Mine by William Cooke with Laura Ungar. Copyright © 2021. Used by permission of Tyndale House Publishers, a Division of Tyndale House Ministries. All rights reserved.