By Brandon Lingle
Brandon Lingle: Tell us about how you came up with the crossings metaphor as a unifying idea for your book?
Jon Kerstetter: That was a late development. I had, in the earliest stages, envisioned the book as a work that played on the practical and literary tensions of being a doctor and a soldier, (the first title was Soldier-Doctor) but in the course of developing it, I realized there was much more to the story because there was much more to me. Who was I in the most complete sense? Well, soldier and doctor certainly, but I was also a Native American with a different cultural perspective, I was a father and an older man. I was a stroke survivor and a patient during the entire time of the writing. Those were the parts that I had to reveal if the memoir was going to be true to my life and the pivotal events in it. During the first four years of the project, I struggled with the unifying theme and the narrative arc. It was only during the final three years that the notion of crossings really hit me as a central metaphor. What had I done during my entire life? Pushed against the boundaries that tried to define me. And I pushed them hard until I was able to cross them all. Crossings, quite literally, were in my DNA. Once I understood my own history, the crossings became clear, both as metaphor and milestones.
BL: I’ve heard surgeons say medicine is as much art as it is science. How do you think medicine and science inform your art?
JK: The core of medicine and science rests in the ability to make precise observations upon which diagnoses and therapeutics are based. To me, that is also the essence of good writing—keen and precise observations about characters, events, and settings followed by thoughtful interpretations of what has been observed. When I first started writing, I tried to write profound meanings for the reader. The writing was forced and unnatural. My mentors gave me some excellent advice: ‘instead of trying to make meaning, focus on making sentences. Give all the details of who, what, where, and when.’ That was great advice. I then drew on my medical training and began writing exactly what I observed, the color of the room, the sound of a bullet, the smell of battle, and when I made the change, my writing came to life and was precise and accurate. The meanings I sought to provide for readers then flowed naturally out of the story and its details, much like a diagnosis logically flowed out of astute clinical observations.
BL: Proximity and distance are threads that run through the book. You wrote, “I learned to get close enough to patients to show empathy and compassion while remaining detached enough to move from one case to the next with the understanding that medical science could not save every patient.” And, later, “remain detached in spirit without being distant in practice.” How does the ability to detach impact your writing?
JK: That detachment was critical in my writing. It allowed me to gain needed distance from emotionally laden stories that tended to trap me in a rather sad and depressed mood. War is a sad state of affairs, but to write effectively about it, about any difficult and emotional encounter, a writer needs to first convey the details of exactly what is seen and experienced. Doing so helps readers see and feel and hear as if they were real-time observers in a scene. That is the “show versus tell” or the “show and tell” of writing. With respect to difficult and highly emotional stories, the ability to move between the proximity of emotion and the distance of details is imperative in conveying the full range of our human experience. Writers are translators: we take one language of human experience and translate it into another language so others can understand us. That translation is never easy. The Triage chapter in the book was originally published as an essay that took me a year and a hundred drafts to complete. In writing the first drafts, I would slump my shoulders, weep, and allow myself to be overcome with grief. I had to make a transition from the participant in the story, to the writer of the story. Without that transition, I was too close emotionally to describe the events in the manner it deserved, with the details that allowed readers to experience firsthand the gut-wrenching challenges of medicine practiced in war.
BL: You note your life’s ironies, “A doctor training to become a soldier, a Native American in the modern cavalry whose roots extended all the way back to the Indian Wars.” Some would cite the ironies of our continued interventions in the Middle East. How does your work help you make sense of these complicated relationships?
JK: Life’s ironies. What would we do without them? In a sense, life merely offers us a sequence of events. We make the interpretations and see the ironies, the tragedies and the humor. We see the love and the hate and the indifference. When I write, whether essays or chapters in a book, I objectify my experiences on paper and then come back months later to encounter them much as a first-time reader would encounter them. That’s why it’s important to let material sit for a while between revisions, so one can get as close to objectivity as possible. And that writing/reading/revising process is the most rewarding kind of experience. It allows me to hone my views, challenge what I believe, see the subtleness of some ironies and the hammering force of others I may have been blind to. Case in point: my assignment to the Cavalry as a medical officer. I knew about Custer’s last stand in an academic, historical sense, but when I was revising that chapter about joining the National Guard, the rich details of my encounter with the commander, his black Stetson with its gold cavalry band and the image of Custer on horseback gave me a fleeting sense that we were playing “Cowboys and Indians,” and the irony hit me. How far had we both come. One needing the other. Now fighting together, yet known in history as fierce enemies. A modern Native doctor in the modern Cavalry. Our ancestors might weep or they might laugh, depending.
BL: You sought out dangerous and necessary humanitarian work in Rwanda, Bosnia, and Kosovo and wrote, “disaster medicine forced a reliance on the ‘thinking’ aspects of medicine rather than the ‘technological’ aspects…” and “I needed those patients just as they needed me. Their need for a doctor fueled my need to be a doctor. Everything I did for them mattered, and as detached as I had to become for professional survival, I became attached to those patients; I was the doctor who gave hope and even laughter with medicine. I lifted patients’ spirits and by doing so, lifted my own. There was a feeling that unified us, patient and doctor, against whatever calamity was trying to destroy us, so in the end we all survived together.” How does writing compare?
JK: Writing defines writers. I am now a writer who is as defined by my writing as I was by my career in medicine. But the defining is not one way. As in medicine and soldiering, I have become part of cadre of people who define writing by pushing boundaries with my unique perspective. We writers all have that opportunity; we shape our craft at the edges where it needs redefining, we bend the rules, twist the structure, challenge the paradigms of what it means to write and create. As much as I need writing now, I have a sense that it also needs me. I have my need to bring a new way of talking about combat and healing and loss, a fresh way of dealing with tragedy and hope. And the canon of literature needs that new approach, needs all of our new viewpoints. I need writing; it needs me.
BL: You spend time discussing the spin-up for your first Iraq deployment… the call up, balancing family with deployment preparations, and training. Then we land in Kuwait. The transition from home to war is a major crossing, and I’m interested in the creative choice to leave the physical trip out?
JK: That trip caused lots of mental anguish in terms of the prospects of putting all that I had learned in training to the test of real-time war medicine. But the anguish was mostly internal and I struggled with its usefulness in the work as a whole. I had written a separate essay in which I explored that physical trip to Iraq, but I had also written about my physical medevac out of Iraq. I decided to maximize the impact of the arrival transition by compressing the time: the reader sees the home preparation and then Bamm! Arrival. That transition is abrupt compared to the months of training preceding it, and the abruptness, I think, adds to the gritty effect of unexpected nature of war. I could have gone the other way and included the trip to Iraq, but that was a choice I made in pacing the story. And that brings up a good point, pacing is a key element in writing. The writer faces many difficult choices in tuning the pace of a story. An essay with the same thematic material may have one pace, yet as part of the larger story in a book, the same material may require different pacing and a different strategy. Choosing what to include or exclude in a story is always a debate.
BL: The entangling nature of war surfaces throughout the book. After orchestrating the autopsies and transfer of Saddam’s sons, you wrote, “I felt my refusal to witness the bodies of Uday and Qusay Hussein was my way of protecting my family from the entangling influences of their evil.” I appreciated your candor and understand this act of looking away. Do you think our country looks away too much from the truths of war? How do you think our society should recount and discuss war? If our society was more candid and open about the costs, would we be less apathetic when it comes to sending people to fight overseas?
JK: I think society as a whole looks away from the horrific and difficult truths of war. It is one of the ways we tell ourselves war is not real, that we humans have not crossed into inhumanity. Of course, we know that is self-deception on a grand scale. The role of war writers and war correspondents is that of truth telling—we writers bear the responsibility of telling about war from our unique vantage point. We are the ones who must call to society, sound the warning bell and show the true cost of war and our inhumanity. Hopefully our candor makes people think enough to challenge our politicians and military leaders as to our future roles in conflict. We all know that some wars must be fought; that will perhaps never change. But what must change is our proclivity for conflict leading to war. We, the military writers must become the lens and the mirrors that show the price of apathy. If we continue turning out excellent literature of war, we have a better chance at driving a cultural dialogue that focuses on the true costs of war. That is why it is important to keep writing and keep pushing our readers.
BL: On war’s insidiousness, you wrote, “In one moment you recalled the good things of home, and in the next moment the things of war and its inhumanity would creep in and destroy a perfectly beautiful and peaceful memory.” Can you discuss how writing this book affected these intrusive memories of war for you?
JK: Well, the intrusions were no small thing. They were the cost of writing about war. Writing makes writers relive experiences and when those experiences make writers plunge headlong into personal conflict and pain, the process takes on a horror all its own. There were several times when it was just too difficult to write. And frankly, some of the most difficult pieces I wrote were difficult for my first readers to get through. I had to learn to write in smaller, manageable chunks of the most gruesome war scenes. I even debated about leaving the most difficult scenes out, but that felt like a violation of the truth and my writing task. I decided that if I was going to write about war and all its ugliness from a physician’s point of view, I had to tell the truth to remain faithful to the craft of writing, but also to the men and women under my care who lost their lives in a most horrific way. My memories would become the memories of readers who trusted me to write the truth… and that became the balm that helped me deal with the intrusiveness of the horrific scenes of war. Yes, there was pain, but the telling of the truth helped in the comprehension of it all.
BL: This vignette about a dying soldier... “The general laid his hand on the expectant soldier’s leg—the leg whose strength I imagined was drifting like a shape-shifting cloud moving against a dark umber sky; strength retreating into a time before it carried a 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 and that that soldier would be their son.” Heart breaking and beautiful, this section captures war’s costs. What can we learn from this loss?
JK: I think the most poignant section of that chapter is the connection I made with the soldier and his mother, with his birth as it relates to two lovers who will one day realize that their greatest joy has become the source of their greatest sorrow. That is the part of war that makes soldier’s human, on both sides of the enemy lines. We are all sons or daughters of someone who loves us; and that relationship will cost some parents and families dearly. The pain will never die. That is the absolute tragedy of war, the loss, the terrible unending loss. That is the part of war that families must shoulder when nobody is looking, when all the Homefront support dies down. It is the part that makes for divorces and drunkenness and depression for survivors. It is the part that no medal or flag ceremony at a military funeral can erase. It is the part of war that continues even when the armistice is signed and armies return home.
BL: Regarding the dying soldier, you wrote, “If this were my son, I would want soldiers to gather in his room, listen to his breathing. I would want them to break stride from their war routines, perhaps to weep, perhaps to pray. And if he called out for his dad, I would want them to be a father to my son. Simply that—nothing more, nothing less—procedures not written in Department of Defense manuals or war theory classes or triage exercises.” How can we develop this type of humanity in our society?
JK: At the heart of that moment I drew on my experiences as a father of four children. And in that, one thing defined my role: love. In that singular moment, love was needed more than all the other things we could give a dying soldier. He didn’t need more medical expertise, no military honor and no blessing from a chaplain. He needed the tenderness of his father holding him in the grasp of loving arms. How do we develop that kind of compassion? That is the stuff of being human and being a parent. It is the stuff of deep reflection on what things are truly important in our lives. Yes of course, as members of the military community we value the mission and our commitment to each other, but in the final hour, in the final moments of our understanding of what it means to be human, we must come to value our love above all else. Not an easy thing to do, and doing so in the crucible of combat is always a challenge, but I think it is exactly what defines us as human and gives us hope that we shall survive from one generation to the next, both as soldiers and as citizens.
BL: Tim O’Brien says “True war stories do not generalize. They do not indulge in abstraction or analysis,” and “It comes down to gut instinct. A true war story, if truly told, makes the stomach believe.” You’ve written some stomach believing moments in this book. One example that stays with me, “As I slid the remains across the stainless steel table, the sharp edges of bone and the tiny rocks embedded in the tissues made a scratchy, metallic sound. I felt the sound in my teeth.” How do you distill such complicated images?
JK: I distil them by working the memories until the details become so clear I can smell the smells and hear the scratching. That is the work of asking questions of the event and revising to get the details just right. The mass of details that can be remembered is truly amazing and it becomes my job to sort through the most telling of details to form the images that carry the most power. When revising, details that are most powerful bubble to the top because they are usually the ones that elicit the most emotional or visceral response. Feeling sound in your teeth, like the scratching a chalkboard, is a sound that we all detest. Equating that kind of “universal” experience to a unique medical experience in battle is one of connecting experiences through common language. Again, I see my role as one of translation. In order to bring readers into my emotional landscape, I must translate things I see into something they can see. And precise control of words and details is what I use to get that done.
BL: The rendering of your stroke and its aftermath offers powerful insight. The moment when you’re looking at the MRI images, and you think, “Those brains have stolen my name,” really hit home. Did you find it difficult as a medical doctor to write about medicine for non-medical professionals?
JK: It’s somewhat difficult. Medicine contains its own special language and doctors are guilty of being so deep into their own specialties that making sense of the very complicated nature of disease and trauma if often not their forte. I had to learn not to speak in medicalease but in language that could be understood. Yet in that, I still used medical terminology without necessarily defining all my terms at the risk of slowing pacing. O’Brien does the same thing in describing things soldiers carried. He does not define every technical military thing and it works to the benefit of his readers. Much of what may be said in medical terminology can be understood contextually without having to know the exact definition of a medical word. More of the issue of writing about medicine came as a result of writing about something from which I was estranged. I was no longer a practicing physician, and the difficulty of using medical language only heightened the distance between me and my love of medicine.
BL: Books and writing helped you during your recovery. I appreciated how writing helped you understand “the dual nature of trauma, real versus remembered.” Do you want to write more about Iraq and your recovery?
JK: I want to write more about recovery because there is much more to be said about it, much more that I learned about the process. I might write another book about war, but I need to rest a bit and consider the emotional cost of doing so. Recovery is different; it is more about healing and hope and the future, and that excites me. One thing I and my healthcare providers learned about my recovery is this: it was unique in that writing had some unforeseen consequences in terms of cognitive recovery and even PTSD recovery. A healing brain is stimulated by use, by thinking and processing. And what is writing but thinking and thinking and thinking. That has been the core of my recovery. Writing and thinking. If I can write about that in more precise clinical terms or even team up with one of my neuropsychologists, that may lead to some very fruitful writing.
BL: In therapy, writing helped you organize and understand your thoughts and experiences. Later you entered an MFA program to hone your craft and create art. What was that crossing like?
JK: It was crazy scary. At the time I entered the writing program I had a reading speed and comprehension rate at the 5th percentile of adults my age (60 at the time). I felt inadequate and ill-prepared to learn something I thought was so far out of my lane of expertise. I felt like an old man on skies with youngsters whizzing by me on a steep slope. I envisioned myself as getting tangled in the rope tow. But the program I attended promised to work with me, and they did. They critiqued my writing as they did other students and pushed me to focus and write better. The environment they created was accepting and challenging. That brings up a point about pedagogy. Teachers have the ability to influence the lives of their students, and the students have the ability to change the way they see and do things. That was certainly operative in my case and I was able to respond in kind to the teaching and mentoring that I received.
BL: The recent politicization of soldier’s deaths in Niger highlighted the civil-military divide in the national dialogue. How can we continue to build understanding in our society?
JK: I think we need to understand that the military is part and parcel of society. We get our mandates from the greater society from which we belong. We are charged with an imperative to kill and destroy, two actions that in a setting other than war, would result in criminal charges. It is that sort of binary social ethic in which the military must do its missions: we are members of our society and members of our military forces; we walk the ethical lines between being both soldier and doctor, soldier and father and soldier and mother. And society demands that we walk that line well. They are the senders: the military are the goers. They are both essential to our continuing existence and even our continuing peace.
BL: I see your story as one of strength, recovery, and resiliency. It’s not a “damaged veteran” narrative. Unfortunately, the “damaged veteran” stereotype still pervades our society. Many works about our nation’s forever wars perpetuate this image. How can we battle against this worn out storyline?
JK: I hate the damaged veteran narrative. It gives such a weak and worn out picture of who veterans really are. The entirety of military training, hopefully of life training, focuses on the ability to adapt and overcome and to interpret the ongoing battle, and if a change is demanded, a change of course follows. What is more demanding of change than a veteran with injuries, mental, physical or both? The veteran must change in order to survive and most do. We are not stuck in a corner of a room twitching at the slightest sound or incapable of learning. My story and so many more like it are the prime evidence that veterans are capable of learning and adapting to change, of moving on in terms of healing and recovery. One of the challenges in redefining the veteran narrative comes in the form of challenging some of the thinking at of healthcare providers who still cling to the damaged veteran model. That is changing as military medicine makes known all it has observed from the current conflicts, but the progress is slower than I would like to see. Interestingly, some of the most intriguing approaches to challenging old paradigms has come from the arts. Private non-profit groups have engaged veterans in plays, painting, paper making, writing and story-telling as forms of healing and growth. If veterans are to expect a different narrative, it may well be up to them to challenge the “expected” with their own stories. And that gives me great hope. As in the battlefield, I see strength and courage displayed among our veterans who face the enormous postwar challenges of healing and learning.
BL: Any advice for veteran writers?
JK: Yes. Write like your life depends on it. Take the time to reflect on all that you have experienced and then put in a first draft and then a second and a third…. When you get to the point where you think you have captured the essence of your story, put it down and revisit it a month later and see how it affects your emotional terrain. If it makes you laugh or weep or cry out in anger, you are on the right track. Give your writing to a very few trusted readers who can give you honest feedback. You are not looking for writing that is just good; you are looking for writing that disrupts readers and demands reflection, writing that is real and truthful, bold and risky. If your writing makes your readers pause and consider things they never considered, you might be done, otherwise, keep writing.
BL: What are you reading now?
JK: I am reading some histories of my tribe and visiting some military museums. Interesting how much can be learned reading those museum placards that you tend to brush over. They tell a story, the visuals and artifacts of a museum tell a story. I want to take more time to learn what they are saying. Currently, I am reading, Empire of the Summer Moon by Gwynne. It was a finalist for the Pulitzer Prize. I tend to think of histories as dry and boring, but in the hands of a master story teller the subject tends to come alive with meaning. Oh, and I finished Everyman, by Philip Roth. It was a Pen/Faulkner Award Winner. Both books, one nonfiction, the other fiction, challenge common presuppositions about their subject matter and in that regard are just the kind of reading I enjoy the most.
BL: What’s your next project?
JK: I am busy defining that now and will most likely go in the direction of writing about stroke recovery. I have learned so much in recovery that it seems almost imperative that I should share it. I am also working on some short essays in fiction. I know, essays are in the nonfiction column. But what if I could write one that uses fictional composites of characters and events to make the same points as its nonfiction counterpart. I say it can be done just as easily as a Native American physician can join a Cavalry Regiment in the U.S. Army. If I can entertain that irony, can I not entertain an irony of literary form? I think your readers know the answer.
BL: Anything else you’d like to add?
JK: Life is full of the unexpected. I never thought I would have a stroke. Never thought I would write a book telling about how I recovered, or write essays about my life as a soldier doctor. What I turn to now is legacy formation, not only for my family and grandchildren, but also for my readers. I trust I am doing that just as I did soldiering and doctoring.
Jon R. Kerstetter is a physician and retired U.S. Army Flight Surgeon. He is a graduate of the Mayo Medical School in Rochester, MN (Class of 1988). He was the in-country director of the Johns Hopkins program in Emergency Medicine in Kosovo and provided humanitarian medical care in the conflicts in Rwanda, Bosnia, and Kosovo and in the hurricane disaster in Honduras. After joining the Iowa Army National Guard in 1994, he served as a medical officer until his retirement in 2009. Kerstetter completed three tours of duty in Iraq with the U.S. Army as a combat physician and flight surgeon.
Dr. Kerstetter also holds an MS in business from the University of Utah and an MFA in creative non-fiction at Ashland University in Ashland, Ohio. He is the author of the memoir, Crossings: A Doctor Soldier’s Story and his essays have appeared in literary journals including The Normal School, Best American Essays, Riverteeth, Lunch Ticket and others.
Brandon Lingle’s essays have appeared in various publications including The Normal School, The American Scholar, Guernica, The New York Times At War, and The North American Review. His work has been noted in five editions of The Best American Essays. An Air Force officer, he’s served in Iraq and Afghanistan. A California native, he currently lives in Texas and edits War, Literature, and the Arts. Views are his own.