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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
One doctor's courageous fight to save a small town from a silent epidemic that threatened the community's future - and exposed a national health crisis.
When Dr. Will Cooke, an idealistic young physician just out of medical training, set up practice in the small rural community of Austin, Indiana, 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, Dr. Cooke decided he had to do something about them. In taking up the fight for Austin's people, however, 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 in the vein of 'Hillbilly Elegy', 'Dreamland', and 'Educated'.
When Dr. Will Cooke, an idealistic young physician just out of medical training, set up practice in the small rural community of Austin, Indiana, 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, Dr. Cooke decided he had to do something about them. In taking up the fight for Austin's people, however, 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 in the vein of 'Hillbilly Elegy', 'Dreamland', and 'Educated'.
308 pages, Kindle Edition
First published May 25, 2021
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Displaying 1 - 30 of 87 reviews
October 7, 2021
I somehow found this book on Hoopla, and was interested to get a doctor's perspective on opioid addiction issues. I have previously read Dopesick: Dealers, Doctors, and the Drug Company that Addicted America and Death in Mud Lick: A Coal Country Fight against the Drug Companies That Delivered the Opioid Epidemic, both by journalists, as well as fiction such as Ohio.
But this book. Cooke is a GP who set up a the only practice in Austin, Indiana, which was in the throes of an opioid epidemic that he was not yet aware of. It goes on to become an HIV epidemic due to shared needles. He is very earnest and definitely wants to help people, but he comes with many preconceptions--which he admits--that he does not fully break down. He contradicts himself. He has a very high opinion of himself as a good Christian and good doctor.
I stuck out this listen even though I found it very frustrating. And he has his own frustrations--Mike Pence, then governor of Indiana; the politicization of needle exchanges; the power-hungry people in medicine and government that look down on a small-town doctor.
I listened on audio, mostly while walking, so I did not take the notes or mark pages as I would have if I had read a paper copy or ebook.
• Too much religion, and by religion I mean Protestant evangelicalism.
• When things go right, it's because of God. When things go wrong, it is because of people (individuals or groups or the general public).
• According to Cooke, addicts are victims and are not at fault, and substance abuse disorder is caused by traumatic events in childhood. Addicts were not raised in safe, loving environments by their parents/guardians. But then of his individual examples, some absolutely had trauma, but how, for example, is a father's death of a heart attack when a child is 12 anyone's "fault"? Most of his examples got hooked on opioids after being prescribed them by a doctor or dentist--he blames their inability to get off on their upbringings.
• Not until chapter 6 or 8 does he mention oxycodone being marketed as "nonaddictive", and how many doctors and dentists handed out Rxs like candy because they believed this. Though he refuses to prescribe such drugs, he proceeds to ignore this common way so many people have their first encounter with opioids--legally and innocently, often as a minor with a sports injury or dental surgery, or with a work-related back injury. He offers no suggestions on how to manage this gateway of real pain and irresponsible prescribers.
• Not until chapter 16? 18? (also: the audiobook chapters on the audio do not match the chapters showing on the screen) does he mention drugs such as cocaine and crack on how they decimated black urban communities, and the answer was to jail people. With this largely rural, white epidemic, the answer is no longer jail. He researches and mentions this, but does not advocate for either emptying the jails of drug offenders or arresting current users.
• He complains about lack of health insurance and transportation as barriers to health care, but never suggests a medicare-for-all or other system. Or offers any solutions to get health care to people who cannot afford it. He just complains.
• He does not mention mental illness until the appendices, and offers up self-medication as part of what is going on. No kidding.
• Though he goes on and on about childhood trauma being an extreme contributor to addiction, he also does not offer any solutions for current and future children. Should schools offer mandatory grief counseling? Does their need to be a change to the foster care/social services systems? Are mandatory reporters not reporting, or being ignored? How can children be given a safe person to confide their secrets to?
And the narrator--he has a great voice when reading the text and portraying the author. His women's voices, however, sound like high school boys mocking their mothers. I will be paying more attention to how male narrators portray women's voices in the future. I have never noticed before, and this was not good.
But this book. Cooke is a GP who set up a the only practice in Austin, Indiana, which was in the throes of an opioid epidemic that he was not yet aware of. It goes on to become an HIV epidemic due to shared needles. He is very earnest and definitely wants to help people, but he comes with many preconceptions--which he admits--that he does not fully break down. He contradicts himself. He has a very high opinion of himself as a good Christian and good doctor.
I stuck out this listen even though I found it very frustrating. And he has his own frustrations--Mike Pence, then governor of Indiana; the politicization of needle exchanges; the power-hungry people in medicine and government that look down on a small-town doctor.
I listened on audio, mostly while walking, so I did not take the notes or mark pages as I would have if I had read a paper copy or ebook.
• Too much religion, and by religion I mean Protestant evangelicalism.
• When things go right, it's because of God. When things go wrong, it is because of people (individuals or groups or the general public).
• According to Cooke, addicts are victims and are not at fault, and substance abuse disorder is caused by traumatic events in childhood. Addicts were not raised in safe, loving environments by their parents/guardians. But then of his individual examples, some absolutely had trauma, but how, for example, is a father's death of a heart attack when a child is 12 anyone's "fault"? Most of his examples got hooked on opioids after being prescribed them by a doctor or dentist--he blames their inability to get off on their upbringings.
• Not until chapter 6 or 8 does he mention oxycodone being marketed as "nonaddictive", and how many doctors and dentists handed out Rxs like candy because they believed this. Though he refuses to prescribe such drugs, he proceeds to ignore this common way so many people have their first encounter with opioids--legally and innocently, often as a minor with a sports injury or dental surgery, or with a work-related back injury. He offers no suggestions on how to manage this gateway of real pain and irresponsible prescribers.
• Not until chapter 16? 18? (also: the audiobook chapters on the audio do not match the chapters showing on the screen) does he mention drugs such as cocaine and crack on how they decimated black urban communities, and the answer was to jail people. With this largely rural, white epidemic, the answer is no longer jail. He researches and mentions this, but does not advocate for either emptying the jails of drug offenders or arresting current users.
• He complains about lack of health insurance and transportation as barriers to health care, but never suggests a medicare-for-all or other system. Or offers any solutions to get health care to people who cannot afford it. He just complains.
• He does not mention mental illness until the appendices, and offers up self-medication as part of what is going on. No kidding.
• Though he goes on and on about childhood trauma being an extreme contributor to addiction, he also does not offer any solutions for current and future children. Should schools offer mandatory grief counseling? Does their need to be a change to the foster care/social services systems? Are mandatory reporters not reporting, or being ignored? How can children be given a safe person to confide their secrets to?
And the narrator--he has a great voice when reading the text and portraying the author. His women's voices, however, sound like high school boys mocking their mothers. I will be paying more attention to how male narrators portray women's voices in the future. I have never noticed before, and this was not good.
July 19, 2021
I grew up in a very rural area of Southern Indiana...not far from Austin, IN where the events of this book happened. I attended Indiana University for undergrad and grad. When an article about this book posted by IU's School of Public and Environmental Affairs popped up on social media...I clicked on it. Dr Cooke did the same Masters program my husband did and they completed IU medical school the same year. When I realized all these similarities I immediately hit "Pre-Order" on Amazon.
This event made national news, but I don't remember it so I was very interested. (We don't live in Indiana anymore.) It was a compelling story and I finished it in 3 days...a great pace for non-fiction! I read "Just Mercy" early this year and what that book was to poverty and mass incarceration, this book is to poverty and public health. There are two main and interesting differences between the books. One is that Dr. Cooke leans heavily on his faith to get him through numerous difficulties. This becomes particularly ironic when Governor Mike Pence, and other elected officials begin sabotaging his efforts to help poor, sick residents with substance use disorder. Time and time again those in charge use "morality" and "prayer" instead of actually helping...which frustrates the author.
The other difference between the two books is that Bryan Stephenson is overrun with requests for help from inmates on death row and knows where to find his clients. Those he helps suggest who he needs to help next. Dr. Cooke has to go out and FIND his patients who are all hiding like feral cats in abandoned buildings and convince them they need help and are worthy of assistance. Distrustful and worried about incarceration...the sick in his community hide from everyone, even those that are trying to help them.
I learned a lot reading this book and highly recommend it.
This event made national news, but I don't remember it so I was very interested. (We don't live in Indiana anymore.) It was a compelling story and I finished it in 3 days...a great pace for non-fiction! I read "Just Mercy" early this year and what that book was to poverty and mass incarceration, this book is to poverty and public health. There are two main and interesting differences between the books. One is that Dr. Cooke leans heavily on his faith to get him through numerous difficulties. This becomes particularly ironic when Governor Mike Pence, and other elected officials begin sabotaging his efforts to help poor, sick residents with substance use disorder. Time and time again those in charge use "morality" and "prayer" instead of actually helping...which frustrates the author.
The other difference between the two books is that Bryan Stephenson is overrun with requests for help from inmates on death row and knows where to find his clients. Those he helps suggest who he needs to help next. Dr. Cooke has to go out and FIND his patients who are all hiding like feral cats in abandoned buildings and convince them they need help and are worthy of assistance. Distrustful and worried about incarceration...the sick in his community hide from everyone, even those that are trying to help them.
I learned a lot reading this book and highly recommend it.
February 18, 2021
The biggest take-away from this book, for me, was to remember to not focus on the tip (“iceberg”) of a problem but to look deeper into the causes. People are multifaceted and need individual, long-term care.
#CanaryInTheCoalMine #netgalley
#CanaryInTheCoalMine #netgalley
August 21, 2021
Canary in the Coal Mine by Dr. William Cooke is an insightful and emotional story of a small towns courage in the face of a silent epidemic. Dr. William Cooke was a young, hopeful physician who established a medical practice in rural Austin, Indiana. He soon discovered it was a town broken and fractured by poverty, illness and addiction. His medical practice became the battleground of an opioid epidemic and HIV crisis - the worse outbreak recorded in rural America. Dr. Cooke dedicated his work and practice to helping and healing his community, facing political pressure, prejudice and discrimination. The community was brought together in the face of such struggle united by faith and belief in people. A compelling, tragic and compassionate portrait of a community in crisis. This is nonfiction at its most essential and finest. 4.5 ⭐️
Thanks to NetGalley and the publisher for a review copy of this book in exchange for honest feedback.
Thanks to NetGalley and the publisher for a review copy of this book in exchange for honest feedback.
July 20, 2021
This book outlines how the lack of health care can create numerous problems. It is well written, combining both facts and a personal story. Three things converge to create a health crisis, poverty, opioid use, and HIV. It is an old story that highlights a pattern that is still relevant today. The desperate search for meaning and hope in troubled times.
October 20, 2021
I would like to preface my review by saying I am not a highly religious person although I have faith.
Canary in the Coal Mine is the true story of Dr. William Cooke. He mentions his Christianity throughout the book, and it is one of his key drivers. Dr. Cooke feels a calling when he is young, and despite adversities, he becomes a doctor. He opens practice in the under-served community of Austin, Indiana. He finds himself struggling financially due to the amount of uninsured and underinsured and emotionally due to the amount of hardships in his community. His marriage crumbles, and there is a lack of community and government support for the local citizens. He sees the opioid epidemic first hand, and suddenly his county is front page national news for leading the country in the rise in AIDS.
Canary also shines a light on how people view their faith and use it for reasoning their actions. Some people say that the weaknesses of others (drugs, poverty, etc) would be better if they just tried harder and had faith. Others see their faith as a reason to help others.
I listened to this as an audiobook, and although I am not religious, I have compassion and appreciate those that work to better themselves and their community rather than turning a blind eye. Dr. Cooke may not have all the answers for this complex problem, but he offers a facet that many people may not realize is there.
Canary in the Coal Mine is the true story of Dr. William Cooke. He mentions his Christianity throughout the book, and it is one of his key drivers. Dr. Cooke feels a calling when he is young, and despite adversities, he becomes a doctor. He opens practice in the under-served community of Austin, Indiana. He finds himself struggling financially due to the amount of uninsured and underinsured and emotionally due to the amount of hardships in his community. His marriage crumbles, and there is a lack of community and government support for the local citizens. He sees the opioid epidemic first hand, and suddenly his county is front page national news for leading the country in the rise in AIDS.
Canary also shines a light on how people view their faith and use it for reasoning their actions. Some people say that the weaknesses of others (drugs, poverty, etc) would be better if they just tried harder and had faith. Others see their faith as a reason to help others.
I listened to this as an audiobook, and although I am not religious, I have compassion and appreciate those that work to better themselves and their community rather than turning a blind eye. Dr. Cooke may not have all the answers for this complex problem, but he offers a facet that many people may not realize is there.
January 26, 2025
This book was very informational and gave accounts of actively substance abuse users as well as those in recovery and out of recovery. It gave me insight into what people finally find as their rock bottom or their wall. It's not always what we imagine. It also went into great detail about how much our political system is centered on what the public perceives them to be doing versus what they actual do, which is to make it harder for those in need to get the basic and necessary care to get better. The author struggled so much with getting state officials to wee the crisis before the HIV outbreak began and how he was ignored and shoved off. When they finally did something, it wasn't nearly enough or what was actually needed. How, as a nation that boasts of being the greatest, been able to fail those who need the most?
Reading this book made me realize how much more we could all be doing. I am passionate about the opioid epidemic but what good is my passion if all I do is post on social media? Where are my real actions beyond informing the public of misconceptions? This book proved to be a challenge with myself as I am not an active member of change.
2nd Read: still a good read but was disheartened by how little we have changed as a society to better the lives of those struggling. We still vastly marginalize people who were failed by society and the healthcare system.
Reading this book made me realize how much more we could all be doing. I am passionate about the opioid epidemic but what good is my passion if all I do is post on social media? Where are my real actions beyond informing the public of misconceptions? This book proved to be a challenge with myself as I am not an active member of change.
2nd Read: still a good read but was disheartened by how little we have changed as a society to better the lives of those struggling. We still vastly marginalize people who were failed by society and the healthcare system.
July 30, 2025
This was so good and also close to home since I work with kiddos from Austin. I really appreciated that it was easy to understand as a non-medical person. Stories like these are so important to help us understand the empathy and support needed for people living with addiction!
November 15, 2024
As a health care provider in Indiana I found this to be fascinating insight into the state politics and to understand how far we have come.
October 20, 2023
I saw Canary in the Coal Mine mentioned somewhere; I think maybe in an email about authors from IU (my alma mater). It’s about William Cooke, a family doctor who decides to set up practice in a town that hasn’t had one in three decades: Austin, Indiana. That happens to be just about 15 miles from the town where I grew up, so I was intrigued.
Cooke opens a practice there in 2004, fresh out of medical school: “I was the only doctor in Austin, Indiana—a city of 4,300 people in Scott County, just off I-65 between Louisville, Kentucky, and Indianapolis, Indiana—when it became ground zero for two unprecedented health-care disasters with roots in the 1980s. One was the national opioid epidemic. The other was the worst-recorded HIV outbreak among people who use drugs in the nation’s history.”
It was interesting to read about that, since, although I no longer lived nearby at that time, I didn’t recall being aware of the woes occurring so close to where I was raised. Cooke “marveled how conditions here in the heart of the richest country on earth rivaled those I saw on mission trips to developing countries.” He finds that “the idea of practicing medicine by myself in such a poverty-stricken and resource-poor area was intimidating” and mentions that there were open sewers and that many many areas in Austin lacked running water.
Again, this was sort of like having an idea of how you look your whole life but having no mirror. Then suddenly, you see your reflection and it’s not the way you thought it would be. Had I really grown up in such a deprived area? I recently asked my dad what he knew about Austin. He had been a teacher and told about a summer job he’d had with a friend, working for a bank. They would go to the homes of people who weren’t paying back their loans and try to convince them to do that. He said that Austin was a place they were frequently sent, to try to collect, and that it was a rough place with some “real characters.” Interesting.
Back to the book: Cooke quickly learns that many of the town’s citizens are hooked on pain-relieving drugs. Side note: one thing I found interesting was that he says that about 15% of people taking such drugs will become addicted to them. I kind of thought everyone would? On the rare occasions I have been prescribed them, I’ve hesitated to take even one, fearing that in no time I’d be a meth head. The idea that 85% of people taking them wouldn’t become hooked was a new concept to me.
Cooke also goes into the history of painkillers, sharing that “during OxyContin’s first five years on the market, Purdue Pharma gave over five thousand health-care professionals all-inclusive trips to resort areas such as Boca Raton, Florida, and Scottsdale, Arizona, in exchange for being in their speakers’ bureau.” This all strengthened my belief that, unless necessary, one wants to stay as far from the medical establishment as possible. The times I’ve been drawn in, it seems one thing leads to another, and it all costs a ridiculous amount of money. It seems wrong that one sector of our lives (medicine) should so outweigh others in terms of cost. I know we pay $16,000 annually for our insurance, and if we actually have any medical expenses, the first $5000 are on us, before that insurance even starts to pay. This seems almost criminal.
Cooke shares many, many stories of patients he works with — mostly sad cases of people living awful lives while also being hooked on drugs. He works with IU Health and with the state to try to tackle the HIV cases that popped up. It was amazing to me to read of all the funding that went to offering the people there free healthcare, free testing, free this-and-that. Most of the HIV patients thankfully did get help and went into remission (which, with HIV, means that you’re pretty much fine if you take your meds). But Cooke was disillusioned that the state wasn’t real interested in learning from the things he’d discovered over his years of practice in Austin. Instead, they wanted their own “experts” to come in and make rules and pronouncements. And all this led my mind to Covid, where our governmental “experts” swooped in to decide how we could all live our lives and slowly regain our freedoms. Just like with healthcare, government is an entity best avoided whenever possible. I had to laugh when one expert showed up at Cooke’s office, telling him “I can assure you, the CDC is here to help.” I can’t think of an agency that I trust much less than the CDC these days. “The focus seemed to be solely on reacting to the symptoms while ensuring the government maintained control,” Cooke lamented. “I started to say something but realized it wouldn’t change anything. How, I wondered, does she think she can replace the system that took us over a decade to develop?”
Cooke ends up staying in Austin to practice, but has lost hope that higher authorities will help in any meaningful way.
The book is published by Tyndale and Cooke shares a lot of his Christian faith, which I appreciated. I found the book itself a pretty “meh” read though overall. It seemed unsure of what it wanted to be: a non-fiction read about the HIV/painkiller epidemic, or a memoir of Cooke? There were long sections detailing all the specific interactions of various governmental officials with all their acronymns (which I quickly lost track of). There were so many patient profiles. Then there were sections with lengthy personal conversations between Cooke and his wife. Honestly, it was a pretty dry read.
I am glad I read it though, due to its setting. Otherwise, if you’re interested in the general topic I would recommend “Dreamland” by Sam Quinones for the drug parts, or J.D. Vance’s “Hillbilly Elegy” for the sociological aspects.
Cooke opens a practice there in 2004, fresh out of medical school: “I was the only doctor in Austin, Indiana—a city of 4,300 people in Scott County, just off I-65 between Louisville, Kentucky, and Indianapolis, Indiana—when it became ground zero for two unprecedented health-care disasters with roots in the 1980s. One was the national opioid epidemic. The other was the worst-recorded HIV outbreak among people who use drugs in the nation’s history.”
It was interesting to read about that, since, although I no longer lived nearby at that time, I didn’t recall being aware of the woes occurring so close to where I was raised. Cooke “marveled how conditions here in the heart of the richest country on earth rivaled those I saw on mission trips to developing countries.” He finds that “the idea of practicing medicine by myself in such a poverty-stricken and resource-poor area was intimidating” and mentions that there were open sewers and that many many areas in Austin lacked running water.
Again, this was sort of like having an idea of how you look your whole life but having no mirror. Then suddenly, you see your reflection and it’s not the way you thought it would be. Had I really grown up in such a deprived area? I recently asked my dad what he knew about Austin. He had been a teacher and told about a summer job he’d had with a friend, working for a bank. They would go to the homes of people who weren’t paying back their loans and try to convince them to do that. He said that Austin was a place they were frequently sent, to try to collect, and that it was a rough place with some “real characters.” Interesting.
Back to the book: Cooke quickly learns that many of the town’s citizens are hooked on pain-relieving drugs. Side note: one thing I found interesting was that he says that about 15% of people taking such drugs will become addicted to them. I kind of thought everyone would? On the rare occasions I have been prescribed them, I’ve hesitated to take even one, fearing that in no time I’d be a meth head. The idea that 85% of people taking them wouldn’t become hooked was a new concept to me.
Cooke also goes into the history of painkillers, sharing that “during OxyContin’s first five years on the market, Purdue Pharma gave over five thousand health-care professionals all-inclusive trips to resort areas such as Boca Raton, Florida, and Scottsdale, Arizona, in exchange for being in their speakers’ bureau.” This all strengthened my belief that, unless necessary, one wants to stay as far from the medical establishment as possible. The times I’ve been drawn in, it seems one thing leads to another, and it all costs a ridiculous amount of money. It seems wrong that one sector of our lives (medicine) should so outweigh others in terms of cost. I know we pay $16,000 annually for our insurance, and if we actually have any medical expenses, the first $5000 are on us, before that insurance even starts to pay. This seems almost criminal.
Cooke shares many, many stories of patients he works with — mostly sad cases of people living awful lives while also being hooked on drugs. He works with IU Health and with the state to try to tackle the HIV cases that popped up. It was amazing to me to read of all the funding that went to offering the people there free healthcare, free testing, free this-and-that. Most of the HIV patients thankfully did get help and went into remission (which, with HIV, means that you’re pretty much fine if you take your meds). But Cooke was disillusioned that the state wasn’t real interested in learning from the things he’d discovered over his years of practice in Austin. Instead, they wanted their own “experts” to come in and make rules and pronouncements. And all this led my mind to Covid, where our governmental “experts” swooped in to decide how we could all live our lives and slowly regain our freedoms. Just like with healthcare, government is an entity best avoided whenever possible. I had to laugh when one expert showed up at Cooke’s office, telling him “I can assure you, the CDC is here to help.” I can’t think of an agency that I trust much less than the CDC these days. “The focus seemed to be solely on reacting to the symptoms while ensuring the government maintained control,” Cooke lamented. “I started to say something but realized it wouldn’t change anything. How, I wondered, does she think she can replace the system that took us over a decade to develop?”
Cooke ends up staying in Austin to practice, but has lost hope that higher authorities will help in any meaningful way.
The book is published by Tyndale and Cooke shares a lot of his Christian faith, which I appreciated. I found the book itself a pretty “meh” read though overall. It seemed unsure of what it wanted to be: a non-fiction read about the HIV/painkiller epidemic, or a memoir of Cooke? There were long sections detailing all the specific interactions of various governmental officials with all their acronymns (which I quickly lost track of). There were so many patient profiles. Then there were sections with lengthy personal conversations between Cooke and his wife. Honestly, it was a pretty dry read.
I am glad I read it though, due to its setting. Otherwise, if you’re interested in the general topic I would recommend “Dreamland” by Sam Quinones for the drug parts, or J.D. Vance’s “Hillbilly Elegy” for the sociological aspects.
March 16, 2022
Compelling and often heartbreaking memoir about the opioid crisis and an HIV outbreak in rural Indiana.
This book is a great read for white Christian folks who demonize drug addicts, as the author (and doctor) is white Christian man. His faith informs his compassion, care, and work towards implementing harm-reduction strategies in his community. Cooke discusses how he came around to changing his mind on many things, and admits his many mistakes as a young doctor working to make a positive impact in his community.
For me, the focus on faith and a Christian god was not a highlight of the book, but I still learned so much about the opioid crisis, harm reduction, HIV, rural America, and drug addiction. It was incredibly frustrating to read of the Christians Cooke discusses who treated those in need very poorly, including a politician who stopped the implementation of syringe exchanges in Indiana after "praying to God" because he didn't "morally agree with it" - even after being presented with the overwhelming evidence that syringe exchanges safe lives.
This book is a great read for white Christian folks who demonize drug addicts, as the author (and doctor) is white Christian man. His faith informs his compassion, care, and work towards implementing harm-reduction strategies in his community. Cooke discusses how he came around to changing his mind on many things, and admits his many mistakes as a young doctor working to make a positive impact in his community.
For me, the focus on faith and a Christian god was not a highlight of the book, but I still learned so much about the opioid crisis, harm reduction, HIV, rural America, and drug addiction. It was incredibly frustrating to read of the Christians Cooke discusses who treated those in need very poorly, including a politician who stopped the implementation of syringe exchanges in Indiana after "praying to God" because he didn't "morally agree with it" - even after being presented with the overwhelming evidence that syringe exchanges safe lives.
January 2, 2023
I think there was a compelling narrative for the community of Austin, IN who was ravaged with simultaneous opioid and HIV epidemics, but this author missed the mark. It was very repetitive and focused on odd parts of the story of what this area was going through. I really appreciate the work he did and the lesson he tackles (that these issues aren't one-off but rather societal issues that need to be tackled holistically and comprehensively) but the story the way he chose to tell it should have been a headline magazine article instead.
October 18, 2024
3.5 stars. I learned a lot related to the HIV crisis in Indiana and the factors that led to the increasing cases. I had heard about VP Pence's track record during the 2016 election, but this brought it into the context and reiterated how terrible bad policy can impact individuals.
I struggled with rating the book because the content and information was really good. However, the memoir part was less than riveting. Partly some of this is because I'm probably not the audience intended to change their mind. I'm pro public health, harm reduction strategies, etc. But I would recommend this book to someone wanting to learn more about how health and poverty are linked and maybe lean toward if people work hard enough, they can do better, get clean, etc.
I struggled with rating the book because the content and information was really good. However, the memoir part was less than riveting. Partly some of this is because I'm probably not the audience intended to change their mind. I'm pro public health, harm reduction strategies, etc. But I would recommend this book to someone wanting to learn more about how health and poverty are linked and maybe lean toward if people work hard enough, they can do better, get clean, etc.
September 15, 2025
Not great writing, but it is a great story. I appreciated how Dr. Cooke vulnerably shares pieces of his own struggles and his faith in the midst of his wider clarion call about society and medicine. I particularly found the appendix “Biblical Principles of Harm Reduction” to be a pleasant surprise in a book I initially assumed to be a secular sociologically focused book about the opioid crisis and rural communities.
January 19, 2026
Really interesting first hand account of the HIV/Hep C outbreak in rural Indiana from the point of view of the one PCP in the county. I liked his compassionate perspective toward people who use drugs and the depth of his discussion on the socioeconomic and social determinants of health that impact use and the cycle of addiction. Learned a lot and enjoyed the narrative
March 4, 2021
Canary in the Coal Mine exposes the disparities that exist in Rural America. The book is not only an in-depth look into the roots of small town culture. It ultimately reveals a community spirit willing to unite to face addiction and poverty head on together.
July 24, 2021
Very well written. Easy to read. Exposes Indiana and its political biases. It’s heartbreaking to read how narrow-minded Governor Pence was during a pandemic. Not to mention the things he did behind the scenes (ie, signing a bill making it a felony to possess a syringe after approving a needle exchange program). Our state was and continues to be in a drug crisis and that was his solution.
January 30, 2025
Incredible story of a primary care doctor on the front lines of the opioid epidemic in rural America. I really appreciated his sharing how his personal faith in Jesus impacted his treatment of patients. A must read for anyone who works in marginalized communities!
February 12, 2024
This is such an important story for so many reasons. Typically books like this are very research-heavy, as they should be, but Dr. Cook weaves his faith into the his perspectives working as the only physician in a rural Indiana town affected by the HIV epidemic in 2015, as well as research about community, connection, and Substance Use Disorders. His perspective is certainly a unique one that I think can encourage Christians to put their money where their mouths are, so to speak, when it comes to Substance Use Disorder, harm reduction, and the social determinants of health that contribute to addiction.
“As long as we require sick, hungry, hurting people to magically change before we offer assistance, we are failing to demonstrate the type of love God has called us to show, the sort of unconditional love we offer to ourselves.”
“As long as we require sick, hungry, hurting people to magically change before we offer assistance, we are failing to demonstrate the type of love God has called us to show, the sort of unconditional love we offer to ourselves.”
April 24, 2021
One Lone Voice in the Howling Wind
This is the story of William Cooke, a physician called to serve in the small town of Austin Indiana. His story is one of hope, sadness, frustration and despair. He desperately tries to help people in this small town. He soon finds that his resources are stretched to the breaking point and that he needs help from other agencies or his small clinic will not survive. He finds getting these resources can be hard work to obtain and that sometimes the hinder as much as they help.
When an outbreak of HIV occurs he gets some help with this outbreak but there is no help to solve the underlying problems in the town that contribute to the outbreak. Those affected can be treated if they can be found, but most are intravenous drug users and do not want to be found or treated. The drug problem of prescription painkiller opioids is an epidemic in itself. Until the underlying problems of the addicted can be addressed and treatment methods found the HIV epidemic will not be solved.
He starts working with Health Districts , churches, social agencies and other helpful programs to provide treatment for HIV, drug addiction, counseling, food, clothing and human compassion for those afflicted by addiction. In order to treat they must be found and this means their trust must be gained. He starts a clean needle program to help with the HIV epidemic. This brings him much push back from the community and a few dire threats but he pushes on with his HIV clinic amidst the turmoil.
His dedication is not without personal troubles as his time away causes his first marriage to end in divorce and also causes some problems in his second marriage which he is able to work out with a caring wife.
This story is about a small town in Indiana, but it is a problem in almost every state. America is set upon by a horrible epidemic of opiod addiction. It is the biggest epidemic ever causing so many to feel despair and worthlessness. We must try to control the drugs causing this epidemic, treat those afflicted and find the causes of the addiction and address them in order to win this war on drugs across our country.
I think everyone should read this book and I highly recommend it. You will learn so much about this epidemic that you never knew and the underlying causes.
Thanks to William Cooke, Tyndale House Publishers, and Netgalley for allowing me to read and review and advanced copy of this book.
This is the story of William Cooke, a physician called to serve in the small town of Austin Indiana. His story is one of hope, sadness, frustration and despair. He desperately tries to help people in this small town. He soon finds that his resources are stretched to the breaking point and that he needs help from other agencies or his small clinic will not survive. He finds getting these resources can be hard work to obtain and that sometimes the hinder as much as they help.
When an outbreak of HIV occurs he gets some help with this outbreak but there is no help to solve the underlying problems in the town that contribute to the outbreak. Those affected can be treated if they can be found, but most are intravenous drug users and do not want to be found or treated. The drug problem of prescription painkiller opioids is an epidemic in itself. Until the underlying problems of the addicted can be addressed and treatment methods found the HIV epidemic will not be solved.
He starts working with Health Districts , churches, social agencies and other helpful programs to provide treatment for HIV, drug addiction, counseling, food, clothing and human compassion for those afflicted by addiction. In order to treat they must be found and this means their trust must be gained. He starts a clean needle program to help with the HIV epidemic. This brings him much push back from the community and a few dire threats but he pushes on with his HIV clinic amidst the turmoil.
His dedication is not without personal troubles as his time away causes his first marriage to end in divorce and also causes some problems in his second marriage which he is able to work out with a caring wife.
This story is about a small town in Indiana, but it is a problem in almost every state. America is set upon by a horrible epidemic of opiod addiction. It is the biggest epidemic ever causing so many to feel despair and worthlessness. We must try to control the drugs causing this epidemic, treat those afflicted and find the causes of the addiction and address them in order to win this war on drugs across our country.
I think everyone should read this book and I highly recommend it. You will learn so much about this epidemic that you never knew and the underlying causes.
Thanks to William Cooke, Tyndale House Publishers, and Netgalley for allowing me to read and review and advanced copy of this book.
May 3, 2024
Life Changing Read
This book was eye opening to such a simple but hard truth of dealing with many problems. There is power in grass roots movements. A great read for someone who wants to make a difference, but they think there are more qualified people. Be prepared to be surprised at Cooke's revelations!
This book was eye opening to such a simple but hard truth of dealing with many problems. There is power in grass roots movements. A great read for someone who wants to make a difference, but they think there are more qualified people. Be prepared to be surprised at Cooke's revelations!
July 23, 2021
I was able to read an early copy of this book through NetGalley in exchange for an honest review.
I have mixed feelings about this book.
I am a Certified Advanced Alcohol and Drug Counselor and for that reason was drawn to this book. The vast majority of the information provided on substance use I was already aware of, but I also ascribe to the belief that genuine care and relationship with your client can have the biggest impact in their treatment.
The main issues I have with this book were the dialogue surrounding some of the information the author found out about addiction (mainly in Chapter 8). This dialogue felt very contrived and did not come across as genuine. The quote in the beginning of the chapter is from Johann Hari and his book Chasing the Scream, which is one of the most definitive and influential books of recent years in the field of substance use. So when the author was talking about studies that were described in-depth within Hari’s book like it was something he just happened to stumble across it seemed off. The quote and information are both significant but presented in this order it felt disingenuous and would have been better if the author had just cited Hari rather than present this hokey dialogue with his father even if the dialogue was real. The dialogue with his wife also came across as contrived. This may not necessarily be an issue with the author himself, but maybe something an editor should have caught since it is obvious that the author doesn’t write a lot of dialogue as a medical doctor. A similar example is when the author discusses going to a conference and being confronted to explore the role of race within the war on drugs and then talks about going to a hotel and doing a google search that just happens to provide the same quotes that were made well known over the past few years through Michelle Alexander’s book The New Jim Crow and through the documentary 13th. Also, talking about systemic racism being to uncomfortable to learn about before bed is privileged and gross.
It was also frustrating that the author would bring up topics such as race, the bill of rights, etc... but did not do more than a surface exploration of these issues and this glossing over seemed to miss the real significant deep issues in these areas. If you are not going to engage in real work in this area it may be better to reserve your opinion. One example is when he talks about the stigma of use and availability of care being related to individual bias and prejudice instead of acknowledging the larger systemic issues that pit people against each other. That is reminiscent of blaming individuals for pollution because they don’t recycle when the vast majority of pollution is created by major corporations and industry that is not within the control of an individual.
Some of the things that I liked about the book was the information specific to the situation in Austin and the role the state government played in this. I think this is important information for the public to know. This is a topic I have read up on a few times but have not found this level of information on how this situation took place and was handled anywhere before. I also appreciate that the author was open about things that were mishandled and things that different organizations did that were blatantly wrong.
I also appreciate the authors use of his faith in his story and feeling compelled to engage in this work and being open to where this led him. It did get rather preachy towards the end, which is something to be careful of in working with people in any type of therapeutic capacity since it is not ethical to push your beliefs and also sometimes pushing faith that someone has lost due to past trauma can be more harmful.
Overall, I wish the book had focused more on the HIV crisis and how it was handled since this appears to be the area that the author is the most knowledgeable about.
I have mixed feelings about this book.
I am a Certified Advanced Alcohol and Drug Counselor and for that reason was drawn to this book. The vast majority of the information provided on substance use I was already aware of, but I also ascribe to the belief that genuine care and relationship with your client can have the biggest impact in their treatment.
The main issues I have with this book were the dialogue surrounding some of the information the author found out about addiction (mainly in Chapter 8). This dialogue felt very contrived and did not come across as genuine. The quote in the beginning of the chapter is from Johann Hari and his book Chasing the Scream, which is one of the most definitive and influential books of recent years in the field of substance use. So when the author was talking about studies that were described in-depth within Hari’s book like it was something he just happened to stumble across it seemed off. The quote and information are both significant but presented in this order it felt disingenuous and would have been better if the author had just cited Hari rather than present this hokey dialogue with his father even if the dialogue was real. The dialogue with his wife also came across as contrived. This may not necessarily be an issue with the author himself, but maybe something an editor should have caught since it is obvious that the author doesn’t write a lot of dialogue as a medical doctor. A similar example is when the author discusses going to a conference and being confronted to explore the role of race within the war on drugs and then talks about going to a hotel and doing a google search that just happens to provide the same quotes that were made well known over the past few years through Michelle Alexander’s book The New Jim Crow and through the documentary 13th. Also, talking about systemic racism being to uncomfortable to learn about before bed is privileged and gross.
It was also frustrating that the author would bring up topics such as race, the bill of rights, etc... but did not do more than a surface exploration of these issues and this glossing over seemed to miss the real significant deep issues in these areas. If you are not going to engage in real work in this area it may be better to reserve your opinion. One example is when he talks about the stigma of use and availability of care being related to individual bias and prejudice instead of acknowledging the larger systemic issues that pit people against each other. That is reminiscent of blaming individuals for pollution because they don’t recycle when the vast majority of pollution is created by major corporations and industry that is not within the control of an individual.
Some of the things that I liked about the book was the information specific to the situation in Austin and the role the state government played in this. I think this is important information for the public to know. This is a topic I have read up on a few times but have not found this level of information on how this situation took place and was handled anywhere before. I also appreciate that the author was open about things that were mishandled and things that different organizations did that were blatantly wrong.
I also appreciate the authors use of his faith in his story and feeling compelled to engage in this work and being open to where this led him. It did get rather preachy towards the end, which is something to be careful of in working with people in any type of therapeutic capacity since it is not ethical to push your beliefs and also sometimes pushing faith that someone has lost due to past trauma can be more harmful.
Overall, I wish the book had focused more on the HIV crisis and how it was handled since this appears to be the area that the author is the most knowledgeable about.
December 14, 2021
A good overview of the complex causes and impacts of poverty in the United States (of which drug use and associated behaviors of desperation are the tip of a much larger iceberg), and an engaging story of how difficult it is to forge a sustained, multifaceted community response that addresses both exposed effects and underlying causes. The ways politics (personal, local, state, and federal) get in the way of said response feature prominently as well.
That said, the overall tone was a bit "savior-complex-y" and centered on the author's personal story over the broader narrative (in other words, it was clearly a memoir, even if not quite advertised as one).
It is, however, a readable introduction to the most pressing rips in our social fabric in 21st century America, effectively articulating and advocating for best practices in harm reduction and community transformation as the keys to a path forward.
That said, the overall tone was a bit "savior-complex-y" and centered on the author's personal story over the broader narrative (in other words, it was clearly a memoir, even if not quite advertised as one).
It is, however, a readable introduction to the most pressing rips in our social fabric in 21st century America, effectively articulating and advocating for best practices in harm reduction and community transformation as the keys to a path forward.
July 1, 2022
“Diseases and disasters do not create disparities and inequalities; they expose the cracks of injustices we’ve ignored. To heal our land, we have to do more than blame the resulting damage on the people huddled along these fissures, and even more than simply patch up the divide. New cracks will undoubtedly emerge, causing even more damage until we are willing to dig deeper to repair the fractured foundation we’ve built communities upon in pursuit of a more perfect union.”
A firsthand glimpse into the public health response to the 2015 HIV outbreak in Scott County, Indiana, as well as what lead up to this crisis occurring in the first place. This book is a powerful testimony to the importance of addressing social determinants of health and structural violence within a community, as well as the importance and effectiveness of harm reduction models, including syringe services programs (SSP). Dr. Cooke is a public health hero and his compassion and empathy for his patients and community are evident. Also, kudos to him for shedding light on U=U (Undetectable=Untransmittable)!
One note readers should be aware of as it’s not mentioned on the book cover or in the author’s bio: Dr. Cooke is a devout Christian and his faith is an integral aspect of his story and his public health practice. Therefore, God and religious teachings are mentioned heavily throughout the text. That being said, I think he does a great job of acknowledging any moral dissonances between his faith and upbringing and his scientific training/practice.
A firsthand glimpse into the public health response to the 2015 HIV outbreak in Scott County, Indiana, as well as what lead up to this crisis occurring in the first place. This book is a powerful testimony to the importance of addressing social determinants of health and structural violence within a community, as well as the importance and effectiveness of harm reduction models, including syringe services programs (SSP). Dr. Cooke is a public health hero and his compassion and empathy for his patients and community are evident. Also, kudos to him for shedding light on U=U (Undetectable=Untransmittable)!
One note readers should be aware of as it’s not mentioned on the book cover or in the author’s bio: Dr. Cooke is a devout Christian and his faith is an integral aspect of his story and his public health practice. Therefore, God and religious teachings are mentioned heavily throughout the text. That being said, I think he does a great job of acknowledging any moral dissonances between his faith and upbringing and his scientific training/practice.
February 1, 2023
Good. An eye-opening account from a small town family doctor whose town was ravaged by opiate epidemic — and HIV. The compassion is palpable.
This quote stood out:
“Communities do not fail because the people within them fail. They fail because we allow those who stumble to be dehumanized. This only encourages people to hide pain and deny mistakes. Communities fail because we keep painting over the cracks in the foundations instead of being willing to accept the struggling among us as our neighbors. We must not banish broken people but rather reject a broken culture that forbids vulnerability.”
I’d probably have slight point of departure with the author as it pertains to the extent of depravity and sin that is at play; without a full body emphasis on the spiritual aspect of knowing Christ we’re simply healing wounds lightly.
I thought the 10 Biblical Principles of Harm Reduction were very helpful, though again my theological under pinnings for many of them would be much more robust at important points.
All in all, it was a human story that put a face to an epidemic that’s still ravaging this country and tearing families asunder.
This quote stood out:
“Communities do not fail because the people within them fail. They fail because we allow those who stumble to be dehumanized. This only encourages people to hide pain and deny mistakes. Communities fail because we keep painting over the cracks in the foundations instead of being willing to accept the struggling among us as our neighbors. We must not banish broken people but rather reject a broken culture that forbids vulnerability.”
I’d probably have slight point of departure with the author as it pertains to the extent of depravity and sin that is at play; without a full body emphasis on the spiritual aspect of knowing Christ we’re simply healing wounds lightly.
I thought the 10 Biblical Principles of Harm Reduction were very helpful, though again my theological under pinnings for many of them would be much more robust at important points.
All in all, it was a human story that put a face to an epidemic that’s still ravaging this country and tearing families asunder.
October 23, 2021
This is a great story. Dr. Cooke shares his story of being a doctor in a small town. And although this isn't just any small town, it could be, and probably is similar to many other small towns all across America. But Austin, Indiana became the center of the HIV epidemic, while also dealing with the opioid epidemic. We learn about various issues his patients brought to his office. Some medical, some personal. Although none of the patients in the book are real, the stories are all based on variations of his real patients.
Dr. Cooke shares his reasons why he believes it takes a community more than any higher level government body to improve the crisis all around him.
This is a book for everyone. It can be a great learning experience for many who are very critical of drug addicts, and those who face poverty. I highly recommend.
Dr. Cooke shares his reasons why he believes it takes a community more than any higher level government body to improve the crisis all around him.
This is a book for everyone. It can be a great learning experience for many who are very critical of drug addicts, and those who face poverty. I highly recommend.
March 29, 2023
A must-read for anyone who works in the substance use disorder treatment, recovery, prevention, and/or education system. I previously heard Dr. Cooke speak, but this book echoes all of the same messages: recovery is possible; people are people first; meet people where they are, but don’t leave them there. (There’s many more, all well-covered in almost heartbreaking detail.) He openly shares about the trials & tribulations in getting the town he loves the help it so desperately needed. Along the way, he experienced failure & success, but throughout it all, he maintained his faith in God. Literally as I was finishing this book, I recommended this book to a colleague. I highly recommend this book to anyone who has a heart for the people who are most overlooked but also the most in need of love.
September 27, 2024
This book provides an important template for many communities throughout the U.S.. In dealing with a health crisis, Dr. Cooke demonstrates the importance of respect and genuine concern for his patients. Too often those who were dealt a bad hand or have outsized struggles are seen as their struggles and not as the individuals they are. While funding for treatment programs is crucial, just as important is respect and engagement from the caregivers and community.
Dr. Cooke communicated how we all have a role to play and what benefits the entire community reaps once they engage in working together to lift everyone up.
The books was interesting and I appreciated learning about Dr. Cooke's journey, his highs and lows and the outcomes derived from perseverance. I hope other communities learn from Austin IN.
Dr. Cooke communicated how we all have a role to play and what benefits the entire community reaps once they engage in working together to lift everyone up.
The books was interesting and I appreciated learning about Dr. Cooke's journey, his highs and lows and the outcomes derived from perseverance. I hope other communities learn from Austin IN.
June 27, 2021
As a public health worker myself many of the topics discussed in this book were not new for me. It was interesting to learn about the Austin crisis from a source who was on the front lines as they worked to find solutions that worked long term. Many of the lengthy generalizations and explanations of drug use and rehab practices felt more like a lecture. I found myself most intrigued and inspired by the specific stories and events of the Austin epidemic, and how they were willing to be there for the patients forming supportive relationships with many in the community, as well as how Dr. Cooke's faith impacted his care for the patients.
I received a complimentary copy of this book. Opinions expressed in this review are completely my own.
I received a complimentary copy of this book. Opinions expressed in this review are completely my own.
September 22, 2021
Audiobook.
A powerful story through the lens of faith about a doctor’s journey of collaborating with his community to make a difference against the opioid epidemic. Dr. Cooke personalizes people who struggle with addiction, which even as someone who works with these types of people frequently, it can be hard to do. It takes a conscious effort at times to separate the human person and the behaviors driven by their disease. The story is also interesting because this small town in Indiana could as well be the small town next door. Dr. Cooke and his team have advocated and done some wonderful things for fighting against the opioid crisis, and this book also educates on some basic concepts such as sterile syringe programs.
A powerful story through the lens of faith about a doctor’s journey of collaborating with his community to make a difference against the opioid epidemic. Dr. Cooke personalizes people who struggle with addiction, which even as someone who works with these types of people frequently, it can be hard to do. It takes a conscious effort at times to separate the human person and the behaviors driven by their disease. The story is also interesting because this small town in Indiana could as well be the small town next door. Dr. Cooke and his team have advocated and done some wonderful things for fighting against the opioid crisis, and this book also educates on some basic concepts such as sterile syringe programs.
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