Coal in a Canary Mine book cover

Canary in the Coal Mine Book

He was the town’s only doctor—fighting a silent epidemic that threatened the future of his rural community— when he exposed a hidden crisis in America that is a growing peril to us all.

When Dr. Will Cooke, an idealistic young physician just out of medical training, set up practice in the small community of Austin, Indiana, he had no idea that much of the town was being torn apart by poverty, addiction, and life-threatening illnesses. Soon, however, he would find himself at the crossroads of two unprecedented health-care disasters: an opioid epidemic and the worst drug-fueled HIV outbreak ever seen in a rural American community.

Confronted with Austin’s hidden secrets, Dr. Cooke decided he had to do something about them. But 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 offers inspiration for anyone fighting in the face of daunting obstacles—and a road map of hope for those concerned about our nation’s preparedness to deal with ever more deadly outbreaks of disease.

Readings & Resources

Listen to chapter one, read by the author

Listen to chapter two, read by the author

Opioid infographic

Download a PDF that discusses the stigma of drug addiction.

In This Together video series toolkit

The In This Together video series toolkit, a collaboration with the Indianapolis Coalition for Patient Safety, provides resources to the community to help groups, professionals, and families start a conversation around substance use disorder.

From the first poignant vignette through many dramatic moments to its inspiringly compassionate conclusion, Dr. William Cooke’s book is a gripping medical chronicle infused with wisdom, science, and deep humanity.

Gabor Maté, MD
author, In the Realm of Hungry Ghosts: Close Encounters with Addiction

You couldn’t find more authoritative tour guides of rural America than Dr. Cooke and Laura Ungar, who have lived and worked among its people—their people—for decades. The pair’s medical savvy and crackling prose can compete with the best out there. . . . This gripping, heartbreaking, and ultimately hopeful book is about far more than a tiny town and its hardscrabble people, many of whom were affected by one of the biggest HIV outbreaks in US history. It’s a look at where so much of America has been heading when so many others weren’t watching.

Jayne O'Donnell,
health policy reporter, USA Today; cofounder, Urban Health Media Project

A very powerful and immensely moving must-read for anyone working to end the syndemics of opioid use disorder, poverty, and the HIV/hepatitis C epidemics among people who inject drugs in rural America. . . . This book is a major contribution that challenges us to see the humanness in everyone and inspires us to care and work to end the suffering caused by the opioid crisis!

Carrie Foote,
sociology professor, Indiana University–Purdue University Indianapolis; chair of the HIV Modernization Movement–Indiana

What a fantastic, inspiring, and informative book on how one person made the difference in leading a rural community from a devastating HIV outbreak and opioid addiction problem to a community of hope and healing. Dr. Will Cooke superbly tells the story of how he, the only physician in the community, guided a small rural town in southern Indiana to recovery by focusing on compassionate, person-centered care. This book is a must-read for all medical students and other health-care professionals. Once you start reading it, you won’t be able to stop.

Dr. William L. Yarber,
senior director, Rural Center for AIDS/STD Prevention; Provost Professor, Indiana University School of Public Health

I found this book to be an inspiring autobiography of how one committed physician truly made a difference in addressing an urgent public health problem through partnerships, persistence, and compassion.

Jim Curran,
dean, Rollins School of Public Health, Emory University; former head of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention

People who use drugs haven’t changed. What has changed is the way physicians and society have become more willing and able to see the humanity of people instead of only their disease and substance use. In his book Canary in the Coal Mine, Will Cooke reaches inward and articulates the steps of his change in a personal treatise of a family physician working to care for an onslaught of opioid injection–related HIV and hepatitis C infection in a small rural town. A black doctor in Chicago reminds Dr. Cooke that blacks have been in the midst of a heroin and HIV epidemic for years. Society was too ready to see this as a problem of “other” and embark on a drug war instead of a treatment war. Dr. Cooke’s care transforms to embrace the tenets of treatment and harm reduction that characterize the care of most diseases, and he articulates their application to mental health and addiction. Primary care serves as the de facto mental health and addiction treatment system in the US. Canary in the Coal Mine reminds us how woefully unprepared and under-resourced these front-line clinicians are. His book provides a wake-up call to the structural violence suffered by too many and should serve as a humanitarian roadmap to address these challenges.

David A. Fiellin, MD,
professor of medicine and director of program in addiction medicine, Yale School of Medicine

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