AUSTIN, Ind. — The only doctor in town has been at work for just half an hour, and already a crowd of nurses has descended upon him.
“We met this gentleman who’s infected with parasites,” one says.
“Someone was arrested and was off their meds,” another tells him.
“We need to talk to the guy with the low viral load,” a third adds. “He’s working nights and two different jobs. He’ll try to call you again today.”
Dr. Will Cooke nods. A low viral load means this man has HIV. It’s an infection most family doctors encounter perhaps a handful of times per year, but since an outbreak in Scott County two years ago, this disease has come to define Cooke’s career.
In the span of a few months in 2015, nearly 150 cases of HIV were diagnosed in Scott County, most caused by needle sharing typical of the opioid epidemic ravaging the Midwest. In Austin, Indiana, a town with a population of 4,200, HIV infection rates rivaled sub-Saharan Africa.
Cooke answers the nurses one at a time and tells them something, too, before they move off to defuse each situation.
“The hospital should be calling me,” he says. “A woman’s cervix might be open at 35 weeks. That’ll be bad if it is.”
In other words, Cooke might be delivering a baby tonight, just like he did last night and as he does several times a month. He also treats strep throat, performs colonoscopies, diagnoses arthritis and makes hospice recommendations.
Cooke may be on the forefront of a crusade against HIV, but he’s still the only doctor in town.
When he was in medical school, Cooke knew he wanted to work where there was a need for better health care, somewhere rural where he could do the most good. He ended up in Austin, which sits in northwest Scott County about an hour and a half southeast of Bloomington. In rankings for county health outcomes, a composite statistic based on quality of life and healthcare factors across the state, Scott County is dead last.
For years, Cooke spent his weeks split between being working shifts in the emergency room, practicing other kinds of medicine for the hospital and working in family medicine at his private practice.
Then the outbreak happened. After more than 80 diagnosed cases, the state declared an emergency. Media inundated the town and the state temporarily brought in a few other doctors to help with treatment.
Cooke became certified in HIV treatment after the outbreak. His practice secured funding so he could offer free HIV testing and treatment. He set up a mobile unit to bring his practice into the community.
After several weeks of media and medical frenzy, then-Gov. Mike Pence finally allowed a needle exchange program in the county. The needle exchange, combined with targeted outreach and care for at-risk people, controlled the outbreak.
New diagnoses have now slowed to one a month or fewer by Cooke’s estimates. The average national rate of viral suppression — the percentage of patients whose treatment has reduced the level of HIV in their blood to a negligible amount — is 25 percent. Thanks to the work of Cooke and his team, Austin’s suppression rate is 73 percent. But that doesn’t mean the HIV problem is solved. New cases are still diagnosed. Cooke currently treats about 140 HIV positive patients, who require regular monitoring and retesting. Partners of people with HIV must also be treated so they don’t become infected, too.
Cooke said he believes a doctor should never try to make their goal to keep people from dying. If that were the goal, they would fail. Every doctor would fail.
Instead, Cooke believes life is just a story you tell yourself. He sees his job as less about prescribing medicine and more about helping his patients understand — and often positively change — the story they tell themselves about themselves.
Are they victim of a disease, or are they someone with control over their treatment and their health? Must they give in to their worst impulses or can they change their behavior?
Then there’s the story Cooke tells himself about himself. He thinks of himself not as a hero, but as a teacher, who can help his kids and his patients learn. He believes his purpose in life is simply to leave the world better than he found it. And he’s extremely aware of the finite nature of life and his own mortality.
He feels chased by the constant desire for more.
Cooke prepares to enter the exam room to visit the fourth patient of the day. He’s 45 and average-sized, wearing navy scrubs and a navy fleece jacket that hangs from his shoulders. He has a scruffy beard and a wide smile — not soap opera but handsome.
He wears skull bracelets on his wrist as a sort of memento mori to remind himself of three things.
People are all the same inside, and everyone should be treated with the same dignity and respect.
Mortality is certain and death will come for us all, so embrace every moment you have.
Everything is temporary, so do not get attached to things. Experiences and relationships are most important.
His main nurse, Carrie Marcum, sits beside him. When someone wants to reach Cooke, Marcum is the person to talk to. She has worked alongside him for years and remembers patients’ names and situations as well as Cooke’s to-do list, email address and all the things that can escape the doctor’s mind.
“Something on the side of my head is itching me to death,” says Cooke, picking at his skin just underneath the edge of his skull-decorated surgical cap.
“It’s probably cancer,” Marcum deadpans.
Cooke smiles. He’s nibbling on a sandwich someone brought into the office for lunch.
Marcum briefs him on the patient’s situation before he walks down the hall and gently knocks on the exam room door.
The patient is a middle-aged man wearing flannel plaid pajama pants and a black T-shirt. He sits in a chair beside his sister and mom, who force him to see Cooke at least once a month.
Cooke asks the man if he’s been taking his medicine for hepatitis B as prescribed.
“I’ve been honest with you about everything,” the man says. “I’ve been trying to get off the drinking.”
Cooke tilts his head as he looks the man in the eyes.
“Do your best each day,” Cooke says. His voice is soft and high.
The man explains how it’s not necessarily the alcohol that he wants but rather the taste. He also admits he has a hard time stopping after a few.
The man suggests he try nonalcoholic beer, and Cooke encourages him by saying that seems like a good solution.
“It’ll get me back on track,” the man says.
The man initially got on track three years ago when he visited the clinic for the first time. He tested positive for hepatitis B and thought he was going to die.
Then Cooke sat him down and explained the disease. He told the man he had not done anything wrong, that sometimes people get sick.
The man likes that Cooke doesn’t breeze into appointments for only a few minutes or act like he is better than his patients. When the man feared for his life, he said Cooke spoke to him like his own father.
“Is there anything else I can do?” Cooke asks.
“Just keep on being my doctor,” he says.
Marcum looks at the practice’s database and scrolls past the name of a patient she hasn’t seen in a while.
“Is she alive?” she asks Cooke.
“Yeah,” he says. “I treated her a few times in the hospital. She’s in prison now.”
Marcum nods, and the pair continues on. Cooke’s sandwich sits on the counter. He’s only managed to grab a few bites between appointments.
He and Marcum work their way down the to-do list for the day, and Cooke feels on schedule.
“I might get to go home and be a dad tonight,” Cooke says to Marcum. “Unless I get called in to do that delivery.”
Cooke was being a dad last night at home when he got a call around 8 p.m. A woman in labor had come to the hospital in Scott County.
He wasn’t supposed to be working that night — he makes his schedule, so he can be home Wednesday and Thursday nights in New Albany, Indiana, with his family — but deliveries are one thing that can pull him away. He tucked his kids into bed and drove 30 minutes back to Austin.
For five hours, he coached the woman into delivering her son. Then he drove 30 minutes back home to grab a few hours of sleep before waking up and driving to Scott County again.
Cooke’s home seems worlds away from the reality of Austin. He lives on an acre of property in a three-story house built in 1850 with his four kids, two stepchildren, his wife, one dog, two cats and 28 chickens. When he goes home, his wife, Melissa Meier, said he truly disconnects. He’s good at separating work from home.
Cooke’s job still pulls him away sometimes, though. Meier said it was the worst during the height of the outbreak, when he had constant meetings and appointments and interviews.
“It was like being a single parent,” Meier said.
Then, of course, there are the deliveries and other common emergencies, which leave Meier alone to manage the sprawling family and property.
Cooke works to be home as much as possible, and one reason Meier was initially interested in him was his involved parenting. Cooke homeschooled his children for a while. He found the time last fall to drive his 18-year-old son, Eli, an hour and a half each way to visit his girlfriend. He used to coach his son’s soccer team. Meier’s ex-husband barely made it to games.
Cooke sometimes stays up late into the night talking with Eli about questions like whether aliens are real. They decided maybe but probably not.
Eli is a senior in high school now. He’s no longer homeschooled but rather attends a private Christian academy. He’s planning to study music in college, just like his dad did once.
Cooke grew up listening to just about everything — folk, rock, Christian — and dreaming of writing music, but after a serious illness at age 16 landed Cooke in the hospital for several days, he started to lean toward medicine. When decision time came, he turned down a scholarship for singing to study biology and chemistry.
Eli’s careful, though, not to say he’s more artistic than his father, who he said bristles at the idea. Cooke spends the little free time he has writing a book, and he sometimes listens to podcasts analyzing movies during his commute.
He likes independent films such as “Captain Fantastic,” but also enjoys watching movies some might consider bad, like “Resident Evil.” He wants films to be an escape from the day-to-day of his job and can’t stand intentionally sad movies full of melodramatics.
“I’m already in that story,” he said.
One of the women who works on the mobile unit emerges from a side office. She’s holding out a cell phone because the man with the low viral load, who has HIV, is on the line.
“What’s his name?” Cooke whispers as she hands off the phone. He wants to call everyone by name.
“Hello?” he says.
The doctor listens as the man explains his situation. Cooke tells him he can come into the clinic or do a video conference with Cooke. The man’s partner can be on the call, too. They’ll do whatever he prefers.
“I really wanted to have a direct conversation with you, so you know who I am,” Cooke says. “I’m available. If you need anything, any time, let us know.”
Cooke hangs up.
He finally reaches the end of his to-do list and starts packing to go home. Marcum tosses his sandwich, only half-eaten after several hours, in the trash.
Cooke is about to leave when a notification appears on his Apple Watch. The watch’s band is outfitted with an engraving of the caduceus, the symbol of healing, and a skull.
The notification isn’t an alert that he’ll be delivering the baby tonight — it’s an alarm he set to remind himself to take a one-minute breather every afternoon.
Cooke said he wants to be more mindful of why he does the things he does. He sometimes eats salad because he wants to be healthier. He believes in God because he prefers to live in an ordered, meaningful world rather than one filled with chaos and devoid of meaning.
The alarm is a concrete reminder to ground himself amid the chaos of his day.
Cooke tells Marcum to do the exercise with him. She rolls her eyes and drags herself upright. Cooke smiles like a little brother poking at his sister.
For one minute they follow the watch’s instructions.
Breathe in. Breathe out. Breathe in. Breathe out.