During the final stages of writing and publishing A Leg to Stand On I was sure that no one could ever convince me to write another book of this sort again. That is probably true. The culprit in any future “convincing” schemes will in fact be me. My threshold for holding back with the pen is far lower than I thought and the frustrations a mite less so in retrospect.

After giving a talk to a group of Billings operating room nurses last week, I reviewed the presentation and made some changes. The nurses’ questions let me know there was much more that should have been addressed. But even more, their e-mailed comments showed how important the pictures were in making the problem real to them. I kicked myself for all the times the camera had remained in my pocket, instead of acting as witness. I also kick myself for all my unasked probing questions, held back for fear of appearing to focus inhumanly on dingy problems that might have reflected poorly on the culture or inadequate institutions .

Reading Dowden’s book, Africa--Altered States, Ordinary Miracles, I saw other aspects of the problem of trauma that I had failed to address. I couldn’t help myself. Scribbled note started to accumulate on my desk, new files have appeared in my computer filled with another set of questions, inconvenient statements, telling quotes.

There is much I left out that I should have addressed in the book. I didn’t write enough about money in A Leg to Stand On. Little about funding of SIGN or even surgical care. I didn’t discuss in any depth the gap in finances that fuel the divide between the haves and haves nots. They need to be addressed, with a look both to the haves and the have-nots.

I just finished reading an article in Clinical Orthopaedics and Related Research by Spiegel, et al. titled “Topics in Global Public Health.” The main points are no different from dozens of articles about global orthopaedic trauma I’ve been reading the past couple years. The few available statistics are the same in every paper of this sort, partly because there are only a few. The repeated numbers take on the character of “Stalin numbers.” (to paraphrase the dictator: 20 million dead is a statistic; one person’s death is a cause to grieve) The millions begin to mean nothing; they are inconceivable. How many times must these same huge figures be trotted out on stage, applauded, and quickly forgotten? How does one make the point?

There is only one way: to tell true stories.