For research into a book about the world of organ transplantation, I was granted unrestricted access to the largest transplant center in the world.  Day and night, people literally on the edge of death arrived in ever-increasing numbers for the opportunity to be considered for a rare heart, liver or heart-lung transplant, including a little girl named Kellie Cochran and her mother, Judy.  Although Kellie has been dead now for more than a decade, her image returns with unnerving clarity in my dreams.

I am sitting in the hospital playroom watching Rashad, a little Arab boy, attached to an intravenous unit like a puppy on a leash, blowing bubbles.  He can't go far, but he covers his ground with nervous quickness.  Soon, I turn my attention to Kellie, whose legs and arms are like twigs, but whose blue eyes sparkle with fascination.  Instinctively, she reaches out to embrace the floating bubbles, which lazily evade her tiny, awkward grasp.  The nurse comes in with Kellie's many medicines, loaded in narrow dispensers, and injects them one-by-one into her mouth.  Kellie accepts each with a glazed-over annoyance.  Medicine is nothing new for this little girl; medicine is something she has tolerated from the very beginning of her short and painful life.

A shot of pink drool suddenly spills from Kellie's mouth and rolls down her T shirt.  It is only noon, but this is the third outfit Kellie has ruined today.  Kellie is crying as Judy, a preppy-looking woman with reddened eyes and disheveled blonde hair, slowly pushes herself up out of the chair in which she has been momentarily dozing and begins to undress her.  This is what the little girl has wanted all along.  Kellie's symptoms are not as pronounced as some of the other patients suffering from liver disease whom I have seen, but they are extraordinarily severe, nonetheless.  She has the brownish-yellow cast--jaundice--and the bloated belly caused by the buildup of poisonous fluid and ammonia.  Her arms and legs are next to nothing in size; my forefinger is nearly as wide as her wrist.

Kellie is two years old.  For more than a year, she has weighed fifteen pounds.  With her emaciated frame, I can't help thinking of concentration camp victims.  For the past few months she has been waiting in the hospital for organs to materialize so that she can be transplanted.  Her life is in imminent jeopardy.  When her clothes come off, Kellie quiets down, and when Judy takes out the hairbrush, Kellie's eyes brighten slightly.  "This," says Judy,"is Kellie's favorite toy."

Judy rubs the hairbrush over Kellie's little body, and for the first time I see more than simple signs of acceptance in Kellie's wondrous blue eyes.  She is not capable of much emotion, but there is a flicker of pleasure and relief, at least momentarily.  The incessant itching caused by liver disease is the greatest torment; adult patients have described the itching as unrelenting, radiating from the inside out.  Kellie is not strong enough to put up much of a struggle, but when Judy attempts to dress her, Kellie begins to squirm and cry.  Judy pauses to caress Kellie with the brush once more and then to apply some lotion to the little girl's arms and feet and hands.  But every time she tries to put on the little shirt and overalls, Kellie screams louder.  It is a slow, tedious process, but Judy knows what she is doing.  If only Kellie will give an inch, allow her shirt to be slipped over her head, then Judy will scratch so that Kellie will relax, and Judy can gain more headway.  A sleeve, a leg, a button.  Sooner or later, Kellie is dressed.

Judy's life here is simple enough--and terrible.  She changes Kellie's clothes four or five times a day, tries to snatch a couple of hours of fitful sleep.  She talks to the nurses and attempts to feed Kellie, begging and cajoling her to eat.  Before and after feeding, there is always bathing, and then oil applied to her skin every few hours.  And in-between everything, there is scratching with the hairbrush, forever scratching.  Kellie also scratches on her own, digging desperately into her nose and ears, raking her tiny fingers through her scalp and picking at her feet.  Two or three times a day, Judy lifts Kellie into the portable stroller and wheels her around the corridors--until, invariably, Kellie will spit up the food that has just been coaxed into her, forcing Judy to return to re-change Kellie's outfit and give another soothing session of therapeutic scratching.  The rhythm is ongoing and relentless.

Judy and I don't talk too much.  After all, I am a writer--what some people refer to as an "immersion journalist," involving myself in a subject or situation as a fly on the wall, observing but not participating.  I am not supposed to allow my presence to affect the situation.  Mostly, I witness her struggle with her dying daughter with admiring fascination.  But once, when I am about to leave, I reach over and touch Judy's shoulder long enough for her to know that I respect her, and then I ask:  "Is there anything I can get you?  Anything you need?"

As usual, she is smiling, but her smile is now just a tight and twitching line across her pale and desperate face.  "A little bit of sanity?"  Her reply is posed as a question more than an answer, as if she were questioning her worthiness of such a modest gift. I stare at her helplessly, drawing my shoulders up tightly against my neck in a slow and nervous shrug.

"Is that too much to ask?"

"No," I reply. "I guess not."

My ongoing memories of Kellie and Judy, and the decade of research I devoted to a hospital setting with people seeking sanity under enormous and unrelenting stress, helped me recognize and appreciate the ways in which strength of character and instinct for survival suddenly emerge in the face of adversity--even death.  In many cases, people seem to became stronger and more resolute in their determination to prevail as the situation grows more pressured, dire and dangerous.  By "prevail," I don't mean to sustain life, necessarily, but more often to die with dignity or to readjust to a philosophy which transcends frustrating irritations and live life for the moment--sometimes with laughter.

Marjorie Gross, whose New Yorker  essay, "Cancer Becomes Me," appears in this reader, provides five good points about being terminally ill, including:  "People don't ask you to help them move" and "Everyone returns your phone calls immediately."  "You first learn about having cancer," Gross says, "when the doctor walks in and gives you the sympathetic head tilt that right away tells you, 'Don't buy in bulk.' "  Gross was a lead writer for "Seinfeld," who died soon after her essay was published.  Joan Mikulka Albert ("Counting on the Heart"), who is also terminally ill, clutches desperately to her sanity by refusing to allow the deterioration of her body to erode her spirit.  "My body is a mess," she told me.  "I'm ill, and I look it.  But weirdly, the more damaged I am, the more fond of my body I become. . ."

Although this reader is not generally about death and dying, all of the essays have a special, sometimes subtle link to the search for or development of character.  I believe that character is a muscle with which we are all born--a tiny button of flesh that must be flexed, strained, stretched on a regular basis in order for it to self-lubricate and grow.  Character is a special muscle in that it is necessarily always taut, a rubber coil ready to spring instinctively into action whenever and wherever required.  The unfortunate thing about the character muscle is that it is susceptible to shock and can be overloaded.  In other words, it can freeze or lock the moment it is most needed or wanted.  Unlocking the character muscle is one of life's greatest challenges, especially if it has been locked up for a long time.  The writers and characters in this creative  nonfiction reader are often being tested; some characters, such as the shop owners in Sandell Morse's "Canning Jars" fail miserably.  Others discover hidden strength and admirable integrity, as did ten-year-old Natalie Kusz who somehow survives a vicious attack by wild dogs deep in the Alaskan wilderness.

Writing books about medicine and children, I have observed many kids like Kellie Cochran and Natalie Kusz under great stress and have been amazed at how simple, straightforward and courageous their responses are to pain, fear and confusion and to a variety of unexpected physical and emotional challenges.

Certainly adults can and will respond in such a direct manner, but more so when an enemy or a challenge can be clearly determined and articulated.  This scenario is captured quite graphically in the excerpt from John McPhee's paean to Alaska, Coming Into the Country, which details the incredible journey of Leon Crane--a lone airman, survivor of a crash landing in the middle of the tundra in the dead of winter.  Crane, an engineer in civilian life, with little experience in the wilderness, lived four months on his own and eventually hiked back to civilization--a five-hundred- mile trek.  Robert McCrum faced an equally terrifying battle for survival described in his essay, "My Old and New Lives," over the course of a day and night in his own home, alone, when he, a healthy man in his middle thirties, was suddenly, without warning,  paralyzed--awake and unable to move.

Leon Crane and Robert McCrum were courageous and heroic; their ability to endure and survive was tested and proven in rare and overwhelming circumstances. Unfortunately, however, adult humans will often face more complicated, less delineated crises to overcome.  In "Three Spheres" Lauren Slater returns to the psychiatric hospital in which she, only a few years before, was a long-term patient.  But now she is a psychotherapist, assigned to treat a patient with a diagnosis similar to her own.  In "The Break" Cynthia Ozick seeks emotional stability through psychic surgery by creating a daring metaphorical procedure in which she separates herself from the negative aspects of her past.  Judy Ruiz's "The Mother, the Daughter, and the Holy Horse," which also partially takes place in a psychiatric setting, is a self-described "Trilogy" of incest, indignity and self-destruction that poses an all-encompassing emotional test of character of marathon proportions.

A marathon runner will hit what is called the wall at approximately the twentieth mile of a twenty-six mile race.  That's when the real test of mettle or character begins--or ends.  Andre Dubus, who, while coming to the aid of a stranded motorist, is crushed on a darkened highway by a speeding car ("Lights of the Long Night"), hits the wall at the beginning of the essay, the marathon struggle of his entire life--and never stops struggling to prevail.

Survival needn't be represented by the winning of a race or contest or by the denial of death; a test of character measures an ability to prevail in the face of all-consuming crisis and to deal with the often far-reaching consequences of difficult circumstances.  Kathy Dobie in "The Only Girl in the Car" survives an eerie and inexplicable obsession with adolescent promiscuity, but not the stinging memories of the indignities of those years, which will forever haunt her.  Dominique, the young stripper in Lisa Hay's "immersion" essay, weakened by the sobering brutality of an abusive relationship, is fighting with all of her psychic strength to regain her confidence and emotional equilibrium.

It is no wonder that the heroic mother of my transplant dreams, Judy Cochran, asks for nothing less or nothing more than sanity, which can be the most steadfast and enduring reward--all we can hope for and expect--in the face of unrelenting trauma and suffering.  In "Killing a Turtle" Joel Agee captures the dramatic impact of this struggle to remain in control of one's own emotional destiny as he describes a man in rural Kentucky joyfully impaling a turtle, while he (Agee) and the man's daughter are forced to watch.  This incident occurred thirty years ago, but Agee is haunted by the memory of the little girl, Emily, "whose shoulders hunched up to her ears, her mouth open, the corners of her lips pulled way down, her arms cramped to her sides, her fingers splayed. . . If I were to paint a soul at the gate of hell, that is how I would picture it; right on the threshold, looking down, with nothing to hold her. . . But there is another figure in this tableau.  It is me.  I am just looking.  Everything in me has turned cold, and in that coldness there is no pity, no pain, only the prayer for an end."

For writers, the genre of creative nonfiction is ideal for such emotionally wrenching scenarios; it demands a special, character-testing effort and challenge and, in contrast to traditional nonfiction, it invites and encourages the writer to become a character in the essay or article--to share emotions, feelings, ideas and to contribute an intellectual and often subjective substance to what can became a dangerously emotionless form.  Thus, from both a personal and a literary point of view, creative nonfiction is the ultimate test of a writer's potential and range because it asks so much more in content and technique than any other genre.  In addition to a writer's insight and reflection and in contrast to the traditional newspaper journalist, creative nonfiction writers skillfully employ literary techniques like scene-setting, dialogue, description, point-of-view.  The essays in this collection read like short stories--smooth, fluent and powerful, structured with a tight action-oriented plot, fortified with believable and often charismatic characters to which readers will relate.

Of course, the characters are believable and the readers relate because these people are real--not a composite of a number of forms and faces.  The people joining John Edgar Wideman at the gates of Western Penitentiary are the members of his family--the real names and faces of his mother, wife and children united by the horrible circumstances of their private reality in which a son, a favorite uncle, Wideman's younger brother, is  a convicted murderer, sentenced to life; this is also Wideman's own personal search for sanity behind this gauntlet of gates and security checks.  Creative nonfiction is the literature of reality.

Poetry and fiction, although believable and often seemingly very authentic, aren't expected to be true.  Creative nonfiction is not only true--at least from the perception of the writer's experience--but also informational.  Wideman begins his family's journey with a description and detailed history of the edifice in which his brother is incarcerated, while Reginald Gibbons introduces us to the frightening, ironic reality of Juvenile Court in Chicago a few days before Christmas.  Of course, literary truth, in contrast to factual truth, is perceived and re-created through the lens of life experiences and the scars of frustration.  In "Fat," Carol Kloss sits in a shopping mall with her charcoal and sketchbook, trying to catch in ten seconds the sling of a belly over a belt or the wobbly scallop of body rolls.  "The people in the mall get nervous when they see me drawing them," she writes, "but I don't think they know that on paper, they're not fat. . .they're powerful, not flabby; fascinating, not shocking, more human than any unpadded bones could ever be.   Sometimes, I look at my own fat and hope that one day someone will draw me."  Scott Murphy also draws his own self-portrait, reliving his life in combat in Vietnam ( "Cold Sweat"), unable to distinguish between the reality of his life and his visions of what he hoped might have happened, which appear in vivid flashbacks in a string of soldier's nightmares.

Annie Dillard's remarkable "Expedition to the Pole" does not deny reality, as much as it bends and manipulates the genre--and demonstrates its great literary potential.  Dillard, employing a parallel narrative, confronts the Catholic church while surveying the history of the exploration of the Arctic Circle, and the decline of the British empire.  Throughout, Dillard is daring.  At one point, in a flight of fantasy, she blends all of these diverse elements into one wild and brooding stew of ideas and implications in the middle of an ice floe.  Inexplicably, she is wearing the uniform of a Keystone Kop.

Age is a theme and a barrier that surfaces in many of these essays--and in the overall revelation and resolution of strength and longevity of character.  Florence Epstein's essay begins with her birthday ( "Sixty") and the recollection of her dream of writing the great American novel in exile, in the tradition of Hemingway and Fitzgerald, and then returning to the United States in triumph.  Epstein fails at both endeavors and suddenly, on her sixtieth birthday, finds herself stranded and nearly destitute in Spain, living with uneducated peasants who do not talk with her, understand her history or recognize her artistic motivations.  As a writer, she is a failure--and yet, as a human being, she has found a way to survive; to preserve or to gain sanity which, in this context, can be defined as an acceptance of and a comfort with the circumstances of one's life, however disappointing.

Such is the essence of creative nonfiction generally and the overall objective of the pieces selected for this creative nonfiction reader, the first of many creative nonfiction readers, specifically:  To maximize literary potential by telling a story about real people that embraces readers in a three dimensional perspective, while providing writers the opportunity to push the boundaries of life, literature, philosophy, history, science and their own creative juices to the ultimate.