It's difficult to imagine Sherman Alexie as a tiny infant, fragile and vulnerable on the operating table in the shadow of a dire prognosis, although that's where his life story began. He was born with hydrocephalus—water on the brain—and after a complex and risky brain operation at 6 months old, doctors believed he wouldn't survive. Four decades later, nothing about him seems weak. He is tall and broad and seems made of denser material than everybody else. And he's loud. When he laughs, he throws his head back and you can almost see the happy noise emanating outward in concentric circles. Other people in Coastal Kitchen look up from their salads and soups when he talks excitedly about masturbation or how one of his characters, a young Indian girl, "cuts off a cowboy soldier's dick" and sticks it in the soldier's mouth. Sherman Alexie commands a lot of space and attention.

"I wasn't funny to begin with," he says. "In the early poetry, the funny was accidental because the poems were about rage. But it was when I started to write fiction that I had people talking to each other, and the way Indians talk to each other is as a series of dirty jokes." Most comic authors know you have to make someone laugh before you make them cry, but most comic authors don't dig as deeply as Alexie does. His humor comes from alcoholic Indians and genocide and the raw deals that have been handed out like candy in this country since white folks first landed here.

Though he wanted to be a doctor when he started school at Washington State University in Spokane, Alexie quickly discovered his aptitude for writing, and he set about consciously learning how to write like (and act like) a real writer: His teacher, the poet Alex Kuo, taught students "how to live a writer's life" by making them read their work aloud at open mics in Spokane. Alexie worked as an assistant for WSU's reading series, often playing host to (and carefully observing) visiting authors. "Carolyn Kizer was in Spokane," he says. "I drove her around and she taught me a lot in one day about being a writer. She's this regal, formalist poet, and she said to me: 'Don't fuck groupies.'"

He also learned by example what not to do: "We had all these incredible writers I admired so much and they would be so fucking dead. It was like a corpse standing up there. How could you write something so passionate and be so dispassionate when you're reading it?" So he practices reading? "Oh yeah. I stand in front of mirrors like everybody suspects. There are people who sell just as many books or even more books than I do and they get tiny readings. I get hundreds, sometimes thousands, wherever I go, and I think my career is built on it. If anything, it helps me stay on the lecture circuit, which is where I get the money so that I can write."

Alexie's first poetry collection, The Business of Fancydancing, was published in 1991. Since then, he has been known primarily for his short stories, collected in books like The Lone Ranger and Tonto Fistfight in Heaven and The Toughest Indian in the World. His first young-adult novel, The Absolutely True Diary of a Part-Time Indian, won a 2007 National Book Award and has been on the New York Times best-seller list for the last 40 weeks. He spends an average of one week each month traveling the country to speak, and even before he published True Diary, he guesses he'd sold 1.3 million copies of his books. "I figure I've written about six stories and 10 poems and I think one novel now that will hold up forever," he says. "So, does that make me a genius? Worthy of $5,000?" He waits a beat. "Probably," he says, and bursts out laughing again.

There's something about Alexie's cloud of confidence—and his aggressive desire for competition—that fuels and improves his work. In recent writing for this newspaper chronicling the death of NBA basketball in Seattle, he recounted watching clips of 1996 Sonics games on the internet late at night with the fervor and intensity of a man desperate for porn. Over lunch, he remembers when he knew he loved performing: "We did a three-school reading with Wazzu, University of Idaho, and Lewis-Clark State College. I'm a basketball player: I'm competitive. I was watching them and I was like, 'Oh, you fuckers, I'm going to blow you away.' I want to humiliate other people."

At readings, he talks with a standup comedian's confidence and charm; years ago, a sold-out Town Hall audience was with him every second as he riffed on topics like how people expect him to have mystical Native-American-healing or fortune-telling powers, or why only white people feel the need to climb mountains without oxygen tanks. I've seen him read a half-dozen times now, and he always makes people laugh and cry with stories that are kind of true and kind of false. He is that rarest of beasts: the extroverted, hilarious author who loves to perform.

If you've never read an Alexie story, the best place to start is a short story published in a 2003 issue of the New Yorker and reprinted in Ten Little Indians, titled "What You Pawn I Will Redeem." It's the story of an Interior Salish Indian named Jackson Jackson who is a homeless drunk in Seattle. He finds his grandmother's powwow dance regalia in a pawnshop window, and the owner gives him one day to raise $974 to buy it. The story is funny and sorrowful and it wanders up and down the Seattle waterfront like—well, like a drunken Indian. Jackson explains how his policeman grandfather died during a domestic dispute involving his own brother:

My grandfather just strolled into the house. He'd been there a thousand times. And his brother and his girlfriend were drunk and beating on each other. And my grandfather stepped between them, just as he'd done a hundred times before. And the girlfriend tripped or something. She fell down and hit her head and started crying. And my grandfather kneeled down beside her to make sure she was all right. And for some reason my great-uncle reached down, pulled my grandfather's pistol out of the holster, and shot him in the head... my great-uncle could never figure out why he did it. He went to prison forever, you know, and he always wrote these long letters. Like fifty pages of tiny little handwriting. And he was always trying to figure out why he did it. He'd write and write and write and try to figure it out. He never did. It's a great big mystery.

Alexie is prolific, but unlike many workhorses, his prevailing confidence is always at odds with a strong self-critical streak: "I'm a flawed and finite human, and that makes me by definition a flawed and fucked-up writer. I have published weak books. I have published strong books with incredibly weak sections." If you talk with him for more than 10 minutes, you can see both sides of Alexie at play with each other—the sickly kid who was mocked on the reservation is always tussling with the larger, surer man he presents to the world. "I figure I bat about .400. In the major leagues that would make me one of the best players of all time. As a writer it makes me pretty good."

Now that his writing has found international success, Alexie is amused, and a little annoyed, by critics who call him an elitist. "They think I walk around like John fuckin' Updike or something. The general oxymoron of being a financially successful artist freaks the shit out of people. A guy from Spokane writing exclusively about Spokane Indians, as if there was some vast opportunity for that kind of art—sure, the world was crying for fiction about Salmon Boys."

There is no other writer who can better convey the mood of Seattle at this early stage of the apocalyptic 21st century: It's so fucking funny that sometimes you have to cry.