- The title of the book, Hot Lights, Cold Steel, immediately sets the tone for contrasts. What contrasts, even contradictions, are found in the book? To what extent might the learning experience (of the main character and perhaps the reader) be enhanced by contrasts?
- The book relates a journey a young doctor takes from insecure first-year resident to accomplished chief resident. And yet it might be said that the book describes not a journey, but THE journeythe journey we all take. What is the metaphoric journey that is undertaken? In what sense is that journey universal?
- The author and his wife seem to handle the stresses of residency fairly well. What helped them overcome this difficult hurdle when so many doctors' marriages fall apart during their residency?
- Compassion has been called the greatest of human virtues. Collins implies (chapter 10) that sometimes compassion can get in the way of being a good surgeon. Is that really the case? If so, why?
- In Chapter 18 Collins tells us that he "longs to connect" with the people he treats, but then he tells himself that patients don't want to connect with their physicians. They just want someone to "fix their earache," or "sew up that cut on their head." What do we look for in a physician? Is it true, as Collins says later, that patients "don't care how philosophically aware" their surgeon is, they just want someone to fix them?
- In Chapter 20 a young farm boy dies in a power take-off injury. Collins' pragmatic side chaffs at his continuing struggle with the emotional aspects of his work, observing that it is not his job to "go around asking patients if they have ever considered the ontological implications of their fragile, mortal state." What are the ontological implications of our fragile mortal state? "Sooner or later," Collins says later, "we have to confront the absurdity of what we do." To what is he referring? To what extent is orthopedics (and medicine in general) absurd?
- In Chapter 23, as he is about to repair a young woman's facial lacerations, the author comments on our society's fixation on appearance, and observes, "The face, the scar, the repair. They're metaphors. There's something else, something deeper, something that explains all this irrational concern." What are these metaphors? What is this "something deeper?"
- In Chapter 36 the author expresses ambivalence about resident education. He wonders if surgical resident should ever be allowed to operate since they are never as proficient as their attending surgeons. He feels guilty that resident education often comes at the expense of "good patient care." Is our present system of medical education always "in the best interest of the patient?" Should it be? Is there a better way?
- In Chapter 37 the author laments his inability to help a woman with polio and a severe leg infection. "I wanted to be the guy people came to when life dealt with them unfairly," he says. "I wanted to be the guy who confronted the arbitrariness of life and strangled the unfairness out of it." How does one accommodate oneself to this "arbitrariness of life?" How does Collins reconcile his aspirations to heal with his realization that some things cannot be healed?
- The original title for this book, The Way There, was taken from a quotation by Wilfred Thesiger: "It is not the goal but the way there that matters. And the harder the way, the more worthwhile the journey." Collins and his wife, Patti, have said elsewhere that the years they spent at the Mayo Clinic were among the happiest of their lives. To what extent might it be said that the hardships they encountered during those years added to, rather than detracted from, their happiness?