All Bleeding Stops

Book Club Questions

1. Let’s start with the title. Obviously, the title is at least in part metaphoric. What do you think, does all bleeding stop?
2. The setting for the first part of the book, Vietnam, seems particularly suited for discussions of mixed motives and conflicting goals. What are Matthew’s goals as he arrives in Vietnam?
3. There are parallels between the United States and Matthew. Both came to Vietnam well-intentioned but naïve, and both suffered greatly because of their misconceptions. What other parallels might be drawn?
4. Trying to better understand his frustration and despair, Matthew tells Therese at one point that he isn’t some Pollyanna who thinks doctors cure every patient every time. But, he asks her, “What’s here, that I didn’t think would be? What’s not here, that I thought would?” What do you think?
5. What parallels exist between Megan, with her battle in the ER to save the old man, and Matthew?
6. What about Tillinghast? What does he add to the story? How is he contrasted with Matthew?
7. As doctors, Matthew, Mac and Denis have different ways of dealing with the inevitable failures inherent in the practice of medicine. What are these ways? What are the pros and cons of each?
8. The section on organ transplantation seems especially dark. What are the criticisms Collins has of our organ transplantation system? Are these criticisms justifiable?
9. In what sense is Packy Wardlaw’s collapse similar to Matthew’s? In what sense is it different?
10. Matthew’s love for Therese Hopkins seems understandable, but what attracts her to him when he is so obviously flawed?
11. Most psychologists would probably agree that Matthew suffered from PTSD. What is it about extreme stress that can make it so hard to recover from? Why is it sometimes so hard to put things behind us and move on?
12. When Therese tells Matthew she doesn’t know how long she can “keep doing this,” what does she mean? When Matthew says he realizes what loving him has done to her, what does he mean?
13. After Matthew encounters the young prostitute in Da Nang and gives her twenty dollars, he castigates himself, wondering whether he has learned anything in the previous 14 months, wondering “How many ripped open bellies and blown apart chests is it going to take?” What does he mean?
14. Joseph, Hunter of Lizards, plays an important role in the story. In what ways is he like Matthew? In what ways is he different?
15. Near the end of his life, Matthew tells Denis that he realizes that Therese left him one last gift, “the one she had been trying to give me all along.” What is that gift?

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Excerpt

He sits on the worn wooden step outside the OR, watching the black curtain of night fade to gray. Another one of his patients died in the waning moments of the night. He keeps thinking about how big a space the kid had between his two front teeth—not that he ever smiled in the ninety minutes Barrett knew him.

Maybe if I had gone after the artery first. Maybe if the liver hadn’t been so damn friable. Maybe if the platelets had gotten there sooner.

They got him on the table, got him prepped and draped—but the damned bleeding. The kid wouldn’t stop bleeding. He tried everything. Clamps, FFP, platelets, pressure, laps, hemostats. But the blood kept rising up from that damned gashed belly, rising and flowing and dripping. He had eleven clamps in there. He had the corpsman holding pressure on the right side of the belly, the scrub nurse holding pressure on the left, but the blood kept coming, kept flowing in crimson sheets down the side of the OR table. The floor was tacky with it. He clamped and cauterized and ligated but the blood kept coming. Every damned thing in his belly was bleeding.

Until it stopped.

All bleeding stops. One of his fellow residents at Mayo coined that phrase. They used to think it was funny.

He looks at the blood stains on his white surgeon’s shoes slowly fading from red to black as they dry in the gray morning light. He knows he has to stop letting everything get to him. Didn’t Henderson warn him? Sensitivity, compassion, idealism—those things look great on paper, Barrett, but they don’t get you very far in this sick world. As a surgeon you can’t weep and wring your hands every time you see a terrible thing. If you wanna get good, you gotta get hard.

He wonders just how hard he has to get.

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Book Club Questions

1. Let’s start with the title. Obviously, the title is at least in part metaphoric. What do you think, does all bleeding stop?
2. The setting for the first part of the book, Vietnam, seems particularly suited for discussions of mixed motives and conflicting goals. What are Matthew’s goals as he arrives in Vietnam?
3. There are parallels between the United States and Matthew. Both came to Vietnam well-intentioned but naïve, and both suffered greatly because of their misconceptions. What other parallels might be drawn?
4. Trying to better understand his frustration and despair, Matthew tells Therese at one point that he isn’t some Pollyanna who thinks doctors cure every patient every time. But, he asks her, “What’s here, that I didn’t think would be? What’s not here, that I thought would?” What do you think?
5. What parallels exist between Megan, with her battle in the ER to save the old man, and Matthew?
6. What about Tillinghast? What does he add to the story? How is he contrasted with Matthew?
7. As doctors, Matthew, Mac and Denis have different ways of dealing with the inevitable failures inherent in the practice of medicine. What are these ways? What are the pros and cons of each?
8. The section on organ transplantation seems especially dark. What are the criticisms Collins has of our organ transplantation system? Are these criticisms justifiable?
9. In what sense is Packy Wardlaw’s collapse similar to Matthew’s? In what sense is it different?
10. Matthew’s love for Therese Hopkins seems understandable, but what attracts her to him when he is so obviously flawed?
11. Most psychologists would probably agree that Matthew suffered from PTSD. What is it about extreme stress that can make it so hard to recover from? Why is it sometimes so hard to put things behind us and move on?
12. When Therese tells Matthew she doesn’t know how long she can “keep doing this,” what does she mean? When Matthew says he realizes what loving him has done to her, what does he mean?
13. After Matthew encounters the young whore in Da Nang and gives her twenty dollars, he castigates himself, wondering whether he has learned anything in the previous 14 months, wondering “How many ripped open bellies and blown apart chests is it going to take?” What does he mean?
14. Joseph, Hunter of Lizards, plays an important role in the story. In what ways is he like Matthew? In what ways is he different?
15. Near the end of his life, Matthew tells Denis that he realizes that Therese left him one last gift, “the one she had been trying to give me all along.” What is that gift?

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