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Hot Lights, Cold Steel

When Michael Collins decides to become a surgeon, he is totally unprepared for the chaotic life of a resident at a major hospital. A natural overachiever, Collins’ success, in college and medical school led to a surgical residency at one of the most respected medical centers in the world, the famed Mayo Clinic. But compared to his fellow residents Collins feels inadequate and unprepared. All too soon, the euphoria of beginning his career as an orthopedic resident gives way to the feeling he is a counterfeit, an imposter who has infiltrated a society of brilliant surgeons.

This story of Collins’ four-year surgical residency traces his rise from an eager but clueless first-year resident to accomplished Chief Resident in his final year. With unparalleled humor, he recounts the disparity between people’s perceptions of a doctor’s glamorous life and the real thing: a succession of run down cars that are towed to the junk yard, long weekends moonlighting at rural hospitals, a family that grows larger every year, and a laughable income.

Collins’ good nature helps him over some of the rough spots but cannot spare him the harsh reality of a doctor’s life. Every day he is confronted with decisions that will change people’s lives-or end them-forever. A young boy’s leg is mangled by a tractor: risk the boy’s life to save his leg, or amputate immediately? A woman diagnosed with bone cancer injures her hip: go through a painful hip operation even though she has only months to live? Like a jolt to the system, he is faced with the reality of suffering and death as he struggles to reconcile his idealism and aspiration to heal with the recognition of his own limitations and imperfections.

Unflinching and deeply engaging, Hot Lights, Cold Steel is a humane and passionate reminder that doctors are people too. This is a gripping memoir, at times devastating, others triumphant, but always compulsively readable.

Excerpt

“We had been training for years to become surgeons. We had excelled in college. We had excelled in medical school. Our lives had been one success after another until we woke up one day, and there we were, surgical residents at the world famous Mayo Clinic. It was all so perfect. But before we could congratulate ourselves, scarcely before we learned where the surgeons’ locker room was, we discovered this was a profession that, like no other, quickly and ruthlessly and uncaringly proclaimed we were not perfect. People came to us with head injuries—and we couldn’t help them. People came to us with gunshot wounds—and we couldn’t heal them. People came to us with ruptured arteries—and we couldn’t save them.

We kept confronting these terrible problems, and we kept failing, again and again and again—we, who had always succeeded, who had always known what to do, who had always been so sure of ourselves. Never before had we attempted anything so important, and never before had we failed so miserably.”

* * *

“Two hours later, when the code was over and the death certificate filled out, when the janitors had mopped the floor and the nurses had re-stocked the crash cart, when the PM shift had gone home and the coroner had come to claim the body, I was still slouched in a chair at the desk. I kept going over the code in my mind, asking myself what I could have done differently. I couldn’t think of a single thing. I ran a perfect code. But I kept seeing the look in the eyes of the kid with the letter jacket, and the fact that I ran a perfect code did nothing for me.

Death, suffering, failure. They were the enemy, but they didn’t play by the rules. Sometimes, even when I did everything right, they still won. I couldn’t give up the childish notion that things ought to be fair. When I ran a perfect code, when I did everything right, the patient ought to live. What more could be asked of me? What more could I give? Day in and day out I did the best I could, the best anyone could—and so often it wasn’t enough.”

* * *

“I rolled down the windows, unbuttoned my shirt, turned up the radio and headed east, into the rising sun, going back to Rochester one last time. In a dream-like, sleep-deprived state I drifted along, flooded with memories. Eagle Lake, Smith’s Mill, Janesville, there wasn’t a town along the way that didn’t have someone I had stitched up or casted or repaired or resuscitated. I felt a fondness for them all, and a sense of gratitude that I had been able to help them. It had been a lot work. At times it felt like I was killing myself. And yet the only thing I could recall at that moment was how much fun it had been, and how wonderful it was to do this for a living.”

Book Club Questions

  1. The title of the book, Hot Lights, Cold Steel, 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?
  2. 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 journey—the journey we all take. What is the metaphoric journey that is undertaken? In what sense is that journey universal?
  3. 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?
  4. 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?
  5. 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?
  6. 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?
  7. 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?”
  8. 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?
  9. 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?
  10. 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?

Excerpt

“We had been training for years to become surgeons. We had excelled in college. We had excelled in medical school. Our lives had been one success after another until we woke up one day, and there we were, surgical residents at the world famous Mayo Clinic. It was all so perfect. But before we could congratulate ourselves, scarcely before we learned where the surgeons’ locker room was, we discovered this was a profession that, like no other, quickly and ruthlessly and uncaringly proclaimed we were not perfect. People came to us with head injuries—and we couldn’t help them. People came to us with gunshot wounds—and we couldn’t heal them. People came to us with ruptured arteries—and we couldn’t save them.

We kept confronting these terrible problems, and we kept failing, again and again and again—we, who had always succeeded, who had always known what to do, who had always been so sure of ourselves. Never before had we attempted anything so important, and never before had we failed so miserably.”

* * *

“Two hours later, when the code was over and the death certificate filled out, when the janitors had mopped the floor and the nurses had re-stocked the crash cart, when the PM shift had gone home and the coroner had come to claim the body, I was still slouched in a chair at the desk. I kept going over the code in my mind, asking myself what I could have done differently. I couldn’t think of a single thing. I ran a perfect code. But I kept seeing the look in the eyes of the kid with the letter jacket, and the fact that I ran a perfect code did nothing for me.

Death, suffering, failure. They were the enemy, but they didn’t play by the rules. Sometimes, even when I did everything right, they still won. I couldn’t give up the childish notion that things ought to be fair. When I ran a perfect code, when I did everything right, the patient ought to live. What more could be asked of me? What more could I give? Day in and day out I did the best I could, the best anyone could—and so often it wasn’t enough.”

* * *

“I rolled down the windows, unbuttoned my shirt, turned up the radio and headed east, into the rising sun, going back to Rochester one last time. In a dream-like, sleep-deprived state I drifted along, flooded with memories. Eagle Lake, Smith’s Mill, Janesville, there wasn’t a town along the way that didn’t have someone I had stitched up or casted or repaired or resuscitated. I felt a fondness for them all, and a sense of gratitude that I had been able to help them. It had been a lot work. At times it felt like I was killing myself. And yet the only thing I could recall at that moment was how much fun it had been, and how wonderful it was to do this for a living.”

Book Club Questions

  1. The title of the book, Hot Lights, Cold Stay, 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?
  2. 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 journey—the journey we all take. What is the metaphoric journey that is undertaken? In what sense is that journey universal?
  3. 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?
  4. 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?
  5. 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?
  6. 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?
  7. 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?”
  8. 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?
  9. 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?
  10. 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?

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