Hot Lights, Cold Steel is an exciting medical memoire, written by Dr. Michael J. Collins regarding his life as a resident at the famed Mayo Clinic. This narrative of Collins’ four-year surgical residency recounts his progress from an enthusiastic but inexperienced first-year resident to an expert Chief Resident. In detailing the rigorous path to a successful medical career, Collins conveys his struggles with academic challenges, familial responsibilities, professional pressures, and personal conflicts. The book opens with orientation for the first year residents.
Entering one of the most recognized residency programs in the country, Collins felt completely underprepared and incompetent in comparison to his classmates—“Although I had been an excellent student in medical school, I had very little exposure to orthopedics… I had done no research, had written no papers, and had only one rotation in ortho. ” Afraid of being drilled by Dr. Harding, the attending surgeon for the beginning of his stint at Rochester Methodist Hospital, Collins works relentlessly to match the level of expertise of colleagues.
Through his hard work and unrelenting academic efforts, Collins begins to portray the hardships that await first year residents. He thwarts the notion that medical students learn everything there is to know about medicine in their time in medical school; instead, he emphasizes that the career itself is a lifelong commitment to the pursuit of knowledge. During his time with Dr. Harding, he learns of a poem called Little Albert which ends with the boy getting eaten by a lion and a subsequent philosophical conclusion: “what can’t be helped must be endured. Although Collins does not specify a meaning that should be extracted from this quote, the reader can assume its relevance to the medical field; there are plenty of ailments about which doctors can do absolutely nothing but watch the patient suffer. After Dr. Harding’s service, Collins spends two weeks under Dr. Coventry. During this time, he learns of the case of Thomas Rodnovich, a patient whose operation went awry because a junior resident prepared the wrong hip. Dr. Coventry warned Collins that he owes it to his patients to always be scared of failure, but says that one can learn much more from failures than successes.
There is clear importance of these ideals for any medical professional. Towards the end of his time with Coventry, Collins is finally allowed to wield a scalpel and make his first incision—a defining moment in his career. Next, Collins does a rotation in the ER with Dr. Joe Stradlack. In the ER, Collins encounters his first death in the form of a young boy who had an accidental gunshot wound. It was the first time Collins had seen someone die, and he realized the unarguable truth that death was a very ordinary and common occurrence, and that life goes on.
Michael Collins’s next set of lessons is embodied by the trouble he had in maintaining a stable family life. The emergency room rotation had damaged the relationships he had with his wife and children—“I had been a terrible husband, a terrible father. I was rarely home, and when I was, I had no patience for anything, no energy for anything, no interest in anything. ” His brother Denny, needing shoulder surgery, visited the family for a few days and proved to be the reality check Collins needed: “What the hell kind of life am I leading?
I wondered. I hardly ever see my wife. My kids don’t even know me. My brother is more of a father to them, and more of a husband to Patti than I am. Is that what I want? ” Through this interaction, Collins highlights the importance of attending to the aspects of life that are not related to one’s career, such as family. Collins admits on several occasions throughout the book that a healthy relationship with his wife Patti helped him immensely through the rigors of surgical residency.
While long hours require residents to invest a substantial amount of time in the hospital, one must prioritize in order to do justice to all the other important things in life. The other issue worth discussing is the concept of moonlighting, when residents work overtime hours at rural hospitals to earn some extra cash. Collins clarifies that the purpose of this extra cash is not to support a lavish lifestyle; instead, the money can merely help him put food on the table and the pay the mortgages.
Although some hospitals and institutions discourage the idea of moonlighting, the necessity for money justifies the cause: while the residency program was only paying them $2. 50 per hour, moonlighting could earn the residents upwards of $20 per hour. Some of the issues that arise because of residents who moonlight have to do with the quality of care that patients receive. Residents already invest long hours at their assigned hospitals, and then they go to a different hospital for moonlighting hours.
Sacrificing sleep causes them to be less focused, more distracted, and sleepy on the job. While it may be justifiable for residents to moonlight for more money, the patients are ultimately at loss because they do not receive the care they would at the doctors’ full potential. While the lessons Collins learns in his first year lay the foundation for the next three of this residency, he encounters some very interesting cases in the following years. When a man named Jason comes in with his fingers cut off, Collins convinces Dr. Wilk to conduct a very intense operation to reattach them.
Even after receiving warning that smoking cigarettes would cause the replants to fail, Jason goes for a smoke and the operation inevitably fails. Collins was greatly disappointed in Jason for going against his advice but Dr. Wilk reminds him that his emotions were selfish and that the doctor’s job is to do nothing but help the patient. Another notable case is that of Sarah Berenson, a young girl who comes in with an osteogenic sarcoma—a cancer with a five-year survival rate below five percent. After a hemipelvectomy (removal of an entire hip—including the leg), the beautiful girl’s physique had been severely disfigured.
However, to Collins’s astonishment, Sarah came out of the surgery content and grateful for the things she had not lost. The final story is that of Kenny Johannson, the one with which Collins begins the book. Kenny was a fourteen year old boy whose leg had been demolished by a tractor and Collins had to make the decision regarding whether the leg should be amputated or salvaged. Collins was torn because amputating Kenny’s leg would mean changing his life forever, but trying to save his leg might take Kenny’s life.
In the end, Collins made the decision which he thought was the best one for Kenny: he amputated Kenny’s leg. While the aforementioned stories all presented themselves at different times to different people in different situations, there is a central message that connects all of them: Collins reminds his readers that patients need a compassionate doctor who will set aside his own internal conflicts to treat his patients in the most favorable way and strive to provide emotional support along with the required medical attention.