Hot Lights, Cold Steel Read online

  Praise for Hot Lights, Cold Steel

  “His compelling and unflinching narrative weaves together his personal life and his most memorable cases, including triumphs and heart-rending tragedies.”

  —The Arizona Republic

  “A good book for those considering the medical profession, or for fans of TV shows such as ER.”

  —San Antonio Express

  “Humanizing detail and with little medical jargon…Collins’s relaxed style…is punctuated by humor—usually at his own expense. Easy to read yet thought provoking, this memoir is an excellent introduction to the requirements of residency medical training.”

  —Library Journal

  “He details, with admirable humor and insight, the early, virtually sleepless years when he learned not only to perfect his craft but to come to terms with the emotional impact of causing pain and losing patients. Collins brings to life the dramatic moments when he made his first, terrifying incision and hand-drilled a traction pin into a weeping six-year-old’s leg…. Collins describes powerfully how he came to understand that his calling was not just to develop as a skilled surgical technician, but to treat his patients humanely as individuals.”

  —Publishers Weekly

  “An orthopedic surgeon’s down-to-earth, fast-paced, and frequently funny memoir of his residency…Collins’s depicts with born storyteller’s skill…Highly animated—and rich in encounters both sad and hilarious.”

  —Kirkus Reviews

  “If it hadn’t been for his innate sense of humor—brilliantly demonstrated in this memoir of his Mayo residency—and a sense of perspective derived from that experience, he might have failed. He didn’t and here he honors those who helped him along the way and those whom he helped. If Collins’s scalpel is as sharp as his pen, his patients are in capable hands indeed.”

  —Booklist

  “A fast-paced memoir of the fear, heartbreak, humor, and triumph.”

  —Notre Dame Magazine

  “I adore this book. It’s so polished and hilarious. It brought back all the stomach-churning anxieties of my own residency so vividly that I felt exhausted reading it. Dr. Collins has my highest admiration. I give this book a 10+!”

  —Tess Gerritsen, New York Times

  bestselling author of The Surgeon

  “One of the best, funniest medical memoirs I have ever read. Hot Lights, Cold Steel is at once darkly humorous and truly compassionate. Not since The House of God has there been such a ferociously funny look at the world of hospital medicine.”

  —Michael Palmer, New York Times

  bestselling author of Fatal and The Patient

  “Like the very best episode of ER, Collins’s memoir races from one trauma to the next, keeping this reader spellbound all the way. Collins’s life as a surgical resident is heartbreaking one minute and triumphant the next. You’ll laugh and cry and cheer along with him as his epic journey to become a doctor races toward its gripping conclusion. I love this book and won’t soon forget it.”

  —Augusten Burroughs, New York Times

  bestselling author of Dry and Magical Thinking

  To Patti—Then, now, and always

  We start here, and we go there. But it’s not that simple, is it? Our paths may be circuitous or direct. We may gaze excitedly ahead, or cast our eyes regretfully behind. Until we reach our destination it exists only in our own minds. It is what we have imagined it to be. And yet we tend to neglect the journey, which is real, in favor of the destination, which is not.

  For too long I neglected this journey. It was an obstacle to be overcome, an ordeal to be endured; for I had never chosen the journey, I had chosen the destination. But now that the journey has ended, I have discovered that here isn’t so important after all. I find myself looking back with particular fondness for how I got here.

  St. Mary’s Hospital Emergency Room

  The Mayo Clinic, Rochester, Minnesota

  June, Year Four

  The ER doors crashed open and the paramedics powered through. I trotted alongside them as they wheeled the patient to Trauma One.

  “Fourteen-year-old kid, run over by a tractor,” the paramedic said. “He was conscious when we got there, BP a hundred over sixty. His right leg’s a mess—open fracture, dirt everywhere.”

  “What’s his name?” I asked.

  “Johannson. Kenny Johannson.”

  “Hang in there, Kenny,” I whispered to the unconscious boy.

  I lifted the sheet covering the lower half of his body, and immediately the thick, fetid stink of manure mushroomed up at me. His leg was twisted obscenely to the side. The jagged end of the tibia stuck through a rent in his dirty blue jeans. A spreading pool of blood soaked the sheet underneath him.

  As we lifted the boy onto the table in Trauma One, his eyes flickered open. He began to whimper softly as he searched for someone he knew. I put my hand on the side of his head and rubbed his hair gently. “Kenny, you’re in the emergency room at St. Mary’s,” I told him. “Your mom and dad are here, too. They’re in the other room.”

  He rolled his head and moaned. “My leg. Oh, God, my leg! It hurts so bad.”

  “I know it does, Kenny, and we are going to help you.”

  “BP seventy-eight over forty,” a nurse called out. “Pulse one-sixty.”

  I probed Kenny’s wound. Under the severed end of the peroneus longus there was a bloody chunk of manure wedged against the bone. I picked it up with a forceps and dropped it on the floor. When I found what was left of the anterior tibial artery I clipped it with a hemostat. His bleeding, except for a slow ooze, ceased.

  In the next several minutes we did a cut-down, put in a subclavian line, and pumped him full of blood and fluid. Within half an hour we had his pressure up to one-ten over sixty. I told the charge nurse to get an OR ready. As she picked up the phone, she said the boy’s parents wanted to talk to me.

  Mr. and Mrs. Johannson were huddled together on a couch in the far corner of the waiting room. They sprang to their feet as I entered the room. Mrs. Johannson wrapped both hands around her husband’s left arm and leaned against him. She kept staring at the bloodstains on my scrub pants.

  I introduced myself and then told them that although Kenny had lost a lot of blood, his vital signs had improved and he seemed stable. “We are just about to take him to the operating room,” I said.

  Before I could say more, the door to the waiting room burst open and a young man rushed in. “Dad!” he said. “I found it.”

  “This is my son Eric,” Mr. Johannson said. “He went back to the farm to look for the missing piece of Kenny’s leg.”

  Eric reached into the pocket of his jacket. He handed me a clean white handkerchief in which he had wrapped a dirty, three-inch section of tibia. I doubted we could use it, but I wanted the boy to feel he had done something worthwhile. “Thanks, Eric,” I said. “This could be a big help.”

  “Will you be able to save Kenny’s leg?” Mr. Johannson asked.

  At that moment I was more worried about saving Kenny’s life. The boy was in shock and had almost bled to death. I longed to reassure his parents, but I had learned not to make promises. “Mr. Johannson,” I said, “we’re going to do everything we can.”

  “Please, Doc. Please.”

  I nodded, shook his hand, squeezed Mrs. Johannson’s shoulder, and sprinted up to the OR.

  They had taken Kenny to OR Ten, the largest of the operating rooms. In contrast to the ER, where everyone had been barking orders, shouting for equipment, and rushing back and forth, the operating room was quiet, almost hushed. Voices were muffled. There was a greater sense of control here. We were surgeons. This was our turf.

  Against the far wall the laminar-flow machi
ne hummed faintly. The cardiac monitor issued its staccato, reassuring beeps. Two anesthesiologists were wedged shoulder to shoulder at the head of the table. They had just finished the intubation. The scrub nurse stood at the back table carefully arranging her instruments. Two circulating nurses shuttled back and forth with instrument trays from the sterilizer. In the corner, a radiology tech waited patiently next to her portable X-ray machine.

  I handed the piece of tibia to the circulating nurse and asked her to sterilize it. Then I scrubbed my hands and joined the five other residents from various surgical specialties who were clustered around the shattered leg. The extent of the boy’s injuries was now apparent. Large sections of muscle, skin, and bone were missing. Parts of nerves and arteries had been torn away. Dirt, manure, and fertilizer contaminated everything.

  First one, then another of the residents poked at the wound, winced or shook his head, then stepped back. No one was sure what to do. Should we try to save this leg, or should we amputate it?

  They all looked at me. I was the chief resident in Orthopedic Surgery. I was the one who had to decide.

  I stood in the center of the operating room with the bright lights trained on the bloody mess that was Kenny’s leg. I tried to put everything else out of my mind. It didn’t matter how much sleep I got the night before. It didn’t matter what else I had planned for the rest of the day. This poor kid, barely alive, was lying unconscious on an operating table with some stranger about to decide whether to cut off his leg.

  I hemmed and hawed for a few minutes. The natural impulse, of course, is to save the leg. If there is a chance in a million, take it. The kid was only fourteen years old. What did we have to lose by trying? If it didn’t work we could always amputate the leg later. Didn’t we owe him at least that much?

  I wasn’t sure. Kenny’s leg was so badly damaged that an attempt to save his leg could cost him his life.

  But what about Kenny? What would he want? If we woke him up and said, “Kenny, your leg is severely injured. Should we cut it off or try to save it?” Did anyone think he would say, “Cut it off”?

  For Christ’s sake, he was only fourteen years old.

  The room was quiet save for the sigh of the ventilator and the steady beep of the cardiac monitor. From behind the drape at the head of the table, the anesthesiologists looked at me questioningly. The other residents stood silent, some looking at the ground, some staring at the gaping wound in front of us. No one moved. No one spoke. They all waited.

  Contents

  Year One

  Chapter One

  Chapter Two

  Chapter Three

  Chapter Four

  Chapter Five

  Chapter Six

  Chapter Seven

  Chapter Eight

  Chapter Nine

  Chapter Ten

  Chapter Eleven

  Chapter Twelve

  Chapter Thirteen

  Chapter Fourteen

  Chapter Fifteen

  Year Two

  Chapter Sixteen

  Chapter Seventeen

  Chapter Eighteen

  Chapter Nineteen

  Chapter Twenty

  Chapter Twenty-One

  Chapter Twenty-Two

  Chapter Twenty-Three

  Chapter Twenty-Four

  Chapter Twenty-Five

  Year Three

  Chapter Twenty-Six

  Chapter Twenty-Seven

  Chapter Twenty-Eight

  Chapter Twenty-Nine

  Chapter Thirty

  Chapter Thirty-One

  Chapter Thirty-Two

  Year Four

  Chapter Thirty-Three

  Chapter Thirty-Four

  Chapter Thirty-Five

  Chapter Thirty-Six

  Chapter Thirty-Seven

  Chapter Thirty-Eight

  Chapter Thirty-Nine

  Chapter Forty

  Chapter Forty-One

  Chapter Forty-Two

  Year One

  Chapter One

  The Mayo Clinic, Rochester, Minnesota

  July, Four Years Earlier

  On a sweltering Friday afternoon, the day before we were to officially begin our residency, we gathered in a small classroom on the fourteenth floor of the Mayo Building for our orientation meeting. Crammed into this room were fifteen incredibly bright first-year orthopedic surgery residents—and me, a twenty-nine-year-old ex-cabdriver and ex-construction worker long on dreams but short on credentials.

  We were introduced one by one. Phi Beta this, Alpha Omega that. The Mayo Clinic was the most prestigious medical center in the world, and I began to wonder what I was doing there. I was the redheaded stepchild, the dullest scalpel in the drawer.

  All the other residents had done several rotations in orthopedics when they were in medical school. Most of them had spent their nights writing papers or doing orthopedic research. When I was in medical school I had spent my nights working on a truck dock. I had done no research, had written no papers, and had done only one rotation in ortho. I had no exposure to the world of adult reconstructive surgery that was such a big part of orthopedics at the Mayo Clinic.

  After the introductions, a towering man with thick lips and wavy gray hair lumbered up to the podium. He introduced himself as Dr. John Harding, the chairman of the department. He welcomed us and then gave a brief history of orthopedic surgery at Mayo, going all the way back to Drs. Will and Charlie Mayo, who had founded the Clinic in the 1890s. He said we were lucky to be starting in orthopedics now. “Twenty years ago there were no joint replacements. There was no arthroscopy. The things we can do for our patients now could scarcely have been imagined back when I started in orthopedics.”

  When Dr. Harding finished, a short, wrinkle-faced man with thick glasses approached the microphone. He waited until the room was quiet before he introduced himself. “I am Dr. Benjamin Burke,” he said, “the director of the residency program.” After a few words of welcome, he reminded us of the sacredness of our profession, and told us we had a long, but gratifying, road ahead of us. “You will spend four years here,” he said. “Two years as a junior resident, and two as a senior resident. If you work hard enough, if you’re skilled enough, we might consider you for chief resident in your final year.” He concluded by saying, “This is the Mayo Clinic. Our patients expect a lot from us, and we are going to expect a lot from you.”

  Finally, Viola Hopkins, Dr. Burke’s secretary, passed out our first-quarter assignments.

  “There are two Mayo Clinic hospitals,” Vi said. “You will spend time at both hospitals, but for the first quarter, twelve of you have been assigned to St. Mary’s Hospital. The remaining four will be at Rochester Methodist Hospital.” She said she looked forward to meeting each of us personally, and wished us a “happy and blessed four years here at Mayo.”

  I tore open my packet. There were four names under the heading Rochester Methodist Hospital:

  Chapin, William T.

  Collins, Michael J.

  Manning, John F.

  Wales, Frank

  As we filed out of the classroom someone tapped me on the shoulder.

  “Mike Collins?”

  “Yeah,” I said, turning around.

  A stocky, freckle-faced man with an unruly mass of red hair held out his hand. “Bill Chapin,” he said. “I guess we’re going to be inmates together.”

  As we shook hands Bill said, “Have you met these two characters yet?” He gestured behind him.

  A friendly-looking guy with a bushy brown mustache and a string tie smiled and took my hand in both of his. “Wales,” he said. “Frank Wales. It’s a gol-dern pleasure to meet you.” Frank, as I was to learn, was a Wyoming farmboy with a big smile and a bigger heart. I never could figure out how much of his country-boy shtick was put on and how much was genuine.

  “And I’m Jack Manning,” said a tall, athletic-looking man with round glasses and a receding hairline. I shook hands with Jack, too, who then asked me where I was
from.

  “Chicago,” I said. “The West Side. How about you?”

  “Corn country. Des Moines, Iowa.”

  I turned back to Frank Wales. “Frank, where are you from?”

  “I’m from God’s country—”

  “You’re from Chicago, too?”

  “Chicago? Why, son, I’m from Wyoming, Wind River Country. Home of elk and bison and wild mustang and mountain peaks stretching as far and as high as the eye can see. I don’t reckon you have anything like that in Chicago.”

  I said no, but we had some pretty big rats and cockroaches.

  After the others left I went back to the residents’ lounge and looked through the rest of my packet. I knew that each staff (or “attending”) surgeon at Mayo had his own list of patients: his service. A senior resident and a junior resident were assigned to each surgeon. I was dismayed to learn I would be the junior resident with Dr. Harding.

  Oh, great, I thought. Just what I need, to have the chairman of the department find out what a dope he has hired. I imagined him grilling me the next day.

  “How much research have you done, Dr. Collins?”

  “Research? Well, I haven’t actually—”

  “What about papers, then? Have you written anything?”

  “Papers? Have I written papers? Well, not exactly. That is, ahem, not a lot. Well, maybe a little here and there, but nothing all that important. Of course I’ve been meaning to write them. Lots of them, in fact. I have some ideas, but I’ve been—” At that point I would let him know that my people would be getting back to his people on this. Soon.