For most first- and second-year medical students, residency is only in their imagination, and it is not truly until the third and fourth years that it becomes something they can imagine very well. It is the mystical land of having ‘made it’: getting through medical school, having the title MD or DO finally applied to you and being thrown head first into the clinical world. Most medical students seem to think of residency with trepidation and cautious excitement. All that we know about it is what we are told by doctors who did it and older medical students who are about to do it, or what we see residents doing on the wards; rarely do they have much time to sit and talk about what it is like. This is unsurprising, given the little that we do know about residency: it is busy, busy, busy. Time is scarce; residents have little family time, are always on call, are often overwhelmed with the amount of work they have to manage. One of the stereotypes, which are variably accurate, is that residents are underpaid, overworked and often miserable.
These stereotypes and more are addressed by Michael Collins in his excellent memoir Hot Lights, Cold Steel. The book recounts his journey through an orthopedic surgery residency at the Mayo Clinic, a journey which is interesting in itself, but made more interesting by Collins’ energetic and thoughtful voice. In keeping with a good memoir, Collins tells of his own journey, but frames it in a larger context and offers his commentary on many subjects, from which nearly anyone could benefit. It is especially useful for medical students, however, in that it offers incredible insight into what residency is like. After all, one of the main goals of medical school (some would argue the main goal) is to get students ready for residency; residency, in turn, gets the new doctors ready to be independent, practicing physicians. For this reason, Hot Lights, Cold Steel is a great read for medical students, as it offers an honest perspective on residency told by a fresh and friendly voice.
Several converging factors make this book a notably good read. First, the obvious: the subject is somewhat unique, as it is not often that a writer is also a surgeon, and not often that the writer would choose to write about residency. Further, Collins is a great writer. He is witty, humorous, cogent and thoughtful, sometimes all within the same paragraph. He acknowledges his love for reading poetry, and has written poetry himself. This has clearly benefited his writing, as he seems to have a poet’s mind and eye, pointing out small details that add to his story and commenting on minor happenings as part of a larger narrative. In this regard, he is also a philosopher of sorts, as he grapples with larger questions of medicine and life in the midst of reflecting on his brief stint as a surgical resident.
Dr. Collins tells many amazing stories about his time as a resident, recounting with sharp detail how he transitioned from medical school to residency, how his expectations were both met and shattered at different times, and how he struggled through his first years. He is perhaps a little hard on himself, but is evidently seeking to be honest as he recounts his experiences: feeling inadequate, feeling out-of-place and feeling like he was always behind. This topic itself is relatable, which is why it is great that he writes about it. He offers it as encouragement to students and residents everywhere who are struggling with feeling alone and behind, and feel that they are the only ones.
In writing about his family, Collins shares times that went well and other times that did not go as smoothly. He speaks candidly of the poor resident’s salary, especially when trying to support a wife and kids whom he rarely gets to see, due to his long work hours. He tells stories of ‘moonlighting,’ a popular practice among residents looking to make some extra money, whereby working in a rural ER and being paid nicely for the extra shift, residents can boost their meager income. Despite the often greedy motives for residents doing this, Collins’ story is one of fighting to provide food for his family. Some of his funniest narratives are about his car troubles, as he is repeatedly patching up his old junker rather than buying a new car. Beyond the financial incentive, he praises the things he is able to learn through the diverse experiences.
Ultimately, Hot Lights, Cold Steel is a story of growing up for Collins, and learning what medicine is all about. He changes throughout the book, from a struggling first-year resident to the confident chief resident by his final year. His clinical vignettes are equally stunning, as he recounts wild stories from the operating room. This book is easy to read, but full of profound ideas and comments on what it is like to be a young doctor anxious to know more and to care for patients. All medical and pre-med students would benefit from reading it, but I would especially commend it to students interested in orthopedics or other surgery. He discusses stereotypes and how they are both true and not true, which is helpful reading for any future doctor; and even though his tales center on orthopedic surgery, his thoughts and picture of what residency is like will be valuable for anyone planning to do a residency — which is pretty much all of us.
Collins offers wisdom and advice on many topics, not the least of which is the idea of journey and appreciating it more than the destination. I believe this message, more than almost any other, can benefit medical students. He says this: “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 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.”
Prints, Pages and Pagers aims to look closely at the lives of medical students and doctors, real or fiction, whose lives and experiences are told in novels, short stories, poetry or any kind of writing. These book reviews are an opportunity for medical students to learn from the many fascinating stories produced by the field of medicine, and maybe to read something other than a textbook.