What we can learn from an orthopedic surgeon who publishes a novel [PODCAST]

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“Transections, eviscerations, exsanguinations, amputations, decapitations, disembowelments, penetrations, disarticulations, emasculations, enucleations, incinerations—these things he has seen. But of late he chooses to see only the glimmering vials. His vision fades and darkens as he draws closer to the OR where the ultimate reality lies prepped, draped, framed, and illuminated, waiting for the surgeon to fix it all, to make sense of it all.

Exposure in surgery is everything.”

Michael J. Collins is an orthopedic surgeon and author of All Bleeding Stops. He can be reached on Twitter @mjcollinsmd.

He shares his story and discusses his KevinMD article, “Exposure in surgery is everything.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Michael J. Collins. He is an orthopedic surgeon, and he’s the author of the book “All Bleeding Stops.” And there’s an excerpt from that book on KevinMD titled “Exposure in surgery is everything.” Michael, welcome to the show.

Michael J. Collins: Thank you, Kevin. I appreciate being invited.

Kevin Pho: We’ll get into your book in a little bit, but first off, can you share your story and journey to where you are today?

Michael J. Collins: I actually wanted to be a writer before I wanted to be a doctor. I came a little bit late into medicine. Those of you who’ve read my first two books, they were memoirs, but I was a construction worker for a few years and finally got the call to medicine, and I have never looked back. I’ve been thrilled with my career. I’ve been encouraging all young people to pursue a career in medicine.

But I had been writing before I went to med school. As you well know, throughout much of med school and residency, you really have no time to do much else except that. So 10 or so years after I’d been in the practice, I wrote my first book. That was called “Hot Lights, Cold Steel.” The second book came out about five years later, called “Blue Collar, Blue Scrubs.” And then “All Bleeding Stops” has just been released in the last month or two. That’s my first attempt at fiction, but I’ve enjoyed it greatly.

Kevin Pho: So, over your long orthopedic career, and I understand that you recently retired, congratulations.

Michael J. Collins: Thank you.

Kevin Pho: So tell me how the field of medicine has changed over all the time that you’ve been practicing.

Michael J. Collins: It’s changed, you know, for the better and for the worse, I think. You know, the technology has been an amazing advance. Personally, in orthopedics, I was there towards the beginning of arthroscopy, which has made huge advances in our ability to do minimally invasive things for people. Joint replacement has come a long way.

I think on the negative, the problem is, I think, the loss of some of the personal interaction in medicine. I think there are fewer hands-on things than there used to be, and I think we’re all feeling the pressure to do more and to produce more, and the human element is somehow being squeezed out of that equation.

Kevin Pho: And as a professional writer, has that changed you as a physician?

Michael J. Collins: Well, it has. I think, as you well know, there have been a great many physician writers, and I have thought about that. I think one of the reasons for that is that each profession requires a sort of refined kind of vision. As doctors, we learn to look at things in a different way, not through our own eyes, but trying to see things through the eyes of our patient. And a writer, if he’s going to connect with his readers, has to do the same thing, to try and put himself in someone else’s shoes and see things in ways that perhaps he wouldn’t ordinarily have seen.

Kevin Pho: So you did mention that your most recent book, “All Bleeding Stops,” is your first attempt at fiction. Tell me some of the challenges in writing fiction.

Michael J. Collins: Well, it was interesting, because after having written two memoirs, nonfiction, I thought fiction would be easier, because there are really no constraints. You can say anything you want to. Say, Martians came down and took over, whatever. But I found it much more difficult, because since there’s an unlimited number of things you can do, it makes it more difficult to decide what you do want to do. I’m not the first person to observe that very often fiction is a way of telling the truth, and I found that to be the case.

It’s hard work, and I often wonder, if you gave me another go-round to revise this book, couldn’t I make it a little bit better? And I think so. And what about one more time after that? And I think that’s the same dilemma that all fiction writers have, thinking that you’re never quite finished.

Kevin Pho: So let’s talk more about that book. It’s titled “All Bleeding Stops.” There’s an excerpt from that book on KevinMD, “Exposure in surgery is everything.” So tell us about the genesis of the book and perhaps some of the inspirations about why you decided to write it.

Michael J. Collins: I guess the central question of the book is: How does a doctor learn to care without caring too much? And my interest in this subject came about when I was a senior in med school. I was assigned to a cardiology service at the local VA hospital, and the intern on our service committed suicide. And this was such a shock to me. I just couldn’t understand it, and it awoke in me a desire to try and figure out what it is that makes physicians take their lives at a rate much higher than the general population.

There are a number of reasons, and some of them are drug and alcohol and stress and those sorts of things, but I think a lot of it has to do with the fact that people who are called to medicine are generally the sensitive and the compassionate, and that sensitivity and compassion leaves them vulnerable. They come in and they see, as we all do in medicine, we see things that are hard to take. Bad things happen to good people, and that’s just a fact of life. That’s morbidity and mortality.

So “All Bleeding Stops” is my attempt to explore what happens to a young, sensitive doctor, in this case, his name was Matthew Barrett, drafted right out of his residency and sent to Vietnam as a combat surgeon, and faced with all kinds of terrible situations, and really not equipped to deal with them in an emotional sense. He’s an excellent surgeon, but his inexperience shames him, his failures torment him, and the book is really an exploration of how a doctor deals with those sorts of issues.

Kevin Pho: So take us through the journey of that main character, and as you take us through that journey, I’m sure that some of your thoughts on how physicians can protect themselves from some of the traumas of the profession.

Michael J. Collins: There are several characters in the book that were meant to help explore this issue. So one of them is another surgeon, whose name is Mack, and he learns to deal with the issue by ignoring it. He lets everything bounce off him. He is a good surgeon but does not get involved, does not really find himself caring or compassionate, but is able to survive because he builds a wall around himself. Matthew, the main character, is very vulnerable and suffers greatly because of his vulnerability.

The character Deni, or Dennis, is meant to be the character that’s sort of held up as an example. He is able to care without letting that care destroy him. The final person in the book is one of the narrators, who was a lawyer who had some experience with Matthew in the Vietnam War, and he is meant to be cold and calculating, someone who has no care.

I think the journey is what makes the book address the issues that I’ve spoken about. It’s difficult for Matthew to handle the things that happened to him. He has a love interest, and she helps him, more than anyone else, I think, realize where he is and where he’s headed.

Kevin Pho: As we consider the various paths that your characters take in the book, I’m sure they mirror a lot of the different choices that real-life physicians have every single day. So what kind of lessons can these physicians learn to protect themselves against burnout and potential suicide?

Michael J. Collins: I think the two points that I would raise: One is, I did not mean this book to be a cautionary tale warning doctors about caring. That was not my intent, and I hope people don’t read it that way. Caring is a necessary, indispensable part of any doctor’s makeup. So Matthew didn’t learn the proper way to channel his care. At some point, I think I have somebody speculating, wondering whether or not care was like a wound that was unstanched and bleeding, or whether or not it should be titrated in drops and milligrams per kilogram.

Matthew never comes to a definite answer about how much is too much and how to discover this, but I think what he does find is that, in a trite sort of way, virtue is its own reward. And I think at the end, Matthew comes to realize that his care and compassion may have caused him pain, but in the end were well worth it.

Kevin Pho: We’re talking to Michael J. Collins. He is an orthopedic surgeon. He’s the author of the book “All Bleeding Stops.” There’s an excerpt from that book on KevinMD titled “Exposure in surgery is everything.” Michael, what parts of your career as an orthopedic surgeon have influenced you in writing this book?

Michael J. Collins: I would say, like most doctors, I think I can see a little of myself in Matthew. I never really struggled to the extent that he did, but I think all of us tend to dwell too much on our failures. If you’re a doctor and you’re taking care of people, the human condition is such that you are not going to be able to cure every person. And if you have a decent heart inside you, that bothers you. You want to help everybody that comes to you.

So part of my problem is that I spent too much of my career fretting over and beating myself up over things that didn’t go well. And certainly, occasionally I thought I made a mistake, and that was understandable, but even when I didn’t make a mistake and things didn’t go well, I let that bother me much more. And I wish I’d taken more time to sit back and listen to the people who said, “Thank you,” people that I did help. I think we tend to put those aside and say, “Well, that business is over. Now I have to move on to the next one,” and focus more on the negative than you do on the positive.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Michael J. Collins: I think it would be that I hope that all of us in the medical profession are proud of what we do and proud of where we came from. We’re in a difficult situation now, where there are all sorts of forces around us that tend to turn us away from where we originally started. You know, most of us went into medicine because we cared and wanted to help people. And I think it’s imperative that we not forget where we came from.

Kevin Pho: Michael, thank you so much for sharing your time and insight, and thanks again for being on the show.

Michael J. Collins: Kevin, I appreciate it. Thanks for having me.

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