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“All the faceless young men who are brought to his operating table, prepped and draped, broken and bleeding, are finding their experience of war bears little resemblance to their reveries of war. They should have known better. At corner taverns in Chicago, Albuquerque, and Murphysboro, there were tired veterans with scars and limps; men with faded names of regiments or slogans like “Semper Fi” tattooed on their biceps; men with creased faces and shuttered eyes, who quietly nursed schooners of beer while they watched the Sox or the Dodgers on the TV behind the bar; men who had been to places like Bastogne and Peleliu and the Chosin Reservoir. They, too, once had reveries. Carelessly fingering an old scar or slowly twisting a worn ring, they might have explained some things to these un-blooded young men, things forever indecipherable to those who have never worn the uniform, who have never lit the flame. But words are weapons, slashing open memories, ripping open wounds, stirring the smoldering fires of pain that old warriors have doused with alcohol and denial for millennia. And while they spoke, these old veterans could not help but see distorted reflections of their own youthful faces on the bar’s polished surface and could not help but remember things they had tried so long to forget.”
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, “War is really not all it’s cracked up to be.”
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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 we welcome back on the show Michael Collins. He is an orthopedic surgeon, and he’s the author of the novel All Bleeding Stops. There’s an excerpt from that book on KevinMD titled “War is really not all it’s cracked up to be.” Michael, welcome back to the show.
Michael J. Collins: Thanks, Kevin. Good morning. It’s nice to be back.
Kevin Pho: So we’ll get into your book and the excerpt in a little bit, but first off, for those who didn’t get a chance to listen to our first episode together, just briefly share your story and journey to where you are today.
Michael J. Collins: Sure. I was not a pre-med major in college. I didn’t know what I wanted to be when I grew up. So I graduated from college and was a construction worker for a couple of years. Through some serendipitous events, I got interested in medicine and had to go back and take two years of pre-med courses to get into med school. Then I went to med school, eventually did my residency in orthopedics at the Mayo Clinic, and then moved back here to Chicago, where I was born and raised, and I have been here ever since.
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Kevin Pho: So I understand you’ve retired from orthopedic practice for a few years now. As you reflect back on your orthopedic surgery career, tell me how the field has evolved over your decades of practice.
Michael J. Collins: Because of my age and my gray hairs, I go back a long ways in orthopedics. When I first started in orthopedics at the Mayo Clinic, arthroscopy was a new thing. Not many people were doing it. So I’ve sort of been in on the ground floor of arthroscopy, and even joint replacements. They were done five or maybe even 10 years before I started, but they were still new. When we started, somebody who had a total hip or total knee would be in bed for three days and in the hospital for two weeks. Now, my brother just had a knee replacement a couple of days ago, and he went home the same day. So things have changed a lot.
Kevin Pho: Tell me what some of the challenges are that still face the field of orthopedic surgery today.
Michael J. Collins: Well, the same challenges that all doctors face, I think: making sure that we don’t get too wrapped up in the things that we didn’t think were important when we started medicine. Trying to earn a living is important, but it’s not the most important reason why people are in medicine.
Orthopedics tends to attract people like me who like positive feedback. Unlike much of medicine, most of what we do in orthopedics is successful. People have a broken leg, we fix it. They have an arthritic hip, we replace it. They have a torn rotator cuff, we repair it. So a lot of the things we do give us immediate positive feedback. Maybe that’s a sign of my, or our, insecurity that we always need that, but it’s a wonderful thing about orthopedics that you’re constantly being thanked and you can see the results of your work quickly.
Kevin Pho: Now, for those medical students who may be considering a career in orthopedic surgery, what kind of characteristics or traits should they have?
Michael J. Collins: Well, you have to be used to hard work. In orthopedics, even now, in this era of having physician assistants and emergency room doctors, there are still calls for you to be brought out at night to do things. So you have to be prepared for long hours and hard nights.
It used to be said, and this is many years ago, that orthopedics was a man’s profession, that it required big, strong guys to do it, and women were discouraged. That’s certainly not the case now. Women are becoming an ever greater presence in the field of orthopedics, which most of us welcome. So I think it’s wide open to almost any interest.
Kevin Pho: All right. So let’s talk about your book next. It’s a novel, All Bleeding Stops, and before we talk about this specific excerpt, talk more about this book.
Michael J. Collins: Well, “all bleeding stops” is an expression that most of us in medicine, or certainly in surgery, are familiar with. It’s sort of a dark-humor kind of thing. In the middle of surgery, if a patient’s bleeding and the doctor’s trying to stop the bleeding, someone can say, “Well, all bleeding stops,” meaning that if you don’t stop it, it will stop by itself when the patient exsanguinates.
I used that title because the book is about a doctor who cared too much, and that’s a topic that’s been important to me for many years. When I was a senior in med school, the intern on our service committed suicide. He was a sensitive guy, and it took me a long time to wrap my head around what happened. You know, why would that happen? Part of my conclusion from this whole thing was that he was a guy who cared too much. His failures just really ate at him. And you know, Kevin, in medicine, you’re going to fail. All patients are going to die eventually, and some of them are going to die real soon, even the ones that you care deeply about or are trying to take care of.
So I’ve seen throughout my career that very sensitive people tend to be drawn to the practice of medicine, and sometimes their sensitivity leaves them vulnerable to the inevitable effects that morbidity and mortality will have. This book is the story of one such doctor. He was a resident who was drafted and sent to Vietnam in 1967, at the heart of the war. He wants to do his best and is concerned about taking care of the soldiers who are brought to him, but it’s a war, and many of the people brought to him are too far gone to save, and he doesn’t handle it very well. He drifts into alcohol and depression. But the book, I think, ends on a positive note, because I think there is something to be said: Despite all the terrible things that we might witness as doctors, there’s a nobility and a satisfaction that comes from taking care of people that’s unlike any other profession.
Kevin Pho: So tell me more about this particular anecdote where you sent your main character into war. Tell us about some of the challenges he faced, some of the emotions he encountered, and how that specifically led to a little bit of a downturn.
Michael J. Collins: Well, I told you sort of the theme that I wanted. I picked Vietnam partly because it was the defining moment of my generation, I suppose. But also because, with a doctor at war, it’s almost oxymoronic that we’re there to help people when war is there to kill people. So how does he deal with a situation like that? He doesn’t deal with it very well, and the excerpt that was on KevinMD tries to point that out.
It opens with him rushing an injured 18-year-old soldier to the operating room despite the advice of the anesthesiologist and the head nurse that this kid’s too far gone. But Matthew, the protagonist, doesn’t see it that way. He sees an 18-year-old kid who’s badly injured and feels, “I can’t just let him die.” And as everyone else except him knew, he died anyway during the operation. It once again points out to him his inadequacies. He doesn’t know: Is he not a good enough surgeon, or is he not well enough prepared to deal with the things that all surgeons should be prepared to deal with? Then I go through a little bit of an anecdote about the fact that there are veterans all over the country who could have pointed out to young doctors and young soldiers just exactly what they’re headed for when they go to war.
Kevin Pho: How do you come up with the anecdotes and experiences in this novel? How much of your personal experience, and what you’ve seen during your decades-long career as a physician, is in the book?
Michael J. Collins: Much of the medical scenes are drawn from personal experience. I did not go to Vietnam. I have not been a combat surgeon. I did just a ton of research on this book, reading almost everything that was written by doctors, and a fair number of doctors wrote about their experiences in Vietnam. So I wrote that. There are a couple of doctors that I know, or whom I met, who served in Vietnam, so they all helped. So the war part of it, I had to do a lot of research for, but the medical part, much of it, the operating room and those sorts of things, are drawn from personal experience.
Kevin Pho: Now, one of the things you said was that doctors who may be a little bit too sensitive can get exposed to burnout from the profession. What are some of the things that we can do to help prevent these scenarios?
Michael J. Collins: One of the things that I didn’t really think about, even though I might have known it deep inside, is that the protagonist in this book, Matthew, suffered from PTSD. He was not on the front lines, actively involved in killing and seeing friends being killed, but he was involved in the aftermath of it all and didn’t handle it very well, or didn’t handle it as well as he would have liked.
So one of the things that came to me in the process of writing the book is the feeling that, no less than the soldiers who suffer from PTSD, many of the doctors are the same way. They’re broken people when they finish these terrible experiences that they go through, entering into them wanting to be helpful and wanting to do their best, but not being prepared emotionally for the fact that we can’t save them.
Kevin Pho: We’re talking to Michael Collins. He’s an orthopedic surgeon, and he’s the author of the novel All Bleeding Stops. Michael, I know that this is a work of fiction, but are there any lessons that clinicians and medical students can come away with after reading your novel?
Michael J. Collins: Well, the one lesson that I would most hope that people would come away with is to recognize that the traits that brought us into medicine, sensitivity and compassion and caring, can be our friend and can be our enemy. Now, they’re more friend than enemy, and I don’t want to discourage people from being sensitive and caring, but one of the things that doctors need to learn along the course of their training is how to give of themselves without giving too much.
We’ve seen what happens with doctors. You know, we have a higher suicide rate, a higher alcoholism rate, and a higher divorce rate, and all those things, I think, reflect the struggle that we all have inside to try to manage these two parts of our personalities: the desire to want to help people and the understanding that some people we can’t help.
Kevin Pho: Now, you’ve practiced medicine for decades. When you say you can’t give too much of yourself, what are some things that you’ve learned? What are some of the things that you’ve done to follow that advice?
Michael J. Collins: One of the big things that has helped me is my family. And I think maybe I could put that in broader terms and say outside interests. I sometimes see the opposite happening in medicine today, where people have what I think are too many outside interests and not enough focus on their career, because our profession is more than a career. I think we have an obligation to our profession, and we are expected, and should expect ourselves, to maybe give more of ourselves than people in other careers have to give.
But having said that, there has to be more to your life, whether it’s your family, whether it’s an outside interest, whether it’s taking time to read or walk in nature, whatever. If you don’t step back occasionally, I think it’s hard to keep your perspective, and it’s hard to not let yourself get swallowed up by the things you’re seeing.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Michael J. Collins: Well, I hope that the book All Bleeding Stops makes doctors reflect on the importance of what we do. I think Matthew Barrett is somewhat of a tragic character. He’s also a noble character. I wouldn’t say he’s exactly a role model for all of us, because I don’t want to see anybody swallowed up the way he was, but at the same time, I hope people come away from this book realizing that this was a man who led a noble life and went to places where he thought he would be doing the things that he was meant to do as a doctor.
Kevin Pho: Michael, thank you so much for sharing your time and insight and coming back on the show. Best wishes with the book.
Michael J. Collins: Thanks, Kevin. I’m delighted to be back. Thank you for asking me.
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