An excerpt from Blue Collar, Blue Scrubs: The Making of a Surgeon.

They drive us. All day long they drive us. They drive us until the heat sears our lungs, and each breath rasps the back of our throats. They drive us until we pant like dogs and our tongues hang from our mouths like hams on a curing hook. They drive us until our sweat dries up and black blood congeals between the cracked calluses on our hands. They drive us until we cramp up so bad we can’t stand up straight and we stagger back and forth like a crew of hunchbacks working the mines of hell.

It is the hottest day I have ever seen. It is the hottest day any of us have ever seen. But the foremen say they don’t give a shit how hot it is. They tell us we are behind schedule and we gotta finish this section – today.

The thermometer at the Pure Oil station reads 104 degrees, but it must be a hundred and forty on the highway. The concrete reflects the heat of the sun back at us, and the air is so hot we can breathe only in shallow gulps. The pavement burns our hands if we touch it. It disintegrates the adhesive that holds our boots together, and we trudge across the highway with the soles of our boots flapping. Pavement buckles, and black tar oozes up from the expansion joints.

The cooler on the back of Johnny’s truck is empty by 10 a.m. and we have nothing else to drink for the rest of the day. There is not the least breath of wind, not the least hint of shade. There are no breaks, no lunch. We gotta finish this section today.

The heat sucks the strength from us, but we force ourselves to go on. No one wants to be the first to give in. JT has been running the gun without stop since 6:30 this morning. He has been breaking the rocks into smaller and smaller pieces, but as the day goes on, they seem heavier and heavier to us. Rosie and I have filled ten trucks today, but we still have several hundred feet to go.

Up and down the line, foremen are screaming and waving their arms. The shimmering waves of heat rising off the highway warp my vision, making the scene even more nightmarish. Trucks are scurrying back and forth, compressors are dangerously overheating and above it all, the roar of the machines obliterates all other sound.

I have a little warm water left in my Coke bottle. I take a mouthful and give the rest to Jesse. He has his red bandana hanging from the back of his hardhat, Foreign Legion-style, but he can barely lift his shovel. I’m worried he’s not going to make it.

We finally finish breaking out the last section around three. For the first time in nine hours, JT shuts down the compressor. I heave the last rock onto the back of The Rat. JT, Rosie and I stand next to each other, bent over, heads down, hands on our thighs, panting slowly. We are looking for a place to sit down when Johnny pulls up in his truck. He tells us to start lining up the lumber and stakes.

“The carpenters’ll be here any minute,” he says, “and they gotta get this thing framed up.”

We can’t believe it. The only thing that has kept us going this last hour was watching as the end of the line approached, thinking that we were almost done, that in a short while we could finally rest.

Now Johnny wants us to start lining?

Rosie straightens up, balls his fists and glares at Johnny. “You gotta be shittin’ me,” he says.

Johnny lifts his hands. “Look, kid. This ain’t my idea. Fred says this job’s gotta be wrapped up today. I know you guys been bustin’ your ass, and I’ll make it up to you, but this lumber’s gotta get lined up – now!”

Rosie doesn’t move. He continues to glare at Johnny. I am afraid he is going to take a swing at him. Finally, JT turns, grabs a sixteen-inch board and drags it into position. I grab the next one and line it up next to JT’s.

Rosie won’t let us work alone. He clenches his teeth and growls out a long stream of profanity directed at the Scalese family lineage with particular emphasis on the unorthodox and incestuous methods by which they were all begotten. Then he turns and drags the next board into position.

JT, Rosie and I, who thought we could handle anything from anyone, are hardly able to stay upright. But we keep working.

The carpenters arrive ten minutes later and are right on our asses. Usually they bitch about having too much or too little lumber, too few or too many stakes. Today they don’t say anything. They grab the boards and start framing. They don’t look much better than we do.

Everything is almost framed up at four o’clock when the Material Service trucks arrive. The foremen are worried that it is so hot that the concrete will harden before the finishers can get to it. The foremen scream and swear and throw clipboards, but the laborers and finishers are too beaten, too worn to do more than plod on. Finally, around 6:00, when the last of the concrete is poured, we stumble into the shade and drop to the ground.

Jesse is sitting on the ground, slumped against the side of a stake truck. He looks up and sees me slinging angle irons onto the back of The Rat. “Boy,” he calls in a soft, raspy voice, “you tryin’ to kill your damn self? Sit your white ass down here.”

I can hardly lift my feet. I trudge over to Jesse and drop down next to him. I think how good it would feel to lay down. I lay back and stretch out, but immediately cramps tear through my stomach, back and shoulders. I sit back up and hook my arms around my drawn-up legs and lay my head on my forearms.

A few minutes later, I struggle to my feet, stumble over to The Rat, pull out a warm can of Old Style and ease back down next to Jesse. I point the can away from us, and pop the top. A shower of white foam shoots into the air and drips down my hand. I shake the foam from my hand and offer the can to Jesse.

“No, thanks, son,” he says, shaking his head. “Save it for my damn funeral.”

I take a long pull of the Old Style and close my eyes. I don’t care that the beer is warm. All that matters is that it is wet.

Jesse is in awful shape. He takes off his hard hat and gets some kid to fill it with water. Then he slowly pours the water over his head, turning his grey Afro into a soggy batch of seaweed. He lets his head hang down, swinging it slowly back and forth as the water streams from his forehead and lips.

“This is the worst day I seen in thirty years,” he says. “You gonna tell your grandchildren about this day.” He is panting as he speaks, and his words are torn from him like rusted barbed wire ripped from a weathered fence post.

“Look around you, boy,” he says.

I nod. “Yeah,” I murmur without looking up.

“No, goddamn it. I said look around!”

I lift my head and look at the men around me, suddenly realizing how much everyone else is suffering. Men are slumped against trucks and leaning on trees. Three of the older guys are laying against the shady side of a compressor, boots off, eyes bulging, mouths open, panting miserably. Lester is in the bushes, bent over with the dry heaves.

“You’re young,” Jesse says, “and it ain’t too late. Look around and remember what you see. And then you get the hell out of here or you’ll wind up like me: an old sack of shit lyin’ in the dirt.”

“Jesse, you’re not –”

“Don’t you f*ck with me, boy,” he says. “Don’t you f*ck with this old man.”

He raises his bloodshot eyes and fixes them on me. “I’m tellin’ you God’s own truth. You don’t wanna listen, that’s your business, but don’t you f*ck with me. I’m too old to be f*cked with. And pretty soon you be old, too. And there ain’t nothin’ you can do about it. But you can do somethin’ about this.” He gestures around us. “You can spend your life on the breakout gang throwin’ rocks like the rest of us no account fools, sweatin’ our lives away, waitin’ to be throwed on the junk pile – or you can get out before it’s too late.”

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