Hot Lights, Cold Steel Life, Death and Sleepless Nights in a Surgeon's First Years

Michael J. Collins, M.D.

St. Martin's Griffin



Trade Paperback

320 Pages



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When Michael Collins decides to become a surgeon, he is totally unprepared for the chaotic life of a resident at a major hospital. Collins's success in college and medical school led to a surgical residency at one of the most respected medical centers in the world, the Mayo Clinic. But compared to his fellow residents, Collins feels inadequate and unprepared. All too soon, the euphoria of beginning his career as an orthopedic resident gives way to the feeling he is a counterfeit, an imposter who has infiltrated a society of brilliant surgeons.

This story of Collins' four-year surgical residency traces his rise from an eager first-year resident to accomplished Chief Resident in his final year. He recounts the disparity between people's perceptions of a doctor's glamorous life and the real thing: a succession of run down cars that are towed to the junk yard, long weekends moonlighting at rural hospitals, a family that grows larger every year, and a laughable income.

Collins' good nature helps him over some of the rough spots but cannot spare him the harsh reality of a doctor's life. Every day he is confronted with decisions that will change people's lives—or end them—forever. A young boy's leg is mangled by a tractor: risk the boy's life to save his leg, or amputate immediately? A woman diagnosed with bone cancer injures her hip: go through a painful hip operation even though she has only months to live? Like a jolt to the system, he is faced with the reality of suffering and death as he struggles to reconcile his idealism and aspiration to heal with the recognition of his own limitations and imperfections.


Praise for Hot Lights, Cold Steel

"Like the very best episode of ER, Collins' memoir races from one trauma to the next, keeping this reader spellbound all the way. Collins' 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

"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 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 Society

"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 and The Apprentice

"[Hot Lights, Cold Steel is told] with a born storyteller's skill . . . Highly animated—and rich in encounters both sad and hilarious."—Kirkus Reviews

"If he didn't feel overwhelmed before the Mayo Clinic senior orthopedic surgery resident lobbed a beeper at him with the nonchalant order, ‘Cover for me,' 29-year-old ex-cabdriver, ex-construction worker, and, at the time, brand-new resident Collins certainly did then. It was his first day on the job, and instantly he began fielding calls from staff nurses requesting orders for patients he hadn't laid eyes on. 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. As a man who recognizes that he, too, makes his living with his hands, Collins anguishes over the options available to a carpenter who had severed four fingers. After assisting at a young cancer patient's leg amputation, only to learn later that she had died within months, anyway, he agonizes over what drew him to his profession in the first place and what could possibly keep him on course. ‘I wanted to be the guy who confronted the arbitrariness of life and strangled the unfairness out of it.' Instead, while honing his craft, he learned from a Vietnam vet that the main thing patients deserve is compassion. If Collins' scalpel is as sharp as his pen, his patients are in capable hands, indeed."—Donna Chavez, Booklist (starred review)

"Collins begins this personal chronicle with an account of a choice he had to make between amputating a 14-year-old boy's leg and saving the limb at a greater risk to the boy's life. (He amputated the leg.) This dilemma came at the conclusion of Collins's grueling four years of residency at the Mayo Clinic, culminating in his appointment as chief resident in orthopedic surgery. Now in practice in Illinois, 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 and his wife, Patti, wanted a large family, but the economic strain of having three children in three years (they eventually had 12) forced him to moonlight every other weekend at rural hospitals. There are moving passages about his love for Patti and the bonds he developed with other residents, and empathetic evocations of those he treats. 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

Reviews from Goodreads



  • Michael J. Collins, M.D.

  • Michael Collins served as Chief Resident in Orthopedic Surgery at the Mayo Clinic. Currently he is an active partner in a busy surgical practice in Chicago where he lives with his wife Patti and their twelve children. This is his first book.

  • Dr. Michael J. Collins




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