Episode Notes
Mike Collins graduated from Notre Dame in 1971 and spent several years working as a truck driver, cab driver, construction laborer, dockworker, and freelance journalist before pursuing medicine. After receiving his M.D. from Loyola University Chicago Stritch School of Medicine, he spent five years in residency at the Mayo Clinic, ultimately serving as chief resident in orthopedic surgery and embarking on a surgical career that has spanned several decades.
Mike has written two memoirs about his journey as a physician: Hot Lights, Cold Steel, recounting his time as a surgical resident, and Blue Collar, Blue Scrubs, about his days as a laborer trying to get into medical school. Since the publication of Hot Lights, Cold Steel in 2005, he has lectured around the country, and the books are on the required or recommended reading list for many medical schools and pre-medical programs.
We had the chance to talk to Mike about his latest book, a novel titled All Bleeding Stops. It’s the story of Dr. Matthew Barrett, who is sent to Vietnam as a combat surgeon shortly after completing his residency. While fiction is a departure from Mike’s previous books, he draws heavily on his experience in the operating room to unfold a story that he hopes will bring attention, both within the medical community and beyond, to the very real mental health issues encountered by physicians routinely asked to navigate the line between life and death.
Setting the story amidst the impossible circumstances that faced those serving in Vietnam makes that point in a particularly affecting way.
LINK
- Mike’s Novel: All Bleeding Stops
Episode Transcript
*Note: We do our best to make these transcripts as accurate as we can. That said, if you want to quote from one of our episodes, particularly the words of our guests, please listen to the audio whenever possible. Thanks.
Ted Fox 0:00
(voiceover) From the University of Notre Dame, this is With a Side of Knowledge. I'm your host, Ted Fox. We started out as the show that invited scholars, makers, and professionals to brunch for informal conversations about their work. But last season, we needed to record remotely This year, we're excited to be able to bring back in-person interviews while still taking advantage of the flexibility afforded by our remote setup. But whether we're literally sitting down with a guest or talking with them virtually from that trusty old walk-in closet, we hope you'll find that you're glad you stopped by. Thanks for listening.
Mike Collins graduated from Notre Dame in 1971 and spent several years working as a truck driver, cab driver, construction laborer, dockworker, and freelance journalist before pursuing medicine. After receiving his M.D. from Loyola University Chicago Stritch School of Medicine, he spent five years in residency at the Mayo Clinic, ultimately serving as chief resident in orthopedic surgery and embarking on a surgical career that has spanned several decades. Mike has written two memoirs about his journey as a physician: Hot Lights, Cold Steel, recounting his time as a surgical resident, and Blue Collar, Blue Scrubs, about his days as a laborer trying to get into medical school. Since the publication of Hot Lights, Cold Steel in 2005, he has lectured around the country, and the books are on the required or recommended reading list for many medical schools and pre-medical programs. I had the chance to talk to Mike about his latest book, a novel titled All Bleeding Stops. It's the story of Dr. Matthew Barrett, who is sent to Vietnam as a combat surgeon shortly after completing his residency. While fiction is a departure from Mike's previous books, he draws heavily on his experience in the operating room to unfold a story that he hopes will bring attention, both within the medical community and beyond, to the very real mental health issues encountered by physicians routinely asked to navigate the line between life and death. Setting the story amidst the impossible circumstances that faced those serving in Vietnam makes that point in a particularly affecting way. (end voiceover)
Mike Collins, welcome to With a Side of Knowledge.
Mike Collins 2:32
Hi, Ted, good morning.
Ted Fox 2:34
So whenever I have a novelist on the show, I always like to start out by asking them to read something from their novel, and you were gracious enough to allow me to continue that here today. So the selection that I picked out, we're about halfway through the book, and we're getting inside what our main character, Dr. Matthew Barrett, is experiencing--or maybe you would say coming to understand--during his deployment at a surgical hospital in Vietnam in 1967 and 1968.
Mike Collins 3:07
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.
On Barrett's operating table, 19-year-old boys achieve communion with the warriors of generations gone by. They grasp hands and clap shoulders. A fraternity of the maimed. They know now, these shattered young men, and the knowledge hemorrhages from them, drips down the side of the table, pools on the floor. The knowledge leaps from their shattered limbs, oozes from their sightless eyes. They, too, have learned there is no preparation for war, no defense against it, no vocabulary for it, and ultimately no survival from it. "War," Balthrop says. "It's really not all it's cracked up to be."
Ted Fox 5:05
That was Mike Collins reading from All Bleeding Stops. Thank you, Mike, for for starting us there.
Mike Collins 5:09
Happy to.
Ted Fox 5:11
So much of the--I mean, part of the reason I picked that is so much of the imagery there is so powerful, as it is throughout the book. But the Vietnam War, I think, for me, it's something I've kept coming back to mentally over the years, I'm sure in part, because my own dad was drafted into that war, although never deployed. My wife has an uncle who did serve multiple tours there in the Marines. So there's that family connection. But it's also always struck me that, even within the context of wars, which by definition are marked by horrible, horrible things, this is a conflict that stands out as particularly hellish, not only in terms of when it was happening, but also for its lasting impact on those who were charged with actually fighting it. So that's how I came to your novel and my interest in it. Why did you, what prompted you to want to write a novel about Vietnam?
Mike Collins 6:08
Yes, I would first of all say in my mind, it's really more of a novel about a doctor than it is a novel about a war. But you're quite right about Vietnam, we all have ambivalent feelings about it. I was a student at Notre Dame, when much of it--I started Notre Dame in the fall of '67. So much of this stuff rang--had resonated with me. And the very issues that Matthew Barrett struggles with as a physician somewhat mirror the issues that we as a country struggled with in Vietnam. Our intentions, at first, I think were good, and Matthew Barrett went into medicine because he wanted to help and wanted to, he cared about people. But his problem was that his sympathy and sensitivity overwhelmed him. And Vietnam just seemed the perfect milieu in which to place this story.
Ted Fox 7:06
As far as I can tell, and please do correct me if I'm wrong about this, you did not serve in the military. Is that correct?
Mike Collins 7:12
That's correct.
Ted Fox 7:13
So, in that selection I asked you to read, there is a line there, and as someone who's never served myself, I really, this rung true to me--you write that there are quote, "things forever indecipherable to those who have never worn the uniform." And I'm wondering in, in writing a book like this, where you give us such strong imagery, and are really trying to put readers in the situation that Matthew finds himself in, how did you approach trying to write that aspect of your narrative, not having the personal experience of military service to draw on?
Mike Collins 7:48
Research, of course, plays a big part in it. You know, I had relatives and friends who served in Vietnam. So I talked to a lot of those people. Although I didn't have experience as a member of the military, I am a surgeon. So I had a lot of experience in blood and guts, if you will. And so much of that part of the book was taken from my own experiences. The military part of it, it is, I think, imperative to do a lot of research when you are trying to write about something that you were not intimately involved in yourself. So talking to other veterans, reading books--that still I think leaves me among those that I mentioned in the reading that it is still indecipherable to me. You know, I think I understand, I think I can put myself in the shoes of the people who served there. But I don't think anyone really can.
Ted Fox 8:38
Right. So the phrase "all bleeding stops," and you talked about blood and guts there. It serves as the title of the book. But it also comes up as an expression that in one of the early chapters is identified as something one of Matthew's fellow residents used to say at the Mayo Clinic, this phrase, "all bleeding stops." And I know that you were chief resident in orthopedic surgery at the Mayo Clinic. Does that phrase "all bleeding stops,' does it come from your own experiences in the OR? Or was this just an invention for the purposes of telling the story?
Mike Collins 9:16
No, it is an example of dark humor in medicine, and I first heard it as a resident at the Mayo Clinic, but almost any of your other listeners who are surgeons will have heard that expression before. It's, as I said, a darkly humorous reference to the fact that in the middle of surgery, and you're desperately trying to stop somebody's bleeding, all bleeding will stop--you know, the implication being if you don't stop it, it's going to stop as the patient dies. So I thought it was a good metaphor for Matthew himself, who, in a sense, was bleeding throughout most of the book.
Ted Fox 9:54
Yeah, most of the story is focused on him and set during his time in Vietnam and a year or two after he comes home. But we do also get chapters that are set more or less in the present day. Some are featuring Megan Parker--an intern who's aspiring to be a pediatrician, she's currently working in the ER--and others with Captain Wesley Tillinghast, who's incarcerated currently in a correctional facility. And I don't want to go really too deeply into how their stories relate to Matthew's because I don't want to spoil anything for people. And I will come back to Captain Tillinghast in a minute here. But Megan, like Matthew, has these very intense realizations of how her life as a doctor is not quite what she imagined it would be. And you talked a few minutes ago about, you know, Matthew, getting into it because he wants to help people and then having really, you know, this traumatic experience in the field where that degree of sensitivity and wanting to help and the degree of empathy can actually be something that ends up tearing you down and making it so you can't even function. So these intense realizations of it not maybe being exactly what you thought it to be, was that something that you experienced in your own career of, my idea of medicine and the actual practice of medicine? Is that a big adjustment that a physician has to make?
Mike Collins 11:16
Yes, I think that's the case. And as we talked about, those who have not served in the military can't really put themselves entirely in the shoes of someone who has, it's the same thing in medicine. Even as you plan your career to go into it, you think you know what it's about. And you do have a pretty good idea, but it's still different. You remember, there's one chapter in the book, it's probably the briefest chapter in the book, where the old man lying on the car asks Megan, How do you like being a doctor? And she struggles with trying to answer; it's not that she doesn't like being a doctor. But it's not exactly what she thought it was going to be like--not necessarily worse, but not necessarily the same. And that's something all doctors go through. Part of the--I tried to make some contrasts in the book. And you remember the surgeon Mac, one of the surgeons in the book, coped with all the bad things that happen to doctors by deflecting everything, nothing got through to him, he just did his job and went home and was able to shut it off. Matthew Barrett was unable to do that, and it wound up destroying him.
Ted Fox 12:25
So what kind of advice would you--because I mean, as we talked about, a practicing surgeon and physician for many years, what kind of advice would you give to someone just starting out in a medical career about how to mentally and emotionally navigate what they're doing? Because clearly, I mean, as we've said, empathy is an important reason to want to do medicine, to want to help people. But if you can't find some way to kind of keep that in check, then it can become your undoing. So what kind of advice would you give to someone who's just starting out on that career path?
Mike Collins 13:04
First thing I would do was encourage them. You may have heard, there's a statistic that's floating around that says some high number, high percentage of practicing physicians would not recommend that their own children follow a career in medicine. I'm not one of those. I love my career in medicine. And it's, I would strongly encourage people to pursue it. It is very fulfilling and very rewarding. But as far as telling young people--and having read the book, you know, a lot of sad things happen in the book. But I hope the takeaway message is positive. My thought was and the idea that I wanted to promote in the book is that dedicating yourself to a noble cause may entail a lot of sacrifices, but ultimately, in many senses of the word--religious and moral and pragmatic--are worth it.
Ted Fox 13:58
I did have a few writing nerd questions for you, because I always love to talk to people about about writing. And one thing that really, I don't know if I'd say it really jumped out at me, but I definitely, I mean, I made a note in the margin, I think, either the first time or second time Captain Tillinghast was telling his piece of the story. And I noticed that his were the only ones written in the first person. The rest of the chapters we're getting, you know, it's kind of this omniscient narrator talking about Matthew or talking about Megan, but Captain Tillinghast is looking back on his relationship, how he came to know Matthew, and the circumstances of that from the first person. And I was wondering, just kind of--whether you wanted to take that writing approach up specifically or just more generally, what are you hoping that he brings to the story? Because I did find him--he does have, I mean, he's an attorney and he has a little bit of that pragmatic of, you know, right or wrong, this is the way things are. So, what were you hoping that his character brings into your story?
Mike Collins 15:06
Well, Tillinghast--I enjoyed writing the Tillinghast parts of the story since I'm not an attorney. (Ted laughs) And Tillinghast is meant to be in opposition or opposed to, personality-wise, the type of person that Matthew was. Matthew was idealistic and sensitive, and Tillinghast is more cold and pragmatic and cynical. And I thought he could bring something to the story with that point of view. Where he comes from is not a wholly unimaginable point of view. He--a lot of people think that way. And in many ways, it's not all bad. Now, Tillinghast did some things that were bad. But he tended to analyze Matthew in ways that Matthew was incapable of analyzing himself. And I thought that was a point of view and brought a breadth of understanding to Matthew's character that could not have [happened] otherwise.
Ted Fox 16:11
The language that you use, and people would have heard that in the selection that I asked you to read there, it's oftentimes--it's brutally descriptive, but it's also very medically precise, which makes sense from your standpoint, having been a practicing surgeon for so long. And it leads to this interesting juxtaposition, even in the words themselves, of kind of on the one side, you have the chaos of war. And on the other side, you have this very exacting nature of medicine. And there's even times, as we see Matthew at some times have more success than others in trying to cope with his circumstances, of just really trying to focus in on the medical task in front of him: This is what I understand, this is what I know, there's very specific things I need to do, this is how I can bring order to my world. And I'm wondering, was that, trying to bring those two things into, I don't know how you want to say it--conversation, conflict, whatever with each other--was that a conscious choice you were making as you were writing to kind of really, I guess, maybe drive home this sense of, at least particularly in Matthew's case, kind of these, the hemisphere of his training meeting his circumstances, even just in the prose itself?
Mike Collins 17:26
Absolutely, Ted. One of the ways that surgeons can learn to cope with what they're doing is, as you're in the middle of surgery, instead of thinking to yourself, I'm trying to save someone's life, or this person in front of me is a mother or a wife or a father or a child--those big thoughts have their place, but maybe not in the middle of surgery.
Ted Fox 17:48
Right.
Mike Collins 17:48
And in many ways, it's much easier--and Matthew does this as trying to escape the meaning of what he's doing--but one of the ways that surgeons can escape from it is to say, I'm not operating on a mother or father, I'm not even operating on a person. I am attempting to sew one piece of a thing to the other piece of a thing. And my job is to do a good job with these two things. So I'm going to take this end of the artery, and I'm gonna get the other end of the artery, and I'm going to sew them together, and you almost take the mind out of the equation. There's a piece of job to do in front of you, and some surgeons cope with the difficulties of life as a surgeon by doing that very thing. To just say, No, if people die, or things happen and they're suffering, that has nothing to do with me. My job, I've got this in front of me, and it's not, it's not a person, it's not even an organ, it's not a kidney even; it's one little tiny focus of attention that's one square inch, and that's what I do.
Ted Fox 18:46
Right.
Mike Collins 18:48
And Matthew, I think, learned throughout the book that ultimately, that's not the way to cope with ...
Ted Fox 18:53
I was gonna say, I mean, I could see the--I could see the appeal of it if you are the person in that situation. But I would imagine that the long-term effects of trying to approach the job--it almost seems like trying to approach it in either of those extremes, either where the empathy completely overwhelms you at all times or, like you were saying there, I'm not even seeing this at an organ level, I'm going down so much more minute than that just to kind of keep my foot in what I need to be doing and keeping my foot in reality, it seems like both of those could be destructive on the person trying to practice medicine. Maybe in very different ways, but they both seem like they could really take a mental toll if practiced that way over a long period of time.
Mike Collins 19:41
Yeah, I'm always fascinated looking at it from the patient's point of view, too. And I'm sure you and your listeners have experienced this. I will sometimes have somebody say to me--I'm talking about their surgeon--and [they] say, He has no personality and he has no bedside manner, but he's really a good surgeon, and that's who I want to take care of me. And, and I get it. I mean, that's not an unreasonable approach. But the opposite extreme is, Boy, he's really warm and fuzzy and nice, but he doesn't know how to operate. Well, you don't want that either.
Ted Fox 20:14
(laughs) Right, right. You know, you talked about talking to veterans, people in your family who had served, others. And I mean, you were a college-age student when Vietnam was going on. And I think one thing that is easy maybe generationally to lose track of because the military and military service tends to be so celebrated in our society now, but so many of these young men when they were coming home, they're having these horrific experiences while deployed and questioning what they're doing there, and then they come home and because of--you mentioned, you know, today we have kind of this ambivalence about Vietnam just because there are so many conflicting things about what to feel about it; so many people were opposed to war at the time that these young men coming home were oftentimes not treated well at all. And I was wondering, some of those, I'm imagining those stories came out, not only from your own memory but in the folks that you talked to, to write this book. And I think it's just an important thing to remember and acknowledge because not only were they put in an untenable position while they were deployed, but it was almost this untenable position--and there's a really powerful scene in the book where Matthew gets into a fight when he's home because there's these guys in a bar basically heckling him and trying to start a fight because he served in Vietnam. And it's not, you know, it's not, I'm gonna get into a fight with you because I think we were right in everything we were doing there, but why am I being treated this way? I was just someone sent over to try and take care of people who were getting hurt. So how much of that part of the history was front of mind for you and front of mind for the people that you talked to just in terms of trying to write the military piece of this?
Mike Collins 22:06
Well, it was a huge part of it. And it is really heartbreaking how poorly veterans were treated when they came back from Vietnam. And all the guys, almost to a man, had something bad to say about, or explaining their feelings of how badly they felt to come home and be treated as, you know, murderers, and that everybody who went to Vietnam must have done horrible things, and most of them did honorable things. And you're right, it's completely different now. I have a son who served in the 82nd Airborne, and he was in Iraq and Afghanistan. And people, you know, when he came home in uniform, people were always saying to him, "Thank you for your service." Well, I never heard that expression, "Thank you for your service," back in the '60s and '70s. Those poor guys who came back were suffering in many ways and had nowhere to turn to. People did not respect their service and did not respect the things that they had done.
Ted Fox 23:03
And I know, and I wanted to give you a chance to talk a little bit about this, I know that some of the proceeds from All Bleeding Stops are going to go to charitable organizations, I believe that helping veterans with PTSD. Have you thought about where you're directing those things?
Mike Collins 23:22
Yes, and I had several reasons to want to write this book. And one of them was to bring the attention of the public but also to ask members of my profession to confront the issues of the sensitivity that brought us into medicine sometimes can be our own worst enemy. And I personally, when I was a senior in med school, I was on a service, a cardiology service, at Hines Veterans Administration Hospital, and the intern committed suicide. And it was horribly difficult. And obviously, this is not, not that I'm taking this on myself or that I suffered more than the people in his family, but it was difficult for me to accept and understand what would bring him to that. Physicians commit suicide at a rate twice the national level. 300-to-400 physicians a year kill themselves, which is twice as many people as graduated from medical school in my class. And so when I wrote the book, I wanted to bring attention to the issues of these poor people who, you know, almost like the Vietnam vets: They didn't ask to be sent to Vietnam, they were drafted and sent there, they had a horrible time, and then come home to, you know, being vilified. And they didn't want to be there in the first place.
And a lot of these doctors that are of Matthew Barrett's ilk come to medicine with all the sensitivity, sensitivity and compassion in the world, and pour that into the practice of medicine, but are faced with things that just happen. You know, we're all mortal, we're all going to get sick, and we're all going to die. And you need to have a grasp of that as well as to have feelings of compassion. And so I wanted to bring attention to both of those things. So I thought one way that I can do that, to bring attention to the issues for doctors, is to write the book but donating some of the proceeds to organizations like PB Abbate and the PTSD Foundation. There is no--unfortunately, there is no one organization that specifically targets mental health among medical practitioners in the military, you know, corpsmen, nurses, doctors. But they all do in general terms help them, these other organizations. So I wanted to not just talk the talk, but walk the walk a little bit.
Ted Fox 25:46
Well, I think it's really powerful, too, just listening to your answer there, and to think about, you know, there is still such a stigma around mental health. It's something that's really important to me personally, and I think to hear someone like you, who has been a practicing surgeon, you know, really being an advocate for, there's another side to this, it's not just about the physical and the body; there is, especially in these professions, there's a mental toll that is taken on people. And to say that, you know, No, we need to be attentive to that, too. And [not] act like, Oh, you know, just buck up and bear it and it's part of life or I guess you should have been more prepared for that's what could happen if you went into this field, and really say, No, there is a mental toll and load to bear there. These are really important jobs that people do, and we need to have resources and, you know, speaking of compassion, compassion to take care of those folks who are bearing the brunt of this load that we all need for our society to function, I guess you could say.
Mike Collins 26:54
I think the COVID situation has brought that a little bit more to people's attention because we're all hearing stories of nurses and doctors working in ICUs and emergency rooms getting burned out, faced with crisis after crisis. And so I think there is a growing awareness of the difficulty that it is to cope with these sort of situations when you're there day after day after day.
Ted Fox 27:18
So the last thing I wanted to ask you, and I think you touched on it a little bit there, but I mentioned this in the intro to the episode that you had already written two really successful memoirs about your career as a surgeon; you had Hot Lights, Cold Steel and Blue Collar, Blue Scrubs. And so I was gonna ask you, why do a novel now? And I think you spoke to it there about these issues that you wanted to bring attention to and some that, you know, you didn't have, as we said, firsthand experience serving in Vietnam. But what did you--what did you find in going from writing nonfiction and writing about your firsthand experience to now this little bit of a pivot to a novel? What was that experience like for you, and what do you feel like it allowed you to do? And do you have plans to write another novel after having--was it a good enough experience that you want to do another one?
Mike Collins 28:13
Well, I enjoyed the experience. There's a lot of creativity involved in it. With memoir, you are constrained by the facts. And I, I won't say that--you know, it's not a complete straightjacket. But generally, you're telling a story of things that happened; you can't just, say, make up where you did things. There's an expectation, a rightful expectation, among readers that you're going to basically stick to the truth. I thought it would be much easier to write fiction. I thought, Well, I'm not constrained by anything. I can say, Martians came down, you know, I can say anything I want to. (Ted laughs) There is more freedom in that sense. But I found it much more difficult. Because with the walls and boundaries that exist for memoir, I didn't even have to think about certain things. With the novel, I did. And it's--but the process was great. I really enjoyed it because I heard other authors say this, and I kind of poo-pooed it thinking, Oh, this sounds like a little too much new age, touchy-feely, where they'd say, Well, the characters write the book. And I wouldn't go that far. But I did not sit down when I started this book 12 or 13 years ago knowing exactly what would happen in every chapter and knowing everything. I had a general idea what I wanted to say, but it changed along the way. And that is, that part of the creative process is very enjoyable and fulfilling. So I liked it.
Ted Fox 29:41
Yeah. Well, the book is All Bleeding Stops. Mike Collins, I really appreciate you taking the time to talk about this today. And being an advocate for some folks who I think it's important that we have advocates for. So thank you for that, as well.
Mike Collins 29:57
I'm delighted to be here, Ted. Thanks for asking me
Ted Fox 29:59
(voiceover) With a Side of Knowledge is a production of the Office of the Provost at the University of Notre Dame. Our website is withasideofpod.nd.edu.