Reviewed by J. Douglas White, M.D.

James Cole’s annals of his activities as a trauma surgeon fall into line with many blood and guts medical memoirs of the post “George Clooney ER” decade, but this book is nonetheless noteworthy for the juxtaposition of very active civilian and military careers. Moreover, there are guilty pleasures aplenty for ambulance chasers, medical groupies and any lay person simply interested in a more detailed delineation of the world (exotic even among physicians) in which Cole dwells.

For the most part, the author sticks to his script. The book starts with his graduation from medical school and presents only the leanest of sermons and self-indulgences in the last chapter. He manages to convey gratitude and avoid the false modesty that detracts from so many medical memoirs. (I would, however, have liked to have heard from/about his selfless wife, and does it say more about the author’s editor or his lifestyle that his four children are only mentioned in passing? I imagine together they could write an equally compelling and insightful book about family sacrifices for the sake of public health and military readiness.)

The author has selected a diverse and fascinating array of surgical challenges to depict, and he is particularly effective in conveying the relentless pace, adrenalized ambience, chronic fatigue, sleep deprivation, and overwhelming responsibility attendant on his chosen career. (Indeed, when he is called up as a reserve officer to the Middle East, the cold hard bunks, terror, life and death decisions, manslaughter, sleepless nights and showerless days make for a rather seamless transition from his civilian and especially surgical residency posts!) For those convinced that MREs are the most tasteless diet imaginable, note well Cole’s description of his pre-microwave diet of cold canned spaghetti when on call as a resident.

Cole is faced with a formidable structural challenge: describing in print what is inherently a visual-mechanical milieu. His unpretentious writing style is more than workmanlike. Despite the perhaps predictable surgeon’s emphasis on active verbs, first person singular, and paucity of adjectives, the presentation rises far above the turgid prose of most medical school graduates. Not to be missed along these lines (and certainly not for the squeamish) is his detailed, visceral vignette of the decay and odors accompanying necrotizing fasciitis literally devouring one patient’s flesh over a matter of hours.

However, it would have taken an extraordinarily gifted writer to infuse his narrative on injuries and operations with the actual emotions surrounding surgery conducted under combat conditions. Most surgeons will concede that it’s the performance, not the description, of surgery that is “the thing,” and Cole’s book bears out this adage. Time and again he relies upon lengthy clinical summaries of involved procedures and operations.

Even though this tome at times reads like a surgical atlas, that’s not its intent or niche, and the scant illustrations are mostly superfluous. With a few exceptions (e.g., Gerald forceps, Castroviejo needles) Cole mercifully eschews most medical jargon (and even more to his credit, military acronyms and patois as well). Nonetheless, the reader really requires exposure to an anatomy course to properly grasp and appreciate this book. For those of us jaded by decades of trauma and emergency medicine practice, it will be hard to read the book without skimming. However, because most of the operative descriptions are at or above the level of senior medical students, only the most tenacious lay reader will stick with the details of 18-hour operations and sundry abdominal fascia cover to cover.

This book works best not as literature but as an example of an exciting and inspiring life. I commend it highly for its genuine portrait of the character and personality of an archetypal trauma surgeon, one who accepts the rigors and commitment of the field, and not only perseveres, but in the process, transcends the quotidian existence of most people. Any physician will confirm that surgeons are not like the rest of us, and most surgeons will tell you trauma surgeons are sui generis. You don’t end up a trauma surgeon by default, and Cole has obviously found enormous stimulation and personal gratification in his service to a breathtaking range of patients.

The author has succeeded admirably in conveying what it takes to be a trauma surgeon. Although Cole in some ways conforms superficially (dress, avocations, etc.) to the popular image of trauma surgeons as cowboys, he presents a convincing portrait of his specialty as a noble calling. He comes off not so much as an egotistical surgeon, but as a confident, patient and competent physician who comprehends the debt he owes his mentors and colleagues. His experience, skills and commitment are formidable even by doctors’ standards. He works long hours long after his residency, indirectly tithing away a large part of his income treating uninsured and often unappreciative accident victims, alcoholics and drug abusers, perhaps the most interpersonally and medically demanding of patients. Burnout is understandably high for trauma surgeons, and in Cole’s case, it could be argued he was already at the front lines even before he shipped off to Iraq and Afghanistan. One concludes the book wondering what is in store for this mid-40s-aged surgeon-author in the second half of his career.

Read this book not only to live vicariously, if only for a few days, the exciting and eminently meaningful life of a trauma surgeon, but also to be exposed to a generous, dedicated and courageous man living life to its fullest in extreme conditions. If Cole’s book inspires even a few readers to make similar sacrifices, his efforts putting pen to paper will have been more than justified, and we will all be better served the next time we are in a serious car accident.

J. Douglas White, M.D., M.P.H., M.B.A. is a career emergency physician, Clinical Professor at Virginia Commonwealth University, and Editor-in-Chief of The American Journal of Emergency Medicine.