An enigma called cancer: A doctor writes on why he chose oncology

An excerpt from Dr BS Ajaikumar’s new book ‘Excellence Has No Borders’.
An enigma called cancer: A doctor writes on why he chose oncology
An enigma called cancer: A doctor writes on why he chose oncology
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At the University of Virginia, I continued to learn, with dreams of taking my learning back to India one day. I continued to absorb what I could. I was put on different rotations in the one year I spent there as a resident surgeon. Once I was posted in the ENT (Ear, Nose and Throat) department. As I did the rounds of the wards, what I saw made me change my choice of speciality in medical studies. For long, I had set my heart on cardiology, because it had been my favourite subject in medical school. I had been very good at it. I was dead certain I would be specializing in cardiology in the US.

At the university hospital, I saw something that changed my mind. Here, I observed cancer patients in wards. They looked like they had no hope. Patients were called ‘victims’, or spoken of as ‘terminal’ cases. Treatments discussed were palliative—which treated only the symptoms and the pain— and never definitive—which treated the root cause of the disease.

No one talked of conquering the disease.

This reminded me of a similar mindset that used to prevail at St Martha’s Hospital in India, where I had done my senior housemanship in 1973–74. There, too, cancer had become a terror of mythical proportions. I was struck by how people were treating cancer patients. I remember a young girl in St Martha’s hospital, who had a type of leukaemia. It almost seemed like she was fobbed off in the ward with some treatment, and eventually died. She was the only daughter in her family. An interaction with her father made me realize they didn’t understand or internalize the severity of her disease. No one knew what to do and everyone felt nothing could be done.

I asked myself: Why not? Why can’t we do anything about cancer? The more I thought about it, the more these questions started haunting me. Cancer is an internal problem, so why can’t it be solved? Why does it cause so much pain? What is this enigma? So, I decided to go deep into it. It was a challenge. A tough challenge. And I was not about to back down. I loved such challenges. I was always a ‘why’ and ‘why not’ kind of person. This came in handy throughout my medical career and other future ventures.

For me, it was settled: I would study oncology and not cardiology. The next question was: Where? When I did my radiation stint in Virginia, I felt it was incomplete. The university hospital was a multispeciality one with an oncology wing, and the University of Virginia was a good school. But I wanted to go to the Mecca of oncology, as one would say.

Unsure of how to go about it, I asked one of my professors, Dr El Madhi. I told him frankly that I was not happy at Virginia, since I wanted to acquire in-depth knowledge of oncology. He told me of the two centres in the US with deep expertise in this area—Sloan Kettering in New York City and MD Anderson Cancer Center in Houston, Texas. He said I could try for MD Anderson. And, holding his coffee, a cigar clenched between his teeth, he sauntered off to his room. This is 1975 we are talking about—there was no internet to research my options. So I did my research work manually to find out about MD Anderson, and applied there. I was determined to go to this place, come what may.

But there was bad news in store. I got a call from MD Anderson saying they were full for the next three years, that 1978 was when the next opening would come up. I was told I could still come for an interview, for which I would have to stay there for three days. Until then, no Indian had joined the radiation department at MD Anderson. If I got in, I’d be the first.

I took a Greyhound again. only, this time, it was 1300 miles through six states of southern US and a daylong journey to reach Houston, Texas. I went through North and South Carolina, Georgia, Alabama, Mississippi and Louisiana, all the while navigating border patrols and stern faces at checkposts. At one such checkpost, I had got out to get some coffee. As I was sipping it, I heard a guttural voice behind me. I turned. ‘I’m going to need to see some form of ID, sir.’ it was the one of the two border patrol officers who had come up behind me.

‘What’s the matter, officer?’

‘Sir, I'm going to repeat. I will need to see some of government-issued ID from you.’

At this point, the second officer, standing behind the first, had spread his stance wide, blocking off any chance of attempted escape. I reached for my wallet to fish out my green card. There was a slight stiffening of their postures. ‘This is my green card.’ I kept my voice calm, extending my ID to the first officer. The moment he saw my green card, the officer’s body language changed. ‘Sorry, doctor, this is because of lots of illegal immigrants around and all that. You can carry on.’ His tone had softened markedly.

Enroute to Houston, there were places like Texarkana where life seemed straight out of the movies. There were people with guns walking into restaurants, cowboys brandishing their double-barrelled shotguns, sheriffs with their shiny badges keeping an eye on things, raucous laughter all around peppered by the trademark Texan drawl. It was just like the Wild West they showed in films.

Houston was more cosmopolitan. I stayed there with an Indian family. The big day arrived. I went to the MD Anderson campus, not knowing what to expect. They put me through a grilling interview. I wanted to do radiobiology as well, so they sent me to the academy wing, which included the PhD department. Luckily, I was interested in everything. On the third day, they came back and said they were so impressed with me that they wanted to take me right away for June next year as a cohort. I was thrilled. There was more good news in store. They also said they would give me a better salary. So, from eight thousand dollars, I went straight to fifteen thousand dollars in pay. It was beyond anything I had hoped for.

Excerpted with the permission of Penguin Randomhouse Books from the book "Excellence Has No Borders” by Dr BS Ajaikumar. You can buy the book here.

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