Change of Plans: Pediatrics in Rural India to Hematology Around the World
Published on: May 01, 2012
Director, CLL Research Program, North Shore-LIJ Medical Center, and Professor of Medicine and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine
What led me to become a hematologist? This question is, perhaps, asked at one time or another of virtually all of our colleagues. I do not believe this question is meant to be idle chit-chat. My experience has been that in most cases, the question provides an important insight into the thinking and motivations of that person. My answer to this question is not simple. I first have to answer why I chose to become a doctor and follow with why hematology became my calling.
As a young boy growing up in Jodhpur, a small town in India, I intensely watched my uncle, a practicing general physician and an overall charismatic guy. Very early on, he had a profound influence on me. Because of his influence, I had made up my mind that I would also become a doctor, but instead of doing general practice, I decided that I would become a pediatrician and treat sick children in the poverty-stricken, rural areas of India. That was the decision I made in 1942 when I was just 10 years old.
I became a physician, but instead of practicing pediatrics in rural India, I ended up practicing hematology in Long Island, New York. I had never considered hematology, and the change in my plans was not one which I made deliberately, nor do I recall experiencing mental anguish or inner struggles. A combination of certain circumstances and the guiding hands of two important mentors who entered my life in the course of my training, led me to become a hematologist. I have some explaining to do.
I received my medical degree in 1955 from the SMS Medical College in Jaipur, India, and in 1957 I came to New York for residency training in pediatrics. I spent a year in the South Bronx at the Lincoln Hospital and then moved to North Shore University Hospital, in Manhasset, NY, to serve as chief resident in Pediatrics. Everything seemed to be going according to my plan; I was scheduled to take the Pediatric Boards and then return to rural India. But that was before I met a charming three-year-old girl whom I will call Lauri. I was on-call on a weekday like any other in September 1958, and I had to perform the admission history and physical on Lauri whom I recall as a vibrant, vivacious young girl who had developed petechiae and had a fever. The attending hematologist came soon after the physical was completed and together we did a bone marrow examination on a screaming, frightened child. The pain and shock on the face of the innocent Lauri still remain etched into my mind. The attending, Dr. Arthur Sawitsky, took me by the hand and showed me how to stain the slides. As we looked at those slides, alongside some normal blood and marrow slides for comparison, for the first time I was face-to-face with an abundance of very angry-looking leukemic lymphoblasts. It took a good part of that night’s work for me to realize that I had actually participated in making a diagnosis of acute lymphocytic leukemia (ALL) on three-year-old Lauri. I asked Dr. Sawitsky how we would treat Lauri and what her prognosis would be. He told me what drugs we would use, and then he told me that Lauri would die in six months to a year. I thought that Dr. Sawitsky was a heartless, evil person, but of course, he was no such thing. This was 1958, and the stark numbers were unfortunately and tragically solid: 90 percent of children with ALL died between six and 18 months after diagnosis.
I became bonded to Lauri. I took care of her during that first admission and two more times in the next seven months until she died with me at her bedside. I was devastated. Dr. Sawitsky had observed all along how deeply affected I was by Lauri’s death, thus he decided for me that I should become a hematologist; I became a fellow in hematology under him at the Long Island Jewish Hospital after finishing the pediatric residency.
Thus, the seeds of becoming a hematologist were sown entirely by chance: the making of a new diagnosis of ALL on a very young child, being deeply affected and challenged by the hopeless statistics of that cruel disease, and a fortuitous combination of a caring senior clinician-teacher who recognized that a younger physician was ripe to enter training as a hematologist. I, the “younger physician,” was ready and, more than a half-a-century later, have never looked back or asked what-if’s or where did my ambition to treat sick children in the villages of India go?
Looking back, 1958 was a turning point in the battle that eventually ended up with a cure for a disease that was once universally fatal. For a detailed chronicle of this story of the battle to defeat childhood acute lymphocytic leukemia, I refer you to Siddhartha Mukherjee’s fascinating book, The Emperor of All Maladies: A Biography of Cancer.
There is more to my story — entry of yet another mentor named Eugene P. Cronkite, MD (a past ASH president) who introduced me to leukemia research and the study of lymphocytes which led to my life that is tied to chronic lymphocytic leukemia. But we will tackle that relationship at another time.
Thoughts From a Former Protégé
Matthew Kaufman, MD
Assistant Professor of Medicine, North Shore-LIJ Medical Center, Hofstra North Shore-LIJ School of Medicine
The first time I saw Dr. Rai, he was ascending the stairwell of Long Island Jewish Hospital during my internship year. The pulmonary attending I was rounding with that day excitedly told me that I was about to meet a legend. In my primitive intern mind, I believed it was perfectly appropriate to stop him and discuss our mutual patient’s magnesium repletion. In his unassuming manner, and with complete attention, Dr. Rai listened carefully. After our discussion, he thanked me sincerely and mentioned that the elevator takes too long and hurried up the stairs. Luckily for me, our dialogue did not end there.
As a second-year resident, Dr. Rai welcomed me into his office for an unscheduled meeting to discuss my protocol idea. The idea was mediocre, but Dr. Rai did not declare a quick strike-out and banishment to the dugout. Instead he spent an hour and a half focused entirely on how to develop my idea into a clinical trial. Despite the demands on his time and his august stature in the field, Dr. Rai made the time to teach me that day and for the next several years to come. Through my residency and fellowship, I have been privileged to be guided by Dr. Rai and to benefit from his knowledge and friendship.
I quickly came to appreciate Dr. Rai as someone who truly loves his work. His devotion to leukemia research is inspirational. For him, every conference yields a fresh idea to explore; and I’ve never seen a lecture finish in his presence without him asking an insightful question (albeit while peeking over his Blackberry). These lessons in dedication, intellectual curiosity, and the prospect of taking so much joy in one’s work continue to guide me in my career.
For all of the travel, meetings, and research success that take him away from the office, Dr. Rai retains a deep affection for his patients and is committed to their care. Rushing off of an overnight flight, he arrives at clinic perfectly composed. Even when his schedule is most demanding, Dr. Rai has a keen ability to remember each and every one of his 800 plus CLL patients. He recalls their situations and details of their lives beyond their disease. To Dr. Rai, his patients are never “the 17p deleted lady” or the “unmutated one.” Rather he or she is “the science fiction writer” or “the woman with all of the cats.” I was always amazed that the namesake of the CLL staging system takes time to look at his patient’s cat pictures. But the patients are completely used to it. Teaching by example, these lessons of humility and commitment make Dr. Rai a truly exceptional mentor. He could learn to have a little patience with the elevator, though.
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