Content Credits : Medha Chatterjee
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What initially drew you to specialize in onco-surgery?
I was drawn to oncosurgery because of two main reasons.
1. It is probably the only surgical specialty where you have to constantly update yourself. So much is changing in oncology and with the advent of robotic and hipec surgeries I feel it is the only branch that continues to challenge the norms of what can be done.
2. I can see a wide variety of patients. On Monday I may be operating on an esophageal cancer on Tuesday I might be removing a uterus. Wednesday I might have to remove a breast and offer reconstruction So the best of all surgical specialities is there in oncosurgery. Of course each patient is a textbook and I have learnt so much from each of them that I feel grateful I can operate on any part of the body.
Can you describe a challenging case you’ve handled recently and how you approached it?
Well yes. Just last week I operated on a huge tumor arising from the inferior cava ( a large vein in the abdomen). We had to patch up the cava with a graft.
There are lots of interesting cases. Especially cases that have been inadequately operated outside. They are the most challenging. As an oncosurgeon I want to give the best oncological outcome to my patients. It is more important for me to do 10 surgeries optimally than 100 surgeries sub-optimally. There really should be no room for error.
What do you think the major differences are in healthcare in India, the USA and Germany?
Major differences in Healthcare in India and Germany / USA
Well this I can answer….since I actually do get a lot of patients … Indians from the US or Europe getting second opinions or treatment here. Or family members getting opinions… I know that healthcare in a corporate setup like Manipal is far superior than the average healthcare in those places. We have had patients for whom it has taken a month upwards for just diagnoses in the US. Many patients complain that they often don’t see the same doctor in follow up visits. Most of my patients have a phone number of my team that they can call in case of emergencies. No one has to wait for more than a day or so to get an appointment to see me. Our pathology and radiology departments work round the clock and have reports ready in good time. We even have them on standby during the surgery incase of tricky surgeries. And I think we can all agree Healthcare costs only a fraction of what it does there in the private sector. As far as technological advancements are concerned, we are almost at par with them. What we lack is basic scientific research… which is our main drawback.
Are there any new development or techniques in the field that you find particularly promising?
Last week I removed two organs (a colon and a uterus) with cancer from a patient with only four tiny incisions of 8mm. I think the new era of minimally invasive surgery is very exciting.
Oncosurgery is moving towards more and more precision surgery. Removing only cancer. Preserving the organ, preserving the function. We have come a long way from the radical procedures that were initially described for cancer. There are new tracers like pafalocyanin that attach themselves to cancer cells.. that enable targeted cytoreduction in peritoneal metastasis. There are newer dyes and probes for targeted lymph node dissection to avoid the morbidity of extensive surgery.
The field of molecular biology is just exploding. We are looking at subtyping cancer behavior in a very revolutionary manner.
Auditing results of surgeries exposes deficiencies and helps to improve patient outcomes in a big way.
How do you handle the emotionally taxing aspects of dealing with a lot of terminal patients that comes with being an oncosurgeon?
It is definitely hard. But the rewards outweigh everything else
As surgeons we are taught to control emotions under we begin our residency and as we get more experienced we fine tune the emotional aspects. The thing with being in oncology is that you see patients who come for follow up for years. They become like family. Some of my patients have been coming for 20-25 years. Patients come and meet me to tell me they have had one more grandchild or to invite me for their son’s wedding or to inform me that their daughter is getting into medical school. So even though it is emotionally gut wrenching to lose some of them to the disease, it is heartening to see their resilience … it is humbling to see their faith. It is an honour to be treated like their friend. And we all would like to be there for our friends till the end.
In you field it is quite common to be called upon to impart a terminal diagnosis. What advice would you have for medical students who might have to do the same in the future?
I would tell all the young doctors to not shy away from their responsibility. Anyone can pronounce a terminal diagnosis, but it takes a lot of heart and a lot of empathy to do so kindly. One must imagine yourself in their shoes. I have many patients who ask me if further treatment will be pointless. I make sure I am honest with them. At that time in their lives even their own family might disguise the truth. So I put it as gently to them but I make sure that I do not betray their trust. Most people are stronger than you give them credit for. You just have to help them find their strength.