Indian Heart Surgeon Took Talents
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By
Amy Waldman
NEW
DELHI — Taken out of context, it looks like Naresh Trehan is playing
a video game. He stares intently into a console at a
three-dimensional image, his feet pressing on pedals, his hands
maneuvering levers.
But
in this case, context is everything. On a television screen several
feet from Dr. Trehan, a heart, embedded in gelatinous tissue and
blood, throbs insistently. Several feet farther still, lies the body
that is home to the heart, on which Dr. Trehan is, at this moment,
operating.
He
moves a lever, and on the screen, a robot's claw lifts the internal
mammary artery, soon to be joined with the coronary artery in a
single bypass. Dr. Trehan is providing the brainpower by remote
control. Two robotic arms with tiny hands, inserted through two
small incisions in the torso, and a tiny camera inserted through a
third, are doing the work.
When
he moves the controls inches, the robots move micromillimeters, with
more precision and steadiness than the human hand.
"Like
going to the moon," Dr. Trehan said of the
procedure.
Minimally invasive robotically controlled
cardiac surgery is the latest frontier in heart surgery. It is
slowly catching on in the United States, as doctors and industry
work to bring the cost down and the clinical value up. But this is
India, where those who can afford it have been accustomed to going
abroad for state-of-the-art care, often provided by Indian doctors
who have migrated themselves. Dr. Trehan was one of them. He went to
the United States in 1969, and by the mid-1980's was earning over
$1.5 million a year as a Manhattan heart surgeon.
But
then he did what few Indian doctors do: he came back, prompted
largely by the Indians who kept showing up on his operating table
and asking why they could not get the same quality of care back
home. He was driven, he said, by "a certain amount of arrogance — a
kind of national pride."
"I
could do things better than most of my American counterparts," he
said.
He
decided against practicing in an established hospital and found an
industrialist to finance his vision of a private heart institute and
research center in New Delhi. The Escorts Heart Institute and
Research Center opened in 1988. Today it is among the largest of its
kind in the world, with 325 beds, 9 operating theaters and satellite
operating rooms in five cities — although that means little in a
nation of a billion people.
At
56, Dr. Trehan may be the most prominent heart surgeon in the
country. He has won just about every award India gives for
citizenship and service. He has operated on almost every major
political figure or businessman and he counts many of them as
friends.
Everyone wants him. One man, accused of
helping to bilk the Delhi Development Authority in a land scheme,
has petitioned the court to have Dr. Trehan perform his heart
bypass.
Escorts also draws Indians and others from
abroad to New Delhi, by bringing the most advanced technologies and
techniques here. It is only the second place in Asia, after Japan,
to perform robotic surgery. It has done about 50 robotic surgeries
since December, moving cautiously because the procedure is costly
and the technology still evolving.
On
some fronts, Dr. Trehan has far outstripped the West. Most American
cardiac surgeons still hesitate to perform "beating heart" surgery,
which does not require stopping the heart or using a heart-lung
machine. The procedure reduces trauma to the body but is challenging
to perform. Escorts has done about 10,000 beating heart surgeries,
including 4,000 last year alone, putting it in the top tier
worldwide for this procedure.
The
center devotes 10 percent of its income to free care for the poor
and subsidizes care for government employees, members of the
military and retirees. Staff members in its mobile echocardiogram
van see 100,000 villagers a year.
Dr.
Trehan said that when he returned to India, after almost two decades
abroad, with his wife, Madhu, and two daughters, he found that
ethics and family values that shaped his youth had been corroded.
Corruption was everywhere; prominent families were at each others'
throats over money. The things he held dear, which he found absent
in America, were disappearing in India, too.
This
interplay with America and the West is one of the narratives of
modern India. In the area of heart disease, Dr. Trehan observed, the
two countries are finding they have more in common than they think.
"For
many decades we were living by the myth that heart disease was a
disease of corrupt, money-minded Western societies," he said. But in
the last 20 years, he said, studies have shown that Indians are
about twice as prone to coronary artery disease as Americans. By
2020, half of all deaths here are expected to be heart-related.
On a
recent morning, the doctor, in scrubs, strode into a
state-of-the-art operating room. It had no corners or protrusions,
to prevent the collection of bacteria; in the wall was a one-touch,
computerized angiogram display. He checked in on a surgery, peering
at the open chest. The surgeons around the patient straightened up
in an almost military stand-at-attention stance. He prompts a
similar reaction everywhere within Escorts' immaculate
premises.
He is
a driven leader and an exacting boss. In his office, he switches
from Hindi to English to Punjabi on mobile phones and landlines, as
assistants, surgeons, anesthesiologists and accountants wait for a
moment of attention and images flicker on five screens and monitors
behind him.
He
works 12-hour days, staying fit and staving off stress with
exercise, yoga and meditation. "What I like about my life is that
it's protected me from any useless or negative thought process," he
said.
Like
many Indians, his life was shaped by the partition of the British
Indian empire. His parents were well-to-do doctors in what is now
Pakistan. Overnight, they lost everything, and became refugees in
New Delhi.
Eventually they found a three-room apartment.
His father, a surgeon, practiced in one room; his mother, a
gynecologist, in another. The family lived in the third. He saw the
gratitude of people so poor they offered his parents a cooked
chicken or handmade shoes in place of cash.
He is
not all soft edges, however. Since childhood, he has been
competitive, a sportsman, who wanted to win. He preferred cricket
and field hockey to books and has always had an intense hands-on
curiosity about how things worked.
He
had wanted to be a pilot; when his father said no, he turned to
medicine. In the United States, he chose heart surgery and then set
about finding its best practitioner to teach him. That, he was told,
was Dr. Frank Spencer at New York University, who became Dr.
Trehan's idol even before they had formally met.
Dr.
Trehan watched Dr. Spencer dress down a doctor for keeping an
elderly black woman waiting overnight in a hospital hallway before
surgery.” It struck me — look at this man's values," Dr. Trehan
said.
His
determination to work under Dr. Spencer was eventually rewarded.
After his training, Dr. Trehan settled into a comfortable life of
teaching, research and operating. But India called.
As
his institute's opening approached, he grew nervous. He asked Dr.
Spencer and New York University for help. They offered to send 20
surgeons to India for two months and pay their salaries. At the last
minute, however, he had second thoughts. "If we bring these guys,"
he recalls thinking, "our whole lives we — and they — will be saying
the Indians couldn't do it themselves." He told them not to come.
These
days, he leads a comfortable life. But Escorts is still expanding,
and he has also taken a leading role in trying to reshape India's
ailing health care system, aware that his efforts are, like so much
else in this vast country, dwarfed by the sheer numbers of people
needing help.
He
says he could have chosen to coast, but the constant striving, he
says, has its own rewards. "You don't get time to get old," he
said.
