Author: Amy Waldman
Publication: The New York Times
Date: May 18, 2003
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 land lines, 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.
