Brotherhood Dharma, Destiny and the American Dream (21 page)

The patient turned out to have a villous adenoma, a tumor, in his rectum. If an adenoma is large, it can be malignant and spread. So the diagnosis changed very quickly from myasthenia gravis to villous adenoma with secretory diarrhea and hypokalemia. The hypokalemia had been causing his profound weakness. Dr. Greenberg was impressed and at lunchtime in the hospital cafeteria he complimented me in front of the other interns and some of the attending doctors.

It was a very smart diagnosis for a young intern and I enjoyed a great feeling of fulfillment. My father had taught me that medicine is not only a science but also an art, and every doctor will make many wrong diagnoses throughout his professional career. So when you do
make the right diagnosis, it’s important to remain humble. I knew that, but inside I was elated. I had made the correct diagnosis and avoided many unnecessary, expensive tests. Any question I might have had about my ability to meet American medical standards was answered to my satisfaction. I could be confident in the quality of my training. By our degrees, Amita and I were doctors—but by our training and our passion, we would become very good doctors.

13

..............

State of the Art

Deepak

Photo credit by Paul Morse/Clinton Global Initiative

Champions of Action–Delos Living™ and Clinton Global Initiative, committed to creating a peaceful, just, sustainable, and healthy world. Morad Fareed, President Bill Clinton, Deepak Chopra, Steve Bing, Terry McAuliffe, Jason McLennan, and will.i.am, September 2012.

B
UYING YOUR FIRST TELEVISION ON
credit seems trivial, but it was enveloped in culture shock for Rita and me. Until we found a Little India in Jamaica Plain, loneliness was never far away for my wife. Just the physical sensation of being by herself in a room made her despondent. Houses are full of family in India and full of the noises that families make. The silence of a small apartment in New Jersey was oppressive, relieved only when Rita came to have lunch with me in the hospital cafeteria, which she did every day. It hurt me to see her sitting by herself in a corner, patiently waiting until I could break free. Even now I can conjure up the image and the feeling.

The solution we hit upon was to buy a TV set, and so with some trepidation we went to a local department store to price one. The salesman was chilly at first, no doubt thinking that Third World immigrants couldn’t afford to buy anything, but once he heard that I worked at the hospital, his eyes lit up. Minutes later we were being offered a revolving line of credit, which we accepted in a kind of daze. At the local Volkswagen dealership the attitude was even more liberal: “The doctor wants a car? Give him a car!” There was only the vaguest sense on my part that credit meant debt, but it was a relief to turn on the TV all day so that Rita could fill the apartment with sound. It wasn’t family, but it kept a frightening silence at bay.

Clearly we didn’t pose a problem of culture shock to the Americans we met. They cared very little about India. We had exchanged British disdain for American blankness. Curiosity seemed to end once we were asked if cobras crawled under our beds and whether we rode elephants. The world was coming to America, which may have been why Americans felt so little need to know about anywhere else.

A doctor at Muhlenberg who owned a two-seater prop plane heard that Rita was pregnant. In a flush of generosity he offered to fly her to
India so that she wouldn’t have to buy a commercial ticket. I pointed out that India was halfway around the world.

“My mistake,” he said. “I thought it was in South America.”

When you arrive in a new country already speaking the language, outfitted with a job and an education, the process of adaptation occurs quickly, on the surface anyway. Rita and I weren’t aware of being changed very deeply. The lack of smells was odd. In India rooms are cooled by running water through a hay filter; the fragrant, evaporation-cooled air is then blown into the room. American air-conditioning was antiseptic and odorless. If the temperature went down to seventy-five degrees, we threw on our sweaters, which occasioned odd glances. We must have looked like seniors, or invalids.

When they come to this country, Asians seem peculiarly adept at throwing off as much of their home culture as they need to. Rita’s father had become a business consultant after leaving the Indian air force. On his first trip to New York City his hosts insisted on taking him to the Rainbow Room at the top of Rockefeller Center. When the menu arrived, they pressed him to order a steak and he obliged. It was only when the food arrived that he realized steak comes from a cow. When we asked him how he managed to eat an animal held sacred in India, he shrugged.

“I struggled with my conscience, but then I thought, ‘This meat came from an American cow. If no one here thinks cows are holy, theirs must not be.’”

Building a self doesn’t stop at twenty-three, my age when I arrived here. Some unconscious shifts were occurring inside, almost all of them caused by the practice of medicine. An obvious influence was the impersonal nature of how we related to our patients. It was much more than what I had faced in India. As distant as I felt meeting sick people for fifteen minutes and running through a short litany about what was wrong with them and what I could do about it, behind my back I had gained a reputation for being warm. This mystified me. Perhaps it had to do with my showing a little personal interest in a patient, if only for fifteen minutes, rather than pretending to be interested. I was never good at putting up a front.

Later on, however, I suspected that there was simply a difference in emotional temperature between the two cultures. Indians love to get excited, and we exaggerate the horror of a crisis and the sentimentality of love. The extravagant excess of Bollywood movies, where a boy and girl exchanging a flirtatious glance makes the earth rumble, looks reasonably normal to an Indian audience. American audiences learn to enjoy it, if they ever do, from a sense of the preposterous. As for the emotional temperature of Americans, that varied, depending, it seemed, on how British their family roots were and how much money they made. My sympathy was with the poor, and almost immediately I gravitated to the Democrats because everyone told me they were friendlier to immigrants. (Years later, on a golf course in Jackson Hole, Wyoming, an oil man told me that I should consider getting close to the second Bush administration. He amazed me by saying, “We have our eyes on you, you know.” The conversation came to an abrupt end when he informed me that there was only one precondition: I had to accept Jesus as my lord and savior. The Christian Brothers were much subtler.)

At the hospital I was shocked to hear other doctors refer offhandedly to “gorks” and “gomers.” Gork refers to a patient who has suffered a severe head injury and lapsed into a coma from which he may never recover; the letters stand for “God only really knows.” A gomer (for “get out of my emergency room”) is a patient who is too far gone mentally or too close to death to be treated in the hospital, with the implication that he is a waste, taking up a perfectly good bed. A family wrestling with the painful decision to take someone off life support would be shattered to hear the doctor say, “Cut the gomer loose.” I heard it almost every day in the residents’ lounge in Boston.

It wasn’t my position to tut-tut over anyone else’s behavior only to wonder how much I was blending into the scene. Going to the VA hospital threw me into a rougher environment after I left Lahey for my second year of residency. You survived by being thick-skinned. Nearly everyone on staff handled the pressure by smoking. Our attendings usually preferred to puff on a pipe, which looked professorial,
while the rest of us dragged on cigarettes. Doctors regularly smoked while making their rounds through the wards. One of the attendings who did this when he came for grand rounds was an eminent gastroenterologist and the editor of
The New England Journal of Medicine.
No one would have questioned him if they’d even dared to think about it. He died of esophageal cancer before he turned seventy.

Of course we disapproved of our patients smoking and warned them about the dangers. On break I’d look out a window to see a lung cancer patient, who had just been given the terrible news of his diagnosis, walking across the street to a convenience store to pick up a carton of Lucky Strikes.

Feeling immune to getting sick is a common trait among doctors. It’s a psychological defense mechanism, an extension of inflated egos (once you start making big money, why not assume that you are invulnerable?), and a fairly realistic notion at the same time, since exposure to so many disease organisms results in a stronger immune system. (One of the things that made AIDS such a baffling mystery in the beginning was that the first patients to show up in the early Eighties were mostly young men with good immune response. By a twist of fate, HIV attacked them first, since their increased white cells were perfect hosts for the retrovirus. At the very outset, many doctors jumped to the wrong conclusion that the disease must be specifically targeting these men because they were active homosexuals.) In India medical care was typically free. In America the money I would make one day signified a state of grace.

These things weren’t lost on me, but they were peripheral to the state-of-the-art medicine I was learning. Ten years after gaping at Rattan Chacha, I had become the guy holding forth with a glass of Scotch in one hand and a cigarette in the other, generally on Fridays when the staff got together at the end of the week to unwind. Yet America was just a window of opportunity to me at that time. I would return home after I had finished my residency in internal medicine. When my family tearfully saw me off at the Delhi airport they could console themselves with that.

I called home to keep in touch as often as I could. My parents had a telephone, fortunately, but I was reluctant to burden them with the expense of a person-to-person call. We used the dodge of having my father pick up the phone, refuse the call, and then immediately phone me back station to station. If Sanjiv was on the line, it felt like we were as close as ever.

I had dropped cricket when I went to med school, but Sanjiv kept playing. In fact, it was hard to keep up cricket madness in America, where the sport was unknown, and it drifted out of my sight. As his big brother, I felt obligated to tell Sanjiv that his grades weren’t high enough in medical school. Was he studying hard? It worried me. No matter how much I did this, I never gave it a second thought that my goading and badgering might be a source of considerable irritation.

The oddest aspect of my assimilation centered around the birth of our daughter, Mallika. Rita was pregnant and getting ready for the flight to India to give birth. A friend took me aside to inform me that if she was born abroad, our baby couldn’t grow up to be president of the United States. In 1970 this was hardly a realistic cause for concern, but it troubled me. I could see my little girl setting her heart on holding the highest office in the land. Could I be the one to dash her hopes? It took some hard convincing and hours of soul searching before I put this problem aside.

The one aspect of American life that I utterly failed at was sports. I made a few attempts to bond with other males. I told them that field hockey was one sport where India had high Olympic hopes. My enthusiasm was cut short when I was informed that in the U.S. field hockey is a girls’ game. The only hockey that counted was played on ice, and it was a teeth-bashing contact sport. I wasn’t keen on anything that happens on ice. Bringing up soccer was met with a blank stare. I had no idea that America was the only place where the game wasn’t an obsession; suburban kids had barely started playing it. When I wouldn’t relent and learn the complicated rules of baseball and football (at least I quickly stopped calling it American football to keep it straight from soccer), my attempts at bonding on the sports front crashed.

Anyway, it was clear from their reactions that everyone felt a bit embarrassed for me.

When Sanjiv followed me to medical school two years later, my parents could say to themselves that they had fulfilled one of their key aims in life. It wasn’t that their sons would be secure financially, or even that good parenting had led to happy children. The issue, which is peculiar to Indian life, was dharma. As a child I don’t remember my mother being disgruntled very often, but if ever she became irritated with my father, he would settle matters with a single phrase: “It’s my dharma.” This had the magical effect of quieting her complaints, answering her doubts, and even bringing a look of contentment to my mother’s face. If her husband was following his dharma, everything would be all right.

Dharma is multilayered. It’s your work, the proper course of your life, and your duty. As taught for thousands of years, dharma is the invisible law that holds life itself together, whether it’s a person’s life or the life of the universe. A highway robber is a lawbreaker and an outcast from society, but in the back of an Indian’s mind, if a dacoit is teaching his son how to be a dacoit, they are following their dharma, even up to the point where the police shoot them down. It’s unthinkable not to have a place in the natural order.