Change of Plans: Pediatrics in Rural India to Hematology Around the World

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.