Soon after completing her training in obstetrics and gynaecology, Dr. Gita Arjun chose to return to India so she could share the knowledge she had access to during her studies in the USA. Despite heavy odds, she has determinedly worked towards setting higher and higher standards of medical practice, inspiring, through example, all those who work with her. Functioning in a system that is not always ethical, she seems to stay on course by drawing from deep within herself, by knowing and acknowledging a core within her that is passionately concerned with human care. In this dialogue with TKV Desikachar, she shares some of her insights on her personal search for strength.
TKVD: Many youngsters in India are disillusioned with what we have to offer in this country and the general drift is westwards- to the land of opportunities! And then, we have people like you, who were doing so well professionally in the US, who have chosen to come back. You could have done anything there. But you came back. What inspired this decision?
Dr. GA: For us, our choices were very clear. Having ourselves grown up in close knit families, my husband and I were absolutely determined that the children would grow up with the culture of a close family- the roots, the love and the affection which is part of growing up in India.
The second reason is that we felt blessed that we were able to go abroad and get a phenomenal education. We went from very low- tech medicine that was being practiced here (this was around 1975), to high-tech medicine of a type that we didn’t even know existed. We adapted to it and both of us did extremely well. One of the important reasons that we came back was that we knew there were a lot of brilliant young doctors in India who could not go abroad and had no way of getting access to this education. We wanted to come back and spread the knowledge. We knew we couldn’t change the world, but we were convinced that within our sphere of influence, we could touch the lives of a few youngsters, cause a ripple effect, set an example about the correct practice of medicine and inculcate some strong principles. I think we have done that.
TKVD: It must have required a lot of courage. Many of us want to make a decision but we say, ‘I wish I could do it, but…’ So what is it that made you stay with the decision? What was that strength?
Dr. GA: We were young and enthusiastic, and I guess we also didn’t give ourselves the choice of going back. We decided that once we had set our path, we were going to stick by it. Looking back, it is obvious that we found enormous strength in each other. We were very supportive of each other, so when one was wavering, the other one was there to offer encouragement. That helped. Of course, we also came back to a small family run hospital, to something that was very low-tech still, but which gave us the impetus to make it high-tech, to make it modern. We had certain goals we wanted to achieve, even if we had to struggle a bit. That was incentive enough.
TKVD: But here you find that there is a lot of distortion in the system and you could easily be disappointed… still you held on. The real test of determination is when things are not going well….
Dr. GA: No doubt it was very difficult, and we had to reach deep within ourselves to find the strength to stay on. Particularly in medicine, when we came back, we had to take a big step down. But I think we knew that we could make things happen. We had a goal to achieve, we had a hunger to succeed. I think, in anything in life, if we give ourselves a certain goal and start working towards it, disappointments fall by the wayside. I definitely believe in that.
And we are very strong people – both of us. Recently somebody asked me, ‘What have you learnt about yourself?’ I said, ‘I know my inner strengths now.’ It takes a long time and some maturity to find your own strengths, but you do know that there is something within you that goads you to keep going. What that is within you, I am not sure. I am not sure whether you are born with it, or you have to find it…
Can I just give you a little example? My father brought us up not believing in rituals. We went to different temples more because my father wanted us to see the architecture and not because we wanted to pray or perform any rituals. He used to tell me that when people take a vow, promising to perform a penance as a bargain with God, and then just sit back in anticipation, no God will come and hand them their wish. If you use that moment to focus your mental energy and then use your physical energy to achieve that goal, you will achieve it. I believe in that focus.
TKVD: That is a beautiful example. We call this tapas. Tapas is not just sitting idly. It is to use the mental energy and channelise it in a physical way. And that energy will make things happen. Not simply shaving the head and waiting for things to happen. Why were you not tempted to go back to the US?
Dr. GA: The distractions were there, the temptations were there. But they weren’t insurmountable because we knew that we had to make things happen. Youth does give you one very big advantage. It gives you burning ambition and hunger and that is very good for you as long as it doesn’t destroy you while you are trying to obtain your goal. You must use it to energise and empower you.
TKVD: Very often ‘burning ambition’ is to buy a beautiful car, own a couple of houses…but your burning ambition is channeled elsewhere…
Dr. GA: Again, as I said, it was absolutely important for both of us to teach the knowledge we had gained abroad to the next generation, for them to carry it on and practice good medicine. We tried offering our time to the Government hospitals, we offered to teach free of charge and volunteered our services. Unfortunately, they had abolished the honorary system at that time. I think it was William Blake who said that you either have to create your own system or be a slave to another man’s. So, since we could not enter the system we made our own! We started teaching, we started having classes on our own.
TKVD: I want to extend this. You are in a very important profession. They say in Sanskrit Vaidhyo narayano harihi - the doctor is God. When we are in trouble we go to the temple, and in the same way we go to the doctor… There is enormous power and influence because we depend on you for life….
Dr. GA: A doctor is very powerful in a situation where the patient is helpless. I think every doctor should try one little exercise. They must lie down at least once on the examining table because it makes one realise how helpless one feels. When you are flat on the back, the human defenses are completely down. People who are unwell are people who are very needy, so in that situation, a doctor is perceived as God.
We see a disease, we give a treatment and there is a cure. But in the progression from disease to diagnosis to medication to cure, there is one ingredient that differentiates a good doctor from an average doctor – empathy. If you like people and you want them to be well again, you must a have a burning desire to know what is wrong with them and must want to help them get well. That is the secret ingredient which transforms treatment to cure. I am a very firm believer in this transaction between a patient and a doctor: the patient must want to get better and the doctor must want the patient to get better.
TKVD: But how is it possible for you to hold on to these principles at a time when Medicine has become a moneymaking industry. You are a part of the system…
Dr. GA: I am a part and yet I am apart! Whatever system you use, whatever profession you are in, if you are good at it and do what you have to do and do it well, monetary compensation will naturally follow. But the very fact that you are dealing with human beings makes this profession different: if you look at the patient as a source of money, then your empathy will dry up.
Something that I tell all my junior colleagues, anybody who comes and works with me and trains with me, is never to lose this principle because that is what differentiates a healer from just another physician. The day we look at a patient and see them as a source of money, we will lose our healing powers. You have to look at a patient from the point of giving them a cure and if not a cure, at least relief. The payment will come by itself- more than the monetary compensation, who can measure the enormous emotional satisfaction you get? Sometimes I strongly feel Medicine is one profession where intelligence and the ability to make money are inversely proportional!
TKVD: So is there anything in the medical education, or ethics or principles where this concept of trust (meaning that when somebody trusts you, you cannot harm them) is suggested and is a part of the education?
Dr. GA: Primum non nocere : primarily, do no harm – emotional harm, physical harm and mental harm. It is part of the oath that every physician takes. It is very much a part of our education. And yes, there are medical ethics. We are taught medical ethics, but unfortunately, those books are thrown out of the window. In modern India, people seem to be forgetting these principles. Kickbacks, fees splitting are practices for which you can be debarred from medicine but they have become the norm now.
But then, nobody can teach you to be honest. Is honesty really a learnable skill? It’s not. It has to come from within. It takes an enormous effort to remain honest. But then, let us face it, this particular transaction between patient and doctor transcends just disease- medicine –cure. It transcends that and becomes a human relationship because that person has come to you, trusting you and you have returned their trust. I think that is one of the greatest rewards that I find in medicine.
TKVD: But to develop a relationship requires time. Doctors say that they hardly have the time to see a patient for more than five minutes because they have a long queue. So how does one establish this relationship that you speak about?
Dr. GA: Yes, I work under terrific time constraints. But, I believe that you can still develop an honest rapport – I do it every day, every minute. Every patient– whether they see me for five minutes or half an hour – knows that I am totally involved with them in that particular time frame. Because I truly am. This applies to anything that you do. Any person who wants to do his job well, whether it is in five minutes, half an hour, or five hours, needs focus.
TKVD: For someone like you, with your experience of treating so many patients, to be there and not to be mechanical, I would call it a state of yoga. So tell me, doctor, do you have some personal practice that helps you to be present with your patients totally, to be so focused?
Dr. GA: I don’t think I am very special. But as I have looked within myself over the years, I know how I have grown. One of the things that I need is to be liked by people. That is very important to me. I love people, I love meeting people and I love relieving their problems. And so when you have that need to be liked by a person, you will make sure that you are focused on that person. For me it is very helpful because in my profession, unless I can establish that trust in the first few minutes, the relationship will fail. Of course, it is not going to be possible every day, every time, with every patient. There are days when you are so tired physically and you are so emotionally worn out that you may not be able to give one hundred percent.
But again, I push my limits; I know that. I have always, always reached beyond myself both physically and emotionally. When you are dealing with human beings, how can you sit back and give less than the best? How can you? It is not acceptable in my ethos. I love the high you get from helping another human being. Today a patient walked in for her appointment. She has lost four pregnancies earlier, in the fourth and fifth months. Because of our treatment, her pregnancy, in the seventh month, is going well. We both listened to the baby’s heartbeat and I don’t know who was smiling more. I was so delighted. I was so thrilled. How can you put a price on that? I am very lucky and privileged to get so much pleasure out of life. I think I am blessed.
TKVD: Tell me, Doctor, when I come to you, I come to you, Dr. Gita Arjun, with so many letters after your name. Is it really your qualification that makes you a special doctor, or is it Gita?
Dr. GA: I worked very hard to get that qualification and I got fantastic training to get that qualification. But at the same time, knowledge has to be updated all the time. I think my strength is that I constantly update my knowledge.
But most importantly, I think I love medicine. I am passionately drawn towards it. There is no ambiguity in that. I believe that if you practice medicine, it eats up your soul, it becomes a part of you. You have to make a lot of sacrifices. You have to want to give up your life for medicine. It is an enormous commitment. It is like a relationship of true, passionate love – and I find myself falling in love everyday!