03 Interview With Dr. Raj Shah

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    2Interview with Dr. Raj Shah30thSeptember 2013

    Transcript

    Akshay Verma: [00:00:18] You can start telling us about surgery in general. How you feel about

    it, being a surgeon.

    Raj Shah: [00:00:29] Well I think, being a surgeon is probably the best things that can happen to

    an individual, and that's what I feel about being a surgeon. Although you'd find it quite

    interesting that I never wanted to enter medicine at all. I always wanted to be an electronics

    engineer, but it was my dad who coaxed me and that age he told me, I still remember his words,

    he said, "At your age you don't know what is good for you. Just do what I tell you to do." And

    that's how I got into medicine. And of course, after I went through my medicine, then during my

    internship I saw that a surgeon's life is probably much more exciting than a physician's life.

    Physicians have a medicine between them and the patient. Whereas a surgeon gets direct contact

    with the patients and the relationship is much closer. And feelings both of satisfaction as well asprobably feelings of inadequacy are both more likely to take place in the mind of a surgeon rather

    than a physician. But I have always enjoyed being a surgeon and I never regretted that I got into

    medicine.

    AV: [00:01:57] It is one of the noblest professions that one can have. What do you think about it?

    RS: [00:02:08] Well, there is no question about it. I think it is clearly a noble profession although

    it has its associated problems in terms of stress. I would that a surgeon's life can be pretty

    stressful in terms of trying to meet the patients' demands or expectations. It is not always

    possible and things are not always in our hands also, because there is a far deeper intelligence

    that controls the mechanisms of a human body, which is so intricate in its manufacturing. So,

    everything is not in the surgeon's hand and, at the same time, to be able to meet the expectations

    of a person can be quite challenging. But definitely it's a noble profession. I don't think therewould be anyone who would have a different opinion about that.

    AV: [00:03:16] Could you share one experience? Maybe you could share what happened

    yesterday.

    RS: [00:03:31] Just recently we were operating on a five year old child. He had a tumor arising

    from his adrenal grand. He had received this chemotherapy and the chemotherapy had resulted

    in the shrinkage of the tumor. But the child can get cured only by open surgery. Or, not by open

    surgery, but by surgery. And the removal of the complete adrenal grand was his only chance of

    cure. So the adrenal gland actually is situated very close to some major structures. It is very close

    to the inferior vena cava, which is the largest vessel taking blood back to the heart. It is very close

    to the hilum of the kidney where the kidney receives its blood supply. So this adrenal gland, we

    approached this by laparoscopy, which is one of the more recent advances in surgical techniques.

    And we had already separated about seventy to eighty percent of the tumor, I would say. And all

    of a sudden, the whole screen on the television was just a pool of blood. We couldn't just see

    anything. So it was obvious that actually the last thing that we had cut was some part of the wall

    of the inferior vena cava because of which there was tremendous bleeding from there. This child

    losing blood at this rate would probably die in the next 1520 minutes if we don't do something

    about it really fast. And this is a laparoscopy procedure, so it is difficult to control so much

    bleeding laparoscopically. So we have to take an immediate decision, you know, what next is to

    be done. And naturally, there is a sense of panic is there. But you have to, sort of, I'd say suppress

    that feeling and allow your reason and intelligence to work at that time. So immediately took a

    decision that the child needs to be opened and immediately the team was prepared and in the

    next five minutes we were ready to open the abdomen of the child. We opened the abdomen and

    immediately packed the area, which is normally how you control any bleeding. Then waited for10 minutes because by that time the anesthetic gets time to catch up on the blood loss and

    replace fluids and all that. And then gradually we remove the pack. As we gradually remove the

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    pack we can just about get chance to see where the blood is coming from. And then again already

    there were places just filled with blood. So with a little patience and the combination of surgical

    technique and experience and all that, a little luck also, and little wait, we are able to catch the

    bleeder and the place where the bleeding is coming from and then stitch it up and the bleeding

    stops. We are able to complete the rest of the procedure, heave a sigh of relief and then close the

    abdomen. So this happened just, I would say, practically two weeks ago, maybe two or three

    weeks ago. And you can imagine you can imagine how the situation will be when it's actuallyhappening live. Afterwards, you know, when all is well everybody is all smiles when everything is

    over. But at that time when it is happening, of course, there is definite atmosphere of tension in

    the whole operating room, when things are actually being done.

    AV: [00:07:39] You said that it creates a lot of stress. How do you deal with it and how do you

    overcome that anxiety of losing a child?

    RS: [00:07:53] See, de-stressing actually is not possible at that very instance. But it depends on

    your whole lifestyle. It starts off, I would say, from the start of your day when if you begin your

    day say with prayer or meditation and you try to tune in with infinite intelligence or God and ask

    Him to guide you in whatever you are going to do during the day then that itself works as a de-

    stressing mechanism. Because it helps you to attain a certain degree of calmness, which helps you

    to cope up with difficult situations when they do arise. There is a beautiful prayer, which says, "I

    will reason, I will will and I will act. But guide thou my reason, will and activity to do the right

    thing always." So which means that you are appealing to the infinite intelligence to guide you in

    those situations where really it is difficult to take a logical decision. You need some intuitive

    guidance at that time. That I think comes through prayer and meditation. You have to train

    yourself also. Suppose, to be detached, it is said that a surgeon should not operate on his own

    family members. Why do they say that? Because basically when you are too attached to a person

    you are not able to think logically. And you are under more stress at that time. So a certain degree

    of detachment has to be cultivated. Detachment is not lack of love. Detachment is something, I

    would say, quite different from that. You can love a person and yet you can be detached. It sounds

    difficult to understand. But it's, I would say, a state of even-mindedness that you try to cultivate

    without the ups and downs. And in stress what happens is that basically the whole brains

    starts getting fired up. And that time when neurons are all generating impulses in a haphazardway and it becomes difficult to think clearly. Your blood pressure goes up, your heart rate goes

    up and everything is geared up to fight or flight, as they say. But when you are even-minded, then

    you are more calm and your system is able to take, I would think, a better decision in a state of

    calmness. So that calmness has to be cultivated over a period. It doesn't come overnight. And, I

    would say that, even today, I am still far away from attaining that kind of state of calmness where

    you are absolutely able to think rationally and clearly under any kind of stressful situation.

    AV: [00:11:29] How do you feel when you are performing a surgery on someone and you have to

    take a major decision? How do you handle such dilemmas?

    RS: [00:11:56] I don't know. I told you, I just said that it's a combination of intuition, experience,

    knowledge and logic. I suppose, I didn't mention common sense. But even that comes into the

    picture. So it's a combination of all these factors. Really, I don't think that there is one magicalanswer to that. But it's all the years that you are putting into the profession, all such experiences

    in the past which have produced certain outcomes, desirable or undesirable and that experience

    which you have gained from there, your theoretical knowledge based on your study of people

    experiences across the globe, your common sense at that point of time, and of course, your

    prayer and guidance, asking for guidance at that time, which comes to you as intuition. I think a

    combination of all these factors helps you to take a call what you should do at that point of time.

    AV: [00:13:10] You were telling me about the two ways that people look at a surgeon...

    RS: [00:13:35] See, that's part of life. Duality is a part of life. We face both kinds of patients. As

    you mentioned, this family who had a child, he was about four when I operated on him. He had a

    very large neuroblastoma, a malignant tumor of nerve tissue. We probably took about 78 hours

    for that surgery. I had specially selected a Sunday so that I have totally no other commitments.

    And we did that surgery and the child became completely all right. And that family is so grateful

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    that I still remember that mother, you know, she kept asking me for my photograph. And I said

    what do you want to do with it? Finally, one day she told me I want to keep it on my altar. And it

    was so embarrassing actually. But that is the extent of gratitude that some people feel. And every

    year they will come and will insist on touching my feet and present me with a box of sweets. They

    come on the day of surgery because they consider that as his birthday, because they say that was

    his new birth, after the surgery.

    [00:14:39] On the other hand we have a, I remember a child who had a very large malignant

    tumor in the chest and I told the father that it is inoperable; it is not possible to remove such a big

    tumor. But he said that the child is going to die anyway. So, should you not try at least? So I said,

    well, if you are willing to accept that kind of risk then it's reasonable to try. I said we can give it a

    chance at least. The father, he didn't have money. So I know a family who owns a trust and I

    talked to the family and told them that they would have to give money for this kind of a surgery.

    And I arranged money for that patient, I called another cardiac surgeon to be with me because I

    thought that it was a very major surgery and I thought that two heads would be better than one.

    And despite all the precautions that we took, intraoperatively we did have some problems, the

    child did develop cardiac arrest during surgery and after that had to be put on ventilator and

    eventually we lost that child. And the father was so abusive that despite him not even having

    spent money, we had arranged his finances also, we put in all this effort, we didn't charge a rupee

    and despite that for months together he would all of a sudden, he would call me up in the middle

    of night at 2 o' clock tell me how come you are sleeping so peacefully when you killed my child

    and we are not able to sleep peacefully, how can you sleep peacefully like this? So that went on

    for more than a year.

    [00:16:10] So this is part of life. We just have to accept both and as I told you earlier, you just

    have to develop even-mindedness. Don't get elated when somebody praises you and don't get

    depressed when somebody blames you or criticizes you. Just take both in stride and just keep

    doing what you have to do.

    AV: [00:16:33] How do you feel when you lose a child, even when you've given it your best?

    RS: [00:16:51] Well, first of all, you feel terrible. In fact, I'll tell you that the child that yesterdaywe operated upon actually, we lost that child. It was actually very painful. But at the same time,

    these are high risk procedures, we explain to the relatives beforehand that there is a chance that

    you may lose the child, but we venture out on such undertakings with the full understanding that

    left alone this child is anyway going to die. The only hope that the child has is that we operate and

    maybe, you know, we are successful, you know, tumor is removed completely the child can have

    a normal life. But the sense of guilt often comes in. Particularly in the earlier stages of my career

    as a surgeon I remember times when I use today to letters to YSS, asking for monks guidance also

    and how to overcome sense of guilt. And ultimately, over the years, what I have learnt is that you

    have to overcome the sense of doership. When you feel that you are the doer, then you want to

    take credit for the successful surgery and then you have to live with the guilt of having an

    unsuccessful operation. But then you realize that, in reality, you are only a doer of a small part.

    There are so many other things in one in a person's recovery. I remember this incidentally, you

    know, absolutely illiterate villager, his son had a problem, and it was a urinary problem and I hadto explain to him before surgery whether he will be able to recover completely, what are the

    likely complications, will the child be able to have urinary control or not. And I was trying to

    explain all these things do that illiterate person. And all of a sudden I was taken aback by the

    wisdom that came out from that man. He suddenly told me, "doctor you don't need to explain all

    these things to me. You just do your duty. It is going to be a combination of your hard work, my

    money, my child's destiny and God's grace back together and decide whether this thing is going

    to be successful or not." So you said you just do your part you don't have to worry about

    explaining to me all these things. So what I'm trying to say is, basically, over the years we realize

    that we are not the only factor in deciding the cure or failure. You may think back and feel that

    maybe if I had done it this way, it would have been better. But later you also realize if God wanted

    me to get that thought in my mind at that time He would have put it. But it's a combination of the

    patient's destiny, the family's destiny, our own lessons that we have to learn in life both as a

    surgeon and as a human being. All these combination of factors affect your judgment and the

    outcome, and ultimately. So I think the one way to overcome sense of guilt is basically to

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    remember that we are not the doers. It's God alone or does, he runs the universe, he decides who

    is to live, who is not to live, who is to have a complication, who is not to have a complication.

    Incidentally, you know, you might find this interesting; among surgeons we have what is called

    the VIP syndrome. The VIP syndrome is basically a syndrome in which a surgeon who is

    operating on a very important person somehow ends up with complications. It is almost

    invariable that surgeons who are operating on some VIP will have some complication or the

    other. And many times I have pondered over why this happens. I think God is trying to teachhumility. And the best way to teach a surgeon humility is to give him a complication in a VIP. I

    think it's the hard way that a surgeon learns to be humble.

    AV: [00:21:24] How is operating on children different from operating on adults?

    RS: [00:21:37] That's a good question. I always say that children are not miniatures adults. This is

    a favorite statement of mine because children think differently, they perceive the world

    differently, they perceive the surgeon differently and issues of finance and so many other aspects

    don't bother them. So child goes entirely by trust. And I realized over the years that a child's

    outcome after surgery depends to a great extent on the child's trust in the treating doctor. So we

    have to spend a lot of time with the child just to gain its trust, to make it realize that we are there

    not to hurt the child, but we are there only to help. And I think that's a very very important step

    before operating on any child. Then you operate on an adult, adults generally go by more logic

    and they will just maybe take two or three opinions and then see how you talk and how you

    convince, and maybe ask you more logical questions like how many such operations have you

    done in the past and what have been your results. Maybe adults judge you like that. But children

    go by feeling. Of course, surgical technique wise things are quite different when you are

    operating on a child. Your margin of error is very small. You hardly have margin of error. You

    have to be very precise, you have to be very delicate in handling the tissues, very gentle. Many

    times in the operating room when we are operating on some delicate structure, I don't permit

    anybody in the operating room to have their mobiles on. I don't like any kind of movement in the

    theater. My boss used to jokingly say, "Don't breathe. Don't breathe." Because even the sound of

    breathing disturbs. So it's that kind of concentration we like to have when we are operating on

    small babies, particularly the neonates, that time it's quite different. And recovery in children is

    far better than in an adult. A child has a point problem where he's not suffering from diabetesand high blood pressure and neumoconiosis and problems of pollutions and other stress factors,

    hypertension. All these things are not there in a child. He has a point problem, you correct it and

    he becomes all right. So recovery is very fast and surgery in children, I would say, is far more

    gratifying than in an adult. It's very gratifying to see a child come back and, you know, come back

    well after a successful surgery.

    AV: [00:24:36] You said about gaining a child's trust. What makes it have faith in you?

    RS: [00:24:56] I think you have to give time to the child to let him get to know you. When I see a

    new child and the child probably needs surgery, I insist on having at least 34 meetings before I

    actually operate on that child. I don't take surgery as a mechanical solution to a specific problem.

    But I would rather look at it in a more holistic way. And I like to get friendly with the child, gain

    the child's confidence. Many times we have children who won't even enter into our cabin, theywon't like to come inside from the waiting room, they just go on crying. And they just keep

    pulling on the mother saying, "I want to go outside." And from that point to convert the child to

    the stage that he has a trust in you, it often takes time. I think you might find it interesting that I

    often use my camera for this. When a kid is crying I just take a photograph of the kid and then I

    show him "look this is how you look when you cry." So for a moment at least he stops crying. He

    thinks this is not a nice picture. So then he just cools off a little bit you know. Then I take another

    picture and show him "look you are looking slightly better." Then slowly get him to smile and

    then show him the picture and then say, "now look, this is how you should be looking." And of

    course, in our clinic ambience we try to keep pictures of happy children, happy birds, happy

    animals, just to create a happy atmosphere. And give the child freedom in your clinic, let him do

    what he wants, let him play with whatever he wants so he feels that you are not a disciplinarian,

    you are a friend. And gradually you gain his confidence and then make him understand that he is

    the one who has got a problem. It's not we who want to do something, but it is he who has got a

    problem and that's why he has come to us. And now, we try to make him understand that don't

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    you want that problem resolved? He says yes. Once he says yes, then I often use this kind of a

    story. I say you will need some kind of magic done on you. Children, they are fascinated by the

    word magic. Children, they say what is this magic? So I say look, you know, we can do some magic

    on you and we can solve this problem of yours. And there are some problems with the magic. The

    magic doesn't work if you are awake. So we have to put you to sleep before we do that magic. So

    that's how I slowly make them understand about anesthesia. I say that you will need to be put to

    sleep because only then the magic takes place. And after all who is the greatest magician. I say itis God. So I ask him who is your favorite God? Many times it's... sometimes it is Krishna,

    sometimes it is some Mataji, something they have in their own mind, Hanumanji. So I say ok,

    what we're going to do is, we are going to put you to sleep and then I am going to call Him. And

    once He comes then together both of us are going to do some magic on you. And then your

    problem is going to be completely solved. And when you wake up everything will be all right. And

    this sort of storytelling actually works wonders on the child's mind. So when we actually take

    them to the operating theater if we have told them this whole story before then they are just

    anticipating the next step. They think that now is the time, now they are going to put me to sleep,

    God is going to be coming and is going to take care of my problem and all that. So I try to use

    these to gain a child's confidence.

    AV: [00:29:005] Surgery is considered to be one of the important professions. Why is it

    important to do the right thing even when you are doing something of less important, some

    mundane job.

    RS: [00:29:315] You have asked a very beautiful question. Actually this question, I myself found

    the answer to this question just two days ago. Very interesting story I will tell you. My son has

    just got into a medical college in Pune. I wanted to transport his writing table and his cot and

    mattress and cupboard and all this. So I was looking for some movers and somehow somebody

    told that you just go to this Agarwal movers. They are very professional. Their name is in the

    Limca book of records. So I went to Agarwal movers and what I saw there was unbelievable.

    What I really saw was the way in which they do their work. The way they do their work is

    unbelievable. The culture that percolates down from the owner of that company, down to the

    lowest level staff is something that has to be seen to be believed. They gave me a small booklet

    about their own principles and about how they work and their system and all that. And I waslooking in that booklet and I found that their business runs on trucks, because trucks transport

    all their material from one place to another. And how this man has spiritualized his own

    business, he has realized that who runs the trucks? The drivers. So said the driver is the most

    important person in his business. What he has done is he has opened a driver's seva kendra on

    the highway where any truck drivers can stop their truck, go there and there are photographs of,

    you know, they have volunteers there who wash the feet of those truck drivers in warm water.

    They actually wash the feet of these drivers, they give them a massage, they have places where

    these drivers can sleep. They get rest. They get refreshments and they are taken care of. It's a

    driver's seva kendra. It is unbelievable. I thought a profession as mundane as just being the

    owner of a transport company who is just carrying cargo or freight from one place to another

    how they can spiritualize their business. So I think any profession can really be converted into a

    spiritual profession if one has the attitude. But at the same time, I do admit that yeah being a

    doctor, it's much easier to do that. But these people, they really touched my heart when I saw theway they are running their business.

    AV: [00:32:325] Why is it important to do what I am doing or anyone else is doing?

    RS: [00:32:545] See, first of all, in any drama you have to have various characters. You can't just

    have a character, you know, only one character in a drama. Then there is no drama. So in this

    cosmic drama every role is important. But of course, that role has to be played in a way that does

    not upset the other person's roles. You have to play it harmoniously and selflessly... and for

    universal good, I would say. So if you are making a film there are so many things that a film can

    be made on. There are themes, endless themes. But a theme which is uplifting to a person's mind,

    which is elevating to his intelligence, which helps in building character and building strength, in

    spreading positive emotions, positive vibrations is a wonderful task. I, as a surgeon, I may

    operate on one or two patients in a day, whereas a person making a film, he can reach millions of

    people through his film, and he can do more good than probably a surgeon can do, provided he

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    takes it with the right perspective. I think any job, if you take in your hospital itself, ok, we as

    surgeons, we are operating and someone may think that ours is the biggest job that we are doing.

    But it's not necessarily so. The class four employee who is actually sterilizing the instruments is

    more important probably. If he is not going to his job properly, if the instruments are not

    autoclaved properly, I may have operated still the child may get infections or get other

    complications. If the nurse who is handling over the instruments over to me is not quick, she is

    not anticipating my next move. Every person's role is important. And if you are talking of filmmaking, I think it is probably more important than a surgeon's role.

    AV: [00:35:086] Is there a surgery that you remember most vividly? Which is the most

    memorable surgery that you have performed?

    RS: [00:35:296] There are two incidents which I would like to tell. The first is not my most

    memorable experience in a positive way. It's a very way. I was doing my post-graduation and it

    was the first child I operated upon and the child had a perforation of his intestine due to typhoid

    fever. Of course, this is almost thirty years ago. At that time medical treatment was also not

    sufficiently advanced and post-operative care, it was a government hospital, the facilities

    available were very limited. But I had operated on the child and closed the perforation and next

    day in the morning when I came to know, you know, I came to the ward. They told me that the

    child had passed away last night. I actually burst into tears there itself. And I just walked away

    from the ward. I just went back home. I said I can't work today. It's not possible for me to work

    today. It was so painful for me that could not just accept it for days together. This was my first

    surgery which I had done and that child passed away. A far more positive experience was one in

    which I performed one of the most complicated liver surgeries, about two years ago, where there

    was a tumor which was just about, maybe, four centimeters in diameter I would say, which was

    located in the most treacherous spot that you can think of in the body. It was, you know, we have

    the structures, the inferior vena cava, the portal vein, the hepatic artery. And this tumor was

    sitting right between all these structures and we had to actually dissect the tumor, I would say,

    nanometer by nanometer, and separate all these major structures around it. I was able to get that

    tumor out safely. Probably, I would rate it as one of the most thrilling operations of my life. But a

    few months later that same child again taught me humility, because few months later he came

    back with a tumor in the liver in another area. So he just showed me that, you know, who has thelast laugh. It is not we who cure patients. You may solve a problem but that doesn't mean that

    you cure patients. If unless the patient's destiny and God's will are agreeable over that, other

    outcomes are not really in our hands. I don't know if that... That child I think taught me a lot.

    Because when we performed the surgery we thought that probably no one else could have

    removed such a tumor. And sooner, few months later, we realized that we hadn't really done

    much. So the ups and downs of life.

    AV: [00:38:5766] What do you seek to achieve?

    RS: [00:38:5966] What you seek to achieve, can I ask you that?

    AV: [00:39:076] I just seek to do the best thing that I can, to do the right thing in the best possible

    way.

    RS: [00:39:186] What do you think everybody seeks to achieve?

    AV: [00:39:206] Happiness.

    RS: [00:39:226] Yeah, ultimately, I think the answer is only happiness. What do you seek, what do

    I seek or what does anybody else seek. We all seek happiness. The only thing is you have to seek

    not a temporary happiness but a happiness that is undiluted, a lasting happiness, which is not

    affected by the ups and downs of life. And attaining that state of happiness is, I think, what

    everybody wants. The only thing is how to get is because that, you know, the world of relativity

    outside cannot provide anything that is lasting, because everything is changing in time and space.

    So what is outside is not going to be able to give you what you want to achieve. So ultimately you

    have to seek that within yourself. And it starts by reducing the amplitude of your ups and downs.

    I don't know if you will understand what I am trying to say. When you go though an up and when

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    you go through a down, we have this huge amplitude, the oscillations are too big. You start

    reducing them down till you attain a state of calmness and ultimately that calmness, I think,

    forms the basis for that unshakable happiness. I think I thought over that question and I saw it

    and I said that well, that's the question which I think every human being wants to ask. This is

    what I think is the answer.

    AV: [00:41:037] Since you deal with people who are dangling on a tightrope, one side is deathand one side is life, how does that make you feel? You, unlike other people, are constantly seeing

    these two sides at one time.

    RS: [00:41:347] Let me tell you something. All of us, all the time, are living in the same state.

    People who went to Badri-Kedar didn't know that they'll never come back. People who are going

    on the road don't know when they are going to have an accident. People who are going with all

    this kind of stress in life, don't know when they are going to get a heart attack. My mother she's

    80. Twice a day she used to walk to the temple. She go down two flights of stairs twice a day, do

    all her activities. And then she was sitting in the evening at 6 o' clock. She was sitting in the

    kitchen and all of a sudden she developed a paralysis. In just in a matter of seconds. Today it's

    two months, she has lost her speech, she has lost complete movement of her right hand, complete

    movement of her right leg. She is totally bed-ridden, she cannot even feed herself, everything is

    being done. If you really think about it, all of us, all the time, are living like that only. It's only how

    much you focus on it. Don't you think so. My brother-in-law, his son was 21. He was studying in

    Duke, Duke University, and he was entering in medicine. He was actually first year in medicine.

    Playing basketball outside in the courtyard at around 7pm, then he just said that, "I'm feeling a

    little tired." He said, "I want to sit down." He sat down, just collapsed and passed away. So all I'm

    trying to tell you is that, basically, all of us are dealing with life and death all the time. But, we

    don't focus on it so much. And that's what keeps you going actually. If you keep focusing on the

    negative all the time, then you can't live. So the same way with us surgeons. When we are

    operating all the time, we may explain to the patient that look there is a certain element of risk

    involved. But once we have finished the explanation, then we tell them now you should be totally

    positive. Now you drop all the negative thoughts out of your mind and we also drop them out of

    our mind, and we just go about everything with as positive attitude as possible.

    AV: [00:45:187] How are you different from your usual self when you are performing a surgery?

    RS: [00:45:437] I think I can answer that in one word probably. Focused. I think when I am

    operating I think I'm pretty much focused. Especially, of course, when you are operating there are

    moments when you just... there are lighter moments and things are easy and there is nothing

    really for you to be tensed about. But in general, we are very focused. We don't like any, any kind

    of disturbance during a surgery whether it is noise or movement. I suppose focused sums it up. I

    can't think of any other way that I'm different.

    AV: [00:46:337] What do you do during your free time?

    RS: [00:46:427] What's my recreation? You know what's my past time. I told you that to deal with

    stress, the stress of life itself, the stress of being a surgeon, the stress of operating on such criticalsituations, small children, the one thing that we need is de-stressing. And I think it can be done by

    its only logical opposite, and that is meditating. Because meditation is the opposite of stress.

    Meditation is de-stressing yourself physically, mentally, in every possible way. You tend to relax

    completely and let go. So I personally like to meditate whenever I am free. And if I am not in the

    mood to meditate, you can say there are times when you are really not in a mood to meditate,

    then I like to read about spiritual things because they give me the proper perspective to at least

    deal with the stress of life. So it reinforces your thoughts. We are all good forgetter. Once you are

    told you are not the doer, but you are not going to remember that for even 5 minutes. Just the

    next thing you do, I tied my shoelace or I combed my hair and we say we are not the doer and

    that we are doing all these things. So you have to keep reminding yourself again and again

    through reading, through introspecting and through meditating. So I suppose it may sound a little

    unconventional but that's what I do for my relaxation.