Brotherhood Dharma, Destiny and the American Dream (27 page)

I actually had three very specific reasons for not wanting to begin meditating: Years earlier, as a gastroenterology fellow, when I’d walk into the radiology department to look at X-rays two of the radiologists would be sitting there smoking their pipes. I would take out my pipe and we would begin seeing all the X-rays of the patients of the gastroenterology service. But before we started we would have a discussion of the different kinds of tobacco. I also liked to drink Scotch to relax, and so I wasn’t about to give up my pipe and my alcohol.

Second, as assistant chief of medicine at the West Roxbury VA, on a few occasions I had to discipline interns and residents. I saw that
meditation made people very mellow and I couldn’t afford that to happen to me. Lives were at stake every day.

Third, my exercise and relaxation came from tennis. I wasn’t interested in having my competitive edge dulled by spirituality. I had no desire to applaud my opponent for making a great passing shot. I was a fierce competitor and wanted to win every match.

Amita went without me and learned the technique. After a month there were noticeable changes in her; she would walk around with a smile, which was not that unusual for her, but it seemed distinctly more peaceful and beautiful. And, to be honest, I felt a little resentful because in the evening dinner was delayed for twenty minutes because she had to go meditate. She did not try to talk me into learning meditation, but my resolve was weakening.

One Saturday morning about a month after she’d started meditating Amita wanted to go to the TM center for a check-up and I volunteered to drive her.

“I’ll come with you,” I said, “but I’m not going into the center. I’m going to wait for you in the car and read a book about tennis.” As I sat there a man tapped on my window and introduced himself as Ted Weisman. I had heard his name.

“You’re the instructor who taught my brother, right?”

I invited him to sit in the car with me. It was a little uncomfortable as I didn’t know what to really talk about. So I suggested he tell me a little bit about TM. After he’d given me an overview, I decided to share the three things that really concerned me about the practice.

“First,” Ted said, “in terms of drinking and smoking the only thing we ask is that people not be on drugs or intoxicated when they first come to be initiated into the practice of TM. Second, you’ll probably be more assertive at work, but from a stronger and more quiet place. Without losing your temper. And third…” he paused and told me he would be right back. He returned with a pamphlet entitled
The TM Programs in Athletics: Excellence in Action,
which included testimonials from many athletes, including baseball star Willie Stargell, football Hall of Famer Joe Namath, and an Olympic diving champion. In
different words they all claimed that TM had actually helped them become more focused and far more competitive. “I can’t guarantee that you’ll win your tennis tournament,” Weisman told me. “But I will promise you that if you lose you won’t feel that bad.” He had literally given me the introductory TM lecture in my BMW.

“Sounds good,” I said to him. “Please sign me up.” I learned Transcendental Meditation the following weekend. It turned out to be nothing at all like what I had expected. I didn’t suddenly want to start wearing a robe and chanting. Instead, within a few days I noticed that I was no longer smoking my pipe. And I realized that smoking that pipe gave me heartburn, so I was able to stop taking antacids.

One day I was stopped at a traffic light when I glanced at the driver in the car next to me, who smiled at me. That’s odd, I thought. Why is that person smiling at me? During a group discussion, one of the other new meditators pointed out that I had a big smile plastered on my own face, and suggested the person in the other car was simply responding to that.

I began meditating regularly, twice a day for fifteen to twenty minutes. I enjoyed the practice, but also the benefits that accrued as a result. Rather than becoming the center of my life, as I had feared, meditation made me more energetic and enthusiastic about the things I was already doing. It was a very profound experience. I found that I was more creative at work, and that I had become a far better thinker. My career blossomed.

While Deepak had opened a private practice, I enjoyed working in a teaching hospital. For the most part the fact that we were Indian immigrants made no difference at all. The only problem I remember was that the
Boston Globe
once printed a story criticizing foreign-trained doctors who had been licensed to practice in America. The tone of the article suggested that doctors trained outside America were inferior to doctors who had graduated from American medical schools. As I saw the evidence to the contrary around me every day, I considered it a ridiculous thing to have declared. Deepak was furious and sent a long, angry letter objecting to that article, arguing that it was not based on any factual information. In response, the
Globe
interviewed
him and put his picture on its front page. Deepak received a lot of calls of support from immigrant physicians who were pleased he had spoken up; within almost every immigrant community there is an unspoken fear about attracting too much attention, as if people might object to their presence. But Deepak also received many more calls from American doctors who were angry at him for airing some of the friction that existed between American and foreign-trained physicians. They did not want people outside the medical field to know about this tension.

My experience was very different from my brother’s. Generally I was welcomed and treated respectfully. Compared to India, where position and rank meant everything and we were never allowed to be casual with people ahead of us, I found there was great camaraderie among all the colleagues I worked with. In 1975, for instance, I was doing the first year of my gastroenterology fellowship at St. Elizabeth’s Hospital. I was the only fellow and by virtue of that I was on call every single night and every single weekend other than my three weeks of vacation. It seemed like I never got a day off. I didn’t complain—I loved what I was doing. The learning trajectory was steep and I soaked it all in.

One Friday after we finished our rounds everyone was furiously writing notes about their patients for me; this person needs this, that person needs that. Make sure you check these results. This is an exercise called a sign-out. And as they got ready to leave for the weekend, everybody told me to have a good weekend and that they would see me the following Tuesday.

Tuesday? I asked them what happened to Monday. It was the Jewish holiday of Yom Kippur, I was told, and at that moment I realized every single person there, the four attendings, the two residents, the two medical interns, the two fourth-year medical students, the GI secretary, the GI nurse, and the GI technician were all Jewish. I thought about that for a minute.

“Well, you know what? I’m not coming to work Monday, either! Who’s covering?”

The room got very quiet. No one knew if I was serious or joking.
Finally one of them asked me, “Sanjiv, what do you mean you’re not working on Monday? Why not?”

“I’ve decided to change my name,” I announced. “From now on, please call me Choprastein!”

In fact, I think there was only one time I ever felt even a slight bit uncomfortable. I had taken up the game of golf and joined a country club. My first day on the golf course I was introduced to one of the long-standing members, an optometrist. When I told him my name was Sanjiv Chopra, he said, “Well, I can’t pronounce that. I’m going to call you Sonny.”

I thought that was rather impolite and culturally insensitive.

“No,” I said, “you will not. You have three choices. You can call me Sanjiv. It’s not that difficult to pronounce, it’s just like ‘sun’ and then ‘jeeve.’ Or you can call me Dr. Chopra, or you can call me sir.” That spread very quickly throughout the country club, that this new member had politely reprimanded a senior member. But if I hadn’t put my foot down, three hundred members of this historic club would have been forever calling me Sonny.

I knew about Deepak’s growing doubts concerning modern medicine, but I didn’t share them. For me, it was simple: Science had provided us with a body of knowledge. Often we could use that knowledge to improve our patients’ health and sometimes even save their lives. I felt that the single most fulfilling words in the English language, words I’ve always used very carefully, are “You’re cured.”

The best doctors, I learned, are detectives. They have a knack for looking for the right clues and asking the right questions. After I started teaching, I emphasized that to my students: Don’t hesitate to ask more probing questions, as many as might be needed to get to the root problem. As a sculptor chips away at a block of stone, keep going until you get the information you need. I found that patients sometimes try to hide the truth from their doctors, from the very people they have trusted to protect their lives. I once had a patient with jaundice tell me he did not drink alcohol. I was skeptical, given that his laboratory tests pointed to alcoholic liver disease.

“Really?” I asked. “When did you quit?”

“Last week,” he admitted with a sheepish grin.

If there is one lesson that I’ve drilled into the ten thousand students I’ve taught during my forty-year career, it is to ask that extra question. I tell them about an incident that took place during hepatology rounds at the Beth Israel Deaconess Medical Center, the major teaching affiliate of Harvard Medical School.

I would tell all of the medical student interns and residents and fellows on the hepatology service, “Every time you see a patient in consultation or after they’ve been admitted to the hepatology service, in addition to asking all the usual questions about alcohol and drugs and alternative medicines, make sure you also ask them how much coffee they drink. And whether they drink regular or decaf.” I did this because numerous studies done over the last several years have shown that coffee appears to confer substantial protection against liver disease. In medicine we call this hepaprotective.

I’d emphasized the benefits of coffee to the liver so much that it became a little joke, Dr. Chopra and his coffee.

One Friday as I began rounds, I noticed all of my students were smiling. As soon as I sat down they told me that, at long last, they had encountered a patient with advanced liver disease who drinks coffee.

“Did you ask him whether it was regular or decaf?” I’d taught them that decaf can be beneficial for people with a variety of diseases, including type 2 diabetes, but only caffeinated coffee appeared to provide protection against liver disease.

“He drinks four cups of regular coffee every day,” the intern who had admitted the patient replied, and then added, “I even asked him about the size and it’s a normal cup.” The team was convinced that they finally had proven me wrong.

“You know, he may be the exception,” I said. “These studies are not ironclad. They’re observational, they’re epidemiological studies. But let me take my own history.”

We went through our rounds. When we got to this patient’s room, I shook his hand warmly and introduced myself, then pulled up a chair and sat down. I always sit down when talking to a patient. Some thirty years earlier a colleague pointed out to me that if you stand by
the patient’s bed for twenty minutes they believe you were only there briefly because you looked like you were ready to turn on your heels and walk out, but if you sit for five minutes it seems like you have given them all the time in the world. So I’ve made it a practice to always sit down.

I began taking a detailed history. The patient told me he did not drink alcohol. He did not use drugs, not even herbal medication. Finally we got to tea and coffee.

“Doc,” he said, “I don’t like tea. I love coffee.”

“Good,” I said. “What type of coffee do you drink?”

“If I’m going to have coffee, I’m going to have regular coffee. Otherwise, why bother?”

“Good. How many cups a day do you drink?”

“Four,” he answered, “regular size.” All around the bed I noticed the young doctors trying hard to repress their smiles while maintaining a professional decorum. Then I asked this patient one more question, a question the young doctors hadn’t thought to ask.

“How long have you been drinking four cups of coffee a day?”

“Oh, ever since my liver transplant. Doc, it was the strangest thing. I never liked coffee, but right after I had my transplant I had this great craving to drink some. Now I drink at least four cups of regular a day. Why, you think I should stop?”

The house staff nearly fell over when they heard his response. As I told them afterward, the information you’re going to need is there, you just need to keep digging until you find it.

For me teaching brings the greatest satisfaction. I feel that by sharing my knowledge I am fulfilling my dharma. At the time, I was very ambitious, much like my brother, and I couldn’t slow down. I was doing everything possible to move my career forward, seeing patients, writing articles and books, learning new techniques. But there came a point when I had to make a career choice: Did I want to stay in academic medicine or open up a private practice? Should I continue working at a hospital? Elements of each of these options appealed to me. I had watched my father at work; I’d seen him on the wards in the hospital and also in his private practice. What I noticed, though, was
that his greatest joy seemed to come from teaching young doctors. He enjoyed sharing his information. Deepak had decided to open his own practice and had been quite successful. I never really had to make that decision; from the first day, I enjoyed teaching and I made the decision that I would work in a teaching hospital affiliated with a prestigious medical school.

Amita followed a different path, going into private practice, which she enjoyed thoroughly. She was completely devoted to her patients. However, in the early Eighties she took two years off to spend with our children. They were growing up and she didn’t want to miss those magical moments of their childhood. During that time, so we could afford for me to accept a gastroenterology fellowship, she would moonlight several nights a month at St. Elizabeth’s Hospital. But she also enjoyed teaching, and even when she was in private practice she would have medical students shadowing her. In fact, for most of her career, spent in a private practice, she was affiliated with a number of major teaching hospitals. So she had her responsibilities to her private patients and responsibilities at the hospital for teaching students and junior doctors; she called it “the best of all possible worlds.”