Podcast | Digging deeper: Renaissance man Atul Gawande

My name is Rakesh Sharma and on Digging Deeper today, we are focussing on 21st Century Renaissance Man, Atul Gawande. And why? Well, we are doing so simply because he is a shining example of an international success story of Indian origin. But more importantly, he may go down in history as the man who has inspired three corporate giants in America to fix health care fault lines and invest billions in improving a debilitated and outmoded system.

Before we get into the specifics of the latest feather in Gawande’s crowded cap, let’s get to grips with who the man is, for the uninitiated among us. Writer-surgeon-researcher, one supposes, is a trifecta that sums up Gawande’s professional life, but fortunately for us, his oeuvre encompasses so much more. He is the executive director of Ariadne Labs, which is a center for health-systems innovation. He chairs Lifebox, an NGO committed to make surgery safe and accessible across the world. He is a surgeon at Brigham and Women’s Hospital, in Boston, and a professor in the department of health policy and management at Harvard School of Public Health and in the department of surgery at Harvard Medical School. More recently, he has made news because he has been named the CEO of a new non-profit health care initiative launched by Amazon, JP Morgan, and Berkshire Hathaway that is meant to decrease health care costs and improve health care delivery in the US. Atul has won the Lewis Thomas Prize for Writing about Science and two National Magazine Awards. In 2004, he was named one of the 20 Most Influential South Asians by Newsweek.

We are telling this story for yet another reason. We find ourselves at an odd moment in history.

“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!”

Those are the words of Emma Lazarus one finds by the Statue of Liberty - America, and Lady Liberty exemplifying the very ideals that this brave new world was built upon. But in these isolationist times, and under President Trump’s misguided America First credo, the American government is cracking down at the very idea of immigrants contributing to the country's narrative. The country has seen a sharp turn in the way immigrants are perceived. One can almost chalk it down to the exact moment Trump came down that escalator and declared Mexicans rapists and murderers. We may just have seen the nadir of that kind of political discourse over the course of last week when the administration separated over 2000 young children - including toddlers - from their families. The words “infestation”, “vermin”, have all now returned in political discourse as has a strong deja vu for Germany circa late 1930s.

Tiki torch marches by neo-Nazis, the rise and rise of the alt-right, and myopia to the extent of cultish blindness, have come to define a large segment of the American population today. Hillary Clinton used a word to describe them, famously beginning with a D, and while the political blowback she received for the statement was immense, one can’t help but wonder if that may well have been her most honest moment during the entire presidential campaign. The daily slings and arrows faced by people of colour, the ritual othering of the queer, the inhuman ripping apart of families… all because they dared to live while black/hispanic/asian/foreign/queer.

A February 2017 cover of the New Yorker simply depicted Lady Liberty with her lamp’s flame out. That lamp “beside the golden door” now leads to baby jails and the cries of foil-blanket huddled masses of children. When political discourse in America and indeed many other parts of the world has sharply divided people into taking inflexible positions, The New Yorker’s own Atul has taken a stand too. He is on the side of all of us.

He stands for inclusion, empathy, and care. Healthcare to be exact. If you look at his story from another prism, it is also the story of an immigrant's triumph, the kind many forthcoming dreamers will be inspired by, the kind we need above all else today.

He could have been just a moderately successful doctor of Indian origin, charting a predictable academic course but he was meant to do more, be more. He went on to not just be a doctor but to address and answer the complex, difficult-to-fathom questions about medicine and healthcare via his writing and his advocacy work.

But let us start at the very beginning to find out what made Atul such a force of good and wellness.

The story began when Atul's father Dr Atmaram Gawande moved to New York in 1962 to become a surgeon and subsequently married Dr Sushila, a paediatrician. His parents were model citizens and great followers of the Gandhian philosophy of seva, of community service and after Atul and his sister Meeta were born, the family moved to rural Athens, Ohio. This move was initiated by the Gawandes to serve a rural community starved of adequate medical care. Here their work touched over 25,000 lives and their social and philanthropic work left a lasting impact. This also left a lasting impact on the young Atul who often recalls this phase with a great sense of pride. He learnt pretty early that success has many meanings, one of which is to be of service and to make a difference.

During all of this, Atmaram and Sushila did not forget their roots back home and in Maharashtra’s Yavatmal district, they funded and founded Gopika Sitaram Gawande College. There is also a chair funded by them at the Ohio University’s College of Arts & Sciences.

They passed on their academic diligence to their children and while Meeta studied law, Atul earned an undergraduate degree in biology and political science from Stanford University in 1987. As a Rhodes Scholar, he earned an M.A. in Philosophy, Politics and Economics (PPE) from Balliol College, Oxford in 1989. He graduated with a Doctor of Medicine from Harvard Medical School in 1995, and earned a Master of Public Health from the Harvard School of Public Health in 1999. He then completed his general surgical residency training, again at Harvard, in 2003. The eclectic choice of subjects he studied impacted his world-view which was never just about medicine but also about the milieu it served.

The second phase of his life began when Atul began to apply his academic smarts to social and political contexts.

While Atul was studying, he got to experience the fret and fever of politics as he contributed elbow grease to the political campaigns of Gary Hart and Al Gore. He also worked as Bill Clinton's healthcare frontman during the 1992 campaign and became a senior advisor in the Department of Health and Human Services after Clinton's inauguration. He directed one of the three committees of the Clinton Health Care Task Force. But he knew perhaps that he needed to do more with his life so post the completion of his medical studies, he became a public health researcher and a surgeon and yes, a New Yorker staff writer and a bestselling author.

The chance to write for The New Yorker came after Atul's pieces for Slate, made waves and later, one of his pieces was even cited by President Barack Obama during his efforts to get health care reform legislation passed by the United States Congress.

Such was the impact of the article that in appreciation, Warren Buffett's long-time business partner Charlie Munger mailed a USD 40,000 check to Atul which he donated to the Brigham and Women's Hospital Center for Surgery and Public Health.

His 2012 TED talk, "How Do We Heal Medicine?" was viewed over one million times. The man was slowly becoming a cultural phenomenon and a perception shifter.

Gawande's writings are a rare Venn diagram of factual data and social context. His experience with the illness of his father and the heart condition of his son, have given him an insight into the limitations of impersonal medicine and an inadequate health care system. His insightful first book, “Complications: A Surgeon's Notes on an Imperfect Science” was successfully published in over one hundred countries.

His second book, “Better: A Surgeon's Notes on Performance,” clarified his stance on what he considers to be a responsible way of practising medicine, with the principles of diligence, uprightness, and ingenuity. The book cites examples of medical practitioners who like his parents have impacted larger causes through their work; and addresses issues, such as legal malpractices, the contentious role of medicine in capital punishment, and treatment variations at hospitals.

His third book, “The Checklist Manifesto: How to Get Things Right,” emphasised the importance of organization in medicine and advocated passionately for medical reform. The book's simple suggestions like the need to confirm a patient’s name before an operation nearly halved death rates and reduced surgical problems almost by a third. Malcolm Gladwell, in his review of the book, summarised Gawande’s ability and humanity - “Gawande is a gorgeous writer and storyteller, and the aims of this book are ambitious. Gawande thinks that the modern world requires us to revisit what we mean by expertise: that experts need help, and that progress depends on experts having the humility to concede that they need help.”

His fourth book, “Being Mortal: Medicine and What Matters in the End,” written post the death of his father became a #1 New York Times bestseller and touched upon the always relevant subjects of assisted living and terminal illnesses. The medical profession, he argued, was so consumed with the sanctity of life and living that often it forgets the certainty of death and the pervasive lack of ability to deal with death and the dying, and the aftermath for the living. Gawande demonstrates in this book that rare ability of a Renaissance man - combining a scientist’s precision with a poet’s poignancy.

His insightful writing for The New Yorker on the subjects of health and illness, life and death, happiness and suffering, have delighted readers for years now, forcing them to do the one basic thing that all good writing must do - introspect.

As the CEO of a new non-profit healthcare initiative launched by Amazon, JP Morgan, and Berkshire Hathaway, he is fulfilling the larger purpose that was first initiated by his parents.

As we told you before, this month, he was named the CEO for a new health care company, formed by billionaire investor Warren Buffett, Amazon’s Jeff Bezos, and JPMorgan Chase CEO Jamie Dimon.

It is clear obviously to the big guns funding this project that Atul is the right man to front this initiative because in Atul's own words, he has devoted his public health career to building scalable solutions for better healthcare delivery.

Much as his parents had seen the potential for improvement in rural Ohio, Gawande sees the broken health care system in corporate culture and wants to fix it. He aims to cut costs in the overblown USD 3tn US healthcare industry that has caused much bewilderment and heartburn to governments and corporate entities. The cost-cutting from the health-care system will hopefully begin a revolution by changing the lives of over 1 million employees of the three companies behind the venture.

Just as Amazon has simplified the retail experience, healthcare too perhaps needs to be revolutionised and digitised devoid of complicated transactions, brokers, middlemen, and baffling fine print.

And who better to pull off this revolution than the man who always sees the larger picture and wants to leave his imprint on the lives of millions who need not just affordable health insurance but also the assurance that they matter.

After all it was Atul Gawande who wrote once, and we quote, "Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.”