This past summer, an extraordinary mini-series aired on ABC: a seven-episode documentary called Hopkins. Hopkins documented the professional and personal lives of several medical professionals and medical students at Baltimore’s Johns Hopkins Hospital, widely regarded as one of the finest hospitals (and one of the finest teaching hospitals) in the world.
I watch very little TV. In fact, I do not own a TV. But I watched all of the episodes of Hopkins online and found the series exceptionally candid, insightful, moving, and at times heartbreaking. Production aspects such as camera work, editing, and music are artfully rendered.
Several South Asians are among the featured players in this real-life drama. I spoke with one of them, Herman Bagga, who was one of the medical students featured in episode number five.
The 26-year-old native of Erie, Pa., is a 2004 graduate of Case Western Reserve University in Cleveland (my alma mater also), with majors in Biology and Economics and minors in Chemistry and Psychology. And he graduated a few weeks ago with his M.D. from the Johns Hopkins University School of Medicine.
Bagga has authored and co-authored numerous articles published in medical journals, as well as chapters in textbooks. He is now in the first year of a six-year residency in Urology at the University of California at San Francisco.
During one scene in Hopkins, you and your colleagues discuss the fact that you came to your specialty—Urology—much more quickly than the typical medical student. How did you make that decision?
I was very fortunate: within two months of starting medical school, I really connected with the Urology department—with the people there and with the work they were doing.
It would have never occurred to me that the people would be what would draw you toward a specialty.
Yeah, the people actually have a huge impact. Different fields have different reputations for the types of people they attract. Urologists tend to be nicer, a little more light-hearted—and that makes sense. The type of work that they’re doing requires that they be able to make patients feel comfortable, and often that skill involves a sense of humor. I sometimes tell people that urology is clean surgeries and dirty jokes.
A lot of your research involves laparoscopic surgery. Will you describe this concept in layperson’s terms?
Laparoscopic surgery is a form of minimally invasive surgery. Ordinarily when you think of surgery you think of a surgeon taking a scalpel, cutting through the skin and the tissue, and really opening up the body. In contrast, laparoscopic surgery and other minimally invasive surgeries involve making very small incisions. With laparoscopic surgery, you make a few small cuts, and through one cut, you insert a tiny camera, and through others you may insert some metallic robotic arms; and then you’re actually watching a video screen while performing the surgery, manipulating what the arms do inside from controls on the outside. With certain technologies, the process can be similar to playing a video game.
There are pros and cons to laparoscopic surgery. It can be difficult and sometimes more expensive, and not all surgeons are trained to do it. Also not all surgeries can be done this way. The key benefit is often a faster recovery time and a faster healing process of the surgical wounds. Sometimes, it can also be more cost-effective by reducing the amount of time a patient has to stay in the hospital.
A few titles on your research C.V. piqued my interest. One is “Addictions in urological diseases.” I don’t get it. What’s the connection between those two topics?
Actually when we were approached about writing this book-chapter, I had the same reaction. I’d never thought about this connection before. But then the more we researched it, the more compelling the topic became.
For example, smoking is highly correlated with certain urological diseases such as bladder cancer. And there’s a phenomenon in which patients who are addicted to opiates will actually pretend to have kidney-stones, to try to get hospitals to give them opiates. So yes, the connections are there.
This writing project was very interesting, because it gave me a different perspective on medicine. This was not only about the science, but also about understanding human behavior as it relates to medicine.
Another title that caught my eye was “Complications of 2,775 urological laparoscopic procedures, 1993-2005.” So you and your collaborators actually crunched data for 2,775 urological laparoscopic procedures?
Yes! (laughs) One of the beautiful things about being at Hopkins is that it’s such a high-volume academic center. The high volume allows for many cases to exist; and the fact that Hopkins is an academic institution means that the documentation is very detailed. So a big team of us had access to this huge amount of data from procedures done at Hopkins.
Though a lot of the information wasn’t on computer. (laughs) There were many late nights spent entering data from old paper charts into the computer.
In medicine, and really in any endeavor, the way to better yourself is to look at what you’re doing and what’s going wrong, and then figure out how to correct and improve your process to reduce or eliminate problems. So that was our motivation. Not only for our own knowledge, but also so that we could share the information with other institutions that may not have the same amount of experience.
Could you give an example of something specific you and your team found?
Sure. If you compare the first half [chronologically] of our series with the second half, the number of complications was much lower during the second half. While this might seem obvious, it was interesting to actually document the learning curve of an institution. This spoke to the question of how long it takes for a center to become proficient at a given procedure. Of course, there is the caveat that the skill level of the surgeons doing the procedures comes into play.
Also we were able to document the sensibility of certain procedures over others. A good example is the partial nephrectomy: the removal of part of a kidney. Early in our series, these were conducted by open surgery (with a large incision). Later many of these were conducted laparoscopically, and we could see that the complication rate was no worse with the less invasive procedure for tumors of certain sizes. This began to address the question: when should a partial nephrectomy be done via open surgery, and when may it be done laparoscopically?
You also co-authored a paper called “Genitourinary myiasis (maggot infestation)” that appeared in the journal Urology. That title definitely grabbed my attention.
This was early on, in my third year of medical school. Hopkins is located in a pretty impoverished area. So in addition to being an institution that gets rare diseases and brings in patients from around the world, we also deal with a lot of pathology that is more often encountered in such a location.
A homeless gentleman was found unconscious outside the hospital. There were complaints that he smelled really bad. Per protocol, our medical staff removed all of his clothing, and discovered that his pelvic region was infested with maggots. They were coming out of his cavity and out of his urethra, and they were all over his scrotum. So the Urology staff was called in.
Since Hopkins is an academic hospital, we document potential teaching cases carefully—especially with anything that strange. With the man’s permission, this case was documented via video camera.
It turns out, the maggots had actually helped this man. The man had a gangrenous infection, which means there was an infection that was attempting to eat through tissue and skin. Such an infection can keep going further and further and cause major damage. One of the ways we can prevent progression is by debriding, or cutting out, the infected tissue. Once you remove all of the infected tissue, you’ve removed the infection and therefore no more tissue can be damaged. But in this case, the maggots had done the debriding for us, eating away the infected tissue. They were like tiny little surgeons in there, removing the diseased tissue.
I am in no way suggesting that being infested with maggots is a good thing, or that maggots are an advisable therapeutic option. But in this case, the maggots had done him some good.
The interesting thing is that I’ve done so much work, so many different types of research, but I’ve had urologists approach me and say, “Hey, you’re the maggot guy!” So for some, that’s what I’m remembered by.
Okay, enough about maggots. Congratulations on winning the Mr. CWRU (Case Western Reserve University) pageant. One year, during my undergraduate days, a Bangladeshi guy won it.
Yeah, so you guys are representin’. He sang a then-current Rick Astley song for his talent. What did you do for your talent?
Well, I treated the whole event in a pretty light-hearted manner. For the swimwear competition I wore a goofy 1930s-style one-piece bathing suit. For formal wear I wore a kurta-pajama. For my talent I did a stand-up comedy routine.
Had you done any stand-up before?
I’d done some speaking but never stand-up. I had some things to say about the school, so I just did that. For example, I commented that CWRU had 17 fraternities and six sororities, and I said that even being a turbaned man, my odds were probably better of getting through airport security than of finding a girl. (laughs)
But my most interesting public speaking experience was giving the convocation speech for my graduation from Hopkins Medical School.
What did you speak about?
The event tends to be quite serious. I decided to have some fun with it. I did a critical analysis of a medical text … the children’s book Everyone Poops. It’s a book to encourage a child to use the toilet, by helping a child understand that even while it might be scary to poop, since everyone does it, it’s ok.
I commented that the title reminded me of my first manual bowel disempaction. This is a medical procedure that is required when a patient is severely constipated. Somebody has to go in and manually remove the feces. As you might imagine, nobody is very excited about doing this. So this job tends to fall to the bottom of the totem pole. The medical student. Me.
In my critical analysis, I concluded from my experience with the disempaction that the author of the book was wrong: actually, not everybody poops—at least not without the assistance of a horrified medical student.
From there I talked about the fact that while we learn a lot of rules in life, many of which are convenient and even useful, we have to maintain a certain flexibility; we must approach each new situation with a critical eye and be willing to question the established rules and assumptions.
You also majored in Economics. What do you enjoy about economics?
I think of economics as not only a science of numbers but also a science of wants and how people get those wants met. Such study taught me a lot about basic human behavior, and I can apply this knowledge to so many aspects of life, whether it be retail work like the work I did in my youth, or the medicine I practice now. One of the fundamental concepts I learned was opportunity cost: the cost of pursuing a particular option isn’t just the monetary cost of obtaining that want—it’s also the other things you are foregoing. For example, buying something at the mall doesn’t just cost what it says on the price-tag; there are additional costs, such as the time that it will take you to find that item, and the foregoing of whatever else you could be doing with that time.
Oh yes! I feel that way about a concept I learned in economics classes—the idea of sunk cost: once a cost is spent and not recoverable, it should no longer factor into the decision. Many people don’t understand this, and they make poor decisions to stick with something just because they’ve already invested in it.
Yes! That’s another great example. You really can apply the idea of sunk cost to everyday decisions. If you understand sunk cost, you can say, well that didn’t work, let’s move on, and you’re so much better off.
From the show I know that you occasionally play video games. What else do you like to do in your free time?
These days I have very little free time. I enjoy skiing but haven’t been able to do much of it lately.
I really enjoy cooking. I see many parallels between cooking and surgery. In surgery, you start as a neophyte and you learn from an expert such as your attending physician. In cooking, you also start naively, but then learn from an expert. For me, that expert was my mom.
And in both, you can memorize a procedure, but to be great, you must really understand the meaning behind each step. In surgery, at first you learn a protocol, but once you understand the significance of the movements, you can adjust them for different patients and their unique anatomies. In cooking, you can simply follow a recipe, but the more you understand the role of each ingredient, the more you can stray from the recipes and get creative—for example, try to make fusion dishes.
What are your specialties?
I’m good at some of the vegetarian dishes. Chhole chawal is my specialty, although it’s generally too chili for anyone else to enjoy. Maybe that’s my subconscious strategy so there is more for me? (laughs)
How did you come to be one of the featured medical students on Hopkins?
I was at one of our weekly surgery meetings, and I was talking and joking around with some people I’d never met before—I love meeting new people. Unbeknownst to me, they were producers of the show, and they contacted me later to ask whether I’d like to be featured.
What did you hope to achieve by being part of the show?
One thing that’s always been important to me is the fact that I’m a Sikh and I wear a turban. I always think of myself as not just representing myself, but representing all turbaned Sikhs—especially in places where there aren’t many of us. For people who have never met a member of our religion before, their impression of me might become their impression of all of us, so I’d better make a good one!
That’s why I agreed to do the Hopkins show. I don’t expect people to remember my name after seeing it. But the next time a viewer sees another person with a turban, I’d like that viewer to think, hey, I’ve seen a guy with a turban before—he was a doctor at Hopkins—and he was a decent guy, so maybe this guy is, too.
|Ranjit Souri (rjsouri [at] gmail [dot] com) teaches classes in improvisation, comedy writing, and creative non-fiction in Chicago.|