For Doctors Day 2015, Kanti Rai, MD, reflects on a personal and professional turning point.
During his career of 50-plus years, Dr. Rai has combined landmark clinical research, exceptional patient care and a steadfast commitment to education and mentoring.
It all began in 1958, when little girl drew Dr. Rai to research and motivated him to invent the first staging system for chronic lymphocytic leukemia:
While I was the chief resident in pediatrics [at North Shore Hospital], I would take care of children who were going to be admitted today and children who were already in the wards. On call one night, I was told that a three-year-old was coming in at 2:30 or 3 in the afternoon, so I made myself available.
I still remember this three-year-old, who was the picture of health. She was having some bad blood counts, and the hematologist who had seen her an hour or so earlier felt that she should be admitted, so her parents came directly from the hematologist’s office.
I took the [medical] history — her name was Laurie — and talked to the parents, examined her. A few hours later, the senior doctor, the hematologist, asked me whether I had seen Laurie and what I thought. He had already sent a little piece of paper with her parents, where he drew a question mark with the words “acute leukemia” before it.
I had done some preliminary work, but I had not made a diagnosis on a child with leukemia before. I had seen children with leukemia and had taken care of them, but not from the get-go.
I hadn’t ordered a bone marrow test on her, so [the senior doctor] recommended doing one that night. He took me by the hand, as a good teacher and mentor, and together we did a bone marrow test. Then he took me to the basement, into the laboratory — it was close to midnight — stained the slides and pulled out from the box some examples of normal bone marrow slides.He put them side by side with Laurie’s slide. It was quite a dramatic session — that is, to see a picture of a deadly disease with such dramatically angry, bad-looking cells, compared to normal cells.
Shortly after, we made the diagnosis of acute leukemia in Laurie. When I asked how we would treat her, my mentor said, “Well, we don’t have too much to offer,” and told me the medications that would be started.
When I asked for the prognosis of this little girl, he told me, “She’ll be dead in six months.”
I thought, “What a heartless son of a bitch this evil character is.”
Of course, he was none of that. What he was doing was telling me the statistics in children’s acute leukemia at that time, in 1958, and that anger kept me going.
During the next two or three months, Laurie was discharged, readmitted and discharged again. I became somewhat attached to the little girl. You know, we all, as doctors, do become attached to our patients, but this was much more than that.
One day, Laurie died right in front of me. I was right there in the room with her parents, and that was a very, very affecting, bothersome event in my life.
My teacher, Dr. Arthur Sawitsky, who was head of hematology at Long Island Jewish Hospital and also practiced at North Shore Hospital, watched everything unfold and advised me to go into hematology at Long Island Jewish. This sad event became the catalyst for my career.
Dr. Rai is the chief of the Chronic Lymphocytic Leukemia Research and Treatment Program at the North Shore-LIJ Cancer Institute, and an investigator in the Peter Karches Center for CLL at the Feinstein Institute for Medical Research, and the Joel Finkelstein Cancer Foundation Professor of Medicine at the Hofstra North Shore-LIJ School of Medicine, where he also serves as professor of molecular medicine.