By Todd Neff | UCH Insider
Akshay Chauhan, MD, sits outside at the Lowry Beer Garden, making quick work of a White Rascal, focusing more on telling his story than on the impact of this beer on the 60-mile drive ahead.
Chauhan is a third-year resident with the University of Colorado School of Medicine’s Department of Surgery. In the summer of 2016, when Chauhan completes his surgical residency and sets off into the world yet again, he will be 40 years old. Most departing surgical residents are closer to 30. But then, few departing surgical residents have done 3,000 surgeries at a hospital 400 miles from Katmandu, Nepal. Nor have most of them already completed a surgical residency and a transplant fellowship.
Everybody’s got a story. Some a writer has to work a bit to make interesting. Others, like Chauhan’s, unwrap themselves like magical gifts as the sun sets over Hangar No. 2. His is a story of determination, perseverance, and a certain flavor of faith combining to spell out yet another sentence in the annals of the American dream. As he will be the first to tell you, his sentence remains incomplete.
New Delhi. Chauhan was born in New Delhi, India, the third of four children. His father was a general in the Indian military whose sons still calls him “sir,” Chauhan says. Akshay went to high school at an Army Public School in New Delhi. His older brother became a military pilot, his younger one a Special Forces officer. Chauhan himself has a directness and intensity familiar among military officers, and he had designs on the military route. Flat feet derailed those plans.
He was a strong student, however, and was accepted at the All India Institute of Medical Sciences in New Delhi, graduating in 2001. He met a medical student named Lakshmi there. They got married. He followed up with a three-year surgical residency; Lakshmi did her residency in internal medicine 200 miles away in Chandigarh.
When he finished his residency, Chauhan went into solo private practice as a general surgeon in New Delhi. This involved hanging out a shingle and marketing his surgical services. He was making a living, but he “wasn’t busy at all,” he says. He was a surgeon who wanted to do surgery, but he didn’t want to market himself and didn’t like asking for money. He also developed a distaste for the Indian medical system, which required advance payment for surgical services rendered.
When prodded, Chauhan recalls an example: a patient who had been in a motor vehicle accident and was bleeding internally.
“Before I could put the chest tube in, the patient was supposed to pay the cashier,” Chauhan says. “It was about $1,500, a ton of money in India. He would die without it.”
The patient managed to pay. Chauhan inserted the chest tube. Soon, he started looking for an exit.
The World Health Organization (WHO) provided one. The WHO was hiring at the 700-bed B.P. Koirala Institute of Health Sciences in Dharan, Nepal, 400 miles east of Katmandu, not far from the Everest base camp. It paid about $4,000 a month, or roughly his resident’s salary in India. Lakshmi was hired, too. They left New Delhi for Dharan in early 2005 with a son not yet two years old and Lakshmi pregnant.
“We didn’t know what we signed up for,” Chauhan says.
Dharan. There were positives. “It was like a young man’s dream – big ORs, being treated like an attending surgeon, and we were busy,” he remembers.
He did all sort of surgeries – including many pediatric cases. He documented some of these in case reports for publication in the Journal of Pediatric Surgery (JPS). This involved writing up manuscripts on a typewriter and taking the printing manuscript and the photos 10 miles to the nearest post office for delivery to the journal’s Indianapolis, Ind. offices. Over about four years, Chauhan estimates he performed roughly 3,000 surgeries. He knows for certain he amassed 36 publications in the JPS.
There were also negatives. Nepal was in a civil war, with a Maoist insurgency battling the monarchy. Maoist soldiers weren’t allowed in a government hospital. Four or five times a year, a man would appear and say, “Doctor, you’re expected in that corridor in 20 minutes.” Chauhan knew he had no choice, but describes the encounters as being “escorted” as opposed to “kidnapped.”
Chauhan and his “escorts” would head for the mountains, where he performed surgeries under rudimentary conditions. Inhaled isoflurane served as anesthesia; there was a ventilator, but no one knew how to use it. Some of the wounded couldn’t be helped. He spent the night, more surgeries followed the next day, then he was escorted back to Dharan.
“The first time, I was scared, but they took good care of us,” Chauhan says. He never told Lakshmi where he was going. “But she knew,” he says.
He took a two-month sabbatical to work in Jaffna, Sri Lanka, where the fighting between government forces and the Tamil Tigers, another revolutionary organization, was less intense than in Nepal, but still produced plenty of surgery patients. By then it was 2007, and Chauhan and Lakshmi sensed it was time to move on.
Cincy. That year, he met Richard Azizkhan, MD, the surgeon-in-chief at Cincinnati Children’s Hospital Medical Center, at a conference in New Delhi. Azizkhan invited Chauhan to Cincinnati.
“I had no idea about the United States,” Chauhan says. “I had never flown across the Atlantic or the Pacific.”
Nonetheless, he flew to Cincinnati in November 2007 as a research fellow and passed his U.S. Medical Licensing Examination. Lakshmi and the kids followed six months later. Given his experience, Chauhan had high hopes of being hired as a pediatric surgeon when it was time to move on. He interviewed 18 times. He wasn’t a finalist even once. The problem was that he wasn’t board certified in general surgery in the United States. The Indian credential and all that experience meant nothing here.
“I gave up my pediatric surgery dreams,” he says.
Memphis. Instead, he was accepted for a two-year transplant-surgery fellowship at the University of Tennessee Health Science Center in Memphis in 2009. In addition to performing liver, kidney, and pancreas transplants, he published four papers, one of them good enough to land him a Vanguard Award from the American Society of Transplant Surgeons, given to the two best research manuscripts in a given year by young investigators.
Chauhan found he loved the challenges of transplant surgery, but as the second year wound down, he knew he still wouldn’t be hired without board certification in general surgery.
“So the only way to survive in this country was to go back to residency, which I had done 10 years ago,” he says.
One of his mentors in Tennessee, Kian Modanlou, MD, had done his surgical residency at the CU School of Medicine. Modanlou called CU surgeon Mark Nehler, MD, the Department of Surgery’s vice-chair for education. Chauhan spoke once with Nehler on the phone. That and Modanlou’s recommendation were enough to land a preliminary spot with the program – a one-year trial, in essence, that would be extended if things worked out. Chauhan understood both the opportunity and the challenge ahead in Colorado.
“I drove all the way from Memphis two days before the orientation,” Chauhan says. “Every time I stopped, I wanted to turn around and go back.”
Aurora. First-year surgical residents are known as “fleas.” Chauhan, however, had far more experience than the “experienced” residents ordering him around. Sometimes international MDs entering residency again struggle because they’ve already been independent elsewhere, but Chauhan’s attitude helped him through. He recognized of the military hierarchy in the program, which helped him navigate it.
When things got especially tough, he reminded himself: “Nobody told you to do this, right?”
“That was never an issue with him,” Nehler says. “And his knowledge base is incredible.”
He was a good intern and earned a second preliminary year. In addition to the on-the-job demands that year, he and then chief surgical resident Max Wohlauer, MD, another preliminary resident, entered the Surgical Jeopardy competition of the American College of Surgeons. They were both, Nehler says, “sort of walk-on free agents nobody else wanted.” But Chauhan and Wohlauer exploited their knowledge base to win the competition in October 2013.
Chauhan’s on the full residency program now, in the third of five years. He’s got a new Surgical Jeopardy partner and wants to repeat as champ.
Fort Morgan. Maggie Hodges, MD, a first-year surgical resident Chauhan describes as “phenomenal,” has arrived at the Lowry Beer Garden, draining a double Moscow Mule. Chauhan repeatedly offers to buy her another, but she’s working at 6 a.m. tomorrow, a Saturday.
“We all very much look up to him, not only for the trivia that is amazingly packed in there, but also for the art of surgery and the art of patient care,” Hodges says. She says Chauhan’s experience in places with little in the way of diagnostics and labs makes him more attentive to patients’ psychological needs.
“It’s a much more holistic approach to patient care, one that should be emphasized but I think is often overlooked in the haste of surgical training,” she says.
Chauhan says he doesn’t yet know where he’ll go when he finally has his board certification in general surgery in hand. He’s interested in his kids having a good education, in watching them grow up to be good people. Ultimately he would like to serve both here and overseas – maybe with the WHO again, “not out of compulsion, but as a board-certified surgeon.”
It’s getting late. The Rascals and the Mule long gone, Chauhan stands. Lakshmi and the kids, now 11 and 8, are in Fort Morgan. She works at the Colorado Plains Medical Center there. Visa requirements gave her a choice: either go back to India or work in an underserved community here. Chauhan keeps an apartment in Denver and drives the 60 miles when he has a day or two off.
Chauhan’s former medical-school classmates in India drive expensive cars. He says he’s worn the black fleece he’s wearing for four years, the jeans for six.
“A lot of people come here for money,” he says. “But that’s not the point. You’re among the best here. The American surgeons are the most aggressive in the whole world. They dare to do things that other people don’t.
“I came to the United States to look for a better future,” he says.
He will finish his second residency; he will earn board certification. He knows this. And he knows that American dreams don’t happen overnight.
