On Saturday, July 31, 2004, Steve Jobs, one of the greatest innovators of our time, was given general anaesthesia for a Whipple procedure at Stanford University Medical Center in Palo Alto, California. Whipple surgery, a complicated procedure for pancreatic cancer, involves removing the pancreas, stomach and part of the small intestine. When the surgeons opened his abdomen, to their dismay, they found that the cancer had already spread beyond the pancreas. They had to close his abdomen after doing modified Whipple, a less radical surgery.
Steve Jobs was diagnosed with pancreatic cancer in October 2003. A shadow was noticed in his pancreas during a routine CAT scan that he underwent as a follow-up to a kidney stone. His doctor recommended further work-up for the abnormal finding in the pancreas. Though hesitant, Jobs eventually relented to an endoscopic biopsy during which a tube is passed through the mouth into the stomach to get a piece from the pancreas.
The Stanford surgeons were jubilant with the result of the biopsy. Jobs had a rare islet cell or pancreatic neuroendocrine tumour, a less aggressive and slow-growing u that could potentially be cured with a surgical resection.
But Steve Jobs refused surgery. He did not want to open up his body. The man who could feel the pulse of a generation failed to sense the rattling of his own body.
One of the first calls that Jobs made after his cancer diagnosis was to Dr Larry Brilliant, an American epidemiologist, author and philanthropist whom he had met in 1974 at the Himalayan Ashram of the spiritual leader Neem Karoli Baba.
In his early twenties, Steve Jobs, the counterculture rebel and genius, spent several months in Nainital and wandered in the foothills of the Himalayas searching for the meaning of his existence. His fascination for Hinduism and Buddhism and search for enlightenment were not just a fleeting interest of a young man in the Hippie era. He practised many of the noble principles of Hinduism and Buddhism throughout his life.
As per Walter Isaacson, the biographer of Steve Jobs, his “magical thinking” may have defined his business brilliance, but may have been counterproductive in his fight against cancer. To the dismay of his friends like Andy Grove, a prostate cancer survivor and the brilliant CEO of Intel who strongly encouraged Steve to go for surgery and chemotherapy, “Steve was trying to cure his cancer by eating horsesh** and horse roots.”
Jobs was often guided by intuition in his business and life. “The main thing I've learned is intuition, that the people in India are not just pure rational thinkers, that the great spiritual ones also have an intuition.”
His intuitive approach dominated his decisions about cancer treatment as well. Jobs refused potential curative surgery despite the insistence of his wife Lawrence Powell and his doctors. Dr Dean Ornish, an eminent cardiologist and a leader in alternative and nutritional methods in treating illnesses, visited him and tried to coax him into doing the surgery.
But Jobs never wavered. He kept a strict vegetarian diet; consuming large quantities of fresh carrots and fruit juices. He tried acupuncture and even consulted a psychic whom he found over the internet. He also sought treatment from a doctor who practised natural healing methods.
According to Isaacson, “Steve Jobs's employees often joked that surrounding him was a “reality distortion field”, which allowed him to make his own rules, and conjure up new products for which there was no precedent or apparent market. His capacity to create the reality he envisioned—and convince others of it—was a large part of his business success.”
But the reality of cancer is unfortunately relentless and unforgiving.
His decision to finally go for the surgery, about nine months after the initial diagnosis, came in too late. A cancer, which had a potential cure rate of 80-90 per cent with appropriate surgery, had advanced beyond cure.
It was a Saturday morning. While waiting outside my son's music class, I got an email from Jackie Jansen who was working for a biotech company in North Carolina. She was desperately looking for an oncologist in West Virginia for her mother. She found me over the internet.
Jackie lives about 1,000 miles from her mother who lives in West Virginia. Jackie just found out that her mother had a bleeding ulcer in the left breast that needed immediate medical care.
Jackie was accompanied by her husband who was about three years older. Jansen told me that he had met his sweetheart at a Bible study at her parents' house. He was 13 and she was 10 years old. She was the most beautiful girl he met in his life.
“I never took my eyes off her since then,” he pulled his suspenders as he laughed.
“We have been married for the past 51 years and are blessed with two beautiful daughters,” she completed the story. Her pale eyes still sparkled when she looked at him.
“She has been using this powder on the wound which was given by our doctor in Florida.” Jansen took out several 5-ounce bottles from his bag and arranged them on my table.
“You know, he is a fine doctor. We have been seeing him for many years.”
I tried to remove the dressing from the large cauliflower sized tumour on her breast. The cotton dressings were stuck to the tumour. It was mixed with green powder and dried blood.
“I don't like doctors in general,” Jackie turned towards me as she spoke. As I peeled off the last piece of gauze, the tumour started bleeding profusely. It was a large tumour encompassing her entire breast and spreading to the chest wall.
“Do you have any pain, Mrs Jansen?” I asked.
“No, I am fine.” She looked at her husband. He was busy arranging the bottles.
“Is she taking all these medicines?”
“Yes, doc, but lately, the bleeding has been getting worse,” Jansen added.
“How long has she had this?” My nurse applied pressure to control the bleeding from a sprouting arteriole.
“I think about 10 months. Just by looking in her eyes, our doctor could see what was wrong with her.” He was still very impressed with the alternative medicine doctor that they trusted completely.
“Why don't you like doctors, Mrs Jansen?” I removed my gloves and washed my hands.
“When I was in my 20s, I had penicillin shot for sore throat, which almost killed me. I could not breathe and I collapsed.” Her eyes squinted as she completed the sentence. She never forgave that doctor and modern medicine.
“I never went back to a hospital other than when I had my two girls. That was about 35 years ago!”
“Doc, we believe in God. You know, he is the ultimate healer. He listens to us. You guys don't listen. You just write medicines.” Jansen kept his fingers folded across his chest as if in prayer.
“I fully agree with you. God is the ultimate healer, but I believe that God works through us. I will try my best to listen to both of you.” I took Jackie's hand in mine.
“I think you have a very serious tumour. We need to do a few tests before we start treatment.”
Blood tests showed that she was very anaemic from chronic bleeding which she had for a year. We did a biopsy of the tumour and a CAT scan. Fortunately, the tumour had not spread.
With each clinical visit, an excellent rapport grew between us. They even invited me to their farm house on top of the Blue Ridge Mountain.
I started her on an anti-oestrogen pill and did not use chemotherapy. Her tumour started showing dramatic response and her bleeding stopped completely.
Her daughter called me several times to express her gratitude. She is a molecular scientist, but her parents did not believe in the power of science. She knew that her parents were old school and it was going to be tough for them to follow medical recommendations.
When I saw the Jansens, my primary goal was to earn their trust. Without trust, none of the treatment plans would have been effective.
About five years ago, during my summer vacation in India, a five -year-old boy was brought for consultation. He was losing his teeth and had a persistent bad odour in his mouth. His parents had consulted many doctors including medical college professors, but with no avail. They were frustrated.
He was a slender, dark-skinned boy with a big smile. When he smiled, his pale toothless gums were exposed.
“We are thinking about starting homoeopathy as a last resort. We have lost all faith in the doctors.” His grandfather was in tears.
I clearly knew that he needed a biopsy to examine the tissue and make a proper diagnosis. I was worried about a rare form of cancer affecting the gums and jaw.
I called one of my friends who is a medical oncologist. He was kind enough to see the boy and offer treatment. After chemotherapy and surgery, the boy is completely cured. He is back to school. He comes to see me every year when I go to India.
The right diagnosis and treatment saved this boy. I am so glad that his parents did not give him homoeopathic treatment which has no scientifically proven treatment for cancer.
About 70 per cent of patients with cancer or other chronic illnesses seek alternative medicine. Many of these complementary or alternative medicines have limited scientific proof of effectiveness. But why is it so popular and widely used that even the brightest mind of our time opted for it when he was diagnosed with cancer?
It is puzzling, but not surprising.
We don't have the humility to admit the limitations of modern medicine. Many branches of medicine are still evolving. We are very good in fixing bones, curing bacterial infections, and controlling many chronic conditions. But a cure for diabetes, hypertension or many cancers is still farfetched.
We don't train our doctors to connect with patients in a very humane way. We follow the principles of the French philosopher Descartes to the core and treat humans as broken machines. We are more focused on curing the disease than healing the illness.
Modern medicine has turned into one of the largest profit-making industries in the world. As in any industry, the end points are often share values and balance sheets and not the well-being of the customer. This undermines the human element in the art of healing.
Many of the traditional approaches such as ayurvedic and Chinese medicines have proven to be highly effective for many chronic conditions. Even though they lack rigorous scientific proof, they have stood the tests of trial and error and emerged from centuries of application.
Complementary medicine, as the name suggests, is very reasonable and beneficial if used to complement conventional medicine. Yoga and meditation have proven to be very effective in many conditions including hypertension, arthritis or diabetes. But when complementary medicine is adopted as an alternative to standard treatment, without proper medical supervision and monitoring, it could be life-threatening.
All branches of medicine have their own merits and relevance. There should be a mutual respect and openness to different approaches. For each diagnosis, it is important to know which medicine or branch of medicine works best. We should not fall into the traps of false hope offered by alternative medicine.
In an interview to Fortune magazine, Steve Jobs clearly regretted the missed opportunity and the chance he took with his life.