Dr. Keshavjee is a renowned leader in Thoracic and Transplant Surgery. He is the current Surgeon-In-Chief at the University Health Network in Toronto Ontario, and has worked in the Cancer Clinical Research Unit (CCRU) of Princess Margaret Cancer Centre. In addition to his research at the Toronto General Hospital where he guides a team of scientists, he was named an Officer of the Order of Canada in 2014 to recognize his contributions towards the evolution of lung transplantation through history. In the early 1990s, there was a 50/50 chance of survival after a transplant. Today, there is a 97 percent survival rate, thanks to innovations by professionals like Dr. Keshavjee. His resilience and altruistic character is reflected in his aspirations of making the medical industry more efficient and accessible to all humanity.
“I’m a thoracic surgeon and I work on lung cancer, operating on patients with cancer in the chest and the lungs. My focus is on lung transplantation, so when lungs fail, these replacements can help save patients’ lives. And the pressing need there is really that there are not enough lungs to go around, so a big part of my research is on how to make donor lungs more useable and find better ways to repair lungs so we can transplant them.
Lung surgery is a very exciting and interesting area. I was fortunate enough to be here at the Toronto General Hospital (TGH) and University of Toronto when lung transplantation was still being developed, so I was able to get involved during its earlier stages. I was able to be inspired and get involved in the research to see how we can improve its current situation in the world.
I cannot remember when I decided that I wanted to play the role I have today, but I certainly did come into medicine knowing that I wanted to be a surgeon. Later on, I happened upon thoracic surgery during my travels as a medical student where I realized that this is a very fascinating area to work in, and I sort of grew up immersed in it.
As a surgeon, there is a large variety of different medical problems to deal with. Sometimes it’s cancer and you’re operating to cure them, while other times it’s lung failure and you’re giving new lungs and a new hope of life to somebody. Likewise, there can be complications such as an infection from trauma, hence there is a variety of different conditions we have to treat as medical professionals.
In terms of research, we have really been pushing the boundaries of new treatments and technologies. When we first developed lung transplantation it was very high risk, and so we only offered lung transplants to patients that were relatively young, under 50 years old. But as we got better and better at it due to advances in technology and breakthrough discoveries, it became less risky, and we were able to advance it to offer it to more patients. This removed the age limits, and increased the availability.
Thus, I trained at Sick Kids as part of my role as a heart surgeon. I certainly operated on children, and it is of course more emotionally challenging. But overall, the surgery is the same- we’ve done lung transplants on babies 6 weeks old, adults 79 years old, and everything in between. The children bounce back in general, as they have more energy and physiological reserves.
Sometimes some of the most impactful moments in my career are when you operate on someone who most people felt were inoperable. To put it into perspective, say there is a patient with advanced lung cancer and you have to do a risky and challenging operation, and you do it regardless of failure or loss, because of hope they may survive. And you know I had many opportunities like that, where the patients were basically found to be inoperable, and yet I’ve operated. Then I have seen them in clinics 10 years later living a normal life, knowing that had I not operated- they would have been dead. And that is pretty gratifying, when you’re able to identify some obvious cases like that, that it was just that dramatic but equally as significant. In fact, it’s even more dramatic with lung transplantations because you know that they’re going to be dead in 6 months. The other day, I met a woman whom we performed a lung transplant on 29 years ago. She would have been dead, but now she’s working full time and living her life to its full potential. That’s pretty amazing.
Though it is not part of my research, I believe there is a looming need for the Canadian health care system to have better technology transfer for patients, similar to one electronic medical record for the whole province. It’s not that people are not technologically inclined, it’s that the system was not set up and pushed. For example, the whole of Finland and Hong Kong are on one electronic medical record, but not Ontario. That’s what E-health was supposed to do. We should definitely follow the other countries’ examples.
One stigma in health care is the stigma of lung cancer, in that it is something that you brought on yourself with smoking. And so people felt blamed by it. On the other hand, most people that are getting lung cancer today started smoking when it wasn’t so well known about the link between lung cancer and smoking, and they got addicted. Having said that, with teenagers starting to smoke these days, there is no excuse for that. Moreover, people are smoking cannabis, which is as detrimental as multiple, unfiltered cigarettes, and that’s a huge problem. To think, what does that do to other aspects of your body, like your ability to function? There are still many unanswered questions related to the stigma of substance abuse, and I’m concerned about that in terms of what it’s going to mean to society. I do think we need to educate people. There are a lot of practises in society that are not good, even though they are available. I think it’s important that we do our best to spread awareness. Just like with cigarettes, it may make a difference by educating the public in school that we shouldn’t be smoking."
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"I love my job because I find it very exciting. I think it’s challenging and every challenge is different, so it’s never boring. I think that saving lives is phenomenal. The other part I appreciate is the fact that I’m involved in research, and so I am actually figuring out how to transform current models and improve them in the time to come, which is equally as exciting. Being able to help others and make a difference keeps me going.
If I would to give young aspiring students advice, I think the important thing is to find out about the different careers and see what you like. Choose something that you enjoy doing, because once you love something it really doesn’t seem like work. The second steps is to do it well. Whatever you do, devote yourself into performing your duties at the highest level. And I think that’s really important- it doesn’t matter what you do in life, you should give it your all and put your soul into it.
A lot of people ask me, ‘how do you take the pressure, you’re operating, you could make one wrong move and the patient could die from that right away. Don’t you find that stressful?’ But interestingly, operating on patients is the least stressful thing in my life. I’m trained to do it, and you get a lot of gratification from doing it- it’s exciting and interesting. Compared to worries like ‘will I have more time, did the patient cancel’, or problematic issues about resources- those are the aspects of my job that are stressful. Doing the surgery in the operating room is actually fun!
In terms of the artificial lung technology, they are devices that can support people for periods of time. It’s not something that I developed myself, but I use the technology to support people who might die because they can’t get a lung in time, and we support them with these artificial devices until we get a lung. And that’s another very exciting part, because even though we do lung transplants and it’s a miracle, there were so many times when we saw people that were so sick they just couldn’t survive long enough to get a lung. Now, we can put people on these devices and only waiting 6-7 months, so we can get them to a successful transplant. That’s a massive and incredible change. Currently, we can have people walking, even exercising while on their device, and soon we could have people going home with an artificial lung. Nevertheless, the technology is unfortunately still not developed enough in terms of being a permanent support solution. This really emphasizes the importance of biomedical engineering, and the growing influence of bio and info-technology in our modern society.
With my work in transplantation, I believe we definitely should push the idea of organ donation, and it’s amazing. It’s really important to get the story out there, on how much good can be done by donating your organs, and how many lives can be saved. I think more people would donate if they just knew the benefits of organ transplantation and donation, and if we just dispel the myths or concerns that they may have.
My work schedule is pretty busy, but the days are generally very different. For example, on Monday I would come and have an early meeting at around 7:00 am, and then I do some endoscopy and bronchoscopy. Later, I go to clinics and see new patients. I might have another administrative meeting at the end of the day.
On Tuesdays I operate all day, so I might have a morning meeting at seven and then I operate from around 8:00 am to 6:00 pm, with another meeting afterwards. Wednesdays are my research days where I go to my research lab and I work with my students and fellows. I go over results, troubleshoot experiments, develop new experiments, work on grants, and basically work purely on the research side of medicine. So it really varies from day to day. On Thursdays, it’s more of an administrative day, where I perform tasks to run the department of surgery at TGH. But again, it’s rewarding and exciting: I get to contribute to running the hospital, but also look after the patients and lead research. It’s a privilege to be doing all that I do for others. ”
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