Ketayun A. Dinshaw, MB
Question: Tell me about how you decided to get into radiation oncology.
Dr. Dinshaw: Well, it was just circumstances. Do you remember the head of anesthesia in CMC, Vellore, Martin Isaac?
Question: Yes.
Dr. Dinshaw: And Prakash Kandouri?
Question: Yes.
Dr. Dinshaw: I was in my second year of medical school when most people had, by then, decided what postgraduate training they wanted to get into. And happily in those days we didn't have to have exams and all the tensions that people have now for postgraduate training. Whatever you wanted to do, you just walked in and registered for. And in my immediate circle of friends, for some reason I was the only person who hadn't committed myself to any postgraduate degree. And the reason was I think that I was really interested in surgery.
Question: Dr. Khandouri was a surgeon.
Dr. Dinshaw: He was a surgeon. He was a cancer surgeon. So I was working in that unit, and I was quite encouraged to go into surgery both by Dr. Khandouri and Dr. Fenn, if you remember he was the pediatric.
Question: Yes, I remember him. A.S Fenn - he was supposed to be the fastest surgeon in the nation.
Dr. Dinshaw: Yes. So both of them were only too happy for me to get into surgery. But for some reason, there was a little bit of a clawing nagging doubt in my mind, and I suppose it was a question of having to claw your way up to the top in those days, as a woman doing surgery. Today I think it's silly, but at that time it was quite prevalent. And it was just sort of a nagging doubt which didn't make me go inside of the dotted lines essentially with the result that I hadn't decided what to do. What I did not want to do, I did not want to do gyne, I did not want to do pathology, I didn't want to do a non-clinical radiology job or anything. I wanted to be with patients. That was really important to me. I wasn't very keen on general medicine. I liked specialties the best. So that sort of dithering went on in my mind -- what to do, what to do. And Martin Isaac who was the head of anesthesia was a wonderful person, had guided me on many occasions and he and Prakash Khandouri were more concerned about me not doing anything than I was myself. And the last six months of my senior residency course I was sitting with them in the operating theater having a cup of coffee during or after surgery. And so the same discussion, come on now, you'd better get on with it. You can't just put off the decision anymore. And he just said, "Why don't you do radiation oncology?" And he was aware of it because, for one thing, Padam Singh was his neighbor and, secondly, that I was in this cancer surgery unit, and Padam Singh was there all the time. Radiation oncology was a distinct specialty department from radiology, unlike most other centers in the country. Remember, this is 1967-'68, so it's really back when it was usually under radiology. But it was distinct from radiology. So he said, "Look, it's a clinical subject, you're working with surgeons, you have a little OR and what to do every now and then, coming into the OR. The surgeons are going to be around and why don't you do this? It's something very new because very few people are doing radiation oncology. Of course, physics is important. But why don't you think about it?" So I just instantly said, "Yeah, I think that's a good idea. Why not?" It happened just like that. And I remember it was in the evening because it was an emergency surgery that was going on, so it was about 6:00 or 7:00 in the evening when all this happened. And the things you remember. And I said, "Yeah, why not?" The next morning, the hospital started working in the morning, I was marched off to Dr. Padam Singh's office and he was also just informed. No “by your leave” or “would you like to consider” or nothing like that. He was just informed that I had to join up for radiation oncology. And it happened just like that.
Question: Did Vellore have a residency program?
Dr. Dinshaw: Yes, they had a program.
Question: Even in 1967 they had it already?
Dr. Dinshaw: They had that. But the only thing was that my family was more concerned that if I stayed on in Vellore, I would remain a South Indian villager all my life. I had no problems with that. I would have been quite happy to remain there for the rest of my life, left to myself. But I was more than just comfortable in Vellore, I got along and it suited me just fine. But they were determined that I had to expand my horizons. By then I was already seven years in Vellore. So I had to expand my horizons beyond the village of Katpadi and Bagayam. So it was sort of just determined that I should go away somewhere and see the world and do something more than just live in Vellore. So then I decided to go to England and, again, with Dr. Padam Singh’s support, I got a placement arranged for me in Cambridge. But I had to wait for a couple of months to go there, so I spent about three or four months in Newcastle upon Tyne again through Dr. Padam Singh. He arranged for that. So I started radiotherapy in the Newcastle General Hospital in Newcastle upon Tyne. And then there was Mr. Bill Russ. He was the consultant and he went on consulting. So I started radiotherapy under them, but I was there only for three or four months. And then when the position in Cambridge was available and I moved to...
Question: You transferred there.
Dr. Dinshaw: Yes, I transferred there. It was arranged from the beginning. And in Cambridge, this professor Mitchell of Synkavit fame, you know that radiosensitizer, - that was Professor Mitchell's hobby horse. And hyperthermia, those horrible cylinders they put people into and gave radiotherapy, cancer of the cervix using hyperthermia. All that happened at Cambridge.
Question: How did you get into medical school? You went all the way from Calcutta to Vellore. How did that happen?
Dr. Dinshaw: Well, again, I think my mentorship more than anything else. I was in this school in Calcutta and the principal was a Christian missionary, Ida Felshlier. She was an American missionary. I knew I wanted to do medicine and there was never any controversy about that. But it was not very easy getting into medical school at that time because you had to be a Bengali, and you had to know Bengali. And as usual, the language is a problem in each state. So getting into medical school was not all that easy. It was thought that it was not going to be. I'm sure I would have got in. I would have got in. There were four medical schools in Calcutta, my eldest sister was in one of them, and I'm sure I would have got in. But there was a little pressure and a little worry that you just may not get in, for whatever the reason, which I don't know exactly. So it was the principal of the school who recommended that I should apply to CMC, Vellore. I don't think we were very much aware of CMC, Vellore at that time. I certainly had not heard of it. But then, you started reading, you sent for the data, information and you got all the prospectus and things like that and we just came through the process of applying.
Question: Did you have difficulty learning Tamil in Vellore?
Dr. Dinshaw: Yes, I think so. I mean, it wasn't easy. It was the only time when you had to learn Tamil, you had to learn Malayalam, you had to learn Telegu, and also, Kannada and the best part was the first year when we were doing our pre-med. They had something called a pre-med there that we had to spend. An American director, Dr. John Carmen, he used to hold these language classes for all of us.
Question: I remember that.
Dr. Dinshaw: And it used to be a scream. I mean, it was more just fun and jokes than really language. It was impossible to learn from him, but it was brave of him to take us all on these four Indian languages to teach us. I don't think I was fluent in Tamil. It was easier to understand Tamil than to speak it. But little colloquialisms, they are there everywhere, you know, vernacular. We managed, - no great problem.
Question: And then when you went to Cambridge and you finished your FRCR.
Dr. Dinshaw: Oh, yes. So when I finished my FRCR, that was the biggest shock in my life -- the first time in my life I failed an exam in the final FRCR, and I thought I had done very well because it was no problem, the examiners were very cordial, the orals went off very nicely. Of course, clinicals, orals and all- not much of a problem, and I thought it was hunky-dory and I was sure I had passed. And when I discovered that I hadn't passed, it came as a real shock to me. This was in '72, I think. And I was mortified that I had failed an exam. And my initial reaction was just to give it all up and come back to India. This was my immediate reaction because I was so mortified of having failed. I had a very nice tutor in Cambridge and we were assigned tutors. I had a lovely person called John Terrance Wheeler. He was my tutor. And he, I think, was very, very disappointed. I was mortified that I could actually fail an exam. And it was only because of their support and their encouragement that I decided to do it again six months later. So I did it again at the end of November 1973. And I remember the exams, the club dinner, you know how the faculty dinner you have, the faculty dinner. And I remember it was the 16th of November and the reason I remember is because it's my birthday. And I had passed the exams, and by the 18th of December I was back in India because I knew that I was just going to finish my training. I wanted to come back and the original idea was to go back to Vellore. There was no question of going anywhere else or doing anything, so I didn't even bother to look for a job or pass my CV around or anything like that because I was just going straight to Vellore.
Question: And then what happened?
Dr. Dinshaw: Again, as the rest of my life, just circumstances. You just move along and circumstances draw the road map for the life. I arrived in Bombay because I had a younger sister who was living there at that time, so from England I came to Bombay just literally to meet her. They were both doctors and she and her husband were doctors, so I first decided to spend some time with them before I went to Calcutta and on to Vellore. And while I was there, we visited an elderly gentleman who was a colleague and friend of my parents, of my father – an elderly person. And it was just a courtesy call to visit him. We had no other intention or agenda in mind. And by talking to him, he discovered who I was and what I was doing, training and all that, and he said, "Oh, you're not going to see Dr. Jussawala?" And I never heard of Dr. Jussawala before or Tata Memorial Hospital, to be quite honest. I had no sort of idea about the hospital or Dr. Jussawala, who happened to be, at that time, the director of the hospital. So I said no, I mean, it wasn't on my agenda at all. I was just making a personal private visit in Bombay. So he said, "Oh, you've got to meet Dr. Jussawala. You're in Bombay, you must go and meet him and you must visit Tata Hospital." So he fixed up an appointment and, not to disappoint this elderly person, I went along with it. I said, okay, what's the harm in meeting Dr. Jussawala? I had no clue who Dr. Jussawala was -- who, incidentally, is one of the senior-most oncologists of the country and who is one of the four people who had started Tata Memorial Hospital in 1941 -- the original four. He was the last of the original four.
Question: So who were the four? Dr. Borges, Dr. Jussawala…?
Dr. Dinshaw: The senior-most is Dr. Paymaster, then Dr. Borges, Dr. Meher-Homji and Dr. Jussawala, one of the youngest of them. And they were the original four who had been sent for training, and they were brought back as the original team to start the hospital. And, by now, the others, I think, had died and Dr. Jussawala was the last. No, Dr. Meher-Homji was alive. He was alive still, but not doing too much in practice, but Dr. Jussawala was alive. And Dr. Desai was the director of the hospital and Dr. Rao was superintendent, or something like that. The three of them were there. Jussawala, Desai and Rao -- none of whom I knew of or had any contact with. So I get this appointment fixed up to meet him and I walk into the hospital. I sat outside where the garden is for an hour, because I was early and wanted to see these crowds moving around and just familiarize myself with the geography of the hospital before I met with Dr. Jussawala. And this is in December of '73. And we just had a general chat. He asked me to send my biodata to him, the official CV, and that was it. We just had a little general chat and I pushed off, I went out to Calcutta. And I decided to be on local holiday before I joined Vellore. So I went off to Delhi. And, I think about two or three months later, I was staying with my elder sister in Calcutta. So she gently approached the subject and it was about time I gave up being on holiday, and thought of getting a job someplace. Having left and gone away to England, then coming back and traveling around India, I have to admit that I realized that there was a big world outside Vellore. Vellore is a very narrow constricted world, and it dawned on me that there is a big world outside and I should really exercise options of that kind. And the only option was Bombay. And I think it was February/March or something by now and there was no reply from Dr. Jussawala. He hadn't written to me or said anything. So I wrote to him and I asked him what was the situation? Was he really keen or interested or what? So upon that, they called me in for an interview to Bombay. I came to Bombay for an interview and Dr. Pinto, who was the head of the department of radiotherapy, was there. And, of course, Dr. Desai, whom I met for the first time, Dr. Jussawala and Dr. Rao were also there. So they interviewed me and, if I remember correctly, Dr. Sanyal, he was another radiotherapy student here. He was interviewed with me there, so he had also been called for the same interview. And we were interviewed for assistant radiotherapist and, at that time, it was still a joint department with radiology, because Dr. Pinto was a radiologist who practiced radiotherapy. But he handled both sides -- the radiology side and the radiotherapy, so it was a joint department in those days. The interview wasn't very good. It was a very, in fact, traumatic interview and I was very upset the way I was spoken to by Dr. Pinto and I was all ready to leave and just go away. But the next day, Dr. Desai asked to meet me again, called me back to his office to meet me and I didn't know who he was at that time. But he was the superintendent, so his secretary called me in and asked me to come over to meet him. And very, very graciously, all he did was apologize for the interview and then I realized it was a bad interview. It was not only me who felt that, but there were other people also who realized it was a bad interview. And so he apologized for the interview and said, “Well, don't take it amiss. It's just his personality and the way he talks. So don't take that amiss.” He literally just apologized for what had happened the previous day. I thought that was very, very nice of Dr. Desai. I didn't know him, he didn't know me, and that's what happened. It so happened that I got the job and I was employed, and I joined, if I'm not mistaken, the 21st of May.
Question: Of '74 now?
Dr. Dinshaw: Seventy-four.
Question: Now how many other people were already there in the department other than Dr. Pinto? Was Dr. Hingorani there?
Dr. Dinshaw: Yes. There was Dr. Hingorani, Dr. O.P. Sharma and Dr. Mukaden. They were essentially the radiologists. O.P. Sharma and Dr. Mukaden were the radiologists, and then there was Dr. Pinto. And before me, I think there were just registrars. They were not on the staff. It was Dr. Bhalavat and Dr. Chaudhary. I think they were registrars. Then Dr. Hingorani, and then I was recruited.
Question: And then where did your career take off from there? Because you became chairman of the department, although there were a lot of people who were ahead of you, so there must have been something phenomenal that you received…
Dr. Dinshaw: No, not really. The other department wasn't very advanced at that stage when I joined, believe it or not. We had three deep X-ray machines, one ghastly cobalt machine called Janus which was an insult to our intelligence to be dumped with a machine like that, which was apparently created only for developing countries. I considered it an insult to our intelligence. And we had a cobalt junior machine. I think it was a 40 centimeter SSD or something like that.
Question: You had a telecesium.
Dr. Dinshaw: And then the telecesium. So that was it. No decent cobalt machine, no decent simulator, no decent treatment plannings, no system at all really. No treatment planning, nothing.
Question: Now, Vellore had all the treatment planning system and simulator at some point?
Dr. Dinshaw: Some semblance of it. Not what we know as we know it today. But some semblance of it.
Question: And then what happened?
Dr. Dinshaw: So we started radiotherapy. Oh, yes, and for intra-cavity we had what they call a cobalt bomb which actually used to be inserted by surgeons. It was the surgeons who used to insert all the pre-loaded brachytherapy, both radium and cobalt. It used to be inserted by the surgeons without anesthesia, without packing, without anything. And it was just X number of hours - the dose was calculated by that - which absolutely horrified me. There was no beam positioning system, no sort of masks or molds or anything. And it was bad to put it mildly.
Question: And then you had a vision for the department? Is that how?
Dr. Dinshaw: No, I didn't have a vision. I was just working at it, a young doctor, just come back from England. I don't think I really had a vision. I can't claim that I had a vision. We were just told to start working and I worked. For six months I didn't have an office table and a chair. So my biggest challenge was to get a table and a chair for myself. That was a challenge. So there is no vision as such.
Question: But by 1984 you were having a new department and…
Dr. Dinshaw: No, 1981. Again, this is circumstances that Dr. Pinto retired in 1981. So it was a very quick opportunity for me and the committee recommended that I take over as the head of the department in Dr. Pinto’s place. Because Dr. Hingorani was 17 years my senior, it caused a lot of heartburn, and quite rightly so. I quite understand the heartburn. But he was a great sport. He was a very sporting man. Others were not very happy about it, but he himself was very sporting about it, my having taken over. But I decided that I didn't want radiology on my plate, so I was very keen that the department be officially split into radiology separately from radiotherapy and radiation oncology. So 1981 officially, on my recommendation, it was finally demarcated into two different departments.
Question: And what else did you do after that? I know that by 1984 you already had new machines because that's when I joined. So you had the Theratron…
Dr. Dinshaw: Yes, very quickly with the support of Dr. Desai who was the director by then, because Dr. Jussawala I think he retired.
Question: He had just retired.
Dr. Dinshaw: Yes. So with the support of Dr. Praful Desai, who really was my mentor from day one and remains so today and extremely supportive and helpful. Very quickly we decommissioned the three deep X-ray machines, we decommissioned the Janus, we decommissioned the cobalt junior and I got the Theratron cobalt at that time into the department. Then I think we got a simulator, if I'm not mistaken, and then slowly, slowly, but in quick succession. I think in 1984 we didn't have a linear accelerator, did we?
Question: You did. You had the Mevatron and the Clinac 600.
Dr. Dinshaw: In 1984?
Question: Yes.
Dr. Dinshaw: Really? That early?
Question: And between '84 and '85 you bought the Alcyon.
Dr. Dinshaw: Yes, that's right. So we got the first Mevatron machine in the country because the President of India had lung cancer and was discovered to have a coin shadow in his lung. And on the argument that there was no accelerator in the country -- not that he was going to have radiotherapy, he was going to have surgery -- but we made a case for it to the government that you need modern treatments and you have modern technology and the president had to go off to Memorial Hospital to have his treatment because we didn't have anything in the country. So on that argument, both Tata Memorial Hospital and AIIMS were given funding for a linear accelerator. So we got that because of that, and then we got a simulator and the treatment planning and then we got the after-loading, the brachytherapy Selectron unit, the first one, and then everything started to come. So you know what I put it down to? To circumstances and grabbing opportunities at the right time. You have to be ready with what you want. I had this habit wherever I traveled or went anywhere or read in the journals of something that we needed and we should be doing. I used to get all the information, all the technical information, all the specifications, the budgeting, and I would just file it. I would just get information and file everything. And more often than not you had to produce this information at a moment's notice because there would be some funding or we would have some money here or something there. And at the last moment somebody would ask you if you need anything, and I would just produce the information that I had from a file because it was all filed and kept ready.
Question: You already had a treatment planning system by 1984. So how did you go about changing that? Because in Vellore, in the late '70s/early '80s they were still using hand-drawn isodose contours.
Dr. Dinshaw: Yes. Yes, that's right. I mean, you train like that.
Question: In medical school. By the time I came to you, you had a treatment planning system.
Dr. Dinshaw: So all this just happened in the middle '80s.
Question: Where did you take the hospital from there?
Dr. Dinshaw: The next important thing that I did was to get an MD degree. For radiation oncology there was no MD. It was joint radiology and radiotherapy.
Question: You had to petition the University of Bombay and ask them.
Dr. Dinshaw: I had to go through the process of applying and putting in applications of this and that. So we did that and I think we got an MD created for something like that, and then we started registering the postgraduate students of which you were in the first batch, plus three or four people.
Question: Yes. And once you had the department set up to go towards a 21st century department, we were already talking about the end of the 20th century by that time. What else did you then start? Because, at some point, you did more than take care of Tata hospital.
Dr. Dinshaw: The most important thing was that I networked with all the other disciplines at Tata Hospital. There was no concept at that time of doing protocols, of having joint clinics, of being considered an equal partner. There was no question about it and quite rightly so, a surgeon-dominated hospital. In fact, the surgeons used to mark the portals for where radiation was needed. They would even do the brachytherapy. They would say give two more fractions or one less, or whatever. So they would decide, they would do the follow up of the patients who were being treated. So it was a very, very surgically-oriented hospital. There was no medical oncology at that time, and radiation therapy was certainly not evolved into what it should have been. So I think maybe I had a role to play in that because the best thing I did was to make friends with the surgeons. Dr. Desai, of course, was my supporter over there. Dr. Murli Kamath was another very nice and supportive person in the gynecology field. And while he was also a very dominant surgeon, both of them were very important dominant surgeons. I think they recognized something in what I was saying, and they allowed me to put my foot into the door. And very quickly we were considered equal partners. So we sat at this joint clinic, and then I had this thing of not wanting them to come to me. I will go to them, go to their offices, have joint clinics, take patients over there. You don't have to have an ego about these things. You have to just do what needs to be done without any legal.
Question: So you felt politically it was better for the radiation oncologist to go to a surgeon…
Dr. Dinshaw: Yes, that's the best way to have done it. You have to bring them over. And finally my favorite adage which I'm sure you've heard many times is that if you behave like a doormat, then don't complain of people who wipe their feet all over you. You see? Which we were, I think, up to that point doing. We were not asserting ourselves; we were not proving ourselves to be good partners. And if you let them do it, then of course they will run all over you. So this, I think, was a culture change which people recognize.
Question: Yes. And it was probably one of the first institutions where it did come to that level. I mean, Vellore probably had it, but otherwise most other radiation therapy units, they were just doing what they were told.
Dr. Dinshaw: Yes. And then the next thing was very quickly after I joined, we had some new medical oncologists joining in. And, again, I took them by the hand and said, come on, we're going to do this, we're going to do this for lymphoma joint clinics like Dr. Advani. Nobody had heard of a lymphoma joint clinic or a protocol for Hodgkins disease or lymphograms. Now, for instance, at that time it was the heyday for lymphograms. This is before CTs and ultrasounds and all were available. And I used to do lymphograms in Cambridge. So I introduced lymphograms into Tata hospital for the first time and worked with the medical oncologists to have some semblance. It was not a clinical trial like the way we do it here.
Question: Well, it was a start.
Dr. Dinshaw: It was a start. So we had this lymphoma clinic, I remember, on Tuesdays and Thursdays and we had a gyne joint clinic, so I used to go to them and see patients with them. And whether they liked it or not, I sort of just pushed my way through as pleasantly as possible.
Question: And at what point did the gyne's move out and let you put in the after-loading applicators?
Dr. Dinshaw: Oh, no. That was from day one. There were a few surgeons who wanted to continue with doing it themselves, but I think once we got our Selectron after-loading unit, there was no question of surgeons doing it. We just took it away. I don't remember how I took it all. We just took it over. That's all. And possibly they were even happy. You see, by now you have a new generation of surgeons who also know that radiotherapy is different and we're doing things differently and it wasn’t the radiotherapy of old.
Question: When did you get a floor admitting patients?
Dr. Dinshaw: Oh, yes. Patients used to be admitted only under the surgeons name. So I think I think I just pestered Dr. Desai for that, saying that we need our own admitting facility. I pestered him a lot, I think.
Question: What do you think was your finest accomplishment in those days? I know it was about the time you started the bone marrow transplant program and you did TBIs for that young girl.
Dr. Dinshaw: Yes, we did. No, I'm trying to think when did we do bone marrow transplant?
Question: It was '85/'86 -- somewhere in that range.
Dr. Dinshaw: Well, that was a wonderful experience. We just decided as a team that it was nice for us to get an infrastructure going and have a program to do first-time bone marrow transplants. So, of course, before that we were doing TBI for non-Hodgkins.
Question: For non-Hodgkins lymphoma…
Dr. Dinshaw: And for the skin and T-cells. And then we got our act together as to do TBI for bone marrow transplants. We did a lot of work making those wax boluses and getting them positioned, protecting the lungs, protecting the eyes and all that sort of thing. And it was quite an experience because we decided to give her five fractions, if I'm not mistaken, 200 x 5. And on the second fraction day or the third fraction day, this child was so sick. She had a temperature of 103, her blood counts were coming down and she was a very sick toxic child and we had to make the decision whether to carry on or to stop and terminate everything. It was really a very tense situation. But we decided to pursue it and to carry on, and she recovered. She responded to the antibiotic, she responded to everything. Of course, her counts were practically zero by that time. But she came out of it and she was alive for another 10 or 15 years after that.
Question: And your favorite memory of that was a telegram you got saying you always knew Indian surgeons could do it -- the transplant? You got a telegram from the Prime Minister when you finished that whole thing, and it said we always knew Indian surgeons could do this transplant. And after all the effort that you have done in getting this department kind of separate from surgery, it was a radiation and a medical oncology effort, really, to do that transplant.
Dr. Dinshaw: By then, of course, I had all the students with me, the nicest heritage that I have is a 96 record, and 96 postgraduate students over the years and of which you were a very important part in the beginning. And I remember when you went to Stanford first. Coincidentally, the same period of time, we had Shabbir going to England to Christie Hospital, and Rajiv going to the Royal Marsden and you were in America -- first at Stanford and then back to Sloan-Kettering in New York. So it was a really proud feeling for me that all three of you, coincidentally the same period of time, were going in there to do further training as good ambassadors.
Question: Where did you take the department after that? You've got a residency program going or a training program going, and you had people start publishing. But then you kept up with technology. How did you do that? It was so expensive.
Dr. Dinshaw: I think the important thing is that we have the opportunity to travel and meet people, open up your horizon to new ideas, and then coming back and getting the opportunity to put it into action. For example, in 1981 I started brachytherapy - Iridium based - and this was a result of my visits to the Memorial Sloan-Kettering in '78 or '79, and also I had gone to Nissar Syed in Los Angeles. So what Dr. Nori and Vikram and all of them at the Memorial and Dr. -- what was his name? The person who was the head of brachytherapy at Memorial?
Question: Hilaris – Basil Hilaris.
Dr. Dinshaw: Basil Hilaris, that's right. Wonderful person. He was more than generous with what I could do over there. So Basil Hilaris, and his team, and Nissar Syed in Los Angeles. So I spent some time with them, and it opened up your mind to what you could do. It took me a little while, but in 1981 we got the infrastructure ready for doing the first implant with iridium. And it was essentially for breast cancer. It started for BCTs. But very quickly I realized that there was a great opportunity for using the implants in India in other sites like head and neck, soft-tissue sarcomas, esophagus, intraluminal -- these were our problems. BCT was not really a big issue at that time. And the surgeons, also, were not really coming into it. But I remember I used to keep xeroxing the articles from the journals and sending them to Dr. Desai and keep pestering him about how we should do BCT, and give him all the data -- the French data, the European data, the American data. And NSABP had just started publishing something at that time. So I used to really pester him, let's do it. And so this was a thing, the opportunity of going abroad, seeing something, coming back here, going to BARC and talking to Dr. V.K. Iyer, who was another mentor of mine. I went to him and I gave him all the information for iridium, because we didn't have iridium at that time. But I fed him all the information that was needed from the clinical side, and he readily looked into it. He also had a very open mind. And it so happened that in 1981 we did our first brachytherapy implant. And then it went on and on from there. So brachytherapy by itself was a big project that we introduced.
Question: We were at the point where you had organized the department. When did you get into IAEA?
Dr. Dinshaw: Oh, from the very beginning, I think. Maybe 20 or 25 years ago. I can't remember exactly how, but it was very nice because I had an introduction there and over the next 25 years, one thing led to another and led to another and then I brought in everybody in the department. And we had a very nice involvement with the IAEA all these years. And I think they very clearly recognize the strength of Tata Hospital and appreciate what we have done to contribute to their programs.
Question: And how do you think that you managed to put Tata Hospital on the map? I was at a GOG meeting, where Gillian Thomas said about some study that had been done, she said, "That was at Tata Hospital and its data can be trusted." And I was very proud to hear that. She said, "Oh, it was done at Tata. I don't see why we should not trust the data." And I've seen more and more publications come out in the Red Journal , the Green journal…
Dr. Dinshaw: Yes. I think we broke through that. It was a little difficult to break through the barrier of getting our articles accepted easily. I remember my first article on Hodgkins disease. It took ages, and so many drafts, repetitions and changes before it ever got published. But it was also a learning curve on how to write articles and how to process the data, and things like that. But I think today, 50 articles a year they publish and most of it in international journals -- the green, the red, the blue, you know, that sort of thing, JCO. I think we've broken through the ceiling.
Question: If you had to look back, what makes you happiest of all that you have achieved? You've achieved a lot in all these years.
Dr. Dinshaw: I'm happy about lots of things, but I think possibly mainly is the human resource development that we have done over the years. So many people training, so many people going out into the country and setting up their own satellite centers, going abroad out of the country. And that has given me a great deal of satisfaction.
Question: How much do you think you've influenced the development of radiation therapy in India?
Dr. Dinshaw: No, I don't think I have claim to it.
Question: Not claim to it, but you've trained all the people who have gone and put staff in centers.
Dr. Dinshaw: So in that sense, yes. In that sense that you win the resources that we had at Tata Hospital. It's really helped. It's really given me also a lot of satisfaction, certainly. Because that's something which is tangible and you can see the difference and enjoy the glory of it.
Question: You were opening the then new wing of radiation oncology where we just had that row of exam rooms. That’s where we had the first room where the residents were sitting, and then the new offices for Dr. Shrivastava and there was Dr. Hingorani and Shrivastava and Lobo shared an office, and then Chaudhary and Bhalavat. So when you opened the new wing, Dr. Desai and Dr. Rao came for the opening ceremony and they were trying to break a coconut. And Dr. Rao couldn't break it. Dr. Desai said, "Come on. I'm a better surgeon than you are. I will try." He couldn't break it. You took it up with your left hand and just popped it open.
Dr. Dinshaw: Oh, really? Actually, I have problems breaking a coconut with my right hand, and I can never really get it to crack.
Question: So we all were very thrilled. We were so proud of you.
Dr. Dinshaw: Well, it was just circumstances. Do you remember the head of anesthesia in CMC, Vellore, Martin Isaac?
Question: Yes.
Dr. Dinshaw: And Prakash Kandouri?
Question: Yes.
Dr. Dinshaw: I was in my second year of medical school when most people had, by then, decided what postgraduate training they wanted to get into. And happily in those days we didn't have to have exams and all the tensions that people have now for postgraduate training. Whatever you wanted to do, you just walked in and registered for. And in my immediate circle of friends, for some reason I was the only person who hadn't committed myself to any postgraduate degree. And the reason was I think that I was really interested in surgery.
Question: Dr. Khandouri was a surgeon.
Dr. Dinshaw: He was a surgeon. He was a cancer surgeon. So I was working in that unit, and I was quite encouraged to go into surgery both by Dr. Khandouri and Dr. Fenn, if you remember he was the pediatric.
Question: Yes, I remember him. A.S Fenn - he was supposed to be the fastest surgeon in the nation.
Dr. Dinshaw: Yes. So both of them were only too happy for me to get into surgery. But for some reason, there was a little bit of a clawing nagging doubt in my mind, and I suppose it was a question of having to claw your way up to the top in those days, as a woman doing surgery. Today I think it's silly, but at that time it was quite prevalent. And it was just sort of a nagging doubt which didn't make me go inside of the dotted lines essentially with the result that I hadn't decided what to do. What I did not want to do, I did not want to do gyne, I did not want to do pathology, I didn't want to do a non-clinical radiology job or anything. I wanted to be with patients. That was really important to me. I wasn't very keen on general medicine. I liked specialties the best. So that sort of dithering went on in my mind -- what to do, what to do. And Martin Isaac who was the head of anesthesia was a wonderful person, had guided me on many occasions and he and Prakash Khandouri were more concerned about me not doing anything than I was myself. And the last six months of my senior residency course I was sitting with them in the operating theater having a cup of coffee during or after surgery. And so the same discussion, come on now, you'd better get on with it. You can't just put off the decision anymore. And he just said, "Why don't you do radiation oncology?" And he was aware of it because, for one thing, Padam Singh was his neighbor and, secondly, that I was in this cancer surgery unit, and Padam Singh was there all the time. Radiation oncology was a distinct specialty department from radiology, unlike most other centers in the country. Remember, this is 1967-'68, so it's really back when it was usually under radiology. But it was distinct from radiology. So he said, "Look, it's a clinical subject, you're working with surgeons, you have a little OR and what to do every now and then, coming into the OR. The surgeons are going to be around and why don't you do this? It's something very new because very few people are doing radiation oncology. Of course, physics is important. But why don't you think about it?" So I just instantly said, "Yeah, I think that's a good idea. Why not?" It happened just like that. And I remember it was in the evening because it was an emergency surgery that was going on, so it was about 6:00 or 7:00 in the evening when all this happened. And the things you remember. And I said, "Yeah, why not?" The next morning, the hospital started working in the morning, I was marched off to Dr. Padam Singh's office and he was also just informed. No “by your leave” or “would you like to consider” or nothing like that. He was just informed that I had to join up for radiation oncology. And it happened just like that.
Question: Did Vellore have a residency program?
Dr. Dinshaw: Yes, they had a program.
Question: Even in 1967 they had it already?
Dr. Dinshaw: They had that. But the only thing was that my family was more concerned that if I stayed on in Vellore, I would remain a South Indian villager all my life. I had no problems with that. I would have been quite happy to remain there for the rest of my life, left to myself. But I was more than just comfortable in Vellore, I got along and it suited me just fine. But they were determined that I had to expand my horizons. By then I was already seven years in Vellore. So I had to expand my horizons beyond the village of Katpadi and Bagayam. So it was sort of just determined that I should go away somewhere and see the world and do something more than just live in Vellore. So then I decided to go to England and, again, with Dr. Padam Singh’s support, I got a placement arranged for me in Cambridge. But I had to wait for a couple of months to go there, so I spent about three or four months in Newcastle upon Tyne again through Dr. Padam Singh. He arranged for that. So I started radiotherapy in the Newcastle General Hospital in Newcastle upon Tyne. And then there was Mr. Bill Russ. He was the consultant and he went on consulting. So I started radiotherapy under them, but I was there only for three or four months. And then when the position in Cambridge was available and I moved to...
Question: You transferred there.
Dr. Dinshaw: Yes, I transferred there. It was arranged from the beginning. And in Cambridge, this professor Mitchell of Synkavit fame, you know that radiosensitizer, - that was Professor Mitchell's hobby horse. And hyperthermia, those horrible cylinders they put people into and gave radiotherapy, cancer of the cervix using hyperthermia. All that happened at Cambridge.
Question: How did you get into medical school? You went all the way from Calcutta to Vellore. How did that happen?
Dr. Dinshaw: Well, again, I think my mentorship more than anything else. I was in this school in Calcutta and the principal was a Christian missionary, Ida Felshlier. She was an American missionary. I knew I wanted to do medicine and there was never any controversy about that. But it was not very easy getting into medical school at that time because you had to be a Bengali, and you had to know Bengali. And as usual, the language is a problem in each state. So getting into medical school was not all that easy. It was thought that it was not going to be. I'm sure I would have got in. I would have got in. There were four medical schools in Calcutta, my eldest sister was in one of them, and I'm sure I would have got in. But there was a little pressure and a little worry that you just may not get in, for whatever the reason, which I don't know exactly. So it was the principal of the school who recommended that I should apply to CMC, Vellore. I don't think we were very much aware of CMC, Vellore at that time. I certainly had not heard of it. But then, you started reading, you sent for the data, information and you got all the prospectus and things like that and we just came through the process of applying.
Question: Did you have difficulty learning Tamil in Vellore?
Dr. Dinshaw: Yes, I think so. I mean, it wasn't easy. It was the only time when you had to learn Tamil, you had to learn Malayalam, you had to learn Telegu, and also, Kannada and the best part was the first year when we were doing our pre-med. They had something called a pre-med there that we had to spend. An American director, Dr. John Carmen, he used to hold these language classes for all of us.
Question: I remember that.
Dr. Dinshaw: And it used to be a scream. I mean, it was more just fun and jokes than really language. It was impossible to learn from him, but it was brave of him to take us all on these four Indian languages to teach us. I don't think I was fluent in Tamil. It was easier to understand Tamil than to speak it. But little colloquialisms, they are there everywhere, you know, vernacular. We managed, - no great problem.
Question: And then when you went to Cambridge and you finished your FRCR.
Dr. Dinshaw: Oh, yes. So when I finished my FRCR, that was the biggest shock in my life -- the first time in my life I failed an exam in the final FRCR, and I thought I had done very well because it was no problem, the examiners were very cordial, the orals went off very nicely. Of course, clinicals, orals and all- not much of a problem, and I thought it was hunky-dory and I was sure I had passed. And when I discovered that I hadn't passed, it came as a real shock to me. This was in '72, I think. And I was mortified that I had failed an exam. And my initial reaction was just to give it all up and come back to India. This was my immediate reaction because I was so mortified of having failed. I had a very nice tutor in Cambridge and we were assigned tutors. I had a lovely person called John Terrance Wheeler. He was my tutor. And he, I think, was very, very disappointed. I was mortified that I could actually fail an exam. And it was only because of their support and their encouragement that I decided to do it again six months later. So I did it again at the end of November 1973. And I remember the exams, the club dinner, you know how the faculty dinner you have, the faculty dinner. And I remember it was the 16th of November and the reason I remember is because it's my birthday. And I had passed the exams, and by the 18th of December I was back in India because I knew that I was just going to finish my training. I wanted to come back and the original idea was to go back to Vellore. There was no question of going anywhere else or doing anything, so I didn't even bother to look for a job or pass my CV around or anything like that because I was just going straight to Vellore.
Question: And then what happened?
Dr. Dinshaw: Again, as the rest of my life, just circumstances. You just move along and circumstances draw the road map for the life. I arrived in Bombay because I had a younger sister who was living there at that time, so from England I came to Bombay just literally to meet her. They were both doctors and she and her husband were doctors, so I first decided to spend some time with them before I went to Calcutta and on to Vellore. And while I was there, we visited an elderly gentleman who was a colleague and friend of my parents, of my father – an elderly person. And it was just a courtesy call to visit him. We had no other intention or agenda in mind. And by talking to him, he discovered who I was and what I was doing, training and all that, and he said, "Oh, you're not going to see Dr. Jussawala?" And I never heard of Dr. Jussawala before or Tata Memorial Hospital, to be quite honest. I had no sort of idea about the hospital or Dr. Jussawala, who happened to be, at that time, the director of the hospital. So I said no, I mean, it wasn't on my agenda at all. I was just making a personal private visit in Bombay. So he said, "Oh, you've got to meet Dr. Jussawala. You're in Bombay, you must go and meet him and you must visit Tata Hospital." So he fixed up an appointment and, not to disappoint this elderly person, I went along with it. I said, okay, what's the harm in meeting Dr. Jussawala? I had no clue who Dr. Jussawala was -- who, incidentally, is one of the senior-most oncologists of the country and who is one of the four people who had started Tata Memorial Hospital in 1941 -- the original four. He was the last of the original four.
Question: So who were the four? Dr. Borges, Dr. Jussawala…?
Dr. Dinshaw: The senior-most is Dr. Paymaster, then Dr. Borges, Dr. Meher-Homji and Dr. Jussawala, one of the youngest of them. And they were the original four who had been sent for training, and they were brought back as the original team to start the hospital. And, by now, the others, I think, had died and Dr. Jussawala was the last. No, Dr. Meher-Homji was alive. He was alive still, but not doing too much in practice, but Dr. Jussawala was alive. And Dr. Desai was the director of the hospital and Dr. Rao was superintendent, or something like that. The three of them were there. Jussawala, Desai and Rao -- none of whom I knew of or had any contact with. So I get this appointment fixed up to meet him and I walk into the hospital. I sat outside where the garden is for an hour, because I was early and wanted to see these crowds moving around and just familiarize myself with the geography of the hospital before I met with Dr. Jussawala. And this is in December of '73. And we just had a general chat. He asked me to send my biodata to him, the official CV, and that was it. We just had a little general chat and I pushed off, I went out to Calcutta. And I decided to be on local holiday before I joined Vellore. So I went off to Delhi. And, I think about two or three months later, I was staying with my elder sister in Calcutta. So she gently approached the subject and it was about time I gave up being on holiday, and thought of getting a job someplace. Having left and gone away to England, then coming back and traveling around India, I have to admit that I realized that there was a big world outside Vellore. Vellore is a very narrow constricted world, and it dawned on me that there is a big world outside and I should really exercise options of that kind. And the only option was Bombay. And I think it was February/March or something by now and there was no reply from Dr. Jussawala. He hadn't written to me or said anything. So I wrote to him and I asked him what was the situation? Was he really keen or interested or what? So upon that, they called me in for an interview to Bombay. I came to Bombay for an interview and Dr. Pinto, who was the head of the department of radiotherapy, was there. And, of course, Dr. Desai, whom I met for the first time, Dr. Jussawala and Dr. Rao were also there. So they interviewed me and, if I remember correctly, Dr. Sanyal, he was another radiotherapy student here. He was interviewed with me there, so he had also been called for the same interview. And we were interviewed for assistant radiotherapist and, at that time, it was still a joint department with radiology, because Dr. Pinto was a radiologist who practiced radiotherapy. But he handled both sides -- the radiology side and the radiotherapy, so it was a joint department in those days. The interview wasn't very good. It was a very, in fact, traumatic interview and I was very upset the way I was spoken to by Dr. Pinto and I was all ready to leave and just go away. But the next day, Dr. Desai asked to meet me again, called me back to his office to meet me and I didn't know who he was at that time. But he was the superintendent, so his secretary called me in and asked me to come over to meet him. And very, very graciously, all he did was apologize for the interview and then I realized it was a bad interview. It was not only me who felt that, but there were other people also who realized it was a bad interview. And so he apologized for the interview and said, “Well, don't take it amiss. It's just his personality and the way he talks. So don't take that amiss.” He literally just apologized for what had happened the previous day. I thought that was very, very nice of Dr. Desai. I didn't know him, he didn't know me, and that's what happened. It so happened that I got the job and I was employed, and I joined, if I'm not mistaken, the 21st of May.
Question: Of '74 now?
Dr. Dinshaw: Seventy-four.
Question: Now how many other people were already there in the department other than Dr. Pinto? Was Dr. Hingorani there?
Dr. Dinshaw: Yes. There was Dr. Hingorani, Dr. O.P. Sharma and Dr. Mukaden. They were essentially the radiologists. O.P. Sharma and Dr. Mukaden were the radiologists, and then there was Dr. Pinto. And before me, I think there were just registrars. They were not on the staff. It was Dr. Bhalavat and Dr. Chaudhary. I think they were registrars. Then Dr. Hingorani, and then I was recruited.
Question: And then where did your career take off from there? Because you became chairman of the department, although there were a lot of people who were ahead of you, so there must have been something phenomenal that you received…
Dr. Dinshaw: No, not really. The other department wasn't very advanced at that stage when I joined, believe it or not. We had three deep X-ray machines, one ghastly cobalt machine called Janus which was an insult to our intelligence to be dumped with a machine like that, which was apparently created only for developing countries. I considered it an insult to our intelligence. And we had a cobalt junior machine. I think it was a 40 centimeter SSD or something like that.
Question: You had a telecesium.
Dr. Dinshaw: And then the telecesium. So that was it. No decent cobalt machine, no decent simulator, no decent treatment plannings, no system at all really. No treatment planning, nothing.
Question: Now, Vellore had all the treatment planning system and simulator at some point?
Dr. Dinshaw: Some semblance of it. Not what we know as we know it today. But some semblance of it.
Question: And then what happened?
Dr. Dinshaw: So we started radiotherapy. Oh, yes, and for intra-cavity we had what they call a cobalt bomb which actually used to be inserted by surgeons. It was the surgeons who used to insert all the pre-loaded brachytherapy, both radium and cobalt. It used to be inserted by the surgeons without anesthesia, without packing, without anything. And it was just X number of hours - the dose was calculated by that - which absolutely horrified me. There was no beam positioning system, no sort of masks or molds or anything. And it was bad to put it mildly.
Question: And then you had a vision for the department? Is that how?
Dr. Dinshaw: No, I didn't have a vision. I was just working at it, a young doctor, just come back from England. I don't think I really had a vision. I can't claim that I had a vision. We were just told to start working and I worked. For six months I didn't have an office table and a chair. So my biggest challenge was to get a table and a chair for myself. That was a challenge. So there is no vision as such.
Question: But by 1984 you were having a new department and…
Dr. Dinshaw: No, 1981. Again, this is circumstances that Dr. Pinto retired in 1981. So it was a very quick opportunity for me and the committee recommended that I take over as the head of the department in Dr. Pinto’s place. Because Dr. Hingorani was 17 years my senior, it caused a lot of heartburn, and quite rightly so. I quite understand the heartburn. But he was a great sport. He was a very sporting man. Others were not very happy about it, but he himself was very sporting about it, my having taken over. But I decided that I didn't want radiology on my plate, so I was very keen that the department be officially split into radiology separately from radiotherapy and radiation oncology. So 1981 officially, on my recommendation, it was finally demarcated into two different departments.
Question: And what else did you do after that? I know that by 1984 you already had new machines because that's when I joined. So you had the Theratron…
Dr. Dinshaw: Yes, very quickly with the support of Dr. Desai who was the director by then, because Dr. Jussawala I think he retired.
Question: He had just retired.
Dr. Dinshaw: Yes. So with the support of Dr. Praful Desai, who really was my mentor from day one and remains so today and extremely supportive and helpful. Very quickly we decommissioned the three deep X-ray machines, we decommissioned the Janus, we decommissioned the cobalt junior and I got the Theratron cobalt at that time into the department. Then I think we got a simulator, if I'm not mistaken, and then slowly, slowly, but in quick succession. I think in 1984 we didn't have a linear accelerator, did we?
Question: You did. You had the Mevatron and the Clinac 600.
Dr. Dinshaw: In 1984?
Question: Yes.
Dr. Dinshaw: Really? That early?
Question: And between '84 and '85 you bought the Alcyon.
Dr. Dinshaw: Yes, that's right. So we got the first Mevatron machine in the country because the President of India had lung cancer and was discovered to have a coin shadow in his lung. And on the argument that there was no accelerator in the country -- not that he was going to have radiotherapy, he was going to have surgery -- but we made a case for it to the government that you need modern treatments and you have modern technology and the president had to go off to Memorial Hospital to have his treatment because we didn't have anything in the country. So on that argument, both Tata Memorial Hospital and AIIMS were given funding for a linear accelerator. So we got that because of that, and then we got a simulator and the treatment planning and then we got the after-loading, the brachytherapy Selectron unit, the first one, and then everything started to come. So you know what I put it down to? To circumstances and grabbing opportunities at the right time. You have to be ready with what you want. I had this habit wherever I traveled or went anywhere or read in the journals of something that we needed and we should be doing. I used to get all the information, all the technical information, all the specifications, the budgeting, and I would just file it. I would just get information and file everything. And more often than not you had to produce this information at a moment's notice because there would be some funding or we would have some money here or something there. And at the last moment somebody would ask you if you need anything, and I would just produce the information that I had from a file because it was all filed and kept ready.
Question: You already had a treatment planning system by 1984. So how did you go about changing that? Because in Vellore, in the late '70s/early '80s they were still using hand-drawn isodose contours.
Dr. Dinshaw: Yes. Yes, that's right. I mean, you train like that.
Question: In medical school. By the time I came to you, you had a treatment planning system.
Dr. Dinshaw: So all this just happened in the middle '80s.
Question: Where did you take the hospital from there?
Dr. Dinshaw: The next important thing that I did was to get an MD degree. For radiation oncology there was no MD. It was joint radiology and radiotherapy.
Question: You had to petition the University of Bombay and ask them.
Dr. Dinshaw: I had to go through the process of applying and putting in applications of this and that. So we did that and I think we got an MD created for something like that, and then we started registering the postgraduate students of which you were in the first batch, plus three or four people.
Question: Yes. And once you had the department set up to go towards a 21st century department, we were already talking about the end of the 20th century by that time. What else did you then start? Because, at some point, you did more than take care of Tata hospital.
Dr. Dinshaw: The most important thing was that I networked with all the other disciplines at Tata Hospital. There was no concept at that time of doing protocols, of having joint clinics, of being considered an equal partner. There was no question about it and quite rightly so, a surgeon-dominated hospital. In fact, the surgeons used to mark the portals for where radiation was needed. They would even do the brachytherapy. They would say give two more fractions or one less, or whatever. So they would decide, they would do the follow up of the patients who were being treated. So it was a very, very surgically-oriented hospital. There was no medical oncology at that time, and radiation therapy was certainly not evolved into what it should have been. So I think maybe I had a role to play in that because the best thing I did was to make friends with the surgeons. Dr. Desai, of course, was my supporter over there. Dr. Murli Kamath was another very nice and supportive person in the gynecology field. And while he was also a very dominant surgeon, both of them were very important dominant surgeons. I think they recognized something in what I was saying, and they allowed me to put my foot into the door. And very quickly we were considered equal partners. So we sat at this joint clinic, and then I had this thing of not wanting them to come to me. I will go to them, go to their offices, have joint clinics, take patients over there. You don't have to have an ego about these things. You have to just do what needs to be done without any legal.
Question: So you felt politically it was better for the radiation oncologist to go to a surgeon…
Dr. Dinshaw: Yes, that's the best way to have done it. You have to bring them over. And finally my favorite adage which I'm sure you've heard many times is that if you behave like a doormat, then don't complain of people who wipe their feet all over you. You see? Which we were, I think, up to that point doing. We were not asserting ourselves; we were not proving ourselves to be good partners. And if you let them do it, then of course they will run all over you. So this, I think, was a culture change which people recognize.
Question: Yes. And it was probably one of the first institutions where it did come to that level. I mean, Vellore probably had it, but otherwise most other radiation therapy units, they were just doing what they were told.
Dr. Dinshaw: Yes. And then the next thing was very quickly after I joined, we had some new medical oncologists joining in. And, again, I took them by the hand and said, come on, we're going to do this, we're going to do this for lymphoma joint clinics like Dr. Advani. Nobody had heard of a lymphoma joint clinic or a protocol for Hodgkins disease or lymphograms. Now, for instance, at that time it was the heyday for lymphograms. This is before CTs and ultrasounds and all were available. And I used to do lymphograms in Cambridge. So I introduced lymphograms into Tata hospital for the first time and worked with the medical oncologists to have some semblance. It was not a clinical trial like the way we do it here.
Question: Well, it was a start.
Dr. Dinshaw: It was a start. So we had this lymphoma clinic, I remember, on Tuesdays and Thursdays and we had a gyne joint clinic, so I used to go to them and see patients with them. And whether they liked it or not, I sort of just pushed my way through as pleasantly as possible.
Question: And at what point did the gyne's move out and let you put in the after-loading applicators?
Dr. Dinshaw: Oh, no. That was from day one. There were a few surgeons who wanted to continue with doing it themselves, but I think once we got our Selectron after-loading unit, there was no question of surgeons doing it. We just took it away. I don't remember how I took it all. We just took it over. That's all. And possibly they were even happy. You see, by now you have a new generation of surgeons who also know that radiotherapy is different and we're doing things differently and it wasn’t the radiotherapy of old.
Question: When did you get a floor admitting patients?
Dr. Dinshaw: Oh, yes. Patients used to be admitted only under the surgeons name. So I think I think I just pestered Dr. Desai for that, saying that we need our own admitting facility. I pestered him a lot, I think.
Question: What do you think was your finest accomplishment in those days? I know it was about the time you started the bone marrow transplant program and you did TBIs for that young girl.
Dr. Dinshaw: Yes, we did. No, I'm trying to think when did we do bone marrow transplant?
Question: It was '85/'86 -- somewhere in that range.
Dr. Dinshaw: Well, that was a wonderful experience. We just decided as a team that it was nice for us to get an infrastructure going and have a program to do first-time bone marrow transplants. So, of course, before that we were doing TBI for non-Hodgkins.
Question: For non-Hodgkins lymphoma…
Dr. Dinshaw: And for the skin and T-cells. And then we got our act together as to do TBI for bone marrow transplants. We did a lot of work making those wax boluses and getting them positioned, protecting the lungs, protecting the eyes and all that sort of thing. And it was quite an experience because we decided to give her five fractions, if I'm not mistaken, 200 x 5. And on the second fraction day or the third fraction day, this child was so sick. She had a temperature of 103, her blood counts were coming down and she was a very sick toxic child and we had to make the decision whether to carry on or to stop and terminate everything. It was really a very tense situation. But we decided to pursue it and to carry on, and she recovered. She responded to the antibiotic, she responded to everything. Of course, her counts were practically zero by that time. But she came out of it and she was alive for another 10 or 15 years after that.
Question: And your favorite memory of that was a telegram you got saying you always knew Indian surgeons could do it -- the transplant? You got a telegram from the Prime Minister when you finished that whole thing, and it said we always knew Indian surgeons could do this transplant. And after all the effort that you have done in getting this department kind of separate from surgery, it was a radiation and a medical oncology effort, really, to do that transplant.
Dr. Dinshaw: By then, of course, I had all the students with me, the nicest heritage that I have is a 96 record, and 96 postgraduate students over the years and of which you were a very important part in the beginning. And I remember when you went to Stanford first. Coincidentally, the same period of time, we had Shabbir going to England to Christie Hospital, and Rajiv going to the Royal Marsden and you were in America -- first at Stanford and then back to Sloan-Kettering in New York. So it was a really proud feeling for me that all three of you, coincidentally the same period of time, were going in there to do further training as good ambassadors.
Question: Where did you take the department after that? You've got a residency program going or a training program going, and you had people start publishing. But then you kept up with technology. How did you do that? It was so expensive.
Dr. Dinshaw: I think the important thing is that we have the opportunity to travel and meet people, open up your horizon to new ideas, and then coming back and getting the opportunity to put it into action. For example, in 1981 I started brachytherapy - Iridium based - and this was a result of my visits to the Memorial Sloan-Kettering in '78 or '79, and also I had gone to Nissar Syed in Los Angeles. So what Dr. Nori and Vikram and all of them at the Memorial and Dr. -- what was his name? The person who was the head of brachytherapy at Memorial?
Question: Hilaris – Basil Hilaris.
Dr. Dinshaw: Basil Hilaris, that's right. Wonderful person. He was more than generous with what I could do over there. So Basil Hilaris, and his team, and Nissar Syed in Los Angeles. So I spent some time with them, and it opened up your mind to what you could do. It took me a little while, but in 1981 we got the infrastructure ready for doing the first implant with iridium. And it was essentially for breast cancer. It started for BCTs. But very quickly I realized that there was a great opportunity for using the implants in India in other sites like head and neck, soft-tissue sarcomas, esophagus, intraluminal -- these were our problems. BCT was not really a big issue at that time. And the surgeons, also, were not really coming into it. But I remember I used to keep xeroxing the articles from the journals and sending them to Dr. Desai and keep pestering him about how we should do BCT, and give him all the data -- the French data, the European data, the American data. And NSABP had just started publishing something at that time. So I used to really pester him, let's do it. And so this was a thing, the opportunity of going abroad, seeing something, coming back here, going to BARC and talking to Dr. V.K. Iyer, who was another mentor of mine. I went to him and I gave him all the information for iridium, because we didn't have iridium at that time. But I fed him all the information that was needed from the clinical side, and he readily looked into it. He also had a very open mind. And it so happened that in 1981 we did our first brachytherapy implant. And then it went on and on from there. So brachytherapy by itself was a big project that we introduced.
Question: We were at the point where you had organized the department. When did you get into IAEA?
Dr. Dinshaw: Oh, from the very beginning, I think. Maybe 20 or 25 years ago. I can't remember exactly how, but it was very nice because I had an introduction there and over the next 25 years, one thing led to another and led to another and then I brought in everybody in the department. And we had a very nice involvement with the IAEA all these years. And I think they very clearly recognize the strength of Tata Hospital and appreciate what we have done to contribute to their programs.
Question: And how do you think that you managed to put Tata Hospital on the map? I was at a GOG meeting, where Gillian Thomas said about some study that had been done, she said, "That was at Tata Hospital and its data can be trusted." And I was very proud to hear that. She said, "Oh, it was done at Tata. I don't see why we should not trust the data." And I've seen more and more publications come out in the Red Journal , the Green journal…
Dr. Dinshaw: Yes. I think we broke through that. It was a little difficult to break through the barrier of getting our articles accepted easily. I remember my first article on Hodgkins disease. It took ages, and so many drafts, repetitions and changes before it ever got published. But it was also a learning curve on how to write articles and how to process the data, and things like that. But I think today, 50 articles a year they publish and most of it in international journals -- the green, the red, the blue, you know, that sort of thing, JCO. I think we've broken through the ceiling.
Question: If you had to look back, what makes you happiest of all that you have achieved? You've achieved a lot in all these years.
Dr. Dinshaw: I'm happy about lots of things, but I think possibly mainly is the human resource development that we have done over the years. So many people training, so many people going out into the country and setting up their own satellite centers, going abroad out of the country. And that has given me a great deal of satisfaction.
Question: How much do you think you've influenced the development of radiation therapy in India?
Dr. Dinshaw: No, I don't think I have claim to it.
Question: Not claim to it, but you've trained all the people who have gone and put staff in centers.
Dr. Dinshaw: So in that sense, yes. In that sense that you win the resources that we had at Tata Hospital. It's really helped. It's really given me also a lot of satisfaction, certainly. Because that's something which is tangible and you can see the difference and enjoy the glory of it.
Question: You were opening the then new wing of radiation oncology where we just had that row of exam rooms. That’s where we had the first room where the residents were sitting, and then the new offices for Dr. Shrivastava and there was Dr. Hingorani and Shrivastava and Lobo shared an office, and then Chaudhary and Bhalavat. So when you opened the new wing, Dr. Desai and Dr. Rao came for the opening ceremony and they were trying to break a coconut. And Dr. Rao couldn't break it. Dr. Desai said, "Come on. I'm a better surgeon than you are. I will try." He couldn't break it. You took it up with your left hand and just popped it open.
Dr. Dinshaw: Oh, really? Actually, I have problems breaking a coconut with my right hand, and I can never really get it to crack.
Question: So we all were very thrilled. We were so proud of you.
