Faculty Feature: Dr. Sunit Das (MD, PhD, MA, BA)

By: Alexandra Kilian, first-year medical student (Class of 2020), University of Toronto

Dr. Sunit Das is a staff neurosurgeon and scientist at St. Michael’s Hospital and the Keenan Research Centre for Biomedical Science, and Assistant Professor in the Department of Surgery at the University of Toronto. His story has intrigued me since I started my research in Neurosurgery in Toronto during my undergraduate studies. A neurosurgeon with a humanities background is certainly not commonplace. Sitting down for coffee on a Friday afternoon, Dr. Das was an incredibly vivid and animated storyteller. I hope the excerpts from our conversation capture the passion, reflection, and kindness that permeated his story, and leave you feeling as inspired as I felt at the end.

AK: What drew you to the humanities, initially?

SD: It was nothing planned. I grew up in a middle-class household just outside of Detroit, in a community of blue-collar white and black folks that had never seen an Indian person. I went through school thinking I was going to play college basketball and hoping I would play professional basketball. I lingered through adolescence, not really caring much about school, getting A’s because I was in a pretty mediocre school and because I was smart, but not really feeling challenged or engaged by it.

And then, when I was a senior in high school, I was in English class, bored, and I started flipping ahead in my primer and I came across a poem by Langston Hughes called the Theme for English B. It still chills me to the bones. It was the first time I had ever engaged with anything that caught me in that way, something that so strongly reflects some element of the human experience. I became obsessed with it and I started to read other poetry by Langston Hughes. That, for me, was the turning point: the start of my life in my head.

I had done well enough that I had gotten accepted to the University of Michigan without trying. So I went to college with the idea that I was going to play basketball. I played a sparing sixteen minutes in my freshman year, but we went to the national championships and lost to Duke.[1] However, by the end of my freshman year, it was very clear to me that I was a fine basketball player, but not an athlete.

I had also been accepted into the Honours College at Michigan, which was a small college within the larger [university]. As a part of the Honours College, we all took a class called “Great Books.” The Cannon[2], the idea that 120 freshmen and read from The Iliad to The Inferno, still existed and I am so thankful. I took this class called Great Books with a man named Don Cameron, who shaped me immensely. Don had done his PhD in classic literature and taught this class for thirty years. He gave the most moving lecture about the traumatic ending of The Iliad where Priam asks for the body of Hector. I was blown away by these people. I was this kid who had grown up in a suburb of Detroit and came to Michigan and found this life that was so unbelievable and so rich and it blew me away. I’m lucky that I sucked at basketball but I wouldn’t have kept going anyway. There was clearly something more worth my time than that. I was smitten, for lack a better word. I was grabbed by it.

AK: Your bachelor degree was in English literature, and your master’s degree is in philosophy; what prompted the switch?

SD: [As an English major at the Honours college], I wrote my thesis on the works of Ralph Ellison, Salman Rushdie and James Joyce; I was interested in how language and notions of nation influence how we construct our self-identity. The title of my thesis was, “Nationalism and Self-Realization.” What I focused on was that all three of these novels have protagonists who are in situations in which they are limited by external ideas that others placed on them of [what their national identities should mean]. The three authors interrogate those limitations, and ultimately recognize that the [national] identity itself is important and can’t be thrown away – it simply has to be enlarged in a way that allows [the protagonist] in.

The novels I wrote about for my thesis were some of my favourite novels. In doing that, I became really interested in philosophy, especially the philosophy of social justice. I had taken my MCAT, but I decided that I wanted to do my graduate studies in philosophy. I happened to be doing something in the Honours Office and one of my informal mentors recommended a program at Harvard that Cornel West was starting. So I sent my thesis to Cornel West and he invited me to be a graduate student.

I had a great time in grad school. I went there with the idea of studying social justice. If you study social justice you have to study Locke and Hume. They wrote so much of the philosophy that is at the core of how we understand the role of government in society. There are two elements to Locke’s philosophy: political philosophy and philosophy of mind. As I was reading Locke, I was supposed to be interested in the first and I became more and more interested in the second. By the time I had finished studying philosophy, I had shifted from having a primary focus in political philosophy to one in epistemology and phenomenology, thinking about how we understand human experience and its relationship to language and mind. I started becoming interested in mind sciences and that brought me back to medicine. I felt that psychiatry was the closest that I could find to finding some bridge between the multiple worlds I wanted to be a part of. The succession from Locke to William James to Nietzsche to Heidegger to Freud to Foucault to psychiatry was pretty quick.

AK: How did the switch from psychiatry to neurosurgery come about?

SD: I started medical school at Northwestern. Initially, I hated medical school, until the last block of first year; Brain and Behaviour. The second lecturer showed a video of real-time dendritic sprouting and it was like reading The Theme for English B; it just changed everything. It became so clear to me that I was going to do something in the neurosciences: this was ‘it.’

I liked second year a little bit more and I went into third year thinking I wanted to be a psychiatrist. My first rotation was in psychiatry. By the end of that month I was even more convinced that I would go into psychiatry; schizophrenia is the most interesting disease in the human experience that just gets to things that are interesting to me about identity. I then took a month off to finish a paper on the philosophy of Aristotle and Heidegger, co-written with a Jesuit Aristotelian Scholar. When I finished that paper, I started on the neuro-oncology service and my attending was Nick Vick. This was at a time where we had no chemotherapies for the treatment of gliomas. His job was essentially to shepherd people through the process of dying and it was amazing! There was clearly something about the anatomic basis of how the brain works that you gain from neurology that’s not there in psych, which I enjoyed, so I started considering neuropsychiatry.

I was dreading my next rotation: surgery. My first four weeks were with a breast surgeon and he was everything that I thought of being stereotypical of a surgeon was: he had no bedside manner, and was miserable with his students and residents. Then, for the next four weeks, I was assigned to Mark Talamonti, who was a surgical oncologist and had a reputation for decimating students and residents. My first case with him was a Whipple[3] procedure. He starts asking questions as soon as the case starts.

In response to the thirteenth question, I say, “Dr. Talamonti, I’m sorry, I don’t know.”

He stops and looks at me, blood [pouring everywhere], and says, “Dammit Sunit, Dave and I prepared for today, can’t you see? What the f*ck is wrong with you?”

He then looks down and doesn’t speak to me for the rest of the case. And it stays like this. But I saw his patients with him and it was amazing. His patients have cancers that are, for the most part, not curable, and their lives are falling apart and they’re scared. It reminded me of stories of sailors who would be in a storm and they would suddenly see this light from the shore. While they were not out of danger, just to know that land was there was meaningful. He was the lighthouse. His patients had nothing to hold onto except for him. The idea that a human being could be this for another human being had never occurred to me.

On my second last day, he brings me with him to look at the pathology with the anatomic pathologist to make sure he has a good margin. There was a radio on in the pathology lab.

He goes: “Sunit, who is this?”

I say, “It’s Marvin Gaye”

He goes: “Good. Cause you’re going to go into surgery.”

I said: “I’m sorry, Dr. Talamonti?”

And he said, “You’re going to go into surgery because you can. For a month, you’ve been in the hospital from 4am to 10pm and you’ve been on call every 3rd night and you’ve been in the OR with me. I’ve destroyed you every day and you’re still standing. So, you’re going to go into surgery, because you can.”

And I would hate to think I went into surgery simply because that’s the most flattering thing that I have ever heard, but there’s a chance that that is the case. However, even after he said that to me, I thought, “Most surgeons are assholes and I am interested in so many things. I want to write about literature and philology, and I can’t choose this life that would not let me have these other things.”

We had been allowed to choose a surgical subspecialty and I had chosen neurosurgery for my next four weeks. And I chose it because I thought, “if I was going to go into psychiatry or neurology, I should do neurosurgery.” I didn’t choose it because I had thought about it. This was before the work hour restrictions, and we showed up at 5:00 AM that morning and the team had already been rounding when we showed up. I had never seen such human misery as I had seen that day in the neuro ICU. It is a jarring experience and it is hard, if you are unprepared for it, to imagine that we could allow such suffering to exist and that we could allow human beings to be reduced to the state that you see. And I know now that we do that because it is a temporary hell that we allow to exist because it is transient, but I didn’t know that then and I was seeing something that I was not mentally or emotionally prepared to see. The first day I rounded with the neurosurgery team and I was in the hospital until 10:30 at night. We went home and they said to me, “You’re on call tomorrow, right?” and I was on call the whole night, running around, and I did this for a month. By the end of the month I thought to myself, “This is f*cked up. I would never do this. But maybe I will just do another month.” And so I went through and I did the rest of my rotations and I loved all of them except OB and urology, but knew I wanted to do something with the brain.

I started my fourth year, and in my first month I did neurosurgery. I said, “I am just going to do a month of this, just to get it out of my system and I’ll be done”. I started with Christ Getch, a dear mentor to me, and one of the smartest and meanest people I have ever met in my life. Chris was the roughest person with the residents, and the hard part about being roughed up by Chris was that he was always right, and when he roughed you up it was because you had done something wrong. And the hardest part about Chris was that he would smash your nose in the fact that you had done something wrong. The reality was that you learned not to do that anymore. And he cared enough to get in your face and tell you that you did something wrong. However, if there were multiple ORs running and if someone was not going to get coverage, it was Chris. So when they started sending me to Getch’s OR when I was a fourth-year medical student, Chris’s answer to this was, “Fine. I am going to let Sunit do more than I let a resident do.” I got to do all of this amazing shit.

The first night, it was 8:30PM and we were starting a case. We were scrubbing in and he looked at me and said, “Sunit, I just want you to know, last year, when you were a third-year medical student, it was all about us showing you the field so that you wanted to become a neurosurgeon. This year, in your fourth year, it’s all about us showing you why you wouldn’t want to.”

I had this month and it was unbelievably miserable. I was on call every other night, and by the end of the rotation, I was in bad shape. I was having auditory hallucinations in the operating room, I had lost 15 pounds, and blood work for a needlestick injury revealed an elevated creatinine level. I thought; “This is miserable. Why would anyone do this? I am never going to do this. I am just going to do one more month.” And I just kept doing that.

In my fourth year, I did a total of three rotations in neurosurgery and one more in neurology. And I had this sick feeling like, “I’m going to have to do neurosurgery.” Neurosurgery still feels like this to me. Neurosurgery is a drug, and I am addicted to this drug, and someday someone will hopefully get me clean. Right now I’m addicted. And it’s not good for me and it’s not good for anyone around me. But I have no choice. And it sounds ridiculous. Because it should just be a clean, good, old-fashioned way to make a living. But it’s not. And I love it.

AK: Wow. What an incredible and unexpected turn of events. When did you develop an interest in academic medicine?

SD: It was actually around that same time, in my fourth year. I wanted to have an element of my identity that was in science, and so I decided I wanted to do academic medicine. Because I had taken that month off in third year, I had to spend a month doing family medicine as a fourth-year medical student. The hours were light: 8:00 AM to 4:00 PM. So, I started a research project with John Disterhoft, who’d become a mentor to me when I was a first-year medical student in that Brain and Behaviour course. His work was in learning and memory, and he outlined a project he wanted me to complete. However, he didn’t tell me what the timeline should be.

I would be in the lab from 3am-7am and then I would come home and shower because I was allergic to rabbits and so I was sick by then. I would go to my family medicine placement until 4pm and then I would be in the lab from about 5pm-8pm and then I would go out. I was 23 and I could do this. And this is also when I started dating my wife. I did this, and two-and-a-half months later, I got a paper in The Journal of Neuroscience.

I decided that rather than going to residency I wanted to get a PhD, and my wife had seen that the Howard Hughes Medical Institute had a program at the NIH [National Institute of Health] for medical students. On the day the application was due, I put together an application. I got an interview and I went to Bethesda for the interview and two things had happened. One is, in the interim this paper had been published in the Journal of Neuroscience. Secondly, that morning someone had had said the word translational. I had never heard this word before, but it made sense to me. My interviewers were Tom Cech and June Chen.

Tom Cech asks me, “Why should we give this to you? Everyone else that has gotten an interview for this has years of basic science research. You’ve done basic science for 3 months.”

I tell them, “I want to be a neurosurgeon. And I think that clinicians can add to basic science because we ask questions that are not absolutely available to science researchers and I want to do translational research.”

And I got the Howard Hughes Award to spend time at the NIH and do my PhD. My now wife, then girlfriend, moved out to Washington with me and she decided to do her residency in Medicine at Georgetown. I asked her to marry me the next year on the steps of the Lincoln Memorial at five in the morning. I was hoping no one else would be there that early to watch the sunrise, but there were three goofy guys there.

After my PhD, we returned to Chicago because I matched to Northwestern for residency and my wife did her ID [Infectious Diseases] fellowship there. Our daughter was born while we lived in Chicago, during my last year of chief residency.

When I was a second-year resident, my chairman told me that he didn’t have a clinician- scientist role model for me at Northwestern. But he introduced me to Jim Rutka, who was the chairman of neurosurgery in Toronto. Dr. Rutka became my mentor. He had me stay at his house, I met all the staff and residents, and on every grant I applied for, Jim Rutka wrote me a letter of support. Ultimately, that was how I ended up here.

AK: What advice would you give to current medical students or trainees?

SD: Firstly, do the things that actually mean something to you. Don’t model yourself to be someone who you are not, just to get something or somewhere. You’ll never do it well enough. The other part of that is, don’t let people tell you that choosing a particular identity in medicine is going to limit you from having the other things that you want.

AK: How do you incorporate the humanities into your career and life today?

 SD: I didn’t read novels during my residency, except for when I was on vacation; I didn’t have energy to read novels. But I read poetry, and I watched film, and I listened to a lot of music. I didn’t let those things escape my life. Now, I read for half an hour a night. I have this list/pile of books that is growing faster than I can keep up with them.

Professionally, I just got appointed at the Center of Ethics at U of T. I am currently putting together a grant with a colleague of mine in the Department of Philosophy and a colleague of mine at the Law school, to look at the implications of AI [Artificial Intelligence] for professionalism in law and medicine. Two years ago, I was a part of a large seminar that explored introducing humanities and notions of professionalism into professional graduates in medicine.

AK: Medicine in general, and neurosurgery especially, is a demanding career. How do you maintain a work life balance?

SD: I’ve laid some ground rules for myself and I think it’s been helpful and valuable. I decided for myself that I wanted to be home for dinner with my family every night. So, unless I’m on call, giving a talk, travelling, or in the operating room, I am at home for dinner. Which means I need to get to work at an ungodly early hour, and be efficient at work so I can leave at 5:30 PM

AK: What books would you recommend to medical students?

SD: Do No Harm– Henry Marsh

When Breath Becomes Air– Paul Kalanithi

To the Lighthouse– Virginia Wolfe

My Struggle– Karl Ove Knausguaard

Anything and everything by Elena Ferrante

AK: How does the your background in the humanities make you a better doctor?

SD: I used to answer this by saying that what you learn by going into the humanities is to be a close reader. And that’s what medicine is. It’s all about close reading and trying to mentally organize the narrative that your patient is giving you, and coming up with some way to analyze it and understand it.

My answer now is a little different. It’s not that I don’t agree with that anymore, but my answer is this: I’m a pretty good doctor and this is partly because I have a lot of myself to give to my patients. And part of the reason for that is that I have a remarkably rich life. And I owe that to the humanities. Literature, film, music, art – these have given me so much richness of life. It’s unbelievable how much grandeur there is in life, and how much of it would be missing if you didn’t work to access it. I wouldn’t have gotten all of it if I had just put my nose down and stayed on the path. And like I say: it happened all by accident.

[1] “I still hate Duke and will always hate Duke and I was actually recruited for a job at Duke and I turned it down be I couldn’t make myself go”

[2] The Cannon is a common reading list across all universities, composed of works that were “predicated in English literature as the cornerstones of humanity”.

[3] A resection for pancreatic cancer, which involves the removal of the pancreas, the spleen, and part of the mesentery