Dr. Venkataramana Vijay – Flying Surgeon

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NEW YORK – In the world of high-flying professions, you won’t find many other unique personalities like the Andhra Pradesh-born physician Dr. Venkataramana Vijay, 54, now a cardio-thoracic and vascular surgeon in New York City, at the Mt. Sinai Hospital of Brooklyn and the Mt. Sinai School of Medicine. He’s an alum of Sri Ventateswara University in Tirupati.

Dr. Vijay is a man of many paths and missions in life. He’s a double Covid Warrior. Not just a surgeon, but also a Boeing 747 pilot, making multiple commercial trips back and forth every month from the United States to cities in Asia, primarily China, to bring back Personal Protection Equipment (PPEs) to fight the coronavirus pandemic.

Every month, Dr. Vijay divides his time between wielding controls in a cockpit and handling a scalpel in an operating theatre. He flies nowadays through the month as he was drafted for the mission under an order by President Trump. Starting from July, he will go back to his normal schedule, which involves usually 18 days of flying beginning of the month, and then devoting himself to surgery the rest of the month.

There’s more to Dr. Vijay, though. He’s a brilliant innovator and scientist too. He’s written and published dozens of research papers, given a TED talk, and co-invented and patented a miniaturized heart lung machine circuit which required no blood transfusions and cost a fraction of the price of a conventional circuit; made open heart surgery very affordable for the common man.

Dr. Vijay is also the founder and Chief Medical Officer of the Institute for Artificial Gravity, which is exploring and doing researching space pursuits. In a phone interview from Alaska, after he had got out of a long flight back from Wuhan, China, this week, Dr. Vijay talked to me about his passionate interest in space, and especially transportation to space, now that there is more privatization. He hopes to travel to space someday. That information spilled out after I asked him as to why he’s still a bachelor, and what he does with time he gets between flying and doing surgery.

“I’ve never been married. It relieves me of certain responsibilities. My decision-making time is not influenced with family, children and their vacation. My time is under my control,” he explained, with a laugh.

In the time he gets for himself, Dr. Vijay also indulges in participating in various scientific and policy making groups online, often in touch with latest scientific happenings. He views crisis management as a critical skill, which he wants to hone in budding scientists and researchers.

Dr. Vijay comes from a family of physicians, with a long lineage in medicine, and social service. His two grandfathers were felicitated by King George the 5^th. His family has built hospitals in India. He emigrated to the US in 1990, after a year’s stint in the Caribbean, in Trinidad and Tobago, after he did his MBBS from India, in 1989.

When he first arrived in New York City with $400 and two sets of clothes, he decided to not take the help of relatives, but sustain himself. He drove a cab for two years, driving from 7 pm to 7 am, in the Bronx. After that he would do volunteer service at a medical facility in Newark, New Jersey, before he went for his classes at medical school, in New York City. I didn’t dare ask him when he got the time to sleep.

“I learnt financial independence and lived within my means,” he says, of that experience, driving a cab. “I truly feel satisfaction in giving back to society. I’m doing my bit in this world.”

Excerpts from an exclusive interview with Dr. Vijay, by Sujeet Rajan, Executive Editor, Parikh Worldwide Media:

A pilot and a physician. For most individuals either one of those professions is just the stuff of imagination. How did this come about?

Flying through the air to cross the seven seas was a fascinating concept for me since childhood. A school excursion in 1972, to the Tirupati airport with a peek inside the cockpit of an Indian Airlines Avro 40 seater turbo prop and a chat with the captain in full uniform at the controls and the gorgeous flight attendant in a saree mesmerized me.

Air India’s advertisement in a 1973 Readers Digest of its first ever Boeing 747 Jumbo Jet named Emperor Ashoka and its sheer size and complexity and its ability to fly to every continent across the oceans,  consolidated my desire to be a pilot.

However, my average mathematics skills at school and a notion that to be a pilot, one needed to be an aeronautical engineer made me reconsider my career move. When in eighth grade,  the concept that air flow and blood flow are similar from a physics standpoint – minus the mathematics – was introduced to me,  I immediately turned my attention to cardiovascular biology and medicine as a career choice.

America, the land of dreams, was the only place where I felt I could accomplish both goals. So my first goal became the United States, in order to accomplish my other two goals.

You divide your time every month between surgery and flying. Does one profession alleviate the pain or the stress of doing the other, or do they complement each other?

Both professions are physically demanding and exhausting resulting in cumulative stress. However, mentally they are complimentary and contrasting which helps to relieve cumulative stress.

When I fly, all my problems are left on the ground which helps me to get a break and to focus and be precise and when I arrive  on the ground I am recharged and energized to provide the required medical care, compassion and emotional support.

I’m sure you have enough anecdotes to fill books on both your professions, flying and surgery. But let’s talk about flying during a pandemic to crisis-hit nations like China and elsewhere in Asia. What are some of the challenges you have faced?

It is certainly a very unique, once in a lifetime experience. These are truly war times. The difference is we know the enemy, but we don’t see it. We can prepare for it but there is no warning before it attacks. One’s best friends could unintentionally carry the enemy. Although there is no physical damage, the biological, emotional and economic damage is equally devastating.

Essential supplies are in severe shortage worldwide, with very few suppliers who can ramp up production to meet the demand, while they themselves are sufferers from the pandemic. So, producers are themselves consumers and exporters as well.  This poses unique supply chain and logistics demands that are hitherto unprecedented.

Infrastructure is overwhelmed, for example, retail markets, emergency medical care, pharmaceuticals, barrier protection equipment becoming scarce for such prolonged periods places enormous strain on public services as transportation and aviation.

Lockdowns, at regional, national and international levels have posed extraordinary strain on regulatory, economic, legal and judicial systems worldwide, requiring a concerted effort on part of all nations to facilitate transport of humans and essential supplies across borders and nations. This Covid19 war has brought the whole world together. For the first time in a war, there are no warring nations; there are only helping nations.

Is there a favorite anecdote you want to share?

During Covid, my essential supplies flights to Japan required an overnight halt in Tokyo. I was pleasantly surprised to find no bold signage anywhere in the airport or malls or hotels indicating a lockdown or requesting face masks or to keep social distancing or to use the hand sanitizer. But everyone in the street and buildings maintained social distancing, used face masks and sanitized on their own with no enforcement at all. Such mental discipline and individual responsibility to that degree is refreshing to see and should be emulated by all. Tolerance and cooperation are the ultimate key to social success.

Do you get worn out more by flying or doing surgery, or by seeing the misery that the coronavirus pandemic has caused?

Physical exhaustion is present both in medicine and aviation and the psychological burden of the human devastation is felt from both in the air and on the ground, but what is most uplifting is the wonderful nature of humankind where suffering brings all nations and peoples together to reach a common goal. Such global human cooperation seen during these Covid times is unprecedented in the history of humankind since the Industrial Revolution.

Dr. Vijay, I hate to ask you this. Yet, I think it’s important for people to understand what you go through. Do you feel safer on land or in the sky? Why?

Flying frequently to different parts of the world afflicted with different strains of the coronavirus at different stages of peaking or working in close quarters at the hospital in one area of a city pose different kinds of threat and risk,  I can confidently say that I feel equally safe in these endeavors due to strict adherence to and compliance with the recommended policies and procedures, combined with frequent testing and accepting individual responsibility.

In a city like New York which has faced one of the worst outbreaks of the pandemic, what was it like for you personally to be in the medical profession, especially during the peak of the pandemic when it seemed local hospitals were overwhelmed by victims?

True, no city or its people and professionals have been put to test like in New York City.

During mid March to early April when Covid symptomatology appeared in the emergency rooms, there was a stage of confusion as to what exactly to do. Guidelines were still being developed, so a lot of the patients were admitted to hospitals, thus using up valuable resources such as ventilators and ICU beds.

Then in mid-April came the stage of peak and overwhelming, when most ERs were seeing over 100 to 200 cases a day with no place to put all the patients and based on evolving guidelines,  the first steps to discharge patients from the ERs was being undertaken.  Healthcare workers were becoming sick in large numbers creating a shortage of frontline workers. The ICUs and the morgues were full with 18 wheeler trucks parked outside the hospitals to store the dead. ER to ICU to morgue to the 18 wheeler seemed like a perpetual pathway.

By late April and early May, we had passed onto a stage of helplessness, when we were running out of protection equipment for the healthcare workers,  severe shortage of healthcare providers, tents outside the hospital to function as ERs, patients being treated with preventive guidelines,  supportive and emotional care, with no real medications or vaccine to combat Covid. The military and professionals provided from other states stepped in to fill the gaps in manpower. It was sheer resolve and dedication of healthcare providers that pulled us through to the next stage.

Finally, by end of May, signs of downtrend and recovery became evident and Covid admission numbers NY mid June had dwindled to less than 20 or so a day per ER. Most of the healthcare workers had recovered and returned to duty.

New Yorkers seemed to have adhered to rules of social distancing, wearing masks. They have flattened the curve. However, with bars, churches and beaches open, do you see a second wave of the coronavirus hitting the city and the US in the Fall?

At present, Beijing is reported to be in a lockdown following an earlier relaxation. We have to study the reasons for their recurrence of cases in order to extrapolate.

Historically, most pandemics transform into endemics.  Any degree of release of lockdown will be associated with endemic hot spots. However, hot spots escalating to a second wave is a serious concern and should be avoided at all costs for health, social, psychological and economic reasons. This can only be achieved by measured release of lockdown, extreme vigilance and individually responsible socializing in compliance with barrier protection and distancing.

You have also been in South Africa, worked there. What did you take away from that experience?

It was a very tumultuous time. Mr. Nelson Mandela had taken over amidst tremendous social upheaval against apartheid. Ultimately patience, tolerance and cooperation triumphed against apartheid. It appears that humans are always at the center of every crisis, whether it is apartheid in South Africa or 9/11 in USA or Covid around the world. The common thread in recovery in all of these crises appears to be tolerance and cooperation.

What I have learned, having been through all these crises at  first hand is that we as humans will be condemned to repeat our sufferings in crises,  if we fail to recognize that tolerance and cooperation are prime requisites in human endeavors for a peaceful existence.

The pandemic seems to be ebbing and flowing in the United States, as in many other nations. What’s your assessment as to when can people go back to a normal life and this will be behind us.

Infectious diseases of this magnitude require a combination of factors to come under control.  Herd immunity, robust vaccinations and targeted medications are necessary to effectively combat any acute and active outbreak. Until such measures are in place, we should consider ourselves still vulnerable to secondary and tertiary waves. Until such measures are available, effective strategies can only be prevention with barrier protection, social distancing, lockdown etc. I sincerely hope that vaccinations and effective drugs will be available by at least early next year.

Talk a little bit about what you think India should be doing to curb the spread of Covid?

India is suffering through its peak phase of Covid19. This phase is expected to last till at least mid-July. Lockdown is only one component and is completely ineffective if it is not combined with individually responsible social distancing, hand washing and wearing masks. These are the four pillars of Covid control during an acute phase. This methodology is proven in all the countries that have suffered a peak.

Isolating elders from younger possible symptomatic carriers in the family is an additional measure that applies to joint family situations in India. Where true social distancing is not practical, it is very important to have open and cross ventilation. This dramatically reduces the time period that the virus will stay airborne in droplets, this reducing transmissability.

Partial or complete relaxation of lockdown is totally ineffective and counter productive if it is done city wide at the same time. This will result in crowding at supermarkets and other essential service areas. Lockdowns must be released at different times, in different areas based on zip codes (pin codes) in a given city or town. Vitamin C, D , turmeric and Zinc may have a beneficial effect on the immune system and can be tried.

What is your advice for aspiring physicians and pilots?

With the evolution of technology and social structure,  it is imperative for the current and coming generations to develop more than one skill to a professional level. Gone are the days of water-tight compartmental qualifications and practice. In order to stay relevant and current in the fast paced current and future digital society, one needs to be resilient in one’s approach and skill set. So explore and master more than one profession and skill. For pilots and physicians, I foresee a closer interaction with artificial intelligence based devices to the point of significant automation of services and skills.

Two areas of particular note would be, one, drone technology which will become incorporated into telemedicine,  crisis medicine etc. via drone based transport of testing materials, medications, first aid during accidents and in crises intervention, and two, space travel and space medicine will become inseparable as one complements the other.

Your contribution to aviation and public service during this crisis has been immense. Talk also about your important contributions to the field of medicine other than surgical practice.

In addition to original research and over 100 peer reviewed publications, I think my single most important contribution is to the field of Open Heart surgery and the Heart Lung machine. The disposable heart lung machine circuits were expensive, monopolized in the market by a couple of manufacturers and required blood transfusions.

I, along with my colleague Dr Kevin McCusker, invented and patented a miniaturized heart lung machine circuit which required no blood transfusions and cost a fraction of the price of a conventional circuit, and made open heart surgery very affordable for the common man.

Patenting them and donating them strategically to the public domain allowed several smaller manufacturers worldwide a market lead time to compete with the monopoly, eventually bringing down the market price and increasing affordability. This miniaturized circuit concept is now fully globalized and universally available and affordable.

Based on your recent TED talk on ‘Resilience in a Crisis’, what is your advice to the next generation ?

Analyze, anticipate and prepare.  Convert your talents into skills. Rise to the occasion before the occasion arises. That is the best way to be prepared to respond to a crisis.