Opportunity & Outcome

Dr Alok Ranjan, Head of Neurosurgery, Apollo Hospitals, Hyderabad
You & I spoke recently with Dr Alok Ranjan, Head of Neurosurgery at Apollo Hospitals in Hyderabad, where he and his team conduct more than a thousand complex neurological procedures annually. The doctor spoke candidly about his professional and family life, including how he got his start, what fuels his passion, and some of the amazing advances in the area of neuroscience.
Where did you grow up, and how did you decide to become a doctor?
I was born in Bihar, where I spent the first 17 years of my life. My father was in government service, so my education took place across Bihar wherever he was transferred. One does not have a specific point at which one decides to pursue a given profession. I chose medicine because the opportunity came my way. In those days, the only other viable options were engineer and administrator.
I was always quite good academically, but I admired the physicians I saw. Growing up in a relatively small place in those days, medicine was not highly developed. It was more about the doctor-to-patient interaction, with very little diagnostic work. Your doctor’s behaviour influenced you more than technology did.
Where were you educated?
In 1979, I joined the highly prestigious Christian Medical College in Vellore. It was a predominantly Christian institute with just a few seats available to open candidates. I cleared the examinations and was one of the fortunate few to gain admission. It was there that I saw first-hand what technology means and how it can help a doctor. The institute was a pioneering one, where many firsts in India were achieved.

I stayed there for close to 16 years, training in neurosurgery. I’d always wanted to be a surgeon, but I admired the mathematical precision with which neurological diagnoses are made. Additionally, the teachers in this discipline impressed me with their dedication. I spent four years in the UK, where I wasn’t very surprised by the advances in technology as I’d already seen in Vellore.
How was life in the UK? What happened afterwards?
What was unique was working with patients in a catchment area.Hence I got to follow up with my patients after surgery for a long period  assessing whether the procedures I performed had been worth it. It changed my perspective on medicine. What may be a great job technically may or may not be beneficial for the patient in the long run.
In 1999, I happened to meet Dr. P.C. Reddy. When you meet a person like him, you can’t help but be influenced. An offer came to join Apollo, and as I had never been to Hyderabad until then, so I took the chance. It has been a great 16 years since then.
What are the neurological issues you treat most often?
In today’s fast-paced world with more speed and less intelligence, road traffic accidents are fairly common. Aside from accidents, which cause head and spine injuries that are treated by a neurosurgeon, the number of lifestyle-induced illnesses and diseases is growing. Diabetes, hypertension, back and neck pain, obesity – all lifestyle diseases. Though one can have these illnesses while living a clean lifestyle, we are not a society that lives in such a way.
The second most common incident I see is pain in the back and neck caused by spinal issues, more so in the younger population lately. The world has opened up, especially in terms of information technology. Many blue-collar jobs have now become white-collar jobs. Instead of physical pressure, younger people nowadays go through mental pressure. Long hours spent sitting in one position take their toll, and the spine pays for it.
The third common issue is what we call blood vessel disease of the brain, known in common parlance as brain stroke. Hypertension and diabetes having become more common in recent years, these conditions are on the rise in certain segments of our country. In the strata of society that is rich in terms of food and comfort, there is little will to stay fit or exercise. Stroke is becoming more common among that demographic.
Is this what the field is about these days?
No, these are not the challenging aspects of neurosurgery. Conditions like brain tumours and spinal surgery are procedures that require a delicate touch to save lives. Conversely, one wrong slip of the knife can destroy that life. As I said, my decision to pursue medicine was not because of technology. I believe that what we have today is the result of pioneering efforts over the 1980s and 90s. The field of neurosurgery has been revolutionised by technologies like MRIs and CT scans. The transparency afforded to patients by these scans means there is great pressure on us to deliver consistent, high-quality treatment.
Technology has also improved to the point that we can do a dozen different things for a patient before surgery is considered. We can suck tumours out with ultrasonic devices. We have drills that rotate at thousands of revolutions per minute. We can monitor nerve function in real time as we operate. And additionally, we have very simple ways of knowing if what we did or did not do in the operation theatre was successful. Surgery has certainly become less invasive, and there is no longer a lack of options.

But the spine is where so much advancement has taken place. I was among the first wave of spinal surgeons in the country to be trained in minimally invasive procedures. You see, the emphasis has changed. The patient today does not have a month to rest. He needs to complete his procedure in a few days, be discharged and allowed to resume work in a week or ten days. Fortunately, we have coped with that restrictive timeframe. A brain tumour removal today requires just three days’ stay in hospital, and we hope that as the home care delivery in India matures, the time required to stay at a medical facility reduces.
What makes neurosurgical care at Apollo so special?
Apollo Hospitals is fortunate that the system has always supported new technology. We have the latest MRI scanners, navigation systems and neurological critical care. The one thing that has set us apart is our cohesive, unified neurosurgical department. Every member of this department works together as one; as nothing more than part of a team. That makes the life of the patient very easy. Because every doctor is aware of every patient, the absence of one team member is never felt. This helps the patients feel safe and comfortable. Apollo is the pioneer in this team approach, which we have been implementing for 13 years.
Is your discipline more demanding than other branches of surgery?
The demands on a neurosurgeon are incredibly high. More so than many other disciplines, operating on the brain requires a particularly steady hand. One small tremor can cause tremendous damage to the surrounding tissue. Neurosurgeons must be physically fit, as some procedures can and do go on for 12 hours or more. Obviously, surgery of this duration and concentration requires a body that is fit both physically and mentally, and one cannot acquire mental strength without physical conditioning. Also to be considered is that a good neurosurgeon does not ever smoke or drink, as both habits affect the nervous system. Third and most important is practice. The more you practice, the better you get. Additionally, if you can control a wandering mind and maintain unwavering focus, it will only benefit the procedure and the patient.
What is the longest you’ve been in front of the operating table?
About 20 years ago, I performed a procedure on a young girl that lasted 25 hours.
That sounds daunting!  Can you tell us about it?
It was very painstaking surgery on a benign brain tumour. The best result would have been being able to remove the entire mass without damaging any surrounding nerves. I must say it was truly fascinating to watch the patient get discharged six days after this marathon, with all her functions intact.
Please tell us about your family.
I was born into a middle-class family to whom it was very important that I succeed in what I chose to do. Fortunately, one of the ways in which you can escape your socio-economic straitjacket is through achievement and excellence. It has always been a priority for children from middle-class homes to strive towards academic achievement. When you join a top institute with toppers from around the country, it only makes you work that much harder for success. You want to shine, even among the stars. Mine has been a difficult journey, but a worthwhile one.
Dr Alok Ranjan, Head of Neurosurgery, with team 
I learned many values from my family. My father, who unfortunately passed away a few months ago, was a very unique character. What I learned from him is that values should never be compromised. My father was a very honest person. I can’t recall ever using a government vehicle for personal transportation, despite it always being available. Dad could compromise on the food we ate, but never in the quality of education that he afforded us.
What is your greatest achievement?
Coming to this place where few have. I’m a boy from Bihar who spent a significant portion of his life in a town in Tamil Nadu, without any contacts or networks, coming to practices his art of medicine in Telangana. And here I am today, sitting in front of you while you ask me what my greatest achievement is. This is it. I achieved it through hard work and passion. I hope I am well respected among my colleagues, but my truest joy comes from my patients.
A happy patient whose procedures or test results come out well will always praise you. The real test lies in those whose results do not come out favourable, yet who come to you again and again because they feel you’ve done your best. Having had many patients in this category is a tremendous achievement for me. We have had many great results, and though sometimes things have not worked out for some individuals, the care has always been appreciated.
Tell us a bit about yourself.
On a personal level, I don’t care very much for parties, though I am sought after because of my skill in generating laughter! Given my choice, I prefer to spend my time at home with family. That includes my wife, my child, and my physically handicapped brother. Until recently, that also included my father. Free time is not very common, though. As a hands-on teacher, I enjoy visiting different parts of India and the world to impart my knowledge. I used to visit Tanzania often for safaris, and though my trips there are now primarily academic, I still enjoy seeing nature in an unspoiled setting. Overall, I’m highly satisfied with my life in Hyderabad, where I feel at home. This is a wonderful and unique city, and it is a privilege to be living and working here and in Apollo Hospitals.