Nikhil Joshi, M.D.
Doctor, Author, Leader
Nikhil Joshi is a young physician, writer, and speaker. He is passionate about furthering his ability to touch the lives of people positively.

Great Minds

Great Minds

It’s late or early and I’m puking.

I’m on my last round and honestly I feel and look like shit. I’m just so nauseated. It’s like I’m in a small boat lost in the ocean. You feel close to death when the chemo is bad, and sometimes you get so close you can breathe it in. Until you’re no longer afraid, you’re just tired. Tired of it all. But vaguely aware that surviving this thing is a desirable ideal.

I’m sweating, tachycardic and ready for it all to end while I’m here praying to the porcelain God. She calls. My phone rings and rings. I miss the first call but get the second. She sounds worried. “It’s been two days Nik…” she says tensely “I’m sorry darling, I’m really sick” I say simply and honestly. “I…I love you” she says, in tears because I’m broken. “I love you too”. “Can you just listen to me, and take something? Take one of your anti-nauseants please” she asks plaintively. “Good, (I breathe) idea” I finish with some trouble and go to my medication box. I take a Zofran, which is an anti-nauseant made by GSK in the 1990’s. This drug changed the game when it came to nausea period, but mostly used in chemotherapy patients. In a few hours I’m asleep. The motion has stopped. I sleep, and sleep until life comes back to me.

The nausea stopped because clinical scientists and industry made a drug that changed my life, and the lives of millions of others. And then they did that a thousand more times. They changed the management of diseases like cancer, diabetes, and heart disease. Which begs the question: why does it seem like everyone hates them?

The pursuit of science and medicine is a beautiful thing. The root desire is to better the lives of humanity. Either through understanding the complex nature of the world we are surrounded by, or by attempting to alleviate human suffering. The picture in this article is of Dr. Gianni Bonadonna, who revolutionized the treatment of many cancers. His work and those of his peers contributed to the lives of hundreds of thousands of people. It was so beautiful and I am so thankful for his work, personally and professionally. It further deepens my sadness that we’re surrounded by so much anti-science bullshit. It’s really frustrating that we live in a world where we slander intelligence in favor of pseudoscience. Because we can’t hurt people’s feelings by telling them their anti-science beliefs are stupid.

We have come so far to eradicating illness and suffering, and we’re going to lose it all because we didn’t shout down the idiots who, by the way, have never in the history of the world made anything that actually made a real impact. The computer you’re reading this on was made by people of great minds. Great minds also figured out how to make Zofran, Carvedilol and Xarelto. Anti-science deniers are hilarious because they voice their opinions using the products of science. You have internet because of great minds. Using one branch of science to discredit another would be funny if it wasn’t so tragic.

Vaccinate your kids. No; your beliefs are irrelevant. Every time I plead in clinic for a child to be vaccinated I get a bad feeling in my stomach, like I’m watching a form of child abuse. I make a silent prayer that the kid doesn’t suffer because of the parents. It’s just that I’d rather a child not suffer of a potentially fatal disease unnecessarily

I forget all those thoughts, when I see who my next patient is. He’s a kind older gentleman, who speaks bluntly and loudly. He’s so warm, it’s like my grandfather is visiting in clinic. I like seeing him. He needs combination treatment for his severe asthma, which is worse because he works in a bakery. He’s usually well, but today his pulmonary function tests are miserable. It’s like he’s on no therapy at all. I ask him what’s going on. “Those samples you gave me were great!” he starts
“But then I ran out…” he finishes sheepishly.
“How long ago?” I inquire
“Six weeks” he says
We were so lucky he didn’t end up in ICU over that time. He told me once that he’d never want a tube down his throat again. I really don’t want him to be in that scenario. I’m not sure what would happen.

I tell my staff person about his financial trouble and she personally goes and picks up enough samples for 3 months, until his next clinic visit. She hands me the brown paper bag and sighs.
“They’re not letting us give samples anymore” she says to me sadly
“Why not?”
“Policy” she snorts.
The academics who make these sort of anti-pharma policies have never looked after patients in the real world, where people can’t make it on a baker’s salary.
But that’s a fight for another day I pointedly tell myself, and give him his inhalers.

“Take a few puffs right now” I tell him, making sure he has some medication on board so I can feel like he’s not going to struggle to get to the parking lot. Maybe I’m just treating myself. He inhales the medication and takes a few deep breaths. I repeat his breathing test in fifteen minutes. Markedly improved. I send him home no longer worried.
“Call us if you run out” I tell him gently.
“Thanks Doc!” he says beaming.

I take a moment to silently thank the great minds that made everything until this moment possible. The ones who made miracle wonder drugs that changed the nature of human illness, and the trajectory of so many terrible, previously fatal diseases. And for a moment, their genius and success is enough to wipe away my bitterness at a world that disparages medical science unfairly.

I take a deep breath. And then I see the next patient. Just thankful I’m no longer nauseous.


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