Technology, Head and Heart

   January 28, 2010   

article10_large.jpgThe first encounter about Dr. Samadi came by chance a day before the interview at his office at 625 Madison Ave., during the final stretch of the train trip from Newark to Manhattan. The afternoon was grey and the landscape looking out the train windows was one of decay, leaving behind twisted fences, abandoned hangars in the midst of puddles of rain and rusty bridges.

A formal conversation was started with an elderly couple of New Yorkers. He is a radiologist, says the husband’s wife, who talked out of her elbows.

I explained who I was coming to see. Of course, they did not know Dr. Samadi. Our train finally arrived at Pennsylvania Station and, just before stepping off the train, a plump woman with blonde hair intercepted me and excused herself not being able to avoid overhearing the conversation with the elderly couple. “My husband Robert was operated for prostate cancer about two years ago by Dr. Samadi.” Her name is Collee Monroe. She guides me to the station exit while assuring me that Mount Sinai Hospital in New York has one of the lowest hospital infection indices. Up the stairs, exiting the station onto 7th Avenue in the midst of a “whirlpool” of people, traffic, horn blowing New York taxis, among eight million people, I run into a woman who spoke wonders of a prostate cancer surgeon. Dr. Samadi must have become a celebrity. What other explanation is there? Men don’t like to talk about their prostate. It is not a sexy theme for conversation on the subway. Apparently though, women don’t mind talking about it.

Dr. Samadi is Chief of Robotic Oncology at Mount Sinai and has distinguished himself by utilizing a four-armed robot baptized Da Vinci, in his operations, surgeries that appear to be taken from a futuristic series such as Star Trek. In 2001, he performed the first eleven such surgeries and now has performed more than 1,850 with an average of 50 operations a month. He arrives punctually at 7:00 AM, his brief case on wheels with him. Dark blue suit, good stature, he offers his surgeon’s hand, long and square fingers, in a firm handshake perfectly calculated to not give a sensation of strength or weakness.

His office is an annex of the complex of buildings spread around Manhattan that give fame to Mount Sinai Hospital, one of the most respected medical institutions in the World. It is also the entrance door for his patients and it does not appear at all like a hospital, but rather a business; reception with secretaries, rooms and areas for private waiting and a discreet operating room for biopsies. There are baskets with presents from his patients in his offices.

He starts his personal vision of the prostate, an organ that produces part of the seminal fluids and a fateful point in which cancer is born, and which in the USA is the worst after lung cancer, with close to 40,000 annual deaths (in Spain, 13,500 cases are detected every year, of which 6,000 people die). “Look at any organ. The thyroid is in your neck, the bladder, the liver, the pancreas, the heart….no sooner you open the body up you can see the organ. With the prostate, something completely different happens.

When God created the human being, he placed all the organs in the body at the same time except for the prostate, which was left behind and only the size of a walnut. It is as if the body was assembled and a body part was left out. What to do with this part? Well, the answer was to place it in an inaccessible place, in the pelvic area, under the bone, ontop of the rectum, surrounded by large blood vessels and tying it to the bladder and the urethra. God thought: “I’m going to surround it with all the nerves that are responsible for urinary continence and sexual functions, and we’ll see if guys such as Dr. Samadi manage to get to it.” He was asked whether in his career as a surgeon he was inspired by heroes such as Christian Bernard or Michael DeBakey. “They were fantastic. But in traditional prostate surgery, one cannot stick a head in there under the bone to see. We use our fingers in the middle of a pool of blood, and we have to trust them to completely remove the cancer. That is why it is so difficult. Now, robots have changed everything.”

A robot in an operating room? The next day, I went to the Guggenheim Pavilion of Mount Sinai Hospital, a pale orange building flanked by quite a few artificial acacias facing Central Park. Mount Sinai started its journey in 1852, when nine Jewish people founded a hospital at 28th Street West, in times when houses in Manhattan had gardens. It was a charitable act to give care to indigent Hebrews. The elevator that takes patients to the floor where Dr. Samadi operates is called “Sabbath Elevator.” On Saturdays, it automatically stops at each floor. “You cannot force it to work,” explains a doctor in a friendly manner. Once in the operating room, Dr. Samadi’s assistants cordially welcome someone with a notebook who has problems tying his mask.

The Da Vinci robot is waiting in the back of the room, with its four arms folded and covered in plastic, three large black monitors and a robot control console. The red emergency STOP button is quite flashy. The console is separated from the robot itself by about 10 feet, connected by cables running along the floor. There are pedals, two joysticks with steel rings to operate the four arms and a stereoscopic visor. Dr. Samadi arrives smiling and soon afterwards they tell him the patient has arrived. There is no one on the operating table and he almost confuses a member of the team as the patient. The patient arrives under his own power. “Here, everyone arrives in this manner, without lying on a gurney. I don’t want there to be anything that reminds them that they are sick.” The patient is from Russia and has prostate cancer. After the anesthesia, we return to the operating room.

Dr. Samadi uses a laser to make an incision on the abdomen, inserts a tube and injects gas to expand the abdominal cavity and make more room to operate, he explains. He feels the swollen skin that trembles like a water bed. Afterwards, he introduces a camera and the black screens turn on. Four additional laser incisions are made for the robot arms. Dr. Samadi then moves back from the operating table and sits down at the console to look through the binocular. It appears strange. The robot comes alive, moving like a spider until it is situated over the patient. The friendly assistants of Dr. Samadi place the arms into the tubes inserted in the incisions, and at this moment, the dazzling journey through the human body, described in the famous science-fiction novel Isaac Asimov, begins to be more real. Four arms stretch tissue, cuts them or separates them, controlled by a human who only has two. The zoom provides enlargement at the surgeon’s wish. One of the arms delicately removes yellow fat tissue, another cuts with a laser….all is viewed on the monitors. “I can freeze one of the arms and switch control to another arm. This journey is like a video game, but the difference is that in this case, you cannot afford to fail. You have to win.”

The robot advances through the abdomen, and Dr. Samadi identifies the blood vessels, places surgical clips that mark the trail, and there hardly is any blood – though he’ll arrive at a more irrigated zone and the field will be stained red – while the path to the prostate is opened. Dr. Samadi invites me to look through the binoculars and, in effect, the view of the tissue turns three-dimensional. The technology has changed the surgeon’s paradigm and the sacred sense of touch of his prodigious fingers. Dr. Samadi admits he can sense the tissue through the controls. But he notes: “If you can see the field of vision in this manner, you don’t have to have your hands on top, touching it. The eyes can compensate for the sense of touch.” Pushing the pedals to enlarge or reduce the field of vision, he sends instructions to the machine, between pneumatic noises and the music of Shakira. It is as if he was inside the patient.

The day before, he was explaining like this, talking about the difference the introduction of the robots in surgery implies. “It is not about the machinery, we are not merely technicians, or that we are merely surgeons taking a course to learn how to operate a robot because of the love of the technology.” The key is experience as an oncologist. Dr. Samadi previously trained in the use of catheters to perform minimally invasive surgery, with laparoscopic technology. To date, he has operated on more than 3,000 patients. “The robotic technology gives you a high definition three-dimensional view, being able to observe things never seen with conventional surgery. I don’t need to touch. The robot is an extension of my arms, as if I was able to stick my head into the abdominal cavity. The probability of leaving cancer fragments or damaging the nerves is greatly reduced.”

Robots burst onto the surgery scene. The Da Vinci robot allows the surgeon to establish a complex route in which the arms cut and open a channel to extract the prostate, leaving intact the nerves responsible for sexual (and urinary continence) functions. Eighty five percent of patients recover their sexual potency and ninety seven percent recover urinary continence. The cancer cure rate is around ninety five percent and blood loss is minimal. Someone who operates 10 feet from the patient is performing a kind of tele-surgery. “There is no doubt that within a short time span I will be able to operate online from New York and you could be in Spain.”

He assures us that the software, hardware and/or communication challenges to achieve this will be resolved. “The robot arms will perform the surgery with the precision and experience of the surgeon that operates them, on anyone and anywhere.” “Now we are using Da Vinci robots to operate on patients with bladder cancer, kidney cancer, and also nose and throat surgeries. The application of robots is expanding into many fields. Robots have been used for many years in cardiac surgeries. There still are conventional surgeries with very good results and patients still wish to have these surgeries.” And the brain? Dr. Samadi shows his large fingers. “There is not much room in which to move around, and what you are doing is removing small lesions, requiring enormous precision without any trembling. You need to maneuver in very small cavities. As robots become more precise and improve their quality, we will be able to perform these types of operations.

Dr. Samadi is forty three years old. He is used to smiling. They bring us breakfast in his office, but he is concerned about what he has to convey and hardly takes a few sips of coffee. Lidia is there from the media and he has gotten used to the cameras. He is a contributor of the Fox Television Network. “The word cancer is scary, and in the case of the prostate, there are no symptoms. When a doctor diagnoses prostate cancer, the majority of men freeze up with fear. Women react differently, are stronger, support their partners and investigate and seek solutions. In my experience, they are the ones who make the decisions in the majority of cases and decide on a course of treatment. They are of great support on which men can rely. Dr. Samadi explains that the problem not only requires a surgical solution. The mind, the spirit, it’s almost a karma. Dr. Samadi has put in place a philosophy of patient treatment as a form of therapy.

He praises his team of nurses and assistants. “I love my patients, I like them. I never treat them as patients, but rather as friends. When they leave my office, they become friends for years. It is a strong relationship. We are not talking about unfriendly surgeons that don’t have the time to talk with their patients despite good results. As far as I am concerned, this is not success. My strength is in putting patients first. If it is a holiday and a patient calls, I’ll go see them in hospital. I’m available twenty four hours a day, seven days a week via cellular telephone, email….I never escape from them. My patients know this and as a result, I’ve created a network of friends, not sick patients, all over the world. This is what the work is all about, getting to know these marvelous people of different races and nationalities and being able to make a difference in their lives and that of their families. When I finish the surgery and I give the good news to the patient’s relatives, emotions run high. Saving lives is a fabulous thing. I would not call it simply work.”

Dr. Samadi was born in Teheran. He was educated in the Jewish faith and was part of a Persian Jewish community. “Iranian Persians have a very long history of nearly five thousand years. They have a very strong culture and I am pleased to be a part of this culture. I have good memories of my life in Iran. I was raised as a Jew in a Muslim country and I attended a Catholic school, Don Bosco, to get the best education. All the efforts my surgical team make in the operating room comes about in part from the fact that I was captain of a soccer team when I was very young. I loved to compete and win, and the majority of times I would change the position of the players to beat the competition. Now, my enemy is a cancerous cell, and my soccer team consists of my anesthesiologist and my nurses, and I continue being the captain.”

Dr. Samadi was 16 when he had to leave his country at the end of 1982 as a result of the Iraq-Iran war. There was no option to continue his education since staying in Iran meant being conscripted into Iran’s armed forces. His life changed with an overnight flight from Teheran to Belgium with just about 300 Dollars in his pocket, accompanied by his brother and with the uncertainty of ever seeing his family again. In Belgium he was welcomed by Jewish friends and four months later the Samadi brothers travelled to London to complete his university studies. Life was not easy. Time passed parsimoniously, something very different from the rhythm of life in Iran, curiously more like that of the United States. Dr. Samadi immigrated to what he calls the land of dreams before the age of 18.

“In twenty five years I went from completing my university, graduate and post graduate studies to being one of most successful doctors in this country, and I’ve managed to touch thousands of lives thanks to my work.” His vision of Iran clashes with the stereotype, televised thousands of times, of a place where extremism is abundant and the hate towards the West is fed by the ayatollahs. “The Iranian government does not reflect the reality of the Iranian people. Europeans and Americans perceive erroneous images, he affirms. “Iranians are extremely friendly and hospitable people who want to be free, and want to enjoy the same things as you and me. The policy of nuclear proliferation carried out by the Iranian government is not a reflection of the country. Iran’s people’s mentality is very European or American, liking the Internet, enjoying music, listening to Michael Jackson songs, enjoying life in general. But currently, they are under a tremendous amount of pressure.”

When I talk with him about the Spanish health care system that covers all, he responds: “It is very similar to ours. What happens is that ours is not official. Nobody dies on the streets of the United States because of a lack of health care. People end up in emergency rooms where they are treated. I’ve worked in these rooms in the past, and no one was ever kicked out because they did not have health insurance.” Dr. Samadi has performed free surgeries and insists that no price can be put on what he does. “Curing people from cancer is not something mechanical. The battle against cancer is not going to be won simply removing the prostate and sending the patient home.

Ninety percent of the battle resides in the mind, thinking that the battle will be won and that there is life after prostate cancer. I am here to help them cross the breach and take them to the other side, so they can enjoy life with their spouse or partner. Today it is robotic surgery. In the past it was laparoscopic surgery. The surgical methods change. Treatment of patients should not instill false hope. They have to know that they are not alone.”

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