The responsibility of leading AIIMS was a heavy one. The hospital was one of the foundational pillars of the new India after Independence and was founded in a spirit of idealism and scientific endeavour. Nehru’s dream was that such a centre of excellence would set the pace for medical education and research in South Asia. It was one of his famous “temples” of modern India. Ever since we doctors had first heard about it, there had been tremendous excitement about it. I first heard about it when I was studying in England.
Over the years, AIIMS had set new standards for research and treatment, and it was my job to maintain them. I was conscious of the fact that in academic medicine, the faculty is directly involved in clinical practice, medical education and research. This synergy is unparalleled in other professions. The complex inter-dependence of these three functions is one of the hallmarks of academic medicine. Consequently, AIIMS was a complex structure to run, as mandated by Parliament, and demanded integrity, truthfulness, compassion and accountability.
I could never have anticipated such a responsibility when, all those years ago, as a little girl playing with my dolls and treating them for tonsillitis, I decided in some strange, intuitive fashion that medicine would be my destiny. It was my luck that my lifework culminated in heading India’s most prestigious medical institution. In the course of my career, I came into contact with every single class of Indian, from the poorest to prime ministers and presidents. The primary physicians to these dignitaries placed their confidence in me whenever they needed help in the management of their patients, and this was a great satisfaction to me professionally and personally.
My chosen field has been radiology. Today we cannot imagine modern medicine without X-rays, magnetic resonance imaging (MRI) scans, ultrasounds, mammograms, computed tomography (CT) scans, angiography and positron emission tomography (PET) scans. Medical imaging is an essential component of the entire healthcare continuum, from wellness and screening to early diagnosis, treatment selection and follow-up.
But it was not ever thus. It took time for radiology to be accepted as a medical specialty that creates and interprets pictures of the human body’s organs and body systems to diagnose sickness or injury. As I relate in this book, it was initially scorned by many otherwise excellent clinicians as mere “photography”.
Till the discovery of X-rays in 1895, physicians had no access to pictures of what was happening inside a patient’s body. Since that moment, radiologists have moved from reporting medical imaging to performing skilful procedures to aid diagnosis and treatment. They have become a core part of modern multidisciplinary team meetings, reviewing imaging and contributing to the discussion of how a patient should be treated with physicians and surgeons.
If I have been at all successful as a doctor, my success has been to pioneer the introduction of radiology into Indian medicine and to raise it to the level and role it deserves in the diagnosis and treatment of illness. My career in radiology began at the time of the X-ray machine with its dark-room processing and dripping films, and passed, in the last three decades of the twentieth century, through unprecedented changes with the advent of ultrasound, CT and MRI scanners.
The engine of modern medicine to a large extent has been technology, a story that began with radiology, an umbrella term used for a group of imaging techniques that play a pivotal role in the detection and treatment of medical conditions. Once radiology began to be accepted at AIIMS and integrated into routine clinical practice – in other words, once it had proved its usefulness in identifying abnormalities, fractures, tumours and infections – I pushed for its expansion into all subspecialties such as paediatrics, cardiology, orthopaedics, rheumatology, gastroenterology, infectious disease, obstetrics and oncology.
Today, artificial intelligence (AI) is being deployed in medical imaging, with algorithms being produced to aid radiologists in the detection and characterisation of pathology. Artificial intelligence is currently being used for many applications in radiology, for example, in detecting and characterising lung nodules, characterising liver lesions in MRI and prioritising follow-up evaluations, and identifying and characterising microcalcifications in mammograms. It is a rapidly evolving technology with infinite possibilities for patient care. Artificial intelligence will be integrated into the daily work of radiologists, assisting physicians in improving their diagnosis thanks to its ability to filter through massive amounts of imaging data in seconds.
I am 95 and will not be around to see the application of AI in medical radiology in all its facets. But I confess to feeling pride in being part of this journey and to have played a part, no matter how small, in radiologists in India having a pivotal role in patient care.
In the ensuing chapters, I trace the arc of my life and career, from growing up in pre-Partition Lahore to studying in England, returning to India due to my desire to contribute to nation-building, and being one of the many people who nurtured and developed AIIMS to be such a sterling institution that it became a byword for the best patient care in the country. I joined AIIMS as an assistant professor and later became a professor and chair of the department of radiology. My colleagues and I developed the department’s postgraduate medical school programme, in which we set standards for radiology education throughout India.
Against opposition, I fought for AIIMS to acquire its first CT scanner and ultrasound machine. Over the 30 years I spent at AIIMS – six of them as director – I helped establish the departments of neuroradiology, cardiovascular radiology, oncoradiology, paediatric radiology and interventional radiology, as well as a separate cancer hospital.
On this journey, I met and married my husband, Dr Amar Nath Bhargava, a cardiologist, and we raised a son and daughter. The remaining 30 years of my career (from the age of 60 to 90) were spent building up Sitaram Bhartia Institute of Science and Research and Dharamshila Narayana Superspeciality Hospital, both in New Delhi.
At 90, I stopped working and began writing this small memoir, starting with my early life and the idyllic childhood created for me by my parents.
Excerpted with permission from The Woman Who Ran AIIMS: The Memoirs of a Medical Pioneer, Sneh Bhargava, Juggernaut.
