A New Direction for Surgery

Surgery is changing rapidly, especially with innovations like robotic surgery, immunotherapy, and epigenetics, which makes this the ideal time for Nita Ahuja, MD, MBA, to take the helm of the surgery department at Yale Medicine.

Dr. Ahuja, who came to the United States from India when she was 8 years old, left Johns Hopkins Medical School to become the first woman to chair surgery at Yale School of Medicine; she became surgeon-in-chief for Yale New Haven Health this past February. When she arrived in New Haven, she was one of only 19 women chairs of surgery across the country—there are now 22, yet another aspect of surgery that is evolving.

Dr. Ahuja wears many hats. In addition to serving as chair, she is a nationally respected cancer specialist, an NIH-funded scientist and a leading member of the Stand Up to Cancer Dream Team, a research group studying epigenetic therapy for cancer management. (Epigenetics is the study of biological mechanisms that switch genes on and off.)

But the patients she’s cared for in the exam room and the operating suites usually see only one hat: The one worn by a warm, caring clinician who saves every card and note they send her.

Dr. Ahuja answered our questions about her work as a surgeon and her new role as chair.

Very good. I’ve heard from people all over the country. Here at Yale, everyone just kind of smiles like they’re really happy to see me. I’ve had people clap for me, which is really cool. My former patients are proud, and some have told me they want to travel here for their care now. I can’t take credit because I happen to be a woman. It’s true that when I first started my career it was less common for a woman to be a surgeon. But now more than 50 percent of medical school graduates are women. For the most part, patients don’t question it any more. Some prefer a woman surgeon.

It’s Yale! This is a historic surgery department, and a global academic medical center that is growing rapidly or exponentially. We are always thinking about how to improve surgical care for our patients. While our first job is patient care, I’m always asking myself, did I learn something today that will make things better tomorrow? At an academic medical center that question is always there. This is important to everyone, because patient care affects us all—we’ll all become patients someday. When that happens, you will want to be in a place that strives for excellence.

I’m the accidental surgeon-scientist. My mom was a teacher and my dad was a certified public accountant, so we had no doctors in the family. But ever since I was a little kid, for some reason, it was always medicine, medicine, medicine. 

Once I got to medical school, I had two light bulb moments. The first was during grand rounds where a surgeon-researcher talked about treating breast cancer with retinoids (vitamin A derivatives). At the time I thought, “Wow, this surgeon is doing research that could cure cancer.” The second was when I assisted with a surgery. It was the best moment of my life! I was taking cancer out of someone’s body. I had been asking myself, how can I make the biggest difference in a patient’s life? I realized that, for me, it was surgery. The majority of what cancer surgeons do is remove solid tumors. We can give people a good chance of survival.

I’m here because I want to do this. I was a surgeon-scientist. I was a lab geek who talked about science and loved it, and I probably could have done it for the rest of my life. Then, at a certain point, people started asking me to run a department. I thought, do I want to do this? It’s a big job, and it’s a hard job—it’s a really hard job. And then I thought who better to do this than a doctor? Doctors live this. I realized the only way to change certain things was to take charge and do it.

I perform a lot of complex gastrointestinal oncology surgery, including treating patients with gastric, rectal, and pancreatic cancers. For people who have advanced cancers, I am involved in treating them with chemotherapy along with surgery for their peritoneal cancers. I’m known nationally for treating soft-tissue sarcomas, cancers that affect the connective tissue. These are very rare—about 13,000 will be diagnosed in the United States in 2019—and they are hard to treat, because they are often big tumors and affect many organs, and there are 50 different types. Not many doctors understand them.

It’s about getting on the same page. At first, the patients may not even understand all the surgeries and treatments we talk about. Understandably, they want to know, “What are my chances of survival? Can I be there for my kid’s graduation or prom?” They bring in all their fears. It’s my job to pay attention to those fears and then explain all that’s happening with the cancer, including the surgery, the imaging, the genomics. I explain all of that—everything—in an hour. I remind them that they probably won’t remember everything I’ve said, but that we will be partners. We’ll talk about it again and again. I trained for 10 years after medical school, and the field has become more and more technical. But at the end of the day it’s about the patient.

Being a woman is one perspective of diversity, but there are many perspectives, and I want this to be an inclusive culture. There are a lot of data that show if you foster diversity and inclusion, ideas will follow. If you aren’t diverse—if all of your doctors look alike—you won’t do that well. Also, our population is changing, and you need a diverse team to manage patients from different backgrounds. Some cultures have particular values around end-of-life care, for example, and you have to pay attention to those things.

The baby boomers are aging and living longer, so we are treating an increasing number of people in their 80s and 90s, and even older. As we age, two things happen: cancer and cardiac problems. Both fields are evolving. For example, we had stenting for heart patients, and now we have management for people with failed stents. In cancer, we are learning about how immunotherapy [treatment that stimulates the body’s immune response] can be part of treatment.

The next innovation is robotic surgery, which involves operating with very small tools attached to a robotic arm. We already do a lot of it. The less stress we can put on the body, the better. Of course, while robotics is superior in some ways, it still has issues in some surgeries. I think robotic surgery will become another tool for surgeons, just like genomics is a tool and the electronic health record is a tool. They’re all tools—the patient-care and the doctor-patient relationship should remain the same.  

I like to think about how to deliver better care. I wake up every day thinking about how I can make my patients’ lives better. I like to focus on the practical details, the nitty gritty. Where do you go? Is the parking good? How do you handle these forms? Are you able to reach us? We are putting a bigger focus on coordinated multidisciplinary care, where a patient sees all the different specialists they need at once. Smilow Cancer Hospital already does that beautifully. It’s important because we’ll be in their position someday. I’ll be there. We all will.

As far as the technical part of surgery, eventually you learn all the pieces. But my patients teach me things about their lives I could never read about in a book. In health care you see the humanity, and you see the good. When I’m watching the TV news and hearing about the bad things, I think about my cancer patients who have such a positive attitude. It’s humbling. It keeps me grounded. My patients will thank me, and I’ll say don’t bother, just send me a card once in a blue moon. So, they send me notes and cards and tell me about their children, the graduations, their lives. I save them all, every one of them.

For more information about Yale Medicine's Surgery Department, click here.