When i was growing up. My father was a plant geneticist so we found ourselves moving around quite a bit because he ended up going to places that focused on crop science. We spent some time in wales and then we moved back to india in 2007 and i spent a year there and for those of you who know a little bit about modern indian history, it was 1976 the year of the emergency rule a tough time for academics and there were a lot of restrictions on free speech. My father decided we have to get out of here so we ended up emigrating to the United States in 1977 and eventually ended up settling in setting california and that is where i grew up. Like i said my father was a plant geneticist. My mother was of biochemist who worked part time but mostly was of homemaker and she spent time raising s and they wanted me to become a doctor. In that generation especially among immigrant indians there was nothing more noble and better that you could do. Sort of coloring their vision was the fact that they had come with no money, Financial Insecurity and they thought this will going into medicine will confer stability on our children and allow them to do good for the worlds. I didnt buy into that when i was growing up. I have a lot of other interests besides science. I remember when i was growing up in india i would spend time with my grandfather a family practitioner in new delhi and i would watch him work and what he did was find. It was reasonably interesting but it didnt appeal to me deeply. Might 10yearold minds thought this is kind of cook book and i dont want to pursue medicine and i didnt see how medicine was going to allow me to develop my creative impulse and i was wrong about that actually but at the time so i was interested in a lot of Different Things so my mother would sort of pushed me to become a doctor. One reason she would say, the, doctors of people will stand when you walk into the room. It didnt work out that way. In the end i ended up going to berkeley. I was very interested in the mysteries of the universe so i decided to become of physicists. In immigrant indian culture, rebellion is saying no to a career in medicine and going into physics. I was really the rebel. So i went to berkeley and studied physics and graduated from undergrad and decided i was going to continue with physics. I wasnt sure what i wanted to do, but to go to graduate school and studied a very esoteric object called a quantum dots and i can talk to you about it afterwards. Of very interesting entities that is sort of like an artificial adam. I became a writer. Studying quantum dots, this was so far removed from what i am doing today, what ended up happening, there was a confluence of things. Any of you who have done research especially graduate Level Research know that it is very slow and i found myself struggling with the equipment, broken vacuum pumps. So the progress was incremental at best and right around that time someone who was very dear to made developed a severe case of lucas and in an effort to help her eyes ended up going to support Group Meetings and talking to doctors and gradually got more interested in medicine as a way to help her but also was fascinating to me how much was uncharted. How little was known about lupus or chronic disease in general and being a physicist, i had this idea that if i dug deeply enough i could figure things out for her and it became very clear is that medicine really is a science of incredible uncertainty and is largely uncharted and that was appealing to the scientist in meade but the biggest appeal, i started to see medicine as away to help people. Sounds naive, but it was the biggest motivating factor for me was at the time when i was sort of toward the end graduate school i desperately wanted out of the ivory tower. I wanted to be with people. I wanted to interact with my fellow human beings and i remember my brother, who is a doctor he is a cardiologist, in a residency at the time, he visited me once and sort of walked around my lab. I showed him the laser and all the cool stuff i was doing and he looked at me and said this is such an ivory tower and i remember thinking, you know, it was the worst thing you could say to me at that moment because it really stimulated me to make a big change. I ended up finishing my ph. D. And applied to medical school. I firmly believe in serendipity. I have always been interested in writing, but had no opportunities to write and other than scientific writing. So after i applied to medical school and had gotten in i was walking in the Physics Department one day and i saw a poster for a science journalism fellowship and sort of 5 when i was in high school, i like to writing and i should do something and i sort of had the summer off before i was going to go to medical school so i applied on a lark to the science fellowships and to my utter amazement ended up getting it and i went to Time Magazine for the summer before i went to medical school and time was an amazing experience for me because i have always been interested in politics and it was just it was it seemed so glamorous. I went there and first week i was there they sent me to the u. S. Capitol to get up quote from bob dole about the working poor. I had never interviewed anyone and i was a physicist. What did i know about it . So i applied my physics acumen, how am i going to all these reporters in the New York Times, cnn they are trying to he was majority leader at the time, trying to get to him so how am i going to work my way in . I figured you know what . I will hang out by the bathroom because i knew he had a prostate condition and he was going to end up in the bathroom at some point. So the land the holds i was just hanging out by myself and he walked in. And i was so nervous i looked at him tall man and i said a bunch of gibberish i am sure it was gibberish and he sort of looked at me and kept walking, completely ignored me so after he came out, done with his speeches and so on, i was talking to his press secretary and trying to get him to get me five minutes to get my quote so people at Time Magazine dont think i am a total loser and so the press secretary was in the process of blowing me off and bob dole walks up and i will never forget this. He said this is sandeep jauhar. He is an intern at Time Magazine and he wants to quote from the about americas working for. Setup the five minute phone conversation. This is what he gleaned from what i was sure was a bunch of nervous gibberish because so really admire the man. And i end up speaking to him the next day and got my quote and so i got bitten by the writing bug that day that week. So when i finished at that Time Magazine, it was the end of the summer and i was supposed to go to st. Louis, to Start Medical School so i went and talked to the bureau chief of Time Magazine, a guy named dan goodgame. I really like writing and maybe i should become a writer, work at time and he is like go to medical school. You dont want to end up and being stained wretch like me. Give me some names of people i can call in the future if i want to try to write about missing . He said sure. Gave me the name of someone, half a trillion, miami herald, but what about the New York Times . All right, sure. Gave me the name of one of the top editors so i went to st. Louis. The first few weeks were tough going from Time Magazine to the anatomy lab and memorizing muscles and nerves. One day i decided to call up this guy at Time Magazine and i really believe that such an Important Role for serendipity in our lives. I ended up calling this fellow gerald a bullet, and he has since passed on, but he was the National Political editor at the time and i didnt know it but he was i believe he was the panelist who asked Michael Dukakis what he would do if his wife were raped and murdered . So he had tremendous influence on the 1988 political president ial election. I didnt notice this at the time. I called him up and was in the process of speaking to someone and suddenly he gets on the phone and i said look gerald boyd what do you want . I was sort of telling him i was a medical student and then it turned out he was from st. Louis. Not just that he was from st. Louis but he actually had lived on the same streets i was currently living on, kings highway. So he started asking me where do you live . You are in medical school and at the end of the conversation he said next time you are in new york give me a call and we will have coffee. I said that is wonderful so i did what any aspiring writer would do up the phone, called American Airlines and book the flight to new york. Is then i called his assistant and i said i am coming to new york and mr. Boyd wants to meet with me. And who are you . So anyway i went to new york, they showed me into his office and i am looking around and there are pictures of him with george bush and the premier of china. At that point i was thinking all right, maybe you dont really know what you are doing. So he walks in and his tone had totally changed from the conversation lisa i have two minutes what do you want . So i started telling him that i wasnt in medical school but really wanted to be a writer and could i write for the New York Times . And he said show me your stuff. I said i dont really have any stuff. I tried to explain how at Time Magazine you dont get stuff. You just get quotes. He looked at me like i was totally crazy but he did do an amazing thing for me. He called in elizabeth rosenthal. She is a doctor and some of you must have read her pay until it hurts series for which i hope she gets the pulitzer but she came in and she said she went to harvard medical school. She was working as a journalist full time but doing a Little Medicine on the side. She said this isnt how you do things. Go back to medical school and see if you can write for the local paper tried to get a portfolio and then send me your stuff. I went back and ended up going to the st. Louis postdispatch and i met a fellow there a very good guy an editor named john curley who had grown up in manhattan and he had taken a liking to me and admired my gumption in coming and asking for an internship and in the end offered me an internship and then faced with this decision, how to i do an internship at the st. Louis postdispatch while i am in medical school . I called my brother and said i have an opportunity, i kind of want to do it but they are going to keep track. I cant be away from medical school for large amounts of time and he said you know what . There are many hours in the day. Remembered that and i thought i am going to go with this. I went to the st. Louis postdispatch and they started giving me stories. I would drive out there after morning classes, skip the afternoon and read the transcription and show up at 1 00, my editor there would say you know what . We want you to write there are a lot of people getting stung by wasps. We want you to write a piece about people getting stung by wasps and you have until 5 00. It would just be like okay, and it was trial by fire and i did a few featured pieces as well, one on diabetes and i did a profile of a surgeon and i would send my stuff to the New York Times to libya and she would read it and sometimes she would respond and sometimes she wouldnt and i had a little portfolio and the next step in serendipity was when i finished mid school i ended up getting an internship in new york and at New York Hospital so i called libby and the science section of the New York Times had a new editor. A woman named cornelius been. When new people come in they want to mix things up and bring in their own people. So i was one of her people. She took a liking to me and i pitched an article about a leprosy hospital in carville, louisiana. She said sure. We will send a photographer down. Go down and do the story so i went to cargill and stayed two or three days and wrote this piece and it came out about three days after i started my internship and two days before i met my wife, sonya. It was an eventful week. And corey dean would say why dont you write about your internship . I said okay. It turned out to be a great indication, because in an internship everything is new. As you go on in medicine you get jaded. You see things and you start questioning but when you are and in turn everything is new is rubles a year end up with i dont give a hoot what i write. I am going to write about what i see and the things that interest me and the things i am going to question. I remember one of my early pieces as an intern, there was a fellow in hospital and who was having difficulty swallowing and when he would swallow food would go into his lungs. Everyone was getting ready to put in the feeding tube into his stomach. The thing was he kept saying i dont want the feeding tube but no one was listening to him. I was on the team and whenever i would bring it up people would say what i you saying . What is the alternative . The alternative to me was listen to what he is saying, let him eat edit he dies of desperation pneumonia, that is the way he wants to live. But because it was such an egregiously crazy choice, who wants to die, people declared without capacity. You cant make your decision. They are getting ready to put in the feeding tube. It was so bothersome to meet at i remember one morning i went to his room and i said they are going to go for your feeding tube today and he said i dont want it. I said you know what . And i went to the refrigerator and brought out some thin liquids. I said here. Drink this. He hadnt drunk anything in over a week, maybe two, and so he drank it and maybe he coughed a little bit, he drank it and i said i documented his charge, did my own swallowing study and he can swallow. He doesnt need to a feeding tube. I called the surgeon and just called it off. Those are the things you need to experience when you are naive because now today, honestly if i were walking through the ward and i saw a guy like that who couldnt swallow and was getting ready to get a feeding tube i would probably just let him get it because i wouldnt be invested. When you are an interim you are investing your patients in a way that you arent, you dont know them as well as you move on. And that is unfortunate but it is the reality. Those are the things i started to write about, things that interested me. Things that seemed ethically or dubious and so by the time i was done with my residency i had 15 or 20 pieces in the New York Times. By then believe it or not i had a book agent who said you should write a book. I said oh sure. I just wanted to have an agent. I thought was cool to have an agent. At the end of my residency i said look why dont we just take my pieces and staple them together and call it a book . We pitched that idea which didnt go over very well. The editor, of my publisher said we dont really like your idea but we have an idea. Why dont you write about your residency, a memoir of development, novel of education . That is what i ended up doing and got turned into my first book which is called in turn. End there are a lot of pieces i published as the president but a lot of stuff i didnt publish. One thing corry told me was the diary and write down the stuff that is interesting to you. So i did and i thought it was so important. When young doctors and aspiring writers asked me how do you get started . I say you have to record your reflections. Ill say a few things and then well take questions. So when i took my job, my current job at long island jewish, it was in the july of 2004 one month before my son mohan was byrne. And i was born. And i had been in school for 19 years. Nineteen years after graduating from high school. Remember, i had that quantum detour. [laughter] so i was just ready to be done and, you know reap some rewards for all that, all those sleepless nights x. What i found and what i found was that doctors were very unhappy. And, you know, when youre in training, the focus is on the physiology and learning about the heart. Its not really about the culture of practice. So i was largely blinded to that. And then i took on my first role and im talking to doctors, and i find that theyre very unhappy with medical practice today. And it wasnt just about the stresses that we all know right . It wasnt just about the paperwork and the malpractice fears and so on. There was a deeper problem. There was what i started to think of as an existential crisis. It was more that doctors felt that they werent being able to Practice Medicine the way they were trained to practice the way that they aspired to practice. And that was deeply troubling to them. And so i sort of watched this and learned a little bit, but i was fairly happy. I was in academic practice and working with trainees, and i specifically chose an academic practice because with i wanted to teach, i wanted to be around young people and residents and people who had that naivete that i had. I wanted to hold on to. But shortly after i started in my practice i found myself with a significant amount of debt and feeling that i had to moonlight to make ends meet. Started a new family and most folks will be surprised that a lot of academic physicians do that. They moonlight on the side. And one of the reasons we choose academia is that we want to be around, you know academics, we want to be around young physicians, we want to teach. But, you know, the Salary Structure is very different. And in american medicine today, youre rewarded for doing as much as possible right . Its the feeforservice model. Do more, more, more. And one of the reasons why i chose academic medicine is i didnt want to be in that position where i had to do more and more and more. But then i found that i had to start moonlighting. And i found a practice in queens with a cardiology friend of my brother who offered me this gig going, doing stress tests and supervising stress tests on the weekends. And this is where i really learned about how medicine is practiced in some parts of this country. Now, most doctors are good. But theres no question that there is a subset in my profession that has taken advantage of the feeforService System. And its not, you know, you can call