Volume - 7 : Issue - 2

Published : Apr. - Jun. 2008

Group : Ruminations

Back to the List


By Lavjay Butani

Address by – Lavjay Butani, MD, Associate Professor and section Chief, Department of Pediatrics, Section of Nephrology, UC Davis Medical Centre, Sacramento, California, on the occasion of the annual gathering of the local chapter of Alpha Omega Alpha (AOA) to honour the new inductees (graduating medical students, residents and some faculty members)

Thank you Dr Fitzgerald…..good evening.

I am so incredibly honored to have been asked to give this talk today at this gathering of such distinguished people that I am at a loss for words. When I was first approached by Molly about this, I was, of course, thrilled and excited at being given this opportunity yet at the same time I was mortified. And the reasons for that are many:

Firstly: I am truly in awe of all of you. I see out in the audience, greatly experienced and respected teachers, students, new inductees into AOA…each and every one of you, who in the true spirit of AOA have proved by your thoughts and actions that you are indeed “worthy to serve the suffering.” I look at you and am faced with self-doubt and question my credentials. I consider myself quite inexperienced and a novice in this field, compared to many giants such as Drs Fitzgerald and Halsted among many others. Even when I look at those of you much younger than me, I see hard working and dedicated students, residents and faculty, I see the enormous breadth of talent and life experiences that you bring with yourselves.

And so I've been plagued by the question: well what do I have to offer here? A simple pediatrician, in the relatively early stages of my life and career; a native of India who moved to the US 15 years ago to pursue my residency and lived what could be considered by many, a very conventional and perhaps boring life.

So as I was mulling over this, I thought, well yes, there are 2 things that are mine and mine alone that I can give you, and so those are the ones I am going to talk about today. And they are first of all: the fears, uncertainties, and mistakes that I have made, the self-doubt and internal conflicts that I, and all of us struggle with, in our day to day lives, and what I have learnt from those. For I do really believe, that it is the mistakes that we make that leave an indelible impression on our minds and it behooves us to firstly recognize them as such and then reflect upon them, explore why we chose a certain path or did something and to try to come to terms with them. Mistakes related to errors of judgment, liberties that I have taken, oftentimes carelessly, disregarding my conscience and justifying my actions as 'necessary' based on the circumstances I was in, and also the liberties that we take, recklessly under the rubric of 'entitlement.' How often have I heard myself and others around me say to friends, family, others, things such as “well I paid so much for medical school…I deserve to get some special treatment and respect”


“I deal with life and death issues….doesn't that count more than what you do?”

OR even

“I am on call every 3rd weekend ….you only work from 9-5 pm. What do you understand how little time I have to myself?”

And little by little, convincing ourselves that our actions are justified, we stray more and more from the path of righteousness and moral conduct, until we can become lost. Another common error, this time of omission, that I have experienced and seen, is that of self-doubt. Early on in our careers, often as we are learning the tricks of the trade, navigating the promotion ladder, there is a tendency for us to try to please everyone, and in the process loose our sense of idealism that drove many of us into medicine in the first place. We sometimes lack the desire or courage to fight the system, even when we see things happening that are not in the best interest of others, be it patients or our colleagues or co-workers, fearing that raising our voice would do us harm in our careers, the belief that we are too small in the big scheme of things to make any difference and that our efforts will go in vain, or from real indecision-not knowing the right thing to do or the right way to do it. And so we give up and go on living our lives and become more and more disillusioned with the system and eventually with ourselves.

So of course I'm not going to leave you depressed with my personal miseries.

And that brings me to the second thing that I offer to you today: an introduction to my culture, my heritage and the Hindu spiritualism and philosophy that I was so fortunate to be exposed to during my growing years and one that always comes to my rescue whenever I am in need of guidance.

Uncertainty and lack of faith in ourselves plague us all, from time to time. And for me the source of inspiration and comfort, the answers to these conflicts, lies in the Bhagavad Gita, which some of you may know about….literally the Bhagavad Gita can be translated into English as 'The song of God”. And it is the story of the Gita that I'd like to share with you. But before I begin, let me very briefly put the Gita into perspective with respect to Hindu Religion and Philosophy.

As a background, Hinduism is over 5000 years old. Hindus, in fact, believe that their philosophical tradition preceded the existence of the earth. The word 'Hindu' is a derivative of 'Sindhu' or the Indus, the name of the river around which Indian civilization was born. There are 3 main tenets of Hindu philosophy..these will seem familiar to you all since they seem obvious and also because they bear so much resemblance to what we in the medical profession have recently been emphasizing under the rubric of  'Professionalism':

1.       First of these is Tolerance. Lord Krishna, one of they key figures in Indian mythology and the reincarnation of Vishnu, the preserver of life, states- “Whomsoever follows any faith and worships me under whatsoever denomination and in whatsoever form, with steadfastness, his faith shall I indeed reinforce.”

2.       Second-Acceptance and open mindedness, specifically recognizing that different people have varying levels of understanding and that there is a way for everyone to achieve success and salavation

3.       Third- the essential need for and encouragement of change/flexibility: Hindu's believe that with time, as the rules of society change, so does religious philosophy and beliefs-so that Hinduism is also referred to as a 'living religion'.

No single book of the Hindus, no set curriculum that can be followed. There are many texts that act as guides: 1st set – 'Vedas' ('Vid'-to know). Books of spiritual knowledge handed down supposedly by a greater power to Brahma, the creator of the universe, one of Trinity of the gods-Brahma, Vishnu and Shiva. 4 main vedas, several sub-texts or sub-vedas; one of which is the Ayurveda- the text that discuss the use of what a very popular non-allopathic practice of medicine in India and is becoming more so here in the US. Parts of the Vedas which describe the-essence of spiritual teaching are referred to as the Upanishads.

Very complex and difficult to understand, and so ancient philosophers created epics with fables to more easily explain to the general public the important concepts of Hindu philosophy. One of the most famous Epic is the Mahabharata, or the Story of the Great Indian War.

One small part of the Mahabharata describes the dialogue between Lord Krishna (reincarnation of Vishnu), and his very confused friend Arjuna, on the philosophy of human life while on the battlefield of the Mahabharata---this is what is known as the Bhagvada Gita, or the Song of God….and this is accepted as the quintessential source of spiritual knowledge and instruction and a guide to life, very relevant in today's technologically advanced, materialistic and quite unhappy world with wars and strife.

In the Gita, Krishna explains to Arjuna about his duty to fight for righteousness in support of his brothers who were wronged and humiliated and who's throne was taken away from them by deceitful means by their step-brothers and many cousins/uncles/nephews who now face them on the battlefield.

On this battlefield, the greatest battle of all is about to be fought, one between the forces of good and evil. Arjuna represents the common man, you and I, and Lord Krishna, his teacher and guide, symbolically represents our own soul, our inner consciousness, our real self that is always present to guide us on the right path. The word 'Krishna' comes from the Sanskrit-Krish: to draw into …reflecting that Krishna, or our inner consciousness is drawing us to itself all the time in an attempt to unite all creation : into an amalgamation of souls.

This is one of the greatest lessons that the Gita is trying to teach us: that the strength to fight against injustice, is within us, and can be tapped into by self-reflection and meditation. Faith in your selves and your strengths is essential-faith gives you courage to take risks and make peace with yourselves when you suffer the inevitable setbacks that are the fate of those who want to change the world and make a difference.

On the battlefield, Arjuna says, and I quote the Gita:

“O Krishna, drive my chariot between the 2 armies. I want to see those who desire to fight with me. And Arjuna as he stood between the 2 armies, saw fathers and grandfathers, teachers, uncles, and brothers, sons and grandsons, in laws and friends. Seeing his kinsmen established in opposition, Arjuna fell into confusion and mournfully spoke: O Krishna I see my own relations here with the desire to fight and my limbs are weak, my body is shaking. The signs are evil for us. I cannot see that any good can come from killing our own relatives in battle. I do not desire victory, or even a kingdom, or pleasure or even life.”


At this point Arjuna recognizes that he is being called to wage war against people he has considered to be part of himself-his own step-brothers. And the brilliance of the Gita is that this is precisely what the step-brothers symbolize: These 100 step-brothers that Arjuna is being asked to fight against symbolically represent the 100's of worldly attachments and our 'ego' that is constantly at war against our true inner self, and that we need to learn to fight against.

Arjuna is suffering from inertia, a very contemporary malady..the same one that you and I frequently encounter-we get concerned about what is happening to the world but when it comes to action, most of us do little to contribute to change. We are limited by our fears, our satisfaction with our own lives and are often unwilling to take a risk to get out of our comfort zone. And yet, our agony is real and doesn't have a clear-cut answer. For while on one hand Arjuna lacks the will to take up the cause of good and justice, on the other he rightly expresses hesitation at creating more disharmony in the world by fighting. He realizes, being a devout Hindu, in the unity of life- the unity that is so complete that injuring anyone else, even the meekest of creatures, injures himself and the whole.

Overwhelmed by sorrow, Arjuna speaks these words and casting away his bow and his arrow, he sits down in his chariot in the middle of the battlefield.

In the Gita, Krishna helps Arjuna realize not only how to tap into his own strength and to grow fearless and face the world, but also how to reconcile his internal conflicts.

And he discusses 2 concepts:

1st: Immortality of the soul and how the physical body is a transient and unreal manifestation of our ego.

And to quote him in the Gita, Krishna says: “As the same person inhabits the body through childhood, youth and old age, so too at the time of death he attains another body. The man of wisdom is not deluded by these changes. The impermanent has no reality; reality lies in the eternal. Those who have seen the boundary between the 2 have attained the end of knowledge”

He goes on to say: “The body is mortal but he who dwells in the body is immortal. As we abandon worn out clothes and acquire new ones, so when the body is worn out a new one is acquired by the real self, who lives within.” And so, he urges Arjuna to give up his fear of hurting the body and fight for what is right. Krishna then says to the still unconvinced Arjuna, “Even if you believe the self to be subject to birth and death, you should not grieve for death is inevitable for the living; birth is inevitable for the dead. Since these are unavoidable, do not grieve and do your duty.'

He then talks about the second important thing: 'duty' or 'dharma' and goes on to say “Considering your dharma, you should not vacillate. For a warrior, there is no higher action than a war against evil. The warrior who is confronted with such a war should be pleased, for it has come of itself as an open gate to heaven. And if you do not participate in this battle against evil, you will be violating your dharma and your honor, and you will incur sin.”

The Gita tells us that Dharma is a Relative term - there is no absolute code of conduct that is equally beneficial to all or applicable in all circumstances. All things in the world are a mix of the good and the bad, and there is a constant battle in our minds to decide which path to take, just like the war in Arjuna's mind between the battle against injustice and peace at the cost of letting evil flourish. How then do we decide what is right and what isn't.

And that is the last thing that I wanted to talk about. The Gita proposes that all actions, even actions such as the acquisition of wealth and desire or war, are acceptable as long as they are rooted in Dharma…righteousness, the good of all. In fact the Gita acknowledges that wealth and prosperity are important, both for the individual and the collective, but must be achieved by following the path of Dharma. The word 'Dharma' literally means 'righteous duty', but is probably best described in the words of the ancient Hindu sage Bhishma, and I quote him, “whatever nurtures, cherishes, provides more amply, increases and enriches all living beings is Dharma.” Dharma is what is done for the good of all with one's heart and mind.”

It then follows that actions that are performed without desire for the fruits or rewards-selfless action, action for the good of the most, are the best actions and the ones that lead to the path of righteousness.

Now this understandably can be very complex and difficult to practice in day to day life and Hinduism recognizes that. Hindu philosophers say that the path to achieve salvation and self-realization, to know ones inner strength and the path to selfless action is best achieved through a combination of: self refection (mediation), keeping the company of the wise, in slowing down in life and in putting others first.

To conclude: Life is a battlefield, in the medical profession, no more or no less so than in any other, and we must strive, till the end, to continue this battle for right, based on justice, basing our actions on what is selfless and without focusing on what there is in it for us, as individuals, reflecting instead on what is good for all, because we are, after all, an amalgamation of souls, and what hurts someone else, hurts us even more

And I want to end with a short passage from one of my favorite poems: Walt Whitman's Song of the Open Road, which to me so very eloquently conveys the enormous power within us all:

Henceforth I ask not good fortune, I myself am good fortune
Henceforth I whimper no more, postpone no more, need nothing.
Done with indoor complaints, libraries, querulous criticisms
Strong and content I travel the open road
O highway I travel, do you say to me. Do not leave me?
Do you say Venture not,-if you leave me you are lost?
Do you say, I am already prepared, I am well beaten and undenied, adhere to me?
O public road, I say back I am not afraid to leave you, yet I love you
You express me better than I can express myself,
You shall be more to me than my poem.
I think heroic deeds were all conceived in the open air, and all free poems too,
I think I could stop here myself and do miracles
I think whatever I shall meet on the road I shall like, and whoever beholds me shall like me.
I think whoever I see must be happy
From this hour, I ordain myself loos'd of limits and imaginary lines,
Going where I list, my own master, total and absolute,
Listening to others, considering well what to say,
Pausing, searching, receiving, contemplating,
Gently, but with undeniable will, divesting myself of the holds that would hold me
I am larger, better than I thought,
I did not know I held so much goodness.
All seems beautiful to me,
I can repeat over to men and women, You have done such good to me and I would do the same to you,
I will recruit for myself and you as I go,
I will scatter myself among men and women as I go,
I will toss a new gladness and roughness among them,
Whoever denies me, it shall not trouble me,
Whoever accepts me he or she shall be blessed and shall bless me.
Forever alive, forever forward
Stately, solemnly, sad, withdrawn, baffled, mad, turbulent, feeble, dissatisfied
Desperate, proud, fond, sick, accepted by men, rejected by men,
They go! They go! I know that they go, but I know not where they go,
But I know that they go towards the best-towards something great.

About AOA

When William Webster Root and five other medical students at the College of Physicians and Surgeons in Chicago organized Alpha Omega Alpha in 1902, "excellence" was hardly the word that would describe American medical education. Indeed, the founder viewed the society as a protest against "a condition which associated the name medical student with rowdyism, boorishness, immorality, and low educational ideals."

Of the approximately 25,000 medical students in the United States at the turn of the century, no more than 15 percent were college graduates. The only requirement in most schools was a high school diploma or its equivalent; the latter often meaning the ability to pay the fee. The schools themselves—there were about 150—were by and large of dubious quality.


In his landmark study of medical education in the United States and Canada, published in 1910, Abraham Flexner found so-called medical schools located in storefronts, tenements, and warehouses, their laboratory equipment consisting of a couple of microscopes, some moldy slides, and a lonely skeleton. With a few exceptions, notably the Johns Hopkins School of Medicine, founded in 1893, the medical school curriculum consisted of a series of lectures, sometimes supplemented by demonstrations at the bedside or in the laboratory, if such existed.

These, then, were the circumstances under which Root and his fellow medical students met to form a society that would foster honesty and formulate higher ideals of scholastic achievement.

Chartered in 1902 by the state of Illinois, Alpha Omega Alpha's growth has paralleled the development of American medical education. Within a decade after the society was founded, chapters were established at seventeen medical schools. At present there are 124 active chapters in the United States and Canada. Today, when students and established physicians alike reject easy platitudes, the tenets of the society are more relevant than ever. As framed by Root, they are a modern interpretation of the Hippocratic oath:

 "It is the duty of members to foster the scientific and philosophical features of the medical profession, to look beyond self to the welfare of the profession and of the public, to cultivate social mindedness, as well as individualistic attitude toward responsibilities, to show respect for colleagues, especially for elders and teachers, to foster research and in all ways to ennoble the profession of medicine and advance it in public opinion. It is equally a duty to avoid that which is unworthy, including the commercial spirit and all practices injurious to the welfare of patients, the public, or the profession."