Not just his surgeon’s scalpel, his business brain and ‘undoctor-like’ attachment to his patients ensures that Dr Naresh Trehan stands out.

PRESENT: Gianormous is not a word. However, there are times when one needs to resort to not words to describe something as big as Medanta–The Medicity. Walk in through its doors and straight up is the OPD (out-patient department) sign flanked by two, tall marble screens. Carved on them are ivory-white trees; exquisite in their details. These are the wishing (mannat) trees at Medanta. This is where patients and families—who knows, an occasional doctor or two—make their wishes by tying ruby-red threads to its branches. At their base are two stone bowls. One simply reads mannat (wish) while the other states a vital truth; each life is precious. It is a hospital after all, and there are wishes galore. The lower branches, crimson due to the threads, stand testament to that fact. On the left of the entrance are the reception areas, on the right are the refreshment corners. Yes, everything exists in plural in this place. Built over 43 acres with 45 operation theatres, 350 critical care units managed by 20 specialists and 1,250 beds, Medanta is a massive operation. The nerve centre of this bustling medical hub is in its first floor which mainly consists of a long corridor—sterilised and hushed—which leads to a small sitting area with steel chairs, almost never empty unless the main man is missing. The man in question is the founder, chairman and managing director of Medanta; Dr Naresh Trehan. Dr Trehan needs little introduction in India. He is a medical administrator who has served as a personal surgeon to the President of India since 1991. He has been granted the Padma Shri and Padma Bhushan. But to his patients and to their families, he is more than a celebrated doctor—he is the doctor. Trehan is respected because he judiciously avoids the lessons of “non-involvement” that most of his ilk learn early in their careers. “Unless you are emotionally involved you can’t do your best,” he lets you know. In fact, in one of his older interviews he had compared his involvement with his patients to the Chipko Movement. “I told the doctors at Medanta: chipko (stick on) to your patient and do not let him slip out of your hands. Hang on to his life, like you would hang on to your own.” It is this dogged devotion that makes him a hero in his patients’ lives. On the day DW was to meet Dr Trehan, there was a man—a father—also waiting for his turn, along with other families. People usually wait patiently for Trehan and when he does enter a room everyone sits up. The doctor has that effect. On that day as he entered Trehan’s chamber, the father took the seat closest to the black desk and awaited his turn as Trehan navigated interview questions (“Why don’t you copy-paste what I have said in my previous interviews? What, you never do that?”). When his turn came, the father passed on his file and lay a shaking hand on the table. It was the doctor’s turn to quiz, “Is he still feeling the spasms?” (Yes.) “What does he play?” (Soccer.) After a moment’s pause, he looked up beaming and said, “Please ask him to play as much as he wants. He is just feeling post-surgery muscle spasms. They would pass, anyway a 14-year-old shouldn’t worry too much.” The case is closed. The father rises and finally, he is genuinely smiling. Watching the interaction one wonders, who does he treat more? The patients or their families? Well, both. In a country where words such as “pull” or “connection” are used to extract the best medical facilities, it is often a family that needs more care after a loved one’s ailment. It is no wonder then that Trehan and Medanta are so well respected—the doctor makes mandatory rounds of all wards, everyday. The hospital with its advanced technologies and techniques draws all sorts of people to far-off Gurgaon and the patient demography proves that—Africans, South-east Asians, Bangladeshis and Pakistanis, every nationality is present there. There are the better-off waiting for their turn, with people you do not normally see in ‘posh’ receptions of five-star hospitals—and it is a fivestar hospital as far as facilities are concerned; Medanta ranks the best in Asia in liver and kidney transplant surgeries. It is one of the few that conducts minimally-invasive, robotically-controlled cardiac surgery and beating heart surgery. Trehan’s patients consider him to be a Scalpel King. Not without reason. He loves conducting surgeries. “If I spend four hours in a surgery I am not tired. I can go on for 24 more hours and still be happy.” Currently, Trehan performs approximately 12 operations a day, meets patients, families, media, his Board and investors. And he is frequently spotted at Page 3 dos. How does he manage all that? “By not thinking about a schedule and jumping right in. Plan, but do not waste time thinking whether you can do it, just do it.” He could be the Nike man or he is simply well-trained. “For seven years Dr Frank Spencer (his mentor) trained us like commandos in his medical boot camp. We slept for four hours. I was barely at home.” On the flip-side, he missed his daughters’ childhood. And Shyel and Shonan (“I don’t know what the names mean, ask Madhu, won’t you?”) grew up with an “absentee father”. Trehan makes sure that he does not repeat the same mistake with his granddaughter now. Talking of his legendary time management skills, Dr Savita Dhillon, director of the Medanta Duke Research Institute, admits, “He is so focused. I believe it has something to do with a tremendous sense of discipline. Interestingly, he manages to make it all look so easy.”

PAST: Trehan’s journey began in a three-roomed apartment at Connaught Place which he shared with an elder sister, Neena, (incidentally not a doctor), a Sindhi gynaecologist mother and a Punjabi father, an ENT specialist. Parents had travelled to New Delhi from Lahore (Faisalabad) post-partition. After the Centre granted the Senior Trehan a flat at Connaught Place, the couple converted two rooms into chambers, while the family happily lived in the third one. “The house was always filled to the brim with patients. Watching my parents interact, I was slowly being indoctrinated. In Class X, I took up biology as a ‘special subject’. That was the first time I made a conscious career statement and proved that my parents’ work had left an imprint. I knew that the sense of gratification was immense in this profession. Much like the Stockholm Syndrome, I grew up to love my captor. But it was not an overnight decision.” In fact, while still in school (Modern School, Barakhamba Road) there was a time when Trehan wished to be a pilot. He went on to study at Hindu where at a party he met his future wife, Madhu Trehan, hailing from one of the most influential media families of India. Fate intervened and Trehan was soon off to King George’s Medical College, Lucknow. After completing his internship at Safdarjung Hospital, he obtained a scholarship from American Board of Surgery and American Board of Cardiothoracic Surgery. Finally, he went on to practice at the New York University Medical Centre from 1979 to 1988. “There was something positive about heart surgeries—those nearly dying and breathless would come out smiling after surgery within some days. Next to that I found neuro-surgery depressing.” Though he switched soon after, there was a catch—Trehan decided to train under the legendary Dr Frank Spencer and none else. “I was a ‘rock star’ complete with a handlebar moustache and sideburns. Dr Spencer must have been shocked to see me,” says Trehan with a laugh. It was Dr Spencer who taught him his greatest lesson. (Along with The Godfather—yes, the film). “On a given day your patients and families will treat you like god. As long as you do not believe it, it is okay. If you do, that’s the beginning of the end,” Dr Spencer would inform his students. By 1976, Trehan had performed his first surgery on a 55-year-old man, a father of three. The operation took four hours and he was exhausted yet elated by the end of it. “Dr Spencer pushed me to grow and create new highs. Even today, I strive to do better. It is such people who question everything, every time, and try to grow, who are able to grow positively.” By mid-1980s Trehan was earning over $1.5 million a year as a Manhattan heart surgeon. Then, he dropped jaws by deciding to move back. “Indian patients kept on reminding me that I was needed more here than there. Not everyone could afford to travel to the US to get themselves operated.” Upon his return, he had two options—to be on his own or practice with an established institution. He did what he was meant to do; finance his vision of a private heart institute and research centre thus forming Escorts Heart Institute and Research Centre (1988). Under his guidance, within decades, Escorts grew to be one of the largest heart institutes in Asia with 325 beds, nine operating theatres and satellite operating rooms in five cities. By then Trehan was the most prominent heart surgeon in the country. He had operated on political figures, businessmen and celebrities. He was a celebrity himself with a Padma Shri, a Padma Bhushan, Lal Bahadur Shastri National Award and Dr BC Roy National Award in his kitty. Dr Trehan was also the president of the International Society for Minimally Invasive Cardiac Surgery. It was around that time that he thought of the concept of Medanta–The Medicity. But a doctor proposes and management disposes. A string of controversies and a management change later, Trehan packed up and left Escorts, working with Apollo for a while. That idea of an integrative health care system and a facility that would usher in a new era of alternative and cutting-edge medicine in India continued to niggle. So he did what he does best—jump right in. He approached Siemens, and numerous proddings later the `1,200-crore project, with Trehan as its chairman, began. Trehan personally oversaw the building of this “integrated health care facility” fashioned after Mayo Medical School and Johns Hopkins Hospital. Its aim; to educate doctors and teach them that they do not need to run to the west to start meaningful research. And he did all that and turned his venture into a commercial success—a fact that he doesn’t shrug off. In fact, he brushes aside allegations that suggest doctors do not make good entrepreneurs. “We are better-equipped to guide and manage hospitals since we are less driven by the thought of profit and more by gratification derived from treating patients. As I have said before, medicine is a business with a soul. We need to think of what we are doing and what we want to do. We do not want any business person coming to us and telling us how to do our surgery and earn money,” he asserts. In his characteristic bluntness he points out that he is a “social capitalist”. Just as he does not mind accepting that he is an occasional smoker and social drinker (two glasses of wine max, seven hours of sleep later and mandatory exercise session in the morning).

FUTURE: These are desolate times for Indian medical care. Private health sector’s dignity is waning and the common citizen’s perception of health care, especially private health care system, is that it is rotten to its core. “I was aware of all the notions. So I felt that the need of the hour was to create an organisation that has a transparent billing system and governance. With Medanta I wished to create such an environment,” he stresses. A member of a patient’s family vouches that Medanta does try to “stay clean”—at least more than others. “An injection that we paid for which was to be used during my husband’s operation was expensive. There was no way that I, or my husband who was unconscious at that time, could know if it was indeed used. It was not. And I was returned the money by the authorities. It is these little points that make patients trust Medanta. It is so easy to fool patients and families when they are at their vulnerable best. Medanta does not take the easy way out,” says she. Dr Trehan dismisses the idea that India’s health care sector’s prominence remains on a decline even after 60 years of Independence. “That time when the health sector was treated as a step-child is past,” says he. “I look after my patients, the administrative bit of the hospital and call myself an entrepreneur. I don’t see why someone can’t do all that,” again that amazing time management Guru. When he started Medanta, despite establishing top-notch cardiac care, Trehan missed a system where there was similar expertise in other specialties. “We needed a space where the unique Indian conditions could be treated. The Indian gene is very different and we should be able to find ways to cure our conditions.” Thus, Medanta’s emphasis is on Indian (Asian) gene, body, its well-being and medicinal traditions. It has the Medanta Duke Research Institute and the Integrative Medicine Department—both slated to play important roles in the future of the hospital. The “Indian theme” of Trehan’s dreams continues even in the design details of the buildings, in its signages and in the mannat trees. “Today I take pride in stating that there is no other institution in the world, including Mayo and Cleveland, which has such talent across the board. We collectively strive to deliver care which is better than any other institute in the world. One day we hope that a major chunk of global research will be conducted right here at Medanta. And that we would be able to treat problems that ail us and help others as well.” He has several similar hopes, wishes and dreams. One wonders, among those thousands of ruby-red threads, is there one that the good doctor has tied?