Exploring the World of Dr. Manohar Shroff
EARLY INSPIRATIONS
What was medical school like? Can you share a memorable anecdote from those days of yore?
The experience in medical school was nothing short of remarkable. The camaraderie, the awe-inspiring wisdom of our teacher – the intense life and death moments in emergency surgical units, the resilience of patients left a lasting impression. It is difficult to choose one memorable anecdote, there were many. The most amazing week was when I spent time in an emergency surgical unit - and we seemed to be saving lives almost every hour - from draining large deep abscesses, to extensive surgeries like intestinal resections, vascular surgery, and even a pneumectomy - the surgical registrar, Dr. Sagade was a surgeon and a doctor like I have never again seen in my life. We remained close friends until he passed. He remains an inspiration in my life.
Graduating at a time when Radiology in itself was in a formative phase in India, what inspired you to steer towards and build your outstanding career in neuroradiology in the year 2000, even going on to found the subspecialty of Neuroradiology at the Royal College of Physicians and Surgeons of Canada?
It is fascinating how life can lead us down unexpected paths! I went into Radiology by chance, I wanted to do family practice because of the human interaction, but to get house jobs in hospitals and more experience, one needed to be registered for a post graduate course and I thought Radiology would be easy, and then I would get back to family practice. But the advancements in CT and MRI happening at that time were revolutionizing medical imaging and I remember reading an article on the technology of MRI in the Radiology which was a pivotal moment – there was no going back, I could see how CT and MRI is going to open up a world of possibilities. Again, the timing could not have been better – when I graduated, we were at the cusp of technological breakthroughs in CT and MRI, nothing prepares you better than having a solid clinical foundation with historical techniques and using that knowledge with new technology.
As far as founding the subspecialty of neuroradiology – I was a small part of it and was lucky to be there at the correct time: Allan Fox and many others before me had set the stage, and when the penny finally dropped, I along with other neuroradiology program directors and the team had the privilege of carrying that work over the finish line at the Royal College.
CAREER INSPIRATIONS AND CHALLENGES
The road less traveled welcomes one with its bumps and snags. What or who helped you with the resilience for these challenges?
The resilience came early from family - during a time when we had meagre resources. I recall a moment when I laughed at my mother because she was trying to squeeze out the last few drops of from a milk bottle. She reminded me of a time when I was a young child, and she had to secretly coax the neighbor’s goat into single dwelling to milk it, so that I had enough to drink. My father, a refugee from the partition worked extremely hard and set an example for the family and teaching me the value of passion and honesty in the work we do. Our humble beginnings shape us and remind us of the value of every small blessing – I am profoundly grateful for where I am today.
And during my medical school training and residency, I learned from both exceptional and the worst of teachers. Regardless of the situation, there is always an opportunity to learn. In my first year of residency, the politics within the program were the most challenging I have ever encountered. We had a departmental head who treated us terribly, to the extent that out of the three new residents, two left. I persevered – it is such real-life experiences that teach us to be resilient. Following that I was fortunate to have the most wonderful teacher, Chandra Thakkar, a neuroradiologist, who treated everyone with equal respect. I strive to emulate that level of respect in my interactions.
Medicine has evolved tremendously over the past decades. Being a veteran in pediatric neuroradiology, could you share a few case scenarios where you have seen paradigm shifts in diagnosis, approach, management or simply nuance of importance?
It is difficult to pin-point just a few case scenarios. We are fortunate to be in an era where paradigm shifts are happening across the board. The biggest change has been the advances in understanding diseases, advances in specific treatments directed to specific disease targets and using our advances in technology to do better with this information. We are now in the era of precision medicine.
Examples of these advancements include the use of imaging phenotypes to supplement clinical phenotypes in understanding and treating genetic diseases. There has been a significant increase in our understanding of neuroinflammatory diseases and neuro-immunology related to the brain in recent years. For the first time, after decades without major advancements in the treatment of gliomas, except for surgery, we are witnessing children whose tumors are actually shrinking due to medication, thanks to the molecular diagnosis of brain tumors and the identification of specific targets for monoclonal antibodies.
One significant development, which may not be apparent to many pediatric neuroradiologists, is the remarkable progress in interventional neuroradiology. This has enabled us to treat conditions that were previously challenging to manage. The ability to deliver chemotherapy or biologics close to the target using catheters is a significant breakthrough. I predict that we will see an increase in catheter-directed drug delivery, like the current treatment approach for retinoblastoma.
INNOVATIONS
What recent advancements excite you the most, and why do you think they're game-changers?
Absolutely, artificial intelligence is indeed a game changer. It’s like having an external brain to assist us - what could be better? The vast amounts of data and complex mathematical processes require AI for processing and automating some of the repetitive tasks. The pace of advancement is rapid - those who adapt to this will undoubtedly thrive. The challenge lies in finding a way to power this advancement efficiently in terms of energy usage.
Photon counting CT and the newer methods of performing fast MRI, including smaller MRI machines, are all exciting developments. The evolution of the internet has enabled us to work and meet more efficiently in a virtual environment. During and immediately after the Covid-19 pandemic, I strongly believed in the value of personal human interaction (and still do), but I have come to appreciate the value of virtual meetings and remote work in certain situations. It’s a testament to our ability to adapt and innovate in the face of challenges.
LEGACY AND IMPACT
What do you hope your legacy will be in the field of pediatric neuroimaging?
The most important legacy to leave is for people not to miss you and for things to happen better than when you were around. The most powerful impact would be on the people around you – enabling them to grow and progress.
If you could change one thing about the healthcare system, what would it be and why?
I wish that healthcare would be easily accessible and available to all. Specifically, for Radiology, I wish face to face interaction would increase. In my initial years of practice, I met most patients who came for CT or MRI – even if only for a minute or two. The way things have evolved, it becomes difficult to interact with more than a minority of children and parents.
What is the one advice you would give to your younger self?
Spend more time with family, striking a balance is something that I failed at miserably. I regret not spending more time with my son and wife - earlier in my career, but I am glad that they still like me and love me. I cherish the moments that I now have with my family - my wife, son, daughter (in- law) and the grandson.
PERSONAL REFLECTIONS
How do you think doctors should balance work and other joys of life? What is your go-to stress buster?
The best way to balance work is finding joy in what you do – then work does not feel like work but a pleasure. I believe that many who choose pediatric neuroradiology do so because they love working with children. As pediatric neuroradiologists – we are the rain makers, and we are the catalysts for change, making a difference. There’s immense satisfaction in making a correct diagnosis that helps a child. One of the joys of my life, is to meet a child in the MRI or CT suite and chitter chatter with them. On challenging days, I will often go to the nurses and ask to hold one of the infants; their innocence is truly wonderful to behold. I always encourage our trainees, to interact with the child, speak to the parents – when the news is good, it is fantastic, and when it’s not, it teaches us empathy and reminds us of the human element behind the images we see.
My biggest go-to stress buster is my family – I have a grandchild with whom I have a lot of fun. We do crazy things together. My wife is the greatest balancer in my life. She sees things that I do not see. We both come from large families, and while there are pros and cons to that, we have weathered many trials and triumphs together. Her presence makes even mundane moments shine. Every day spent with her is a celebration for me.
Can you share a funny or heartwarming story from your medical career that still makes you smile?
I’d like to share a story from my past that taught me the profound impact of small acts of kindness. This incident took place in India on a particularly busy day at the MRI center. The waiting room was teeming with patients. As I walked through the crowd to get a cup of tea, I noticed an elderly gentleman who had been waiting since the early morning.
On my way out, I asked him if he would like some coffee or tea. He declined, but I could see a hint of longing in his eyes. He seemed hesitant to accept the offer from me, a doctor dressed in a tie and jacket. Regardless, I decided to bring him an extra cup of tea on my way back. I didn’t give it much thought at the time.
Fast forward a year, I was speaking at an orthopedic conference in Dibrugarh, Assam, located at the easternmost tip of India. During one of the breaks, I was informed that someone was waiting to meet me outside the venue. As I stepped outside, I was greeted by the same gentleman I had met in the MRI center. He was a family doctor who had traveled a great distance for an MRI in Mumbai.
Upon hearing that I was in town, he had come with his wife, two sons, and a daughter just to introduce them to the doctor who had shown him kindness by offering him a cup of tea. He wanted his children to meet me and inspire them to treat everyone they meet with kindness. I was taken aback and deeply moved by this gesture. It made me reflect on the times I had been dismissive or short with people.
Since that day, I have made a conscious effort to be more kind and helpful. This experience served as a powerful reminder that even the smallest act of kindness can have a lasting impact.
Three things about you that only a few know!
The Hidden Struggles: Life is often likened to a cup of joy, but it inevitably contains a few bitter drops. These moments hit me particularly hard when they impact my close family, plunging me into profound lows.
Burnout Moments: It’s not the long hours of work that lead to burnout, but the heavy weight of responsibility. The hardest moments are when someone who entrusted their health to me doesn’t fare well.
The Golf and Yoga Paradox: I often talk at work and to my friends about my pursuits in golf and yoga. Funnily enough, instead of progressing and improving as one might expect, I find myself regressing.
I think it is okay to have struggles and setbacks. They’re part of the human experience and often lead to growth and resilience. It’s important to acknowledge these feelings and seek support when needed. Remember, we are not alone in this journey.
