Pulling Back the Curtain: Ranjana Advani, MD

Dr. Advani on a trip with her family

When did you know that you wanted to pursue medicine as a career?

My parents told me that I wanted to be a doctor like my grandmother ever since I was two years old. She lived with us while I was growing up in India and had graduated from medical school in 1929, practicing “women and children’s health,” which included primary care, pediatrics, and OB/GYN care. Apparently, I never went through the phase of saying I wanted to be a teacher like many young girls do – I always said I would be a doctor.

 

Why did you decide to specialize in hematology?

There are a couple of reasons: Around the time I entered medical school, my grandmother died of chronic myeloid leukemia. In those days, there were few treatment options available, so that sparked my interest in learning more about leukemia.

Then, when I was in my final year of medical school, I was diagnosed with Hodgkin lymphoma. This was the early 1980s, when I was still living in India and malignant hematology wasn’t a very well-developed specialty. My father did some research and discovered that Stanford University was on the cutting edge of Hodgkin lymphoma treatment, so my parents brought me to Stanford to see leaders in the field, Saul A. Rosenberg, MD, and Henry Kaplan, MD. Being a patient and undergoing treatment for Hodgkin lymphoma was a career-defining moment. I decided then that my calling was to train in the hematologic malignancies, conduct research in the field, and care for patients with these diseases. I didn’t know at the time that I would end up coming back to Stanford for the rest of my medical career, and that Dr. Rosenberg would become one of my most important mentors.

Were there any other mentors who helped further shape your career?

During my fellowship, Stanley Schrier, MD, was my mentor when I was first exposed to formal hematology training. I had never worked in a lab; working with Dr. Schrier was an outstanding experience. The first exposure I had to actually conducting clinical trials with new drugs was with Peter Greenberg, MD. Training under him was an amazing opportunity at an exciting time when growth factors were starting to enter clinical trials.

Then, during my oncology fellowship training, I was able to work with Dr. Rosenberg and several other outstanding mentors including Sandra Horning, MD, Charlotte Jacobs, MD, and Brandy Sikic, MD. I have been blessed with the opportunity to work with and learn from leaders in the field. They set very high standards of excellence, which I’ve tried to model on a day-to-day basis.

They taught me how to be a critical thinker, analyze data, give a good presentation, and simplify complex concepts so that you can be a better teacher. More importantly, I learned how to be a compassionate physician; Dr. Rosenberg, in particular, taught by example that it was okay to hold your patients’ hands, to hug them, and to ultimately develop deep relationships with them. Having been on the other side of the doctor−patient relationship, I understand how important it is to connect with patients.

What advice would you pass on to your own mentees?

Everyone needs mentorship, but just getting assigned a mentor is not enough; you have to develop a relationship with him or her and take advice seriously. I never said no to an opportunity or task my mentors sent my way – whether it was seeing patients on a non-clinic day, helping with a research project, or writing a simple report or a major paper. All of these experiences helped me develop as a physician and ultimately opened other opportunities.

Next, I would tell younger hematologists not to impose timelines or artificial boundaries on themselves. For the first seven or eight years of my career, I worked part-time as an instructor so that I could spend more time with my three young children. When my youngest started kindergarten, I joined the faculty full-time. Of course, I was lucky that I had a husband who could support that career decision, but it was very important for me to have that time with them. When I look back, I know that I became an assistant professor seven years later than I should have; however, it was worth it. And, because it was a productive seven years, I made up for the “lost time” by getting an early promotion. At the end of the day, the time from my appointment as an assistant professor to a full professor was seven years, so eventually everything fell into place. The ultimate honor for me was receiving an endowed chair, titled the Saul A. Rosenberg Professor of Lymphoma, 32 years after first being treated by him. Life had truly come full circle.

Witnessing how my mentors were innovators in their respective fields instilled in me a true love of academia. Returning that great mentorship by teaching and working with residents, fellows, and medical students is important to me. I’m involved with the Stanford Immersion in Medicine Series, a program for undergraduate students interested in pursuing medicine. Students shadow a physician mentor in clinics and on rounds. My interaction with these young and very bright individuals keeps me going, and I think those are opportunities you get only in academia.

Who were your role models growing up?

I grew up with self-made people. My mother was a homemaker and my father was educated as a lawyer. Circumstances were tough for that generation. My father was set to take the bar exam in England in 1947, and at that time, the British separated India into India and Pakistan. He and his family moved as refugees from what is now Pakistan to India. With just the clothes on their backs and – most importantly – their education, they had to start their lives anew. My grandmother was a doctor and my father’s sister had a physics degree, so they were able to start working and support the family for a while. My father eventually became an entrepreneur and ran a fairly successful business.

So, the values of hard work and education were drilled into me at an early age. In particular, women’s education was – and continues to be – a huge priority in our family.

Were there any unexpected turns in your career?

When I was just about to finish my hematology fellowship and start my oncology fellowship, my husband’s job transferred him to Germany for three years. Our oldest child was six months old, and I was very torn about whether to stay and start my oncology fellowship or to move our family to Germany. At that time, I was insecure about my career and where it would go.

I went to talk with Dr. Schrier who told me, “A family stays together. You all go to Germany.” It took hearing that from a senior mentor to realize that it was okay. So, we moved, and that simple, wise advice resulted in a unique, rich, and fulfilling experience. We had a second child in Germany, and when I returned to California, Dr. Rosenberg offered me a fellowship spot in oncology and lymphoma. Once again, it all worked out, and I’ve never regretted that move.

Thankfully, my mentors valued a balanced life.

When you started working full time at Stanford again, how did you maintain that balanced life?

My husband and I had very busy careers, but we have made it work – and we were lucky to have flexible jobs. We’ve been married 31 years, and we have three wonderful children: our oldest daughter works for Apple in Tokyo; our second daughter works in finance (and has moved back home – which is lovely); and our son is a sophomore at the University of Michigan in Ann Arbor.

One strategy that helped was giving my children liberty to call me at work anytime, even if I was in the middle of a busy clinic. They understood that mom was at work, so they shouldn’t call for trivial things, but I didn’t want to miss out on anything they wanted to share with me. It was sometimes just a 30-second call to say, “Mom, I got an A in math on my report card!” For me, those calls, and the ability to stay connected with them, meant a lot to me. One year, my husband even became my daughter’s Girl Scout Troop Cookie Chair because we needed a parent and he was available.

Being involved in your children’s lives or your family’s life is important to keeping a balance, because I think if that part of your life is not balanced, you likely won’t succeed in your career.

In a typical day, what is the best part of your day and what is the part you least look forward to?

I could spend all day with my patients in the clinic. It’s so engaging that I completely lose track of time. I love the clinical aspect of what I do because I get to form very meaningful relationships with the patients and their extended families, especially in my long-term follow-up clinic for patients with Hodgkin lymphoma. I see patients we treated more than 20 years ago coming back with their children, or showing me photographs of their grandchildren, or handing me invitations to their children’s weddings – it’s so satisfying.

But, the flipside of that is the documentation that comes at the end of a 25- or 30-patient day. It’s getting more and more complex. Of course, there is bureaucracy like this in any job – whether it’s a corporation or a university or a private practice – so I try to stay focused on the positive aspects and try to ignore the negatives.

What is a skill that you’d like to add to your repertoire?

I trained under the British system of medicine, which is very structured. In the ninth grade you chose sciences and there was no room for a liberal arts education. Watching my children go to college in the United States, I thought, “Wow, they’re getting a real, well-rounded education.” My husband is retired, and he actually is a full-time student again, taking classes in the environment, policy, art history – all kinds of things. I would like to go back to take classes in some of the broader aspects of undergraduate education, like philosophy, music, or something completely different – not for a degree, but just for the exposure to the broader aspects of a liberal arts education.

Professionally, if I had the time and the bandwidth, I would like to expand my statistics knowledge a bit more or take an “immunology 101” class. So many things have changed since I went through medical school, and so much progress has been made. I think it would be interesting to take some basic classes to learn different perspectives on how we got to where we are now.

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