Dr. Kanti Rai, researcher and ‘doctor’s doctor’

ABSTRACT: He trained to practice pediatrics, but cancer research won the day.

Kanti R. Rai, MD, was born in the sun-drenched city of Jodhpur, India, during the waning years of British colonial rule. It was a beloved uncle who inspired his medical career-a free-spirited doctor who once took 8-year-old Kanti with him on house calls, riding atop a camel.

Since then, across more than half a century of work in the clinic and laboratory, the name Kanti Rai has become synonymous with the classification and treatment of leukemia.

“We lived together, two families under one roof. My parents had eight children; my uncle and aunt had seven. But even my uncle’s children called my parents father and mother. It was a joint family, but with only one patriarch and one matriarch, my parents. We all abided by that rule,” Dr. Rai said, during an interview with ONI at Long Island Jewish (LIJ) Medical Center, where he is chief of the Division of Hematology-Oncology in the Department of Medicine.

Dr. Rai remembers his father as a hard-working civil servant who commanded unflinching respect in the Rai’s overcrowded household, but it paid off-more than half of the 15 children went to college.

“My uncle was a doctor who headed emergency services at the hospital. Each morning, my father gave him a ride to work. But if he wasn’t ready, my father would take off without him,” Dr. Rai said with a wry smile, explaining that his uncle would simply walk to the corner and the first passing driver would stop for him, cashing in on bragging rights to have taken the “famous” Dr. Rai to the hospital.

“Everyone knew my uncle! He was a fantastic doctor, but he was also my friend and a fun guy to be with,” Dr. Rai said.

The city hospital was a stone’s throw from the neighborhood school, and after class, young Kanti would pop in to visit.

“It was a huge, bustling emergency room,” said Dr. Rai, shaking his head as he relived the chaos.

He recalled one particularly hectic time: His uncle was doing a throat exam. While the patient’s mouth was wide open saying ‘ah,’ he was pulled away to another patient on his knees waiting for a rectal examination.

“Just as my uncle slipped the gloves on, the phone rang. He grabbed it. Then an orderly rushed over with a requisition. My uncle was talking rapidly on the phone, signing papers, giving orders to a nurse, one man is still saying ‘ah,’ and the other poor man is on his knees. What excitement. I was hooked!” he said.

Dr. Rai’s uncle lives on in his memory, the quintessential doctor who embraced all aspects of the profession. “In 1940, after he had a minor operation,” Dr. Rai continued, “my uncle asked for lighter duty and was sent to a small village. I went there during summer recess. Every morning, I would see a line of camels with drivers to pick up my uncle for house calls.”

Kanti was allowed to go along if he behaved. “So there I’d go, sitting in front of my uncle on the camel. He never cared if his patients were poor or if they had means; he doctored them all the same. It was then that I realized being a doctor was a great profession,” Dr. Rai said.

A pediatrician’s calling

Dr. Rai confessed that he never thought about oncology; he dreamed of becoming a pediatrician. “At that time, if you were diagnosed with cancer, you went home, covered yourself with a sheet, and waited to die,” he said.

In 1955, after graduating from medical school in Jaipur, Dr. Rai received a much-coveted residency in the United States. After that, he planned to return home and practice pediatrics in rural villages.

Landing in the destination of his choice, New York City, the young medical resident was given a list of hospitals to choose from.

“I was a kid from India. What did I know? But next to Mahatma Gandhi, the greatest person I could think of was Abraham Lincoln. So I chose Lincoln Hospital in the South Bronx,” he said, with a reflective shrug.

Dr. Rai’s voice raised an octave retelling his first experience in an American inner-city hospital in June 1957. “I had never seen African-American or Hispanic people. And here I was, trial by fire at Lincoln Hospital, taking care of their sick babies!”

But within a matter of weeks, the culture-shock subsided, and, like his uncle, he became a doctor, staying up nights in the library studying the literature for answers to problems he encountered during the day.

“It was a glorious introduction to pediatrics, having sick children’s lives in your hands,” Dr. Rai said.

A little girl named Lori

Dr. Rai spent a super-intensive year at Lincoln Hospital. Then, in a polar-opposite move, he was hired as chief pediatric resident at North Shore Hospital in Manhasset, on the “Gold Coast” of Long Island. “I suddenly entered a totally different America,” Dr. Rai said, describing his second wave of culture shock. “I went from treating kids of working-poor blacks and Hispanics, to a Mercedes-Benz world of wealthy Anglo-Saxons.”

But he quickly adjusted, finding that “people are people,” and there’s no class distinction in the universal reality of sick children and desperately worried parents-as was the case with a 3-year-old girl named Lori.

Dr. Rai said his memory of her is still vivid. “Lori was diagnosed with acute childhood leukemia, curable today, but in 1958 it was a death sentence.”

His attending physician and first mentor, Arthur Sawitsky, MD, “showed me how to do a bone marrow aspiration on Lori, read the slides, teaching me step-by-step. When I asked about her treatment, he told me the name of the drug and added matter-of-factly, ‘she’ll be dead in 3 months.’ I got deeply involved, and sure enough she died a few months later on my watch,” Dr. Rai said.

Seeing Dr. Rai’s passion, his attending physician suggested he pursue a fellowship in hematology. So Dr. Rai did a year’s fellowship at Long Island Jewish-still intending to return to India as a rural pediatrician.

Seeking to bolster his credentials, he applied and was accepted for a prominent research opportunity at Brookhaven National Laboratory. He was quickly taken under the wing of senior scientist, Eugene Cronkite, MD, whom he described as his “mentor, a great role model, and an original thinker.”

It was 1960, the “Dark Ages” in medical research, but Dr. Rai stressed there was an inherent excitement in the lab about breaking new ground.

“After a year or so, Cronkite wanted me to take a full-time position, but I had promised myself I would return to India,” Dr. Rai said.

Return to India

Driven by a sense of national pride and service, Dr. Rai went back to his homeland for 4 years-a time he ultimately considered “a sad failure.”

He knew he was overtrained to pursue his original dream of serving as a rural pediatrician, and was determined to focus on research. “I had left a cutting-edge research environment, but when I tried to initiate research programs in India, well, it seemed that nobody really cared.”

Although Dr. Rai received accolades from the Indian government for his research attempts, he felt that if he stayed in India, he would be “intellectually dead within a year.” He wrote his mentor, Eugene Cronkite, explaining his situation. Cronkite, who never wanted Rai to leave in the first place, was more than happy to invite him back.

Staring at the walls

Back at Brookhaven, Dr. Rai thrust himself into leukemia research, conducting morning and afternoon clinics. During this time, the bricks of his life’s work in chronic lymphocytic leukemia (CLL) would be set.

“I had two patients with the same CLL diagnosis. One had been coming to Brookhaven for 12 years, and he was doing fine. The other, diagnosed only a year before, was practically at death’s door,” Dr. Rai said.

Puzzled as to why patients with identical disease had such different outcomes, Dr. Rai asked Cronkite if it were possible that they actually were observing two different diseases.

“Cronkite was a tall, elegant, imposing man. He bent, put his hand on my shoulder, and said, ‘That’s for you to figure out, my boy,’” Dr. Rai said with a laugh.

The idea became adhesive in Dr. Rai’s mind; he transferred all his energy to CLL research: “I got the medical records of our CLL patients and began reviewing them. At first, each chart simply told a story of one patient. That was it. But I said to myself, ‘nature, or God, or science has some explanation, and it’s staring me right in the eye!’”

So Dr. Rai summarized the charts and thumb-tacked them to the walls of his small office, spending month after month rearranging the data according to outcomes. “I studied the summaries so obsessively that my associates joked, ‘Don’t go down that hall, there’s a crazy Indian staring at the walls!’”

It eventually materialized in his mind-a visible physiological pattern connecting outcomes and certain levels of health criteria among CLL patients.

Dr. Rai worked for another year, fine-tuning his staging theory before he presented it to Dr. Cronkite. It took him about an hour to demonstrate his premise, but after he finished, “I saw Cronkite’s eyes sparkle, and he said, ‘Well, you’ve got something there, my boy.’”

The Rai Staging System

“I left Brookhaven in 1970, returning to Long Island Jewish to Dr. Sawitsky’s department, where I continued to work on the staging theory. It took me another year before everything fit into place. So we wrote a paper and submitted it to Blood,” Dr. Rai said. However, the paper was rejected, filled with page after page of dense criticism on its statistics and retrospective data. “It wasn’t a big deal to me,” he said, “so I shoved it in my drawer.”

Of course, the paper Dr. Rai “shoved in the drawer” was later published in Blood, permanently inscribing the Rai Staging System in medical literature, and, more important, in the way clinicians approach the treatment of CLL.

“There were others involved, but somehow the staging system got attached to my name. I’m not a big shot, I’m just an ordinary doctor,” Dr. Rai said. Of course nothing could be further from the truth. Ask his colleagues in the lab and the patients he continues to see, day after day. Kanti Rai, it seems, was born to medicine, a doctor’s doctor, just like his uncle.