Northern States

Lasker: Where did you grow up and what first got you interested in medicine?

I was born in Nairobi in Kenya and grew up in a typical Indian joint family household. We had three family members who were physicians. I would see patients come over to our house after hours to see my uncle, a family doc – he would see and treat patients in his own home. I admired the way he interacted with his patients. Sometimes he got paid in chicken, or in a piece of a leg of lamb – that was just what they could afford to bring in. Even though he had his own outpatient practice, in the middle of the night, when patients called he would just see them at home. Witnessing that interaction led to my interest in helping people.

Lasker: What initially motivated you to focus your clinical training in hematology?

It’s always hard when you’re in medical school and you’re exposed to so many specialties during your medical school rotations. You don’t know what you don’t know about the profession and about each speciality. All you have in front of you is the patient and the  teachers and mentors. You can have really good mentors and you identify with them and with the patients automatically, but there are others mentors and teachers that drive you away from the specialty. I had an interest in the cognitive aspects of medicine, so internal medicine was a natural first step. I just found that the patients on the cancer wards were the most delightful people you could ever meet. I just identified with that group of patients, and so I decided to go into hematology-oncology. I ended up focusing on hematology, currently my practice is mainly benign hematology.

Lasker: How has the care landscape changed over your career from when you first started?

It’s been phenomenal – I have to say earth shaking changes. I would never have imagined that we’d come so far in managing bleeding disorder. In the early days all we had was blood fractionated products. We needed good products to treat a bleed and prevent bleeds. Because of the advocacy of patients with bleeding disorders, pharmaceutical companies stepped up and spent money on the research that was needed to isolate factors from plasma and then to develop recombinant and then long-acting products, a huge step forward. And then gene therapy is coming along. Emicizumab or Hemlibra was a big surprise and a huge step forward. Other similar products are in development.

Lasker: Do you have any reflections on the future of precision medicine in the bleeding disorder community?

If you look at any tests we do in any part of medicine, I like to group them into two buckets: There’s the diagnostic, and then there’s therapeutics for the diagnostics. For a male patient in hemophilia, the diagnosis generally is made with factor levels after they’re born. But you can now make a diagnosis prenatally. I think that’s really been a big change in that you can prepare for the child’s birth. Genetic tests have helped in clarifying the diagnosis. We’re doing collaborative research from all hemophilia centers looking at a genetic mutation and whether it predicts for one of the most devastating complications, the development of inhibitors, so that we can predict who’s going to develop an inhibitor. I think that’s a huge advance to be able to risk stratify patients based on their genotype.

I would predict in the future, if you have a patient with a high risk gene profile for inhibitors, you would try to avoid exposing them to the factor product and just go with something like a non-factor product. And there are a couple of other drugs that are being studied, you know, Fitusiran, Concizumab as well.  The approach is really a setup for precision medicine.

Lasker: What do you hope to see for the future of this community?

I certainly want to see our patient’s quality of life get better. We have made good advances in reducing hospitalization, keeping them in school, and keeping them at work so they don’t lose days from work. I’m hoping we will collectively improve on that. It’s not perfect. I think we need to improve on that and continue the good work that the whole community is doing.
I think we still need to study why some patients still have bad joints at an earlier age, impacting quality of life. And I think we need to improve very much on research on women with bleeding disorders. So much more research to be done in that field. I’m going to use the word cure… I hope to see a cure.

Azubuike: What do you look forward to most in your work?

I look forward to coming to work with the team. We build these relationships with our own team and with the patients—if you have an effective team, we will come together to look after the patient. I just look forward to coming in every day. And I work on both sides. We call it the street. At Mayo, the lab building is on the south side of second street. And the clinic building is on the north side of second street. Combined, the lab and the clinic, we strive to provide the best care for our patients. I get the most satisfaction by being able to help patients.

Azubuike: What are some key lessons you have learned from mentors throughout your career?

I think mentors can be found in many different areas and it doesn’t have to be in your field. You want to emulate some of them, and you don’t want to emulate some of them. And so, you learn, provided you have enough insight to know what’s right from wrong.

I’ve all been very fortunate to be able to work with good mentors in medicine. Gerry Gilchrist was the pediatric hemophilia center director many years before he retired and you just wanted to be like him. Within hematology, the folks at Mayo put the needs of the patient first. You come in every day, you meet every day with your team and all you talk about is how can we improve, you know, XYZ? How can we make it better for the patients? I can’t think of any one single mentor, but multiple mentors.

Azubuike: What are some key lessons you would impart to new people and employees in the bleeding disorders community?

Listen to the patient. Number one. You walk in the room and you have a patient there. There’s a tendency for physicians, care providers to, to launch off – talk about this, talk about that. I think the most important thing is sit back and listen. The patient feels valued. They feel heard. And one of the risks of not listening is you might miss things, you might misdiagnose things. I think that’s the best advice I can give anyone: Pause, focus on the patient, listen to what they’re saying. Each patient has a different story, a different mindset, a different hope and expectation. And how do you know where they fit if you don’t listen to them?

Azubuike: What advice would you give your younger self?

I guess one thing I would say is, don’t do anything your mother would not approve of. Anything you do you ask yourself, is your mom going to approve of that?

Azubuike: What is your favorite life lesson quote?

You guys are asking some tough questions! They’re good questions. This is not my quote, but I have a plaque that I keep here that says: “Hands that help, are holier than lips that pray”. There’s nothing wrong with praying, but you’ve got to be able to serve the people around you. I think that’s the best advice I can give. If you keep that principle in mind, everything else just falls into place. If you treat people with respect, you’ll get respect. If you help those in need, you will be helped at some point when you are in need.