Reconstructive surgery, although a niche speciality, has restored the lives of several patients with malignant tumors and congenital defects !
Dr. Akash Menon, our next pathbreaker, Oral and Maxillofacial Surgeon at a Tertiary-Care Super Speciality Cancer Institute in Central India, treats patients suffering from head and neck cancers as well as non-cancerous diseases of the face, throat and jaws through surgical therapy.
Akash talks to Shyam Krishnamurthy from The Interview Portal about his unique career path, from the field of dentistry to the field of reconstructive surgery, especially related to oral tumors.
For students and medical aspirants, the field of oncology requires multi-disciplinary skills, which could be research oriented or clinical . Evaluate where your interests lie, because skills can be learnt, but enthusiasm cannot be fabricated.
Akash, Your background?
I was born in Mumbai, but the Middle East raised me. I spent my pre-school years in Saudi Arabia and then went on to do my schooling entirely in Dubai. Because I was always in Indian CBSE curriculum schools, making my transition to professional education in India was quite easy. As an above-average student who was always curious, I found myself drawn to the sciences from an early age. My interests were sparked by a variety of non-fiction books and edutainment TV channels. I especially remember being glued to TV shows like “Inside:” on the National Geographic channel and losing myself in the pages of Collier’s Encyclopedia. These early stimuli generated what now feels like a scientific temperament and the mindset of wanting to fully understand concepts.
High school brought out the geek in me along with academic challenges, but I always found concepts of biology both fascinating and easy to understand. Being able to dive deep into human biology, organ systems and cell biology was my favourite part of the curriculum. With the help of some mild nudging from my working-class parents, I gravitated towards the “safe” and traditional PCMB (Physics-Chemistry-Math-Biology) route.
Grade XI – Enter calculus and exit any hopes of pursuing a degree involving advanced mathematics. Here, I toyed with the idea of a career in medicine or biomedical science and explored them further. I interacted with doctors (and dentists) to understand the realities of the profession. Finally, drawing inspiration from my elder sister, I decided to pursue dentistry at university. At the time, I felt this profession seemed a good fit for me because it combined my interest in life sciences and working with my hands along with a relatively secure career path.
What did you do for graduation/post-graduation?
After school in the UAE, I moved to Bangalore for my undergraduate education.
I studied BDS (Bachelor in Dental Surgery) at Rajiv Gandhi University of Health Sciences between 2009 and 2014
I then shifted base to Mangalore for my masters. I chose to do my MDS (Master in Dental Surgery) in the speciality of Oral and Maxillo-facial Surgery (OMFS). This was a 3-year course that I completed in 2018. During this time, I fell in love with OMFS and decided to train further to improve my proficiency and dexterity.
My post-doctoral fellowship in Cleft and Craniofacial Surgery was funded by a Swiss non-profit – Cleft Children International, Zurich. Here I worked with patients who ranged from a few days old up to young adults. This was a deeply rewarding experience because I got to be a part of a team that was permanently improving the quality of life of so many children. Repairing these congenital deformities have a massive impact on the child’s wellbeing and learning how to perform these surgeries have given me the skills to bring that same impact.
Subsequently, I felt the need to further diversify my portfolio with an advent into cancer surgery. I was selected for the prestigious FHNO (Foundation of Head and Neck Oncology) Fellowship in 2020. In the pursuit of this qualification, I am training in the management of cancers of the head and neck. This involves diagnosing these conditions, collaborating with multidisciplinary teams and of course, performing surgery.
What made you choose this career?
There are quite a few paths taken by dentists after their basic education. Some people (like me) prefer a patient-facing clinical career, some may prefer a non-clinical path such as pathology, radiology or public health. Still, others make a bigger leap from the core subject into healthcare management/administration. Finally, the avenues of medical entrepreneurship and medical research remain viable to all wishing to stay relevant to healthcare.
About 2 years into dental school, I realised that I needed something more than the 9-to-5 routine. Most dentists work in clinics, don’t stay on call for emergencies nor do they perform surgeries in operation theatres. Weirdly, this was the kind of adrenaline rush I was chasing. Beyond developing a deeper understanding of subjects like anatomy, OMFS offered a career filled with adventure, lifelong learning and above all, that ultimate feeling of healing someone with the tools in your hands!
The tipping point for me was one December afternoon in Bangalore, when I observed my professor perform surgery to fix a fractured jaw bone. This is a very routine procedure for an OMF surgeon, but I came back home that day with only one thought in my mind – I have found my calling, OMFS.
One must understand that this is a very niche speciality. Not only do you have a long, arduous training pathway (even after your university days) you will often find yourself hanging in the balance between medical and dental professions. In fact, in many countries OMFS’ are required to hold both medical (MBBS) and dental (BDS) degrees! Despite the hindrances, many hard-working individuals with a passion for surgery can come out with flying colours and develop a flourishing career.
How did you plan the steps to get into the career you wanted? Or how did you make a transition to a new career? Tell us about your career path
When planning your career it is important to look two steps ahead before you take a single step. While some may advocate a more think-as-you-go philosophy, I find that being aware and prepared for future challenges greatly reduces my anxiety and maximizes my decision-making capabilities. As I mentioned, my eureka moment came to me quite early in my university days, but I knew that building a career around it was an uphill task. I started working at the earliest opportunity (as soon as I was licensed to practice) at a dental clinic. I wanted to experience how to handle a real life patient-facing scenario. I thoroughly enjoyed the 6-8 months I spent working as a general dentist. I prioritized learning practice management (how to run a medical establishment) and improving my chair-side manner. I was fortunate to land a place at a prestigious university for my masters which brought this clinical experience to a halt.
After my post-graduation, I realized that there was still so much to be learned and many skills to be mastered. In the four years since, I have worked towards constantly improving my knowledge, skills, and network. In such a profession, it is easy to rest on your laurels and stop growing given how many years of education you have put in. However, when it comes to improving your patient’s outcomes, short term investments in courses/fellowships/training can go a long way for your career. I have always been on the lookout for such opportunities and try to improve my repertoire.
How did you get your first break?
LinkedIn. Never underestimate the power of social media and networking. Putting yourself out there regularly will place you in the minds of potential employers and colleagues who may recommend you for ideal positions.
After my stint with cleft lip and palate surgery, I was on the lookout for training positions in oncology. This was a subject that greatly interested me since my early training days but had limited exposure to.
I posted on LinkedIn about this desire and a number of people commented or liked the post giving it much greater visibility. A few weeks later I was contacted by an anonymous HR agent asking about my experience, availability etc.
After a few days, I received a message from a recruiter for my current workplace asking if I was interested to interview for a position. I was thrilled that such an opportunity came to me out of thin air! This really strengthened my faith in the power of LinkedIn and social media.
I went on to join the hospital in the role of a Senior Resident. Here I started learning in-depth about oncology and how this field is vastly different from most other medical specialities. The more I learned, the more fascinating it seemed. To think that at this very moment there are drugs and therapies being trialled which could change hundreds of years of practice is something that enthralled me. I knew I was hooked and decided to delve deeper.
One year into this position, my institute got accredited as a hosting centre for the FHNO Fellowship. Although my learning trajectory wouldn’t change much, I decided to apply for this fellowship, knowing that the certification received at the end would hold me in good stead. I was lucky enough to get short-listed and later went on to continue at my erstwhile institute but in an enhanced role. Now, about a year and a half into the program, I am glad I opted for it. I have not only improved my surgical skills and knowledge, but I have built a large network of young doctors in the same field.
What were some of the challenges you faced? How did you address them?
The greatest challenge I faced so far is adapting to different healthcare models. I spent my early years working in an educational institute. Here the focus lies primarily on the students and learning outcomes. Academic discussions prevail in most interactions and treatment is usually orthodox. Moving to a corporate hospital has brought a different mindset that is more patient-centric. Here we are tasked with providing not only the best medical care but providing a good patient (customer) experience. We are tasked with maintaining the highest ethical standards while generating revenue for the hospital. Adapting to this medical model was a great personal learning experience. I approached the challenge with an open mind and understood that at the core the values of beneficence and non-maleficence remained unchanged regardless of the setting. This helps guide every clinical decision I have made since.
Where do you work now? What problems do you solve?
I work at a tertiary-care super-speciality cancer institute in Central India.
I diagnose, manage and care for patients suffering from head and neck cancers. My role involves surgical therapy of such conditions. Occasionally we treat non-cancerous diseases of the face, throat and jaws.
What skills are needed in your role? How did you acquire the skills?
In-depth knowledge of the subject alongside practical experience in the field is mandatory to confidently practice this science. These skills require laborious dedication, usually developed in medical/dental colleges and furthered in junior roles assisting or shadowing senior colleagues and experts.
What’s a typical day like?
We start our day with a small academic session where we review the latest medical literature or discuss challenging cases which are yet to be treated. This is followed by ward rounds. Here we visit each inpatient to check on his/her progress. Post-surgery, patients often require a lot of attention to enhance their recovery. We also plan surgeries for the upcoming days at this time. Following this, we either proceed to the operating theatre where we may spend anywhere between 4 to 14 hours on cancer surgery. On other days, we consult outpatients in the clinics. Here we attend to new patients who require a diagnosis and treatment planning, or review patients who are in advanced stages of recovery from surgery. Finally, we also consult with patients who have completed their treatment but are on a routine follow-up to ensure that they are disease-free with no further complications.
Another interesting part of our job is a multidisciplinary tumour board. This is a clinical meeting between all the stakeholders in our cancer institute including surgeons, radiation oncologists, medical oncologists, radiologists, nuclear medicine physicians, anaesthesiologists and palliative care specialists to name a few. Here we discuss challenging cases that require interdepartmental collaboration for ideal patient outcomes. This aspect of oncology is a time-tested method of providing an evidence-based treatment while ensuring a holistic approach to care.
What is it you love about this job?
Having given my career path a lot of thought, I have constantly prioritized experiences that primarily excite me while advancing my learning, and secondarily promote career growth. One of my biggest pleasures is interacting with a multitude of patients from various backgrounds. I have learned so much from them and every new patient presents a unique challenge, which motivates me on a daily basis.
Ask any surgeon and they will tell you, there is no place they would rather be than the operating room. This holds true for me as well. I experience a zen state of mind while performing surgery. The gentle beeping of the monitors while I pour every inch of my focus into my craft is where I am at peace. Another greatly rewarding experience is when my patients have recovered and return to their daily lives as if nothing has changed. The ability to contribute to this restoration of balance is a gift I am most thankful for.
How does your work benefit society?
Doctors are known to have a deep and lasting impact on society. As an OMFS I am able to improve the quality of life of each of my patients individually and the ripple effect that has on their families and friends is a bonus. Specifically, working in the oncology field has tasked me with many responsibilities. Not only do I treat cancer, but also spread awareness, conduct habit cessation campaigns, participate in community outreach activities and try to inspire budding doctors and colleagues to support the cause.
Tell us an example of a specific memorable work you did that is very close to you!
A couple of years ago we treated a young female patient. She was diagnosed with a malignant tumour of the lower jaw which required surgery to remove a large part of the jaw. She was visibly distressed about the surgery. As a young adult, she was scared of the consequences it would have on her future life and marriage prospects. After many sessions of personal counselling, she finally consented to undergo the procedure. Her only condition was that we restore her face to its normal condition to the best of our abilities.
Keeping her demands in mind we went into the operating theatre feeling challenged and motivated. After a gruelling 12-hour surgery we were able to safely remove the tumour and reconstruct her jaw with a bone we obtained from her leg. She was spirited in her recovery period and went above and beyond to get back to normal. After a rapid postoperative recovery period, she was discharged and reviewed periodically. 4 weeks later I bumped into her on the hospital staircase. Not only was she climbing the stairs with ease (despite recent surgery on her leg), she was also sporting a wide smile from ear to ear. Witnessing her warrior mentality along with the satisfying results we achieved was enough to earmark this memory as a truly special one. She now visits us regularly for routine check-ups. Her scars are almost invisible, her life is back to normal and most importantly her spirits are at an all-time high!
Your advice to students based on your experience?
Start early and make each day count. If you are a high school student who is struggling with a career choice, don’t look for outside validation at the outset. Spend a few minutes a day, over weeks and months, to evaluate your strengths, weaknesses and interests.
You need not be good at something to enjoy doing it. Remember that skills can be learnt, but enthusiasm cannot be fabricated. Use online forums to cold-email/DM people from various professions. Ask them the questions that I have just answered above. Note their responses and how they align with your interests.
Engage with work – seek opportunities like internships, apprenticeships, volunteering work, etc. Think about your career passionately, especially when you are young. If you are good at something you will easily earn a living doing it. Just make sure you keep the fire alive and the goal in sight at all times.
Seek self-improvement. Work on bettering yourself a little bit each day. Education may end but learning and growth must never cease.
Finally, remember to make time for fun, family and friends. That is an important and irreplaceable part of a well-balanced life.
I plan to continue working in clinical medicine to serve my patients as a doctor and as a surgeon. My interests in reconstructive surgery are constantly growing and I see myself practicing this niche speciality in the years to come. I look to improve my knowledge of research methodology and actively participate in clinical research with real-world impact. I also have an interest in academics and plan to pursue some form of teaching in the future.