Making a difference for patients doesn’t always look like creation of a new medical device or procedure. Sometimes the most ordinary choices create extraordinary outcomes both for patients and for our own perspective on what we do and where our value lies.

 I have chosen to participate in extensive medical volunteering work, including founding a primary Health Care Clinic at the Tibetan refugee in southern India. Not only did that work add to my experience, it also helped me realize how lucky I am. Importantly, it also taught me to improvise. When you have to find a solution and you do not have a lot of options, you must improvise and that skill is very useful.  Sometimes we forget why we became doctors. Volunteering and such things to remind us how lucky we are. We have the skills that are needed all over the world. It’s important to give it back. One way is to educate. Because in that way you can have conversations that you couldn’t have anywhere else and you could inspire people to do different things. That’s the whole world of mentorship and mentorship is very important.

Sometimes an overwhelming challenge will tap into my nature of being able to improvise. For example, I had many tough cases at (Johns) Hopkins in the 10 years from 1998 to 2008.

Phillppe Gailloud was then my fellow attending. One night, we had a hell of a case—a truck driver had a basilar thrombosis a left vertebral artery stenosis, a right vertrebral artery occlusion, a left carotid occlusion and a right carotid severe stenosis. I needed stents and had none. I went upstairs at about 2am, tried to get into the cardiology store room and could not. So I lifted up the ceiling tiles and climbed in from the room next to the store, stole the stents and stented his right carotid and his left sublclavian, angioplastied his left vertebral artery and thrombolysed his basilar occlusion.

He did really, really well and was discharged the next day— I was in trouble for messing up the ceiling in cardiology.

Improvisation doesn’t always turn out with such positive results, but when it is grounded in a history and experience of such actions over time, the odds are in favor of best possible outcomes.