- Dr. Joshua Budhu is a neuro-oncologist at Memorial Sloan Kettering Cancer Center.
- In addition to treating brain cancer, he works toward health equity.
This as-told-to essay is based on a conversation with Joshua Budhu. It has been edited for length and clarity.
When I was a sophomore in college, my brother, Ravi, didn't come home one night. My mother knew something was wrong, and she started calling local hospital rooms. That's when my family found out that Ravi was hospitalized and in police custody.
Ravi was the oldest of the four children in my family, 12 years older than me. He was born in Guyana, whereas I was born in Queens. Ravi's life was very different from mine. As soon as he graduated from high school he started working to help support our family. Despite that challenge, he founded a successful IT company.
Unfortunately, after the tech bubble burst, Ravi's company failed. He moved back in with our parents and gained a significant amount of weight. He became depressed, but culturally that wasn't something we talked about. Ravi used alcohol and cocaine to cope.
The night he didn't come home, he had been driving while intoxicated. He was arrested after he hit a parked car and was taken to the hospital for a few scrapes and bruises. He was handcuffed and shackled there, with two police officers standing guard.
Over the next few days, Ravi's health deteriorated. He was sedated and intubated, still in handcuffs.
Then the hospital called us to come quickly. Since Ravi was in police custody, we had to go to the precinct first to get a pass to visit him. When we finally made it to the hospital, we learned that Ravi had died from a pulmonary embolism.
Ravi's death made me want to become a doctor
Ravi's death was a seminal moment in my life. Before he died, I'd been considering going into economics or finance. After losing my brother, I knew I didn't want anyone else to go through what he had been through. I decided to study medicine.
At first I thought that if Ravi hadn't been picked up by the police that night he wouldn't have died. But with time I realized it wasn't that simple. If it hadn't been this that killed him, it would've been something else.
As a first-generation immigrant, Ravi had poor health literacy. He lived in a food desert and had diabetes. He had untreated depression and a substance-use disorder. He had no job, was on Medicaid, and ultimately ended up at an underfunded public hospital.
All these social determinants of health manifested in Ravi's demise. My brother was set up to fail. But I came to believe that I could help change that landscape for other patients.
I want everyone to have equitable access to healthcare
Now that I'm a doctor treating brain-cancer patients, I know medicine doesn't start at the bedside. I need to understand the bigger picture of what my patients are going through. If they can't afford rent or food to eat — a big concern this year with rising grocery prices — they're not thinking about treatment.
I've devoted my career to addressing those disparities and finding solutions. I work with the Immigrant Health and Cancer Disparities Service at Memorial Sloan Kettering Cancer Center to make sure patients with backgrounds similar to Ravi's have equitable access to healthcare.
Sometimes that's as simple as providing stipends for food assistance or copays. Other solutions are more complex.
Last year I was accepted into a program by the drug research program Bristol Myers Squibb to support diversity in clinical trials. Too often clinical trials exclude people from diverse populations. That can be downright dangerous. The most egregious example is the blood thinner warfarin. It was developed in the 1960s and tested almost exclusively on white men. But in the past 20 years, researchers have learned that people of different ethnicities require different doses of the drug. That means that for decades we were overdosing or underdosing millions of patients.
In my specialty — treating brain cancers — clinical trials are considered a first-line treatment. If we're not including people of color, immigrants, and people of various socioeconomic statuses in those trials, we're not providing them with the best healthcare.
I think Ravi would be proud of the work I've accomplished. Every time I see patients or achieve a milestone toward alleviating health disparities, it's for him. Everyone deserves an equal opportunity to achieve their optimal health. My brother certainly did. Though I can't help Ravi, I'm dedicated to increasing equity for others like him.