Doctor, Scientist, Entrepreneur

Eminent surgeon Susan Lim believes technology is the key to pushing fresh frontiers in medicine, and saving more lives. She tells Jaime Ee why

If she had time for the movies, Susan Lim might have been intrigued with I, Robot - a futuristic tale in which robots take over the world's menial jobs and exist purely to serve and protect Man. While they spend most of their time running amok and trying to kill Will Smith, one wonders what would happen if they had run into Singapore's eminent surgeon instead. She might have simply fixed them with her cool, steel gaze, got them to obey 'sit' and 'stay' commands, and proceeded to teach them how to perform complicated surgery.

The greatest satisfaction comes from saving a life and trying to pioneer new cures, trying to make the delivery of medicine more acceptable to patients because all of us are going to be sick one day

The robots are fictional, but Dr Lim's thinking is not. They represent the way of the future - not as domestic help but as crucial elements in precision surgery - and while robotic surgery is already being practised here, the technology is not moving fast enough for her. She's a scientist who believes in the future, but she wants that future now, and much of her work today is aimed at doing just that.

'Why should we who are born today be deprived of what will be available tomorrow? I think it's so unfair!' laments the surgeon who made her name by performing Singapore's first successful liver transplant in 1990, and continues to break new ground in the local medical arena.

Being first in her field is something she has always worked for, not so much for the glamour but simply so she can get the new technology to work on patients. She has done it before, first with the liver transplant and in 1998, she was the first to introduce mammotome breast biopsy in Singapore, a minimally invasive procedure for breast lumps which previously required surgery.

'It's all about moving surgery into a patient-friendly, minimalist, outpatient type setting,' she says. 'Breast cancer is the leading cause of death in Singapore, and as a female surgeon, I want to find ways to treat it more effectively. And two areas I have identified is diagnostics and minimally invasive procedures.

'Nowadays, you see a lot of screening and all the women get into this mammo-bus and some freak out when they get their envelopes and it says they have a lump. A lot of times the woman stops there, and puts the envelope in the drawer because of the question mark: are they going to cut me up? It's this unknown factor of the surgeon - cutting, etc.

'That's how I started mammotome, so that as long as the lump is small enough and is not obviously cancer, there's no need to go into the operating theatre. It's just a needle that goes into the breast and sucks out the lump.'

Besides cancer which is one of her key focus areas, Dr Lim is also focusing on adult stem cell research, which she sees as a potential solution to organ transplants' one basic problem - 'the finite source of donor organs'.

She adds: 'From a very early point in time I was very disturbed that it just can't be that for the rest of transplantation's existence, we're going to have to wait for somebody to die or donate a part of the organ to resuscitate someone else.

'So I pushed in that direction in my research. At that point in time there was a programme of transplantation for diabetics using pancreases. I got a travelling scholarship to Minneapolis where I saw the first 10 living related pancreas transplants being performed in the world there - with horrible outcomes. I knew at that time that organ transplantation for pancreas was not optimal.

'At the same time, they were thinking of using cells, and dissecting the pancreas into little bits to make cells that could potentially cure diabetes, and there was born the concept of cell transplantation. So two years ago in Edmonton, Canada, they had a very big programme and it was successful. But again here is the problem - taking a dead person's pancreas, so you are still looking to a human organ donor, but it's worse because you need two to three whole pancreases to get enough cells for one patient.'

At that time, embryonic stem cell research was gaining speed in the US. 'They set the platform for this research and I thought, yes, stem cells to generate different types of cells. My interest was insulin-producing cells to cure diabetes. But I felt that using embryos and foetuses - I was not so much against it because of religious or moral issues, but again, that this source has its pros and cons.

'So I thought let's complement the programme and start something less controversial - adult stem cells. It's an idea that came to me two years ago. Then I founded Stem Cell Technologies (SCTi) - with the aim of putting together a team that would research the concept of using adult tissue from self to heal self.'

The concept, she says, is 'sublime'. As she puts it: 'It's tissue from self - to heal self. Of course all the groundbreaking research and preliminary data that's come out today has been done on embryonic stem cells. Adult stem cells is a relatively new field, so like any new field there will be obstacles. But whenever there are obstacles, I am challenged.'

Dr Lim sees herself as part of a growing breed who can bridge the difference between pure clinicians and scientists. 'A lot of excellent science is being done and a lot of excellent clinical work is being done but sometimes they are running in a parallel direction. What we can do as clinician scientists is to identify the clinical problems, and apply the science.'

In other words, theirs is a cure-driven field and given Singapore's intensive efforts to become a bio-medical hub, 'we are in a race to try and be in the pole position, because this is very much a vision for Singapore.'

She reckons that 'in five years, we will see some significant clinical research being done', but she is not going to commit to being able to find an actual cure for diabetes within that time.

'Along the way it may not be so easy to produce an insulin-secreting cell but we may produce other cell types such as muscle or cartilage which may spin off to other applications. It's going to grow and we will get there - there's enough work going on and I think within five years we will see some significant developments.'

For her, the key word to describing her current work is simply technology.

'Today, the practice of surgery has changed significantly due to technology platforms that are coming and the combination of technology and surgery has actually merged the boundaries between the specialties. For example, a breast biopsy can be done by a radiologist rather than a surgeon because it's so minimal and it's done under X-ray guidance. For cardiology, in the past it was always open heart surgery but now radiologists are also starting to do cardiovascular procedures because technology has given us the tools to actually merge the boundaries a little bit.'

But what ties in all her areas of research and interest together is the ultimate in technology - robotics. 'This will merge all the surgical disciplines together,' she says. 'Robotic technology is still very new. It's expensive and we are still trying to get to grips with how to apply robotic technology meaningfully and in a cost-effective way.

'It's a whole new dimension,' she enthuses. 'A lot of people think oh, I don't want a robot to operate on me but no, it's the surgeon who is in the driving seat. The robot cannot move until the surgeon activates it. And the robot has more precision, it has a magnified view, there is no tremor and it can access very small and deep holes. It can perform very complex surgery. And its application is throughout all the specialties of surgery.'

Whether or not local surgeons take to this new phenomenon is not a choice. 'It's not a question of want, it's a question of robotics coming onto the scene and I think we have to move in that direction. We have at this point to show interest and do research so that when it becomes applicable on a wide scale, we know how to do it, otherwise we get left behind.'

Does she see herself as a medical entrepreneur, then?

'There's a lot of talk lately to identify entrepreneurs - I'm not saying they're leaders, but they are just individuals who like to do new things, who are prepared to take calculated risks and who wish to push the boundaries of their practice further.

'I'm not saying that the rest are doing nothing. They are doing what the practice is set up to be, which is mainstream service. So you have a broad base of medical doctors who will service patients, and some, because of the nature of their minds, are more enquiring - for me, I think that when you have spent so much of your education overseas, you don't just want to be the best in Singapore, you want to be the best globally.'

The New Wave

So yes, she does see herself as a medical entrepreneur. 'I firmly believe that bio-entrepreneurs and medical entrepreneurs will lead the next new wave in medical enterprise. It's a major industry. Look at the population today, we are globally aging, we have higher disposable income, we want quality of life so there is a demand for better and better treatments.

'So there has to be, along with the mainstream medical practices, new areas that are being researched, like stem cells which hold the promise of cell transplant and regenerative medicine. Look at the movement for Parkinsons and Alzheimers; the sports industry and the growth of cartilage; diabetes ... so to me, the regenerative industry is going to be the next huge industry.'

If it seems like her work takes up her entire waking hours, one would be sorely mistaken. Besides taking care of her patients, working on her research and regularly being bestowed awards, like her latest - being the youngest and first Singaporean to receive a fellowship from Australia's prestigious Trinity College of the University of Melbourne - she miraculously manages to also play corporate wife to her husband Deepak Sharma - head of Citigroup Private Bank (Middle East and Asia Pacific).

'We have a lot of entertaining to do. I might have to fly to Hong Kong overnight, or to Dubai, and I had to go to Geneva. But what I do is tie it with my conferences, and so on. Like last week, I had to go to Hong Kong, but I flew in in the afternoon and came back the next morning, so it's not a big deal to my practice. My staff are also very happy to see me go because then the monsoon is gone and they can start to tidy up!'

Apart from doting on her three children (now five between her and Mr Sharma), Dr Lim feels that she is perhaps at the happiest stage of her life. 'As a person, I'm still evolving. My goals - these are my three goals: stem cells, cancer treatment and robotics. I'm still coming to grips with applying myself to study the new technology and look at possible cures for cancer. This is what drives me. I'm looking at my children and hoping to somehow steer them in the right direction. I'm looking at my own happiness. I think I am very happy at this point in time, both my husband and I live meaningful lives and we are both very very focused on our work.

'But I've always been happy. Happiness is a state of mind. You can have a problem and still be happy. If you are not happy, you give very bad vibes to your patients - how can a sad doctor instil a sense of being able to be cured?'

While she sees herself as competitive, 'it's not competition against others that drives me, it's my own personal competition.'

Ultimately, it's not the glory of fame or awards that makes it all worthwhile for her. 'The biggest reward, and I think not many people know this, is that the first liver transplant patient that I worked on is alive today after 14 years, and she has a son, who is now in primary school. That is the biggest award you can get. And yes, I still continue to take care of her.

'The greatest satisfaction comes from saving a life and trying to pioneer new cures, trying to make the delivery of medicine more acceptable to patients because all of us are going to be sick one day - doctors, nurses, everyone - and when you are at the receiving end you want to have compassion, access to the best technology, and you want to know that although you are in Singapore you're getting the same treatment as would be done around the world.'

Indeed, regrets are few, if any, even though Dr Lim does go home to hunt down her photo albums every time patients show her pictures of their children. 'I'm thinking at the back of my head, how did my kid look at that age? Of course, there are only 24 hours in a day and everybody wishes they could have done more in everything.'

But would she have done things differently, like spend more time with her children?

With a toss of her long hair, Dr Lim responds: 'No, I think it's enough. They seem happy and hey, I've still got a lot of things to do with my life!'

Copyright © 2004 Singapore Press Holdings.

This article posted August 19, 2004.