Content Credits: Mariyah Haji
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Webpost Credits: Saachi Kurudi
- What motivated you to choose the field of medicine and later specialise in anaesthesia?
I was always of a science bent with a special interest in biology and chemistry. I had an aunt who was a physiotherapist and she was my ideal. In India marks dictate everything and so when I had a score which gave me entry to MBBS, it became my path by default. Again at PG level I stumbled onto anaesthesia as a practical choice as it meant a good MD seat (KEM hospital in Mumbai) and after the first 6 months I was happy with my choice as it exposed me to medicine, surgery and acute care in the high adrenaline setting in which I thrive.
Anaesthesia is not a field you are exposed to at UG level but it is a good clinical field where teamwork is needed. There are further super specialisation/fellowships for anaesthesia such as cardiac, critical care and pain medicine. I discovered ECMO as a field for anaesthetists to branch into as they understand the physiology and are trained in vascular access.
2. What core values would you like to see instilled in budding medical students?
Along the course of my career I have realised that medicine is fast evolving technologically and no knowledge is wasted. The way we were taught, our expectations from knowledge were different from today’s generation. We had no means or skills to stay updated or to participate in knowledge sharing on platforms nationally and internationally. That journey for me began well into my career, when I started looking for bylanes to expand my scope in medicine and my chosen speciality. I would like to see these skills instilled far earlier in today’s students.
3. You began your career in anaesthesia and are now an important figure in critical care. What was the turning point in your journey?
A relocation to Bangalore taught me that change of scenery brings new opportunities, new work culture and expanded circles of learning.
My critical care journey started when I became a liver transplant anaesthetist. These patients needed close observation prior to surgery and continuum of care post operatively for good outcomes. Their long hospital stays made me invested in seeing them through and deepened my interest in critical care, expanding my scope beyond the operation theatre.
Hence at the next change, I took up a cardio thoracic ICU post in Singapore which shaped me as an intensivist and ECMO specialist. Subsequently I joined a heart lung transplant team as their intensivist. This again brought great satisfaction, especially when I saw patients struggling with weak hearts get back to normal lives running marathons, dancing, completing their studies etc.
4. Could you tell us a bit about your work with ECMO?
Extracorporeal Membrane Oxygenation or ECMO is quite simply using a heart lung bypass machine to achieve gas exchange and circulatory support which are the functions of the thoracic organs.
Today I work to train other intensivists in the skill. I also endeavour to educate fellow physicians and patient populations. The goal is to create awareness for the correct window to offer life saving treatment options.
Currently I head a department dedicated to ECMO which is the first of its kind in India. ECMO deals with the most critically ill patients in intensive care suffering from a vital organ failure. Developing set protocols and pathways for escalation to this treatment form for successfully managing patients is my mission. Working on what would be the blueprint of ECMO service and extensively training all across Mumbai and India for the same. My goal is that all critical care personnel be it the emergency department, anaesthesia, nursing, perfusionists should be well versed with ECMO. To this end I have introduced a fellowship in ECMO for nurses.
5. What is a case you will remember and learn from throughout your life?
Kids are the most resilient and even though my work is mostly in adults there are two paediatric cases that come to mind. One was a 5 year old 10kg child with 3kg hepatoblastoma who presented with haemoglobin of 4 due to bleeding into the tumour. Against all odds she underwent a complex liver resection during which she bled enough to need a 3 time replacement of her blood volume and a 3 month hospitalisation. She walked home and thrives to this date. The second was a child with congenital heart disease who was from a low socioeconomic single parent background, a tiny but extremely bold 5 year old. She too challenged all adversities to emerge as a healthy 6 year old. My journey with them shaped me and trained me as an intensivist who learnt to look beyond diagnostics and towards the science of rehabilitation.
A phase that changed me as a person were the COVID 19 ECMO cases. These patients had irreversible lung failure but ECMO was keeping them alive. Science was pushed to its boundary as each day new evidence emerged. It was challenging as there were so few ECMO specialists in India and the demand was huge.
6. How do you manage the emotional stress associated with being in contact with such critically ill patients?
Anaesthesia is a branch that is rooted in teamwork with well defined shifts, and very brief peri op interaction with patients and their families. When I first started in critical care I realised I enjoyed dealing with and hand-holding patients and their families through the adverse times. This I considered my strength. However as my patient population got sicker and the contact longer my empathetic nature and inability to detach took a toll on my mental well-being. At this point I realised that I disconnected from everything. My life, thoughts and connections centred only around my patients. This, in the long run, affected me as a clinician as well. This is when I started searching and creating boundaries. Today I am a better clinician because I can think more objectively when dealing with patients. My empathetic nature is not lost as I involve myself with allied avenues of healthcare such as rehabilitation, end of life care and organ donation.
7. What is one thing you’d improve and one thing you’d remove from the world of medicine today?
I strongly feel that good medicine is about teamwork and communication. Currently I feel that it is sorely lacking in healthcare. Clinicians get insufficient training in communication with patients, peers from other specialities and allied branches. This is the aspect I’d choose to improve.
I would like to remove quack practice and over the counter sale of medicines, especially antibiotics. These practices harm individual patients due to misdiagnosis, delayed treatment and side effects of wrong medication/or substandard interventions by unqualified people. Additionally there is a larger danger of antibiotic resistance which develops in the community. This needs urgent policies or we will be left with no means to fight infections.