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What was your thought process when you were deciding to take up cardiothoracic surgery as a career?
In medical school, I was fascinated by anatomy, particularly with the three-dimensional nature of the anatomic structures, and their close inter-relationship. In addition, I enjoyed physiology, especially cardiovascular physiology. During my clinical years, I was drawn towards surgery as I found certain aspects of surgery exciting such as: the ability to make an immediate impact on patients’ lives, the unique opportunity to actually visualize the proposed diagnosis, the dexterity involved in executing a successful operation, and the need to make split-second lifesaving decisions. Ultimately, during my early surgical career as a general surgery postgraduate, I had an increasing interest in cardiac surgery as it nicely combined all of my passions: that of anatomy, cardiovascular physiology, critical care, and surgery.
Can you tell us about one case that you will always remember?
It’s a case of a young boy who was born with half a heart. He received a series of surgeries over several years, a common approach in these patients to partially fix his heart. Eventually, his heart, not unexpectedly, was giving up. He suffered a cardiac arrest and needed an emergent insertion of a temporary mechanical heart which was then converted to a more permanent mechanical heart to keep him alive. In fact, he was the first child in the world to receive a particular type of mechanical heart for his cardiac condition. Eventually, he received a heart transplant. It was one of the most difficult pediatric heart transplants I have done in my career so far. He had a slow recovery. His care was transitioned gradually from me to my pediatric transplant cardiology colleague’s care. I saw him a few months later, incidentally when he was visiting his transplant cardiologist. I was astonished to see a completely normal child as if nothing had happened in his life! Children are so resilient and this is what draws me towards pediatric cardiac surgery.
If you were an Indian medical graduate in today’s world, what would be your opinion on studying in the US?
Studying medicine abroad is like traveling. One gets a different perspective as to how medicine is practiced differently, akin to experiencing a new country or culture while traveling. Besides learning technical aspects of medicine, one learns soft skills such as interacting with patients and colleagues from diverse backgrounds. This makes one a well rounded doctor who is not only able but also affable.
The East is always adopting technology and practices from the West. What is one thing that the East does better, that has been adopted in the US, or will be in the future?
Once a process is well understood and perfected, the East, particularly India, has developed an ability to cut cost without compromising quality so that it is available to everyone. An example is in robotic surgery. There is an Indian robotic platform which is currently available. It is world class but at the same time the operating cost is such that it has expanded the reach of robotic surgery to the wider population of the world!
Cardiothoracic surgery is considered a very competitive field. What do you think made your application stand out to the program?
I did well during my general surgery residency with exceptional inservice exam scores. In fact, I got a 99th percentile in all the 5-years of the residency! In addition, I did extra rotations in cardiac surgery during my residency and worked on publications pertaining to cardiothoracic surgery. During my final years in the general surgery residency, I also did more vascular surgery rotations to refine my technical ability to do fine vascular anastomosis. With this, I had a well rounded application while applying for a cardiothoracic surgery residency.
What is one lesser known aspect of cardiothoracic surgery that you would like to highlight?
While cardiothoracic surgery is an exciting field, It certainly has a learning curve. The learning curve is actually individual specific and depends on one’s innate ability and the environment. It can be very steep for some. The ability to surmount the curve will ultimately define one’s success in the specialty with a productive and satisfying career.
What specific considerations and challenges do cardiothoracic surgeons face when dealing with pediatric cases, and how do these differ from adult cases in your experience?
The pathology seen in pediatric cardiac cases is far more varied than the adult cases. As a result, there are more surgical procedures one has to master. The scale is also much smaller and has more exacting requirements as far as technical ability is concerned. Also, one is not dealing with just the patient but with the family as a whole.