Dr. Shanti Narasimhan, Children's Heart Link

We visit with a remarkable person, Pediatric Cardiologist Dr. Shanti Narasimhan. A University of Minnesota Professor, Heart Doctor at Masonic Children's Hospital and volunteer for Children's Heartlink traveling to Brazil and India on mission trips providing cardiac care to underserved children. Amazing person!

Transcript

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John, what touched me? When I went to Brazil, I didn't speak the language. I didn't speak Portuguese, but the language was kindness and hugging and compassion. That's all they cared for. Welcome to the Kindness Chronicles, where once again, we hope to inject, stop doing that. It's a drum roll. Inject the world with a dose of the Minnesota nice that it desperately needs. We have a very, very special guest we're going to get to in just a moment, but good morning or afternoon or what are we evening? Hi Steve. Hi. And then Kevin Gorg is back from a 12 day trip with the Minnesota wild. Have you, have you survived Kevin? Yep, just got the third load of laundry into the uh, washer and uh, progressing nicely, reacquainting myself with uh, beautiful Minnesota. It's good to be home. Good to hear. You sound like you caught a little bit of a bug. Bringing back a little souvenir. Yeah, I, I was good all trip and the last couple of days when we were in Pittsburgh, um, I caught a little cold. Well, you know, it's that time of year, right? It's, it's cold and Doc knows this. It's cold and flu season, so we'll be fine. Well, let's get right to Dr. Shanti. Dr. Shanti, welcome. Thank you. I had the pleasure of meeting Dr. Shanti. I'm not going to even attempt her last name, uh, this past weekend at the gala for the, uh, the Children's Heart Link. And some of you might recall about a year ago, we had Dr. Tom Armitage was the, or is still, The chairman of the board of Children's Heart Link, but coincidentally, Dr. Shanti is also a pediatric cardiologist at Masonic Children's Hospital, which of course is near and dear to my heart. Dr. Shanti, how are you? Good, thank you. How are you guys doing? We're just enjoying a lovely Minnesota time. That feels like fall is finally happening. Just turn the corner today. So, Dr. Shanti, for starters, how is it that you made your way to Minnesota of all places? Well, I, I didn't know where Minnesota was in the map that you had, okay? I'm being very honest. And you're from India? Yes. I'm from South India and, um, I traveled directly to Minnesota from India, um, and landed in Minnesota. About 30 years ago, exactly 30 years ago. And I had only two suitcases. One was filled with medical books and the other was Indian clothes and some spices from India. And, and, uh, a heart full of opportunities and, uh, I, I just wanted to be out of the country and, uh, start to explore, uh, what is there for me. So the first question is, did you come here during the summer, winter, when did you first arrive? I arrived in September. Oh, so you were tricked. Eased into it, yeah. Yeah, eased into the reality of Minnesota living. Yes. And we've kept you. You've stuck around. Actually, it's the other way. I think Minnesota wanted me to stay here. Of course. I think SOTA wanted me to serve everyone here. That's what I'm getting through this journey over the past 30 years now. So did you do your medical school in India? Correct. Okay, and you were, were you recruited by the University of Minnesota or how did that all happen? Um, well, I started, uh, coming to the University of Minnesota as a part of a researcher, um, to observe, uh, the clinical part of medicine, how it is different from India. And I, I got some great mentors to guide me through the clinical process. What is academic medicine is all about. How do you even teach anyone regarding medical knowledge? How do you transfer medical knowledge? How do you conduct the research and also, uh, uh, patient care? So that was it. Really a nice journey that I had in Minnesota. I bet. And have you been at the Masonic Children's Hospital for your entire career in Minnesota? Um, I just, uh, went to Columbia, New York to get trained for pediatric cardiology. And then I returned back to start a fetal cardiac program here. So, what is that like? Tell us about a fetal cardiac program. That is just fascinating to us. So fetal cardiac program is, um, at the time in a very primitive state about 25 years ago. Um, My mentor was, uh, Charlie Kleinman, was the guru, we call it, of fetal cardiology, who transferred the knowledge to me, and I said, I, I really want to go back to Minnesota, because there is no, um, there is no program like that, and I wanted to launch the program. And, um, a lot of healthcare people said, we don't know what she's talking about. She wants to see the baby's heart in utero at 16 to 18 weeks. And we didn't have adequate kind of technology at the time but I had something to look at the fetal heart and start to explore the opportunities. So we can now diagnose fetal congenital heart defects as early as 16 weeks in utero. So how do you first discover that? Is it through like an echocardiogram or yes. Yeah, it's like a regular, uh, um, maternal or mothers who are pregnant go through the regular ultrasound just to make sure the baby's, uh, growth is fine. So we utilize that ultrasound technology. to further, uh, uh, look at the heart carefully in utero. As the technology got better and better, the resolution of the images were better to look at the heart carefully. Incredible. The, um, the, the relationship between the University of, uh, of Minnesota and the Masonic Children's Hospital, do you, are you a professor at the university? Yes, I'm a full professor of academic medicine in pediatrics, yes. Okay, um, we had also had the chance to meet one of your colleagues, Megan, who also, uh, she's a physician's assistant, but she also doubles as an artist. And, uh, we, uh, bid on some of Megan's artwork and happened to win the, uh, the, uh, the bidding process for that. What's Megan's last name? T U A R T. Stewart. Stewart. Okay. Yeah. And do you work with Megan? Absolutely. I work with her every single day. Oh, no kidding. What a young artist and a young, um, an educator. Uh, she takes care of patients who are in the step down unit, we call it, when the babies have undergone cardiac surgery. We are transferring, uh, the, uh, patients from the ICU to the floor status where they, where they need, the families need a lot of hand holding to make sure that they are ready to go home. Um, and Megan is one of the key players, um, And making sure that the families are ready to take their little one home comfortably. Well, as um, this is the Kindness Chronicles, one of the things that I was absolutely struck by immediately was both by your kindness and Megan's kindness. When you sat down at our table, it felt like just serendipity that here are these two wonderfully kind people who are doing these wonderful things for children's heart length. Who also happened to work at the Masonic Children's Hospital. And, Of course. Yes, I've been dominating the conversation. Do either of you guys have any questions about, yes. Go ahead. Go ahead, Casey. I have one. Yeah, I just wonder about technology and your time, uh, being here in the States for 30 years. I know in the sports world, you know, with, I think for our listeners, the simplest way to put it, like the GoPro cameras now that are available, you know, The different perspectives with the tiny cameras. How has the technology improved the way that you treat those critical situations on the pediatric side? Because I would have to think with the way technology has shifted. It's far easier to get a diagnosis now with what we have available. Perfect. Very nice question to answer to you when I started the fetal cardiac program, um, the images were little blurred only When you go through that we call it pattern recognition Over 10 years 15 years of training you recognize that in that kind of blur image Now, when you ask me the question, the family is laying down or mom is laying down with the ultrasound and she can tell me, ah, I see that four chambered heart. You know, you think the heart rate is fine. That is what the technology revolution is all about. That I can make them feel comfortable. They understand what I'm showing. But 20 years ago, they were like, what are you even talking about? Even healthcare team will say what? And now everybody gets to understand, uh, the benefit of this technological advancement. Dr. Shanti, I would assume that you are brought in on a case, so to speak, when there is an abnormality or an anomaly that is, that is detected. Is that accurate or do you participate? So if there is an abnormality, is that something that is seen? Is it heard? Is it, how is it that that is identified? Yeah, it can be identified in several different ways. If there is a family history, let's say mom, dad, cousins, they had some cardiac issues at a very young age. That will prompt. The obstetricians to say, hey, I think it's time for you guys. Also, we need to get an opinion from the cardiologist. So that's 1 of the indications we talk about. The 2nd indication is if the obstetrician during a routine scan, um, Um, during the scan, they feel like if there is a genetic abnormality or extracardiac abnormality, they see, um, I'm not seeing the same image of a four chambered heart. The vessels are all, uh, not, um, in a proper place, then they refer directly to the pediatric or fetal cardiologist. After birth, it's heart murmur or the babies look blue or pale. Or they are not able to play like other kids. So these are some of the Indications where they tend to refer the pediatricians will refer the patients to us Uh, to the pediatric cardiologist for evaluation. Yeah. And I, it sounds like this, the technology allows you to get rid of so much ambiguity. You can be very clear and it's very, you can see so much more. That's that's amazing. Yeah. 90 percent of our congenital hearts are now detected, uh, thanks to fetal cardiology, that critical, severe, critical congenital heart disease are detected. Now detected during pregnancy and then we can deliver the optimal care during the postnatal transition phase. Okay, so I have a question Dr. Shanti about, this is kind of changing corners here a little bit. Um, I'm interested in culturally how you find, uh, you've 30 years, but what was your impression of, Minnesota the people of Minnesota and we call it Minnesota nice versus, the people from Southern India, good question. Um, in India, doctors or any healthcare providers are considered to be. Like I'm not saying the word God, but someone higher power, like whatever they say, they will accept it. There is no question. Um, what is the plan? Would you ask for plan A, plan B? Um, can you, can you go through this again with me? So there is kind of that, um, hesitation, you know, um, to ask a physician or a healthcare provider to explain further. But when I came to Minnesota. It was a little bit different, like, Hey, what are your thoughts? Can you explain to me? I just don't get it because we are trained for 15 years, 17 years to actually finally start to focus on our, you know, as an attending and you tend to lose that very simple concept. How do you explain, how do you relate to the family? I think that grounded me in Minnesota. They said, Hey, come to earth first. Can you come and talk to us in very simple terms? Yeah. And, and then that was really awesome. Uh, and then now I can empower people in India. That's what I do. I go to, uh, uh, the reason I took, uh, the medical mission trip is now I can empower nursing physicians, um, healthcare providers to say, you are a team player. Just physicians are not just the team players. You are part of the team and you have to, you have to ask questions to us and challenge us in a way that it's about patient safety, advocacy for the family. What a night, what a nice turn for you to be able to pass that on. That's, that's really cool. Absolutely. So we, uh, the three of us combined probably don't have enough mental octane to really ask a thoughtful questions about this. But I do have one question. Um, if you detect a significant problem while the baby is still inside of mom, is that in your utero? Is that how you say that? Yeah, yeah. Is it possible to do surgery on a baby that's, or do you have to wait until the baby is born? I really don't know the answer, and I'm curious. Um, in the inside the mom, the environment is very, very, um, clean, safe environment. Um, and we are, when we come out, it's the same too, but it's very protected environment is the word probably I should have used. Um, when you have a very protected environment, we have to be very careful about the risk and the benefit. Am I with this baby in utero versus. Is there a benefit? Yes, there are medications, you know, for treating fast, low heart rate. That we captured. We really were able to manage that in utero. If a baby's heart rate goes 250 beats per minute, I do not care. I do not want to deliver the baby. I want to keep the baby safe in the mom by giving mom the medication to transfer to the placenta and we are able to convert the word to be used as the word tachycardia. So we have, we have revolutionized some of the things in utero for treating tachycardia, some degree of pain. lower heart rate. Can we prevent lower heart rate like a heart block? So we, we are, we are well on our way in technological advancement. Can I do surgery in utero? Yes. Um, they have been doing some type of surgery for tracheal, uh, certain conditions, but not cardiac surgery because cardiac surgery, the pressures are very different in utero. And so we can, um, we can do some balloon dilatation in utero, but not absolutely correct cardiac surgery in neuro. Okay. So just curiously, when you give mom, uh, a, a, a medication to ha to, to manage tachycardia in the baby, does it also impact the heart rate of the mom, or how does that work? So we, I, I, we need to understand the medications and I usually admit the mom, um, to the hospital for two to three days because I need to monitor her heart rate and her, the effect of these medications on her. So I'm treating two patients at the same time, so I have to be very, very careful, um, uh, monitor mom's, um, mom's blood levels of certain medications, how the kidneys are functioning, liver is functioning, depending on that, the medications that I give can change in dosing or Um, change in a certain other formulation. Yeah. I got to tell you, men got it easy. Don't we have it easy? My goodness. This is the No doubt. So I want to, uh, transition to, uh, Children's Heart Link. How is it that you discovered Children's Heart Link and, um, how, how is it that they, uh, got you enamored with the work that they do so much that you would travel to other countries to, to help young children with cardiac disorders? I, I think it was everything was, uh, supposed to be, uh, planned by somebody. So I, I, I had a vacation one week off, so I didn't have a plan and somebody, one of the cardiologists said, Hey, my family has some emergency. Would you mind going? I said, for what? I didn't know anything about medical missions for And I said, okay, I have vacation time, so let me take off. And they said, pack your bags, get your passport ready. And I said, where are we going? And they said, you're going to Brazil. Brazil, I'm not kidding. It was just one bag. To Brazil in Sa Paulo Rio Metro. Um, and I didn't know anything about the place or the, uh, we were just the American team going to Brazil. That's what it matters in medical mission is not, I'm a Minnesotan, I'm a Viking fan. I'm a Packers. Guess what? I'm a Vik Um, so it doesn't matter. It was all about, uh, the patients. John, what touched me? When I went to Brazil, I didn't speak the language. I didn't speak Portuguese, but the language was kindness and hugging and compassion. That's all they cared for. Um, One example was a patient, um, a young family, a young dad with his kid walked from Amazon Forest. I am not kidding. That kid still is in my vision all the time when I need to be grounded is he walked all the way to just get to the bus station. That was one day of walking. And then he took two or three, uh, service buses to get to where to Sao Paulo. Um, just to meet the American doctors who are there to, or the American team to, it didn't matter whether I was able to correct, will I be able to give a positive result or nothing mattered. If they just wanted to see us. Wow. And how long ago was that? maybe 12 years ago. And how many of these mission trips have you taken? Um, I went to Brazil twice. Um, and then the big, the center became the excellent center, center of excellency. Once you have done your work, then you move on to the next center. Um, and then my, my mission was towards, um, empowering healthcare team in India, because that's where I felt was lacking the doctors were not about, um, they cannot question the doctors. So then I went to the nursing staff, I said, you need to question them. Um, how did the surgery go? What am I supposed to do tonight? So then I started, um, Educating and being part of the Heartlink team, um, as a, as a person who can transfer the knowledge to everybody. Sounds like it was a good fit. Sounds like you were the right person to chance upon this, uh, endeavor for Brazil. That's, that's quite a, quite a move. Yeah. Serendipity. Yeah. Yeah. We operated, we landed on Sunday. So when you land, you just. Get to go find a hotel. Um, they'll give you you just leave your bag come back and you go through the What is it called briefing process? About what to expect you don't walk outside this time and then you go to the hospital directly first thing in the morning Monday at 7 7 30 and you don't leave until Basically till friday you're basically sitting there. You may sleep there Um, wow. It's just, it's nothing. You don't get exhausted at all. You're just happy that you're there to help those kids. Wow. Well, I would imagine they're awfully happy that you're there as well. Yeah. So, um, how many people will you see during the week? So, our goal is to see, at least we have to look at all the cases. You know, on Monday morning we round the hospital. We just figure out what equipments are needed, what. Set up we need, um, and then be up to review all the charts. Let's say we have 30 patients. We cannot operate on all 30 patients because either their infection or they have running nose cold cough symptoms or diarrhea. So, those are contraindications to go to surgical procedure. So, then we can, we can say, how safely can we operate Monday through Thursday night? Friday, we want to make sure the postoperative patients are ready to go home, or if there's anything that is needed, we can do it. So more about debriefing on Friday, what went well, what went, what are the, what could be different. So Monday through Thursday, we can operate every day two cases because the operation is about five hours or six hours. Um, so we operate roughly. Eight, eight, eight to nine patients we operate that week. Holy cow. And Children's Heartlink, for everybody's information, is a Minnesota based non profit. And it's been in existence for decades now. And can you tell us a little bit about the different countries that Children's Heartlink operates in? Absolutely. Um, they operate in India. Uh, several centers in India. Um, Brazil. Um, it's they, they depend on the government support. So, you know, the government needs to support these type of organizations for safety for policies. Um, so they try to expand as much as possible to every part of the world, but the government needs to also work with them. So, so Vietnam is one of the places they were in China, um, um, Singapore. I think they worked in Singapore, um, but they have several educational programs all over. Yeah, I know that they've been looking at some countries in Africa that are underserved. And, uh, the, the challenge is, is dealing with the, the government of those countries, which is got to be very frustrating. Here you are trying to make a, go ahead. Yeah, because we, we have a mission, right? In this year, in when a team of 10 people, Um, walk into the hospital, we need the infrastructure, the equipment, and the government needs to sponsor. There's not an individual sponsor who can invest so much of money financially, so we need to partner with the government to make sure that we will bring the team, but you have to support us through infrastructure and resources because that is the key for success of any program., I want to go back to the gala. I want to hear, um, About the gala, where it was, what was served for food, the atmosphere. Um, I feel like I missed out on a pretty good party. It's beautiful girls. Okay. Handsome gentlemen that I have well dressed well behaved, uh, with lots of auction items and, um, it's like a party. Uh, and tell us about the food. Tell us about the food. Cause I want to hear about the food. It was Indian food, so what is there not to talk about? Oh, man. Yes, we had, uh, we had samosas, we had all types of Indian curries, uh, chutneys, uh, so it's kind of that blend of spices that we wanted to showcase. And there was a dance, absolutely. There was, uh, a cultural performance, uh, by the Indian artists. just to showcase, a different side to, uh, healing process to because my, my patient's first question, um, when I'm treating patients in utero or counseling is, Can my son play football? Okay, period. After all the discussions we had, we wanted to show the different side to us, ourselves. So the gala had that type of cultural event to say, these kids will do fine. These kids can play football, basketball, uh, hockey, soccer, all those stuff. You guys, have 100 Foot Journey? No, no. Okay, this is one, as we talked about the gala and the Indian food, it right away took me back to a movie because that's what I do. It's an amazing story. I've seen the movie a couple of times. Helen Mirren is the lead actress and it's a family from India that gets displaced. To this quaint little French village. And they decide to open up a traditional Indian restaurant in a place that you normally wouldn't see that. And across the street, a hundred feet away, Helen Mirren runs this traditional high end French restaurant. And she does everything in her power early in the movie to try to run them out of business. And it's a family run restaurant. And the son in this Indian family is this remarkably talented chef. It comes full circle. It's a wonderful family type story. And being that Indian food came up, I have to recommend this movie to you guys. And obviously our listeners, it's from 2014, the hundred foot journey. It is not to be missed. I think I've seen that movie. It's so good. I can tell you, Kevin spends more time in a movie theater than he does just about anywhere. So if there's a movie that's come out, he has seen the movie. One last question, then we'll let you go because I promised we'd only keep you for 30 minutes, but you know, it seems like people from India tend to gravitate towards professional careers in medicine, in engineering, so on and so forth. is that accurate in India? Yes, John. The reason is that it's always I talk about history. History is important for us. In India, we had several different things, um, several different type of setup. We are talking about several centuries ago. We were, we are farmers, we, we were looted or, you know, we always get invaded by several different, um, countries all the time. So we lost a lot of things. The only thing that kept us grounded was our brain power. So they said they couldn't take the knowledge out of you. So don't forget that. Don't find material presence as the most important thing, because you could lose any time. But just go educate yourself, so that when you educate, you know how to be financially be secured, and you can live a life. That's what is being grounded to us, generations after generations. It's interesting, my, uh, future daughter in law is a kindergarten teacher at a school that, uh, that has, uh, quite a few Indian that are part of the school. And she says that the, the young kindergartners are, and it's specifically the Indian kids are just remarkably advanced. And I wonder if just genetically they're smarter or is it just the ambition that, that comes from the parents? Yeah, it's driven by the parents, grandparents, cousins, family members. We are a very close knit family, so one look after the other, and they try to encourage kids to be, um, what they want, but at the same time, um, be realistic about the world. They will grow up to. So, did any of your family from southern India make their way to Minnesota? Minnesota. No, the coldest schools. I can't blame them. I was just gonna say. Yes. They're too smart for that. Somehow we got you sucked in. Yeah. This one, one thing I want to tell you guys, John, I did not mention in the gala to you, is my first pediatric training in India was in a Masonic Children's Hospital. Really? That is one of the, one of the few. Masonic Children's Hospital in India. Wow. You're kidding! No. No, I realized it only when I came to Minnesota. I was like, wow, I need to tell my story to someone about this. Yeah. I have full goosebumps right now. We're gonna have to bring you to one of our, one of our galas and have you tell that story. Yeah. Because Masons are all over the world and our objective is just to do good for the community. So I am so grateful that you mentioned that. That is a wonderful story. Yeah, we don't, we don't have a specific speciality hospital, I mean, in my hometown, which is a small, even though it's small, it has a lot of millions of people. But, um, we don't have focused hospital at all. It cannot, it doesn't bring revenue or it's not generating revenue. So all the hospitals are adult focused and we have a small pediatric ward, but this Masonic Children's Hospital is only dedicated. This I'm talking about 40 years, 50 years ago, or more than that, uh, was established only to be dedicated to kids it's only dedicated to take care of Children. We didn't know when we were in training. We said what? This was a new concept for us. That's fascinating. Who knew? That's more than coincidence. That's, that's wild. Well, Dr. Shanti, thank you so much for your time. Yes, thank you. God bless you for the work that you do and the impact that you not only have on families and kiddos in Minnesota, but Keep going. all over the world. You are a blessing to all of us. Thank you. I'm eternally grateful for, uh, having surrounded by amazing people like all of you guys. I'm not kidding. You say hello to Megan and tell her, uh, we're enjoying her art and we'd like to have her on the podcast soon as well. Absolutely. All right. Thank you. Have a great night. Thank you, doctor. Bye bye. All right. Off we go.