The Guiding Star: The Journey of an International Physician From Maternal Fetal Medicine to Fetal Neonatal Neurology

Abstract

My path to the American dream took me from maternal fetal medicine in India to fetal and neonatal neurology in the United States, a journey spanning 2 continents, 3 countries, 3 healthcare systems, 4 rounds of the residency match process, 2 residency trainings and 4 fellowships. Through it all I had the good fortune to be guided by a wonderful support system of mentors, family, and friends. This is my story of how and why.

My path to the American dream took me from maternal-fetal medicine in India to fetal/neonatal neurology in the United States. This journey spanned 2 continents, 3 countries, 3 healthcare systems, 4 rounds of the residency match process, 2 residency trainings and 4 fellowships. While an arduous and enthralling adventure, I would do it all again. I had the good fortune to be guided by a wonderful support system of mentors, family, and friends. This is my story of how and why.

I knew I wanted to be a physician and help families as a young girl. I worked diligently, excelling with honors and reaching the top rank holder on the national high school merit list. After training in Obstetrics and Gynecology (Ob-Gyn) from the Institute of Medical Sciences (Banaras Hindu University), I specialized in Maternal-Fetal Medicine, and served as faculty at the preeminent All India Institute of Medical Sciences in Delhi, India. I enjoyed the moments of quick decision-making, hours in the operating room and bonds with multi-generational families. The joyous look at a parent as they held their little one for the first time, following months of stress during pregnancy, was always gratifying. The trust from families and my connections with them over 14 years added to my passion and fulfillment. I dreamt of coming to the US, but the opportunity never presented itself during this time.

In 2005, my husband received an offer to develop and lead a new division in Toronto, Canada for a large multi-national Indian pharmaceutical company. My excitement for new opportunities were tempered by the challenge of re-certification and a major interruption in my hard-earned and rewarding career-path. Once in Canada, I was confronted by the arduous path to first establishing permanent residency before eligibility to train in a clinical residency training and re-establish the clinical position I had held in India. My sister, an OB/GYN researcher in the US, advised me to relocate to America for better opportunities. Not deterred to re-learn medical school basics for the USMLE, complete clinical observerships and gain research experience, I sent numerous emails every week, seeking positions throughout the US.

I was thankful to God for my gift of surgical skills, honed by experience from the long, intense hours in the operating room where lives were saved, bringing joy to families. I was therefore unwilling to abandon this surgical part of my professional experience. While in Toronto, despite limited knowledge about the Match process, I applied to about 15 top-rated Ob-Gyn residency programs over 2 years. Family and friends cautioned me to consider other medical specialties, given the competitive nature of Ob-Gyn residencies. Yet, my years of training, clinical and academic experience, bolstered by numerous awards and publications sustained my confidence that I would match. Interviews went well, including comments that I was 1 of their best candidates given my experience! However, the visa process presented new hurdles. While I sought a H1B due for the flexibility with the immigration process, residencies preferred J1 visas. This led to my failure to match.

Following Match Day, Dr. Cleeland at the M.D. Anderson Cancer Center in Houston, Texas offered me a research faculty position, and with my husband’s incredible support, we moved to Houston. I managed clinical research trials, presented self-initiated protocols and published my work. I meanwhile shadowed medical clinics at MD Anderson to gain insight into the US healthcare system. While enjoying research, I was motivated to return to clinical medicine where I had a personal impact in the lives of patients and families. Without clinical practice, my whole world seemed shattered, with less purpose.

My research brought positive experiences as well—it gave my family time to adjust to a new country and permitted me to spend more time with my son, who has cerebral palsy and neurodevelopmental challenges. We established his care with wonderful specialists at Texas Children’s Hospital impressed by their vision and mission. My son’s developmental pediatrician, Dr. Sherry Vinson, learned of my career path and suggested that I consider the Child Neurology/Neurodevelopmental Disabilities program at Baylor. As I was recovering from yet another match failure, I did not pay this advice much heed. However, every single day over the next year, driving along Holcombe Boulevard to M.D. Anderson, I passed the looming towers and connecting bridges of Texas Children’s Hospital, praying for my successful Match and the opportunity to work at an academic center like Texas Children’s.

I met with an immigration attorney and filed for a Green Card in the self-sponsored EB1A (extraordinary ability in science) category. While the Match process had been a struggle, I was delighted to become a US permanent resident on Christmas eve of 2009. With renewed enthusiasm, I applied again for approximately 100 residency programs across 3 specialties. More than 15 years had elapsed since medical school graduation, and I feverishly emailed program directors asking them to look at my application, assuming many would have misgivings and exclude me from the interview pool. Over those many years since medical school, I had gained so much experience: I worked as a physician and researcher; I published and presented original research; I raised a child with cerebral palsy. Experience is invaluable in medicine, and yet the Match system did not acknowledge my personal and professional histories. From those 100 applications, I was offered 6 interviews. Despite my US experience on my CV and wonderful letters of recommendations from US mentors, Match Day unfortunately again ended with tears. Yet I still never stopped dreaming as I drove on Holcombe Boulevard the next day, and again, said my little prayer.

It was suggested that international physicians might have a better chance of matching in New York State. I accepted a NIH-funded post-doctoral fellowship in health services research and policymaking at University of Rochester Medical Center. The following year, I again, sent out 80 applications to 3 specialties, this time including preliminary pediatrics. I aimed for IMG-friendly programs, mostly in the northeast. In a country with a national physician shortage and underserved areas, surely there would be opportunities for international physicians to receive on-the-job training, utilizing their skills and experiences in a supervised setting. However, each unmatched year distanced me further from medical school and clinical medicine, worsening my chances with the Match. At some point, I needed to consider ending my pursuit of this increasingly futile dream. I promised my family this would be the last year I would try to match in clinical medicine and remain in a research career path.

I then received an email inviting me to interview with the Baylor College of Medicine/Texas Children’s Hospital Child Neurology and Pediatrics residency program. Dr. Tim Lotze, the program director, guided me through the San Francisco Match process (used for the Child Neurology Match at the time). He relayed to me that my accomplishments were reflected on my CV and through my interviews, but I had heard this story before, and remained unenthusiastic.

One cold, dark, wintry evening in Rochester, NY, I received a call: “Hello, this is Tim Lotze. Congratulations! You have matched to our child neurology fellowship and we are thrilled to have you!” Tears of joy flowed, along with a sigh of relief! I decided at that moment that I could now follow that guiding star to fulfill my destiny for a new career-path. I committed myself to those who valued my experience, were ready to bet on my skills and give me a platform to learn, excel and make a difference. I am forever grateful to Drs. Tim Lotze and Gary Clark for this wonderful opportunity, welcoming me to the world of child neurology and giving me the opportunity to re-invent myself within the US healthcare system.

Through my years as a trainee and faculty at Baylor/Texas Children’s, I have had many wonderful mentors who guided me to develop a niche in fetal and neonatal neurology, applying my previous experiences in maternal-fetal medicine. Both my parents are pediatricians, and always wished for one of their daughters to choose Pediatrics as a specialty. I finally ended up there—almost against my will but guided by my destiny to merge maternal care with pediatric care. At my graduation, Dr. Bob Zeller, one of the senior clinical faculty at Baylor joked: “Dr. A, you could be a womb-to-tomb neurologist—do the cesarean, resuscitate the baby, see them in the nursery and follow long term until they are old!”

I now know that there is no better field for me than child neurology with an emphasis on fetal-neonatal neurology. I am driven by endless passion and commitment, in part, by my personal experiences raising my son with cerebral palsy; experiences I can share with families. I know what a family goes through when a child has a brain disorder. I live through this every day, knowing that hope must be kept alive, one day at a time, focused always on the strengths of the child while working on life-course challenges. It is my life’s mission to make a difference in the lives of all the children and families that cross my path. I am most fulfilled by the trust and connections with these families. I strive to empower parents through this journey so we can partner to care for their child as they blossom over their childhood and adult years.

During residency training, shortly before I started my child neurology rotations, my son began to suffer with seizures. He was evaluated by Dr. Gary Clark who remarked, in the exasperated humor of a seasoned neurologist, “Ah, your very own? Welcome to neurology.” Despite these set-backs, my son, now a teenager, is an amazing person with endless energy, zest for life, and a great sense of humor.

As I wrote of my own story of challenges, hope and persistence, it gave me personal perspective of the American dream, reinforcing my belief in the Indian philosophy of karma, and the importance of guiding stars that illuminate our paths. In my journey as a clinician and educator I am committed to connect the dots through my experience, and mentor and inspire the next generation child neurologists to serve as an advocate for women and children while considering the developmental origins of brain heath and disease across the lifespan. I am grateful every day that I now get to be a guiding star for so many children and families and other young medical professionals.