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A Heart for Research

For Dr Upendra Kaul, Executive Director and Dean of Cardiology at Escorts Hospital and Fortis Hospital (Vasant Kunj), being engulfed in path-breaking research and working beyond the metros hold more significance than the number of coronary angioplasties. Rita Dutta unveils the unconventional cardiologist

What makes an interventional cardiologist become a name to reckon with, pan India? The number of path-breaking techniques that he has courageously pioneered and his super success rate! In today's age, the volume of procedures and perhaps celebrity clientele would also count. However, one significant factor that not many acclaimed cardiologists can boast of is panache for research. Yes, that is what distinguishes Dr Upendra Kaul, Executive Director and Dean of Cardiology at Escorts Hospital and Fortis Hospital (Vasant Kunj) from his contemporaries. Always keen on embracing the latest technology and exploring the effectiveness and efficacy of these technologies through multiple research trials (both national and international) is what defines Padmashri Dr Kaul. Besides interventional cardiology, he has dabbled in research projects in cardiac pacing and electrophysiology, surgical cardiology, constrictive pericarditis and cardiac pharmacotherapy.

His love and passion for research has made him accomplish a stupendous feat — that of publishing articles in more than 450 national and international publications. However, the most significant research study, according to him, has been the results of primary angioplasty — stenting in patents with acute myocardial infarction within one hour of the patent reaching the hospital and without any clot buster. "The results published, before any other major international study, showed that the mortality of acute heart attack could be reduced to less than three per cent. This finding has led to widespread acceptance of the procedure in our country," he states, one evening at Fortis Hospital, Vasant Kunj. (see box for key research projects)

From Playing Truant to Studious Boy

But don't be mistaken to believe that this research-loving and medical techno-savvy doctor was a brilliant academician right from his childhood. An above average student till his seventh standard, he fell in bad company in his eighth standard at Delhi's Government Model School, Ludlow Castle. "I started bunking school to play cricket and watch movies," he reveals, smiling at his imprudent ways. His waywardness culminated in obtaining zero in mathematics and failing in various other subjects in the final exam— the outcome was that he failed in his eight standard annual exam. As a naïve 13-year-old boy, he was shocked that he had to pay such a heavy price for his mischief. "I thought I could continue like this forever, without any major impact. Suddenly, I realised that I could not lie anymore and decided to belt out my web of lies to my parents that day," he recollects. Not surprisingly, the revelation led to severe thrashing by his father. However, it's not the chastisement that made him reform himself. For this Kashmiri-born, not being allowed to go to vacation that year to Srinagar was the ultimate punishment.

"Throughout the year, I looked forward to my visit to Srinagar. I was heart broken that I was not allowed to go there that year, though my mother and brother went. This made me promise to myself that I would prove to my father that I am not that bad by reforming myself and becoming serious about my studies," says he, about the turning point of his life. Post that phase, he immersed himself in studies and always emerged with flying colours in his exams.

After his pre-medical in 1965 from Hans Raj College, he completed his MBBS and MD in Internal Medicine from Maulana Azad Medical College. He was awarded DR Thapar Gold Medal in General Surgery in MBBS. In 1978, he did his DM, Cardiology from GB Pant Hospital. Known as a student who was completely immersed in books 24X7 in his college days, today he is bemused by his erratic reading habits. "I remember when I had to go to collect milk in the wee hours of the morning, standing in that queue I was studying below the streetlight. More interestingly, even while walking on the road I would be cramming my notes. That was not necessary, but somehow I was so driven that I wanted to study all day," he muses.

Professional Journey

In front of Satya Sai Hospital, Puttapatti

With cath lab team in Srinagar

Dr Kaul receiving BC Roy award from former president Dr KR Narayanan

In 1979, he started his career as an Assistant Professor-Cardiology at PGI, Chandigarh. He later joined as a lecturer of Cardiology, GB Pant Hospital, New Delhi and then in 1981 moved to AIIMS as Assistant Professor, Cardiology. His 17 years at AIIMS was the most significant period of his professional life as he went about pioneering the coronary intervention programme of AIIMS. Some of the techniques that he pioneered at AIIMS include laser myocardial revascularisation (first time in Asia), primary coronary angioplasty, percutaneous cardiopulmonary bypass, rotational and directional atherectomy, percutaneous and coronary stenting including drug coated stents.

The technique of percutaneous cardiopulmonary bypass for high risk PTCA was initiated by him in India in 1990-1991. "I have the largest experience of carrying out high risk PTCA not only in India but whole of Asia, including far East and Australia," he says with pride. Procedures like intracoronary stenting and atherectomy (directional and rotational) were started by him in India in 1991. He is credited with setting up the coronary care unit at the Cardiothoracic Centre of AIIMS.

He also started intravascular ultrasound for diagnostic purposes and carrying out optimal angioplasty and stenting procedures, in addition to physiological measurements like coronary flow reserve estimation. The breakthrough method of carrying out percutaneous transluminal myocardial laser revascularisation for patients who are not suitable to undergo coronary angioplasty or bypass surgery was also introduced under his supervision with technical help provided by American technical experts.

Joining Batra

His long stay with AIIMS did provide him with tremendous professional satisfaction, acclaim and respect, but as his children grew up monetary pressure started building. "I was drawing only Rs 19,000 per month in 1997. At that time, my daughter required Rs 5 lakh as donation for her medical education. I had to borrow that money from friends. That was when I decided to take up a more paying job in the private sector than compromise on my principles and earn money the wrong way at AIIMS," says Dr Kaul, always known for his honest ways. This made him leave AIIMS in 1997 for Batra Hospital, New Delhi.

He remembers his stint with Batra Hospital with fondness. "I was given full freedom to resurrect the cardiology unit of the hospital," says he. Dr Kaul started a new unit of interventional cardiology and electrophysiology unit at Batra Hospital with cineless cardiac imaging facilities, intracoronary ultrasound, coronary flow reserve measurement, etc. "In October 1999, a new method of myocardial channeling using a non laser method based upon mechanical channeling was used for the first time in nine patients by me. This was the first human experience with this method anywhere in the world," he informs.

At Batra Hospital, he carried on his passion for teaching by training DNB students. "Prior to me, no students at Batra could pass DNB, Cardiology," says he, as a matter of fact. While he was with Batra Hospital, he won the BC Roy Award in 1999. After eight years in Batra Hospital, he joined Fortis Healthcare in June 2005, when some of his friends moved out of Batra and started joining corporate hospitals. At Fortis, he established two new cardiology departments at Noida and Vasant Kunj facilities. It was at this juncture that he was awarded Padmashiri in year 2006. His plans as the Dean of Research at Fortis include promoting multi-centric research within the Fortis Network Hospitals and make Fortis a site-management organisation. "I have to get prestigious global research projects and distribute them in various network hospitals, depending upon the interests and facilities available. I need to have a central independent ethics committee for the network hospitals and have Institutional Review Boards in the network hospitals as per the guidelines of the ICMR," he enthuses.

Personal Diary

He was born in Srinagar on 14th June, 1948. In 1950, his family shifted from Srinagar to Delhi for better employment opportunities. His father, who was a practising lawyer in Srinagar, took up a clerical job initially in New Asiatic Insurance Company, as job opportunities were shrinking in the valley due to terrorism. They stayed in a one-room house at Prem Nagar near Birla Mill in Old Delhi for many years. Here he started studying in Lahore Montessori School. "I still remember a 'mai' taking a few of us to the school," he remembers. In the fifth standard, his family shifted to a one-room house to Jawhar Nagar in Delhi. In the sixth standard, he enrolled in Government Model School. He remembers helping his mother in daily chores. He still remembers how once every week, the family secretly cooked and relished a dish of mutton. "Other people in our building did not like the smell of non veg, so we closed our doors to cook non veg. We wrapped the leftovers and bones and threw them miles away, so that no one could catch us," he beams. The best memory of his childhood is spending his annual vacations in Kashmir with his bunch of cousins. "At Prem Nagar in Delhi, there were lot of restrictions imposed on me to play with other school children. But that was not the case in Kashmir,” he says. Family: His wife Upkar (66), who is a Sikh, retired as Professor of Cardiology at GB Pant Hospital, Delhi. Right now, she practices at one of the centres of Diwan Chand Hospital in Delhi. Their daughter Amita (32) is married and settled in Pune, practising as a paediatrician at Aditya Birla Memorial Hospital. Son Samir (30) is an investment advisor in Barkley's Bank. Food: He loves Kashmiri food, right from wazwan to dum aloo to meat balls to yakhni. Besides being a gourmand, he also loves whipping up all these dishes, thrice a week. Books: Besides reading academic journals, he loves reading books on Kahmir. Some of his favourites are 'Kashmir' by Sir Francis Young Husband, 'Slender was the Thread' by Lt Gen Sen, 'Kashmir: A Disputed Legacy' by A Lamb and Narinder Singh Sarila's book on ‘Partition of India and Pakistan’. Music: He listens to old time Hindi music, mainly Suraiya. Car: He owns a Laura, which is mostly driven by his driver. Vacation: Though he travelled across various countries (mostly for conferences), he loves going back to Kashmir time and again for vacation.

Beyond Metros

Research and pioneering techniques may have been his passion, but there is another facet that is more deep-seated in his heart. It's his love for Kashmir and his determination to contribute towards development of the valley. Despite his family having moved out of Kashmir many decades ago due to militancy, Dr Kaul's heart still beats and bleeds for Kashmir. "Even at AIIMS, I went out of my way to get beds for Kashmiris irrespective of their religion and took special care of them," he discloses.

From 1997 onwards, he started going back to the valley more regularly. "I was approached by several well wishers in the Government and also from some of the separatists that I should visit Srinagar throughout the year to provide consultation to cardiac patients. I readily accepted the offer," says Dr Kaul, who was in fact one of the first doctors to go back to the valley after militancy forced Kashmiri Pandit to relocate.

The Government gave him a place in Kashmir Nursing Home, a medical centre in a security zone. "Seeing the huge patient inflow, the Government encouraged doctors from other specialities also to visit periodically," he beams. Dr Kaul helped the authorities to formulate plans of setting up a good diagnostic centre in the nursing home. For all his good work, he was also appointed as an advisor and an institute body member of the Sher a Kashmir Institute of Medical Sciences (SKIMS). In recent times, he has started going as a visiting professor to SKIMS and conducts teaching courses in coronary interventions.

So, is he thinking of re-locating in the valley, I cheekily ask. For the first time, the practical side in him takes over. "That would have been superb— seeing patients in scenic surrounding and gazing at stars in the night. But my parents, who are staying with me, are over 80 years and thus moving to Kashmir which does not have good healthcare facility, is not feasible at this point of time," he reasons.

What is admirable is that he has not restricted his expertise to set up a cardiology unit to J&K only. In 1993, he helped setting up the cardiology unit at Sri Sathya Sai Institute of Higher Medical Sciences at Puttaparthy. "In June 1993, the project was still a barren land, when Sri Sai Baba gave all a challenge to construct the hospital by November that year. It's unbelievable but true that the hospital was commissioned by the said deadline. I set up the cardiology unit with telemetery built in computerised ambulatory monitoring and facilities for intra aortic balloon pump and percutaneous cardiopulmonary bypass support," he remembers, with a glint of happiness in his eyes.

Other cardiac labs where he has been involved with are Jayadeva Institute of Cardiology, Bangaluru and Medical College, Cuttack. At present, he is helping setting up the cardiology unit at GNRC, Guwahati and Florence Hospital, Srinagar.

One interesting aspect of this technical support is that Dr Kaul always trains people manning these units, so that they can work as independent unit in the long-run. This is quite contrary to the concept of getting patients from these units as a source of revenue. "I always think of patients first and never worry about what would be more revenue-generating. It's inconvenient for patients to travel all the way to Delhi to get treatment. These units should be made to provide complete care in the long-run," says he.

And what are his predictions about the stents and pacemakers of the future? "Coronary stents of the future would be even more trackable, safer with no polymer required to hold the drug and in many instances the stent getting bio absorbed leaving the vessel without any metal after six to eight months of deployment. The need for dual antiplatet therapy would be reduced and the problem of very late stent thrombosis would be no major issue," avers the soft-spoken Dr Kaul. After a brief pause, he adds, "Pacemakers in most situations would be pacing both the ventricles and heart failure would become a major indication for cardiac pacing. The pacemakers defibrillator combinations would become further miniaturised with longer durability."

Looking Ahead

Why did this revered cardiologist, who is extending support to set up other cardiology set-ups, did not think of kick-starting his own hospital? "I don't think like a businessman. I don't event understand business jargons as EBIDTA and PAT. I am just happy treating people and attending to my patients," says he, grinning. So, what more does this 62-year-old want to achieve in life? "I want to help set up more cardiac labs across the country, so that people get medical help near their doorstep," he concludes.

I walk away from his chamber thinking that if more cardiologists have his research bent of mind and his high principles, then India would witness more technical advancements and the medical world would be less corrupt and more empathetic towards the plight of patients.

rita.dutta@expresshealthcare.in