My Kind of Medicine: Real Lives of Practicing Internists: Kalpalatha Guntupalli, MD, MACP
Texas is a long way from Kay Guntupalli’s childhood home in Hyderabad, India, but there are certain things she has kept close to her heart since leaving years ago. The most significant of these were the memories of growing up with her sisters. As the youngest of five, she looked to her older sisters and brother for guidance and inspiration, so when all three of her sisters decided to pursue medicine as a career, she was quick to fall in line. “I used to go through their books to get an idea of what medical school was about,” she recalls. “I was awed when they discussed diseases and approaches for diagnosing and treating. At one point when all four of us were in medical school, our house was like a girls’ dorm with everyone talking and discussing different topics.”
Today as a professor, fellowship director and ICU director, her environment is anything but that of a girls’ dorm, but the spirit is much the same. “I am surrounded by young and enthusiastic medical students, residents and fellows all day,” she says. “I love the stimulation it provides me being questioned and challenged by young minds. I couldn’t imagine myself working in any other setting.”
The Making of a Doctor
As a student at The Institute of Medical Sciences, Osmania Medical College in Hyderabad, Dr. Guntupalli was drawn to internal medicine because as she puts it, internal medicine “paused to dig deeper into a problem.” Watching internists at work was also a persuasive factor for her and she credits a former professor with inspiring her to become an internist. “As a student I saw outstanding internists diagnosing complicated cases with a methodical approach. It seemed to be a specialty that would let me grow in other fields by providing me with a solid foundation.”
Following medical school and residency at District of Columbia General Hospital, Dr. Guntupalli completed a pulmonary fellowship. Then she and her husband prepared to pursue further training—he in nephrology and she in critical care. His plan was to attend the University of Michigan; hers the University of Pittsburgh, where she knew the training program for her fellowship was excellent. The problem, however, was the fact that they now had a six-week-old son. Everyone urged them not to do it, but Dr. Guntupalli says she and her husband knew it would work. “We were apart for two years which was most difficult because we were trying to raise an infant,” she says, “but we knew that to get what we wanted, we had to make some sacrifices. Not many of our family or friends agreed with the decision but we do not regret it. We have a very strong marriage. In fact, both of our children have decided to go into medicine which I think is a testimony to the fact that they did think what my husband and I did was important.”
Dr. Guntupalli has also learned valuable lessons from her patients. One patient in particular stands out to her, a young woman who had been suffering so badly from severe asthma that she was being admitted repeatedly to the ICU on a ventilator. “She had many stressors in her life,” explains Dr. Guntupalli, “and she was difficult to treat and deal with for a few years. But by working with her steadily, we not only got her asthma under control but also motivated her to volunteer in our ICU. She enriched my life in many ways—from her I learned how determination can overcome many odds.” Dr. Guntapalli would need that determination more than she would know soon enough.
Dr. Guntupalli with her family.
The moment a thin and tall young man named Prakash walked into Dr. Guntupalli’s office one morning Dr. Guntupalli’s career would never be the same, although it would be weeks before she knew it. Prakash explained to her how his brother, Prem, just 40 years old, was critically ill at Apollo Hospital in New Delhi, India. The patient’s doctor had given Prakash Dr. Guntupalli’s name and Prakash wanted to know if she could help. The case summary of the patient was dire: post influenza pneumonia, complicated by acute respiratory distress syndrome. “I wondered what I could contribute,” she says, “but I made the decision, went home and told my husband and children that I was going to India.”
On the flight spanning the 10,000 miles to India, Dr. Guntupalli made hourly calls, during which she learned that while the patient had not deteriorated, he also hadn’t improved. “I told Prakash that things were ok but did not use terms like “stable” or “out of danger,” she says. When she arrived at the hospital at 3 a.m., Prem was pharmacologically paralyzed, heavily sedated and on a ventilator. She also learned that he had tested positive for a resistant variety of Staphylococcus. Complicating matters was Prem’s agitation. If not sedated adequately, he would fight the ventilator, yet if too sedated he would be unable to be assessed. “By the end of the day I had new worries,” Dr. Guntupalli admits. “Finding the right balance was a delicate task. How neurologically intact was he? My worry was for the head.” An echocardiogram was ordered and returned positive for possible involvement of the heart. “My heart sank,” she says.
As impossible as the situation seemed, however, Dr. Guntupalli knew people were counting on her. “I had to keep going,” she says. “I had to keep going because of his two young children…because of the faith the family had in me.”
Dr. Guntupalli’s day begins with rounds in the ICU of Ben Taub Hospital in Houston, TX from 7 a.m. until noon. This is followed by a teaching session in the ICU for residents and more “rounding.” She meets with patients’ families in the afternoon, and follows that with administrative work before finally calling it quits for the day around 6 or 7 p.m. Once home, she does her academic reading and writing. When asked what the benefits of working in her setting are, she talks of satisfaction and stimulation. “I have worked in an academic teaching setting all my professional life,” she explains. “I love working with all of the different personalities and experience level of residents, fellows, faculty and other colleagues. Through my career I have gained many opportunities. I would like to continue teaching not only physician trainees but also contribute more to family and patient teaching.”
She also has a passion for humanism and social responsibility, which she mentions repeatedly. “Humanism and social responsibility in medicine are very important,” she says. “I have been developing materials for patient education and public education for many years and would like to continue these efforts in the future.” One such effort of Dr. Guntupalli’s includes tobacco prevention education, for which she developed anti-tobacco materials in seven languages, which have been distributed to over 150,000 children in several countries.
Back in the ICU in Delhi, India, Prem was weak going into surgery. Dr. Guntupalli knew she had to level with the family. She explained to Prem’s younger brother, Padam, what the complications and risks were and how the level of support needed had escalated by several notches. “From over 20 years of experience, I know that one of the important aspects of taking care of critically ill patients is not only to convey the realistic picture honestly, but also not to leave the loved ones ignorant to form their own interpretations,” she says.
Prem pulled through the surgery well enough and Dr. Guntupalli was confident of a satisfactory recovery. Everything was going according to plan, until Dr. Guntupalli’s phone rang at 11 p.m. It was the respiratory therapist, Rajender. Prem was bleeding heavily from the nose and an incision wound in the neck. When Dr. Guntupalli reached the hospital, the ENT surgeon had derailed the emergency by re-exploring the wound, putting in deep stitches, and packing the nose, but Prem’s condition had declined again.
The next 24 hours were tense for patient, family and doctor. “That night I asked myself, ‘Did I come all this way to convey bad tidings to this family?’” Dr. Guntupalli recalls. They waited and watched. Gradually, the bleeding stopped and Prem began waking up. Dr. Guntupalli had at this point been in Delhi for over a week, but even despite his recent turnaround, Dr. Guntupalli knew that she could not leave. “I could not leave him in unknown hands,” she says. “I had to get someone who thought like me and was dedicated to the patient. So I stayed another week.”
During that last week, Prem became fully awake. Dr. Guntapalli went to his bedside to introduce herself. She said, “Prem, although I have been around for about ten days, you don’t remember anything that transpired. I am a professor at Baylor College of Medicine in Houston, TX and also an Intensive Care Specialist. I have been asked to care for you.” “He smiled, extended his hand and mouthed ‘thank you,’” she says, “and then, ‘take me to America,’” and we both laughed. “It was a good moment. I was able to catch a glimpse of the person everyone knew apart from me.” Prem has since recovered fully and remains friends with Dr. Guntupalli. “Whenever I see his family, I get a great sense of satisfaction,” she says.
Dr. Guntupalli has accomplished much in her life and has made the most of her education and professional career in the U.S. Yet she longs for the same opportunity and progress in her native country. “India has come a long way since I left to pursue higher education in the U.S.,” she says, “and it is possible to do the right things to save lives there now. The question is, how do we take these services to those who need them most?” As far as she has come, Dr. Guntupalli is still very much the young girl lying on her bed in Hyderabad, India, peering into a medical book with eyes wide open, searching for a way to heal the world of its ills.
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