By Natosha Monfore, DO, PGY-3, University of Oklahoma College of Medicine
Dr. Nishita Kothary is this quarter’s Women in IR Spotlight for being a leader and innovator in the field of Interventional radiology.
Dr. Kothary completed medical school at Topiwala National Medical College in Mumbai (Bombay) India in 1996, before moving to the United States of America where she completed an Internship in Internal Medicine at the Good Samaritan Hospital and Diagnostic Radiology at George Washington University in Washington D.C. After completing residency, Dr. Kothary began a neuroradiology fellowship, but after a year of Neuroradiology, opted to switch specialties to Interventional Radiology which she completed at the University of Pennsylvania, Philadelphia. She is currently an Associate Professor of Radiology at Stanford University. During her time at Stanford, she has been the Fellowship and Education Director for IR from 2006-2009 as well as the Director of clinical operations from 2008-2013.
I had the pleasure of interviewing Dr. Kothary for this month’s Women in IR spotlight article. Her passion for IR and her uncanny ability to persevere has shaped her into a very successful Interventional Radiologist.
How did you get into the field of Interventional Radiology?
I got into Interventional radiology purely by chance and a bit of a circuitous route. After medical school, I came to the US to do Critical Care and was in a categorical Internal Medicine residency. I loved critical care during internship but my perception became skewed into believing intensivists were burnt out, unhappy and getting divorced. I was also made to believe that most critical care physicians do ICU for 3-4 years and then switch to ambulatory medicine. One thing I knew for sure was that I did not want to do ambulatory care, BUT unfortunately at that time, I didn’t have the foresight to talk to OTHER critical care residents.
Around that time, I also had some personal conflicts, so I switched to Radiology for an “easier” life! I never actually enjoyed or “really got into” diagnostic radiology but I had a great mentor in neuroradiology and since I did not want to change residencies again, I hung on and chose Neuroradiology as my fellowship. I’m not sure if it was the commute, the place or finally realizing I wasn’t really cut out for the dark room, but I was miserable in my fellowship. The only salvation was I was married and my husband is one of the most grounded, sensible people I know. With my husband by my side, I sought out people in both NeuroIR and body IR and decided on NeuroIR. I learned I do not have the patience for NeuroIR, so I switched fellowships and started my body IR fellowship at UPenn and the rest is history. To date, that was the best year of my life and I credit the Penn faculty for putting me back on track.
Along the way I learned two very important lessons. First, never make decisions based on just a couple of people. There is a reason why due diligence is critical. Second, never under-estimate the power of mentorship. Interestingly, a fair number of interventionalists land into IR in their quest to find a good fit and a circuitous route is not uncommon. This is at least in part due to the lack of visibility of IR in medical school and most interventionalists are almost too busy to mentor. Both aspects are changing, but we have a long way to go.
What is a typical day for you?
Typical is not always typical, but in a nutshell – I get my best thinking done in the morning. It is not uncommon for me to wake up in the wee hours and put in a couple of solid hours. My kids, who are 8 and 5, are early risers too (6-6:30), so once they are up, our morning ritual is to spend some time in bed just giggling or talking. It is our time before I start my drill sergeant routine. We don’t like having a nanny (too intrusive) and so from the time they get up to the time we drop off them off at school, it’s the usual household chores. Between my husband and me, we figure out the drop off each day. I do the drop of on my academic and clinic days, and he does the rest. When he is traveling and I have an early day – we have a babysitter who helps us. My kids are in the public school, and it is less than half a mile away, thus making drop off easy. Clinical days usually start at 7:30 and ends somewhere b/w 5:30 and 7 (outside of call days). Once the kids get home, we make dinner, and hang out until bed time. Until recently we ended most of our days with The Daily Show! And then, business starts all over again!
Do you have a specific focus on your procedures ie, women’s health, IO etc, Or do you do everything?
I love HCC and transplant in the IO world, but generally I like everything in IR.
What are some of the biggest challenges you have faced in your career?
My first 2-3 years in the United States were challenging, both in my career and personally. To put things in perspective, I moved from a major metropolitan area with 20 million people (Bombay/Mumbai) to a city that had less than 400,000 people (Cincinnati, OH). I had never been outside India and I left my entire social circle behind except for one friend who had just gotten married and was living in Ann Arbor, MI. Also during that time, I realized I wasn’t going to do what I came to do (Critical Care). The cherry on the top, was that I was 23 and clueless. So talk about a complete reset in my life! I cannot point to a specific incident that was challenging because at that time, it all seemed like a challenge. Two years into my life in the US, I moved to Washington DC, where I lived in the city itself. It helped that my sister moved to DC as well. It was then that life went back to normal. Those 2-3 long years taught me more about life and myself than my preceding 23 years.
How do you maintain a balanced lifestyle?
Lifestyle is very individualized so what works for me may not be work for others, but here are key things that have helped me. My innate motivation is that I have always “wanted it all.” That need drives me to do all of the crazy things I tend to do! And for that, your most precious commodity is time. So here’s what I do to carve out time:
Spouses are multiple roles all rolled into one. Basically, they are your biggest cheerleader, your critic, your personal assistant (!), your pick-me-up and the person who can make dinner when you are too tired to function. Niraj (my husband) and I are equal partners in crime and that has been by far the biggest factor in helping me achieve a balanced life. Equal partners DOES NOT mean dividing EVERY chore 50-50, since from an efficiency point of view this is not realistic. A constant gripe I hear is “women have to do all the kid stuff” which is “generally” speaking true, but on the flip side, Niraj does all the bills, insurance, finances, mortgage, cleaning up the kitchen (my favorite), cooking etc… Our relationship has to be a partnership and in every good partnership, each partner pulls their own weight.
My mantra that helps with making time is, “Giant steps for kids, baby steps for adults.” I don’t believe kids are “too young” to do anything and I am shameless in putting them to work. At 8 and 5, my kids do their own laundry, start to finish. They put their stuff away (although this prompts nagging as I refuse to do it for them). Currently my older child is learning to cook, so it’s only a matter of time! On the other hand, “baby steps for adults” means do not expect miracles from yourself. It’s amazing how many times I used to start the new year saying that I was going to work out 6 days/week for at least 1 hour, unfortunately its unrealistic and fizzles out very quickly. I am happy when I can get a workout in 4 times a week with two 20 min sessions! Needless to say, I set smaller more realistic goals for myself.
Finally, I concentrate on a single task when it is important and multi-task with the mundane tasks, but that in and of itself needs planning as well.
What advice do you have for women who are junior to you?
This is a difficult question, because as with the lifestyle question this topic varies with the situation and there is no “one size fits all.” Here are a few pearls, in no specific order, which I have learned along the way:
- A classic from one of my partners is “I’m not sure what people mean by work-life balance because work is a part of my life!” My mom is an OB-GYN who still works at the age of 81. So you can see what my biggest influence was growing up and how working is something that is very “obvious” to me. Similarly, my dad was my biggest supporter especially when it came to spreading my wings and flying. My dad and mom were equals at every level. Both of my parents have advanced degrees (MD and PhD), so for my sister and I, not obtaining an advanced degree was not an option! And once you have an advanced degree and have spent more than a decade in school, I would be devastated to give it all up! But to make it worth it, you have to LOVE what you do and LOVE the institution/people you work with. This has a significant impact on your personal and professional satisfaction. The women and men who end up feeling guilty, typically do not have this sense of satisfaction and often end up miserable and quitting. Think about it – we spend more waking hours with our colleagues then our spouse! When you love what you do, you are actually better at home because you come home without baggage. I truly believe I am a better parent now then I would be if I reduced my hours.
- Setting limits: On the flip side, you have to know when to stop working. I DON’T have a nanny, because I know if I had one, I would not get home before 7:30 pm. My goal at work is to get my work done so I can be out of the office by 6 (unless I am on call or IR2). This way when I get home I can dedicate the next 3 hours to my kids, without interruption. Once they go to sleep or before work in the mornings, as I described above, I finish my work for the day. As I said before, I do some of my best thinking in the early morning so sometimes on the weekend, I will go into work at 4 am and be back by 9 am. This gives me a solid 5 hours, without it impacting my weekend or my family. Of course this doesn’t happen every weekend…
- Diversity at the workplace: Gender. Bias. Exists. More often subconsciously these days, but it is there. I spent the first few years of my adult life denying it, but it is there. Men as bread winners and women as nurtures is as old as dirt. And yes plenty of data has shown that people’s reaction to a strong woman is very different from that to a strong man. My advice – get over it. Support all. Work hard. Don’t care. Do right. Stay strong and kick butt. Life will give you rewards and if nothing else, at least you will have the pleasure of being yourself!
- Don’t sweat over the “baking treats for the class” concept. One of the great things about kids, is that kids don’t remember anything besides the fun or the consistent support you provide. The rest does not matter. And let’s say you work 60 hrs/week, then you deserve a pass. There is an interesting study from Maryland that shows that the number of hours you spend with your kids is NOT related to or does not correlate with anything, BUT positive memories do. When I look back on my childhood, the ONLY nuggets I remember: My mom was the person my friends talked to about life, we always had breakfast together as a family and most dinners, vacations sometimes got cancelled because my mom was in solo practice (taught me about work=life and vice versa), our birthdays were a huge fanfare (and the practice still continues with my kids), that I couldn’t buy whatever I wanted and finally dream big! Anyway, you get the gist… Ultimately the memories survive and the rest is bogus. Once you believe in this mantra, you actually become more relaxed and efficient.
- But it also takes a village. My parents knew every one of my teachers, personally. And they always invited parents and kids over to our house. I thought we were just friendly folks, but these were the eyes and ears for my parents when they were at work. I have done the same – being a PTA president for a year had its painful moments, but that one year I built contacts from the district superintendent, principal, teachers and all the way to our custodian. And with my son, I need all the help I can get!
- Mike Soulen told me this and its etched in my brain – when you work and you have kids, it’s not the lack of time with the kids you need to worry about but the lack of time with your spouse. Of all the things, that’s the one that gets taken most for granted.
- Finally, commute as little as you can and definitely not more than 30 mins. There is a reason why commuting is the top reason for dissatisfaction in life.