MY TOUGHEST CASE
Reconciling Life Aspirations with Heart Limitations
Dr. Shah’s patients are no strangers to hospitals, clinics and tests. Her patients are adults who have lived their lives with heart disease. Going to doctor’s appointments, undergoing surgeries, limiting and modifying their activities and taking medications since birth, they’ve grown up cautiously. When they reach young adulthood, Shah’s patients often find that this constant maintenance, while assisting in their survival, hinders their ability to reach their goals, such as having children and supporting a family. This intersection of care and risk is where Shah meets her patients.
Early in her medical education she became fascinated by children born with complex misconnections of the heart. She was impressed by the ability of pediatric cardiologists’ and surgeons’ ingenuity, and their ability to reroute blood flow to make these children feel better. She chose to focus on taking care of adults, whom she felt could communicate their wants and needs, and cooperate in the treatment of their disease. Initially, she completed her internship and residency at Ochsner’s Internal Medicine Residency Program, followed by Cardiology Fellowships at the universities of Texas and of South Florida. In her desire to help care for adults born with heart defects, she moved to Washington D.C., to pursue additional training in Adult Congenital Heart Disease with a focus on Cardiovascular Imaging.
Shah currently serves as the medical director of Cardiovascular MRI and co-director of Adult Congenital Heart Clinic at Ochsner. Much of the care Shah and her team provide centers around testing the heart by non-invasive means including ultrasounds and MRIs to assess damage of the heart as well as resolve secondary symptoms of the disease or side effects of surgeries. Nonetheless, Shah’s most challenging cases require her to implement a program of care both despite of and in support of a patient’s complex congenital heart disease.
Shah’s patients want to lead typical lives without the restrictions they grew up having placed on them, and they want to reach certain goals. For example, many patients want to become pregnant and have healthy children. Although this endeavor may be risky, Shah rallies her team to help them: “They want to lead normal lives and they want to have and support their families. Our job is to optimize the heart through multi-disciplinary care so we can help them accomplish that goal.” Shah says.
Similarly, Shah sees many patients that have physically demanding jobs. Despite the risk posed, they must maintain employment to have the health insurance benefits needed for their heart disease care as well as support of their families. Every case is challenging, and Shah individualizes the plan of care. “If the patient and the employer are unable to understand the patient’s limitations and modify the work, we may talk about alternatives, such as working at a less physically strenuous job or obtaining an advanced degree to reach that goal.”
Shah emphasizes that she puts the patients’ desires at the forefront of the plan of care. “As young adults, they have goals in mind that I may not understand, but the goals are important to them, and so I support those goals. You learn that as a doctor, you do what you think is best, but the patients will do what is best for them. Your job is to support them the best you can and help them become successful members in society,” she says.
At Ochsner, Shah also serves as the Program Director of the Cardiology Subspecialty and Senior Lecturer for Ochsner Clinical School and University of Queensland School of Medicine, as well as the Director of Sonographer CME, Society of Diagnostic Medical Sonography. Additionally, she’s a Committee Member of the Cardiology Educational Task Force and serves as an Imaging and Fellowship Mentor for Cardiology.