DR. PRABHAKAR BALIGA: MUSC transplant doctor's dad taught him compassion
Favorite book: “Bhagavad Gita,” the 700-verse Hindu scripture that’s part of the epic “Mahabharata.”
Favorite sports: Soccer and cricket.
Most important role model: My father.
Most important lesson learned: Humility.
What you'd have done had you not pursued medicine: Financial or spiritual planning.
Best part of your job: Seeing patients get well.
Worst part of your job: Bureaucracy.
Grace Beahm // The Post and Courier
Prabhakar Baliga receives a hug from Janice Crosby, whose husband, William “Woody” Crosby (right), received a new liver in February.
Growing up in Madras, India, a huge city in the south renamed Chennai in 1996, Prabhakar Baliga didn't really want to be a doctor.
His mother advised against it. It meant hard work, long hours, time away from family and uncertain finances. She would have known: Her husband, Rathnakar Baliga, was an old-fashioned family practitioner. He worked six days a week and was on call the seventh. He sometimes was paid with currencies other than cash. He made house calls.
"He's given me my core values," Baliga said. His always positive outlook toward work and his carefree attitude about money and other material concerns were a big influence. "It was about helping people."
When Baliga was in high school, he learned how to drive by being a chauffeur. The family had just one car, and his father needed it to see his patients, so the young Baliga drove his dad around.
That's when he learned what it meant to be a doctor. That's when he began to understand that practicing medicine wasn't really about needles and drugs and physical exams. It was about compassion and kindness. It was about improving the quality of someone's life.
After that, he spent two summers working in a health clinic, and he was hooked. Once enrolled in Madras Medical College, he took note of the high mortality rates in India associated with kidney failure. One solution was radical and not yet the standard practice: transplantation.
It was a difficult procedure, risky, the sort of surgery that requires specialization and intense commitment. And kidney transplants weren't even the most complicated; livers were especially tricky, especially bloody. But when the organ transplant worked, it provided a terrific thrill. After all, someone who rightfully should be dead instead was saved, made whole again.
"It's amazing that you can take a person on his death bed ... and two weeks later he's up and walking," Baliga said. "I still haven't gotten over it. It still gets my juices flowing."
So he came to the U.S. and completed his residency in general surgery at Tulane University in New Orleans, then went to the University of Michigan, where he learned the fine art of transplants.
When he was done in 1992, liver transplants were becoming more frequent and their success rate was improving significantly. Baliga was a marketable man, wooed by various institutions. He could have gone to a big hospital in a big metropolis, but he liked his experience in Ann Arbor, he liked the dynamics of the Michigan college town and wanted to be in a smaller city. He chose the Medical University of South Carolina.
He had worked on two liver transplants when he joined the surgery team at MUSC in 1992. Today, he's performed about 1,000 liver transplants and nearly 5,000 kidney transplants, he said.
Getting her to smile
When Claire Roberson was 4 months old, she was diagnosed with congenital biliary atresia. The bile ducts in her liver were blocked, and the organ wasn't working. So Claire was put on the waiting list for a new liver.
She had been adopted by her parents, Clay and Sandy Roberson from the Upstate, and did not share their blood type, her mother said. They waited for a donor -- two months, three, four. By the time Claire was 9 months, she was on death's door, bloated, yellow and uncomfortable.
Finally, a nurse drew Sandy's blood, if only to confirm what the family assumed. But it turned out to be O-negative, a universal type, and this meant that Sandy could be a living donor.
One week later, on March 7, 2001, the surgery, which carries significant risk for the donor and the recipient, was performed. Several doctors explained to Sandy the dangers of the procedure, which would require a major dissection and removal of one-fourth of the organ. They assured her that she shouldn't feel responsible should Claire die of "natural causes."
But joy, not guilt, was the overwhelming emotion.
"I was so happy when they said yes that I could make her better," Roberson said. "The idea that there was some risk to me was not very relevant."
At 6 a.m., Baliga began operating on Sandy. Two hours later, a piece of her liver replaced the nonfunctional one inside Claire.
Nine days later, Claire was out of the hospital, visibly relieved, happy, cheerful, a person transformed.
"She was always a very serious baby," her mother said. "You had to work hard to get her to smile."
The experience was traumatic for the family, but Baliga's straightforward manner and calm approach were a balm, Roberson said.
The family joins other transplant patients in the fall for an MUSC-sponsored Charleston picnic. Baliga tries to attend.
"When he's there, he's just like a rock star," Roberson said.
The coolest thing
Baliga was recruited by MUSC in 1992 to help start a pediatric liver transplant program.
"Since his arrival 19 years ago, Dr. Baliga has distinguished himself as a true leader, excellent surgeon and accomplished scientist," Etta Pisano, vice president for medical affairs at MUSC, wrote in a recent letter of recommendation. "The volume and successful outcomes of all types of solid organ transplants have increased dramatically, placing MUSC in the top rated transplant institutions in the country at a rate over two and a half times the U.S. transplant rate."
Last week, he gave a 22-pound baby a new liver. "Fortunately, everything went great," he wrote in an email.
It usually does, but liver transplants in children are the most difficult to perform, he said. "Their blood vessels are like noodles, it's hard to put them together." And you have less than an hour to make multiple connections to restore blood flow.
Each year, the transplant center's abdominal team, which includes five full-time surgeons plus other staff, performs about 300 operations -- typically 200 kidney transplants, 75 livers and 25 pancreases -- as well as perhaps 500 kidney dialysis procedures and numerous follow-up surgeries. The center's surgeons also do heart, lung and small bowel transplants. It's the only hospital in the state that performs such procedures.
Once or twice a year, a transplant fails, often due to postsurgical complications, and a family loses a loved one.
"It's like somebody punches you hard in your solar plexus and takes the wind out of you," Baliga said.
It's always a blow to the surgical staff, but when the patient is a child, it's especially saddening, he added.
"I don't know why, you're not supposed to have a bias, but losing a young child makes it a lot more difficult. ... It keeps you humble."
Kenneth Chavin has known Baliga for 20 years since Chavin was pursuing his Ph.D. in the research lab. Later, he would work under Baliga as a resident and then become a surgery partner, serving as liver transplant director.
"First, I would call him a friend, and as a friend we have lots of shared experiences," Chavin said.
Chavin, a die-hard Philadelphia Eagles fan, has brought out Baliga's inner football fanatic. And the two families have spent a lot of time together.
Baliga's humility and integrity, not to mention his technical skill, have made him a role model for Chavin, who's particularly impressed by his mentor's humane approach, he said.
"Although we do very complex and technical surgery, there's always a person there."
Both men consider themselves adventurers, and both get a thrill from the intensity of transplant surgery -- and not only the operating room experience. Because living donors often are involved, and because transplant procedures always are a matter of life and death, there is an ethical and moral component that adds to the complexity, Chavin said.
"It's one of the most coolest things I get to do," he said. "It's a lifestyle for us, both of us."
So does surgery attract a certain personality?
Baliga thinks so. While "it is a tremendous privilege to operate on somebody," a task that demands finesse, patience, long hours and deliberation, doctors outside the operating room often find release through adventure or by taking on different kinds of challenges, he said.
Baliga always has been athletic and interested in the outdoors. A few weeks ago, he heard about paddleboarding, so he grabbed a board, threw in on the creek and tried his hand at it. Why not?
He likes sailing, running and cycling. He likes to go hiking on the weekends. Both of his sons, Abhay, 19, and Uday, 18, are avid skiers, so Baliga and his wife, Kamakshi, enrolled them in a ski class some years ago.
"Who's going with them?" Kamakshi asked her husband. So Baliga dutifully learned to ski.
When he was young, he was a member of his field hockey team. He played soccer in school and joined the swim team. He practiced yoga.
After Abhay did exceptionally well at Academic Magnet High School, his parents decided to reward him with a gift. He chose snowmobiling in Yellowstone National Park in the dead of winter, so the family embarked on a new adventure.
They have chased humpback whales off the coast of Nova Scotia in a small motorboat. They have gone cycling and hiking across North America. Baliga has gone sailing with Abhay and golfing with Uday.
Both sons are karate practitioners who have second-degree black belts. And both love kickboxing.
"So I go to kickboxing class with them," Baliga said.
The physical activity keeps him fit and prepared for the long hours spent hovering over an operating table, he said.
The family is active at the Hindu Temple of Charleston. He serves as vice chairman of the board. The temple gives the Baligas "a way to adhere to identity" in a multicultural society, he said.
Maintaining a clear sense of cultural identity is an active pursuit, Baliga said. He plays the mridangam, a small Indian drum. His wife is an accomplished sitar player.
Balancing career and family life can be tricky, and he didn't do it very well when he was younger, he said. But his family is very supportive and understanding of his work commitments and erratic schedule. He makes every effort to be with his wife and sons whenever he's away from the hospital.
Sometimes, what he considers his biggest strength -- level-headedness -- works against him. When one of the children would develop a high fever, naturally his wife would worry. But Baliga wouldn't show the same concern. After all, everything's relative. A 103 fever is not in the same category as a nonfunctional liver or kidney.
The transplant surgeon's level-headedness would prevail, often exacerbating his wife's anxiety, he said.
"If someone's not dying, it's not worth worrying about."
MUSC statistics on transplant operations:
Median wait times
Kidney: 29 months
Liver: 1 month
Heart: 3 months
No. of transplants since 1968
Total kidneys: 3,828
Total livers: 1,032
Total pancreases: 309
Total hearts: 455
Total lungs: 4, since program reinitiated in 2010
Graft survival: 93.18%
Patient survival: 98.77%
Graft survival: 95.83%
Patient survival: 100%
Graft survival: 87.14%
Patient survival: 88.39%
Graft survival (based on 33 transplants): 93.38%
Patient survival (based on 33 transplants): 93.38%
Source: MUSC Transplant Center
In 2001, Dr. Prabhakar Baliga performed a liver transplant on then-9-month-old Claire Roberson. ... Baliga and the Roberson family have kept in touch since. Following are a series of emails between Baliga and Claire and Sandy Roberson, her mother:
April 19, 2007
Dear Dr. Baliga,
Claire's class is studying heroes at school and each student must prepare a project about a hero of their choice. She chose you. The project requires her to write a paper and give a presentation and to be able to do this, she has come up with a list of questions to help her learn more about you and your work. ...
Thanks for your help in advance and for all you and your team has done for our family.
Dear Dr. Baliga,
I have a lot of questions because I am doing a report at school about a hero that I know. You are the hero that I picked because you saved my life.
My questions are:
What do you do when you are not being a doctor? I play a little bit of golf and attend martial arts class with my 2 boys
Is doing liver transplants your favorite thing? Yes
How long do liver transplants take? A straightforward one takes about 5 hours
Did you get to hold the liver? Yes
Did you get to cut me open? Yes
What was it like doing your first transplant? Very exciting and I was very nervous!
How many transplants have you done? Stopped counting after the first 100. I have probably done a few hundred.
Why did you want to become a doctor? Help others
Where were you born? Madras, India now called Chennai
Did you decide to be a doctor when you were a kid? No, until college I was sure I did not want to be a doctor (I was too scared!)
How old are you? This year I will be 47
How long did it take to become a doctor? 5 years after college
Is it fun looking at kids? Great fun when they do well, sad when they feel sick
Thank you very much for helping me with my project.
Dear Sandy and Claire: We had an extremely busy stretch and I apologise (sic) for not getting back to you in time. I was hoping to accomplish this task earlier. Hopefully you can use this for another occasion if it is too late. I am deeply honored that you chose me as your hero and I have tried to answer your questions below (in italics above). Once again, my sincere apologies.