Lakshmi Katakam, MD, MPH, completed her Neonatology fellowship at Duke in in 2009, but she continues to draw on the lessons she learned here to this day. In this Alumni Spotlight interview, Katakam talks to us about her work treating patients in the largest NICU in the country at Texas Children’s Hospital, the lessons she learned as a fellow from her mentors and colleagues at Duke, and her love of nature, travel, and spending time with family.
What are your current responsibilities in the Neonatal Intensive Care Unit at Texas Children’s Hospital? What does your average work day look like?
I’m the Medical Director of a 173 bed, Level 4 Neonatal Intensive Care Unit at Texas Children’s Hospital which is the largest children’s hospital and the largest NICU in the country. I oversee the daily operations of the NICU and ensure that the unit is well-staffed and well-equipped with resources necessary to provide the best possible care for our patients each and every day.
My typical work day starts with our morning report where we have lively and educational discussions about patients who were admitted or actively manage overnight in our NICU. Neonatologists share their thoughts about topics related to medical care of our patients and educate our trainees. This gives me a great overview and an assessment of the “pulse” of the unit so that I know where to focus my time and energy. Following this, I participate in patient flow huddles to track the movement of patients in and out of our health care system and gauge what’s in store for us on any given day so that our teams can prepare accordingly.
Some days, my day consists of rounding on patients, discussing their care plans with our medical teams and families, doing procedures in the NICU and talking to consultants. But most days, I’m also attending series of meetings to discuss topics such as quality assurance and performance improvement, patient outcomes, program development, guidelines, infection prevention, leadership collaboration, practice changes etc. (to name a few). I also try to spend some time in each one of our 3 NICUs to see how our staff are feeling and how our families are coping with their NICU stay. Each day is very unique in some ways and brings new challenges, but the majority of my time is spent on truly understanding the needs of our patients, families and staff and coming up with short-term and long-term solutions for areas that need improvement.
There is never a dull moment in this job. It requires quick thinking and thoughtful problem solving under sometimes intense circumstances. Since we work in a very large unit with many stakeholders and a lot of moving pieces, it requires extensive teamwork and coordination and is akin to solving a very complex Rubik’s cube.
How and when did you first get interested in neonatology? What about the field interests you the most?
I first became interested in Neonatology during my pediatric residency at the University of Florida. I was immediately drawn to the ICU environment and felt privileged to take care of newborns who are in a critical condition. There is something very special about getting to know a newborn baby from the first moments of life and helping them take their very first breath. Even after all these years, I still find it very exciting to be present at a baby’s birth, helping them transition from the intrauterine to extrauterine environment and introducing them to their family for the first time.
I continue to appreciate the aspects of the field that first drew me and find it to be intellectually stimulating and fulfilling work. There are times when I am in the midst of a resuscitation performing life-saving interventions and procedures that require focus and hand eye coordination. And other times, I am in the middle of solving an ethical dilemma or helping a family through difficult life decisions. Whatever the task at hand, it always feels significant and meaningful, and it challenges different portions of my mind, allowing me to grow as a person and as a clinician.
What do you find most rewarding and about working in neonatal-perinatal medicine? What’s the most difficult part of your work?
The most rewarding part is the opportunity to make a difference in a newborn’s life during a very influential and critical period. It’s really heartwarming to see a patient receive life-saving therapies and surgical procedures and send them home to live a “normal life” with their family. The most difficult part is when we are not able to provide this outcome for a family or satisfactorily deliver answers to their questions. Even with the best available technology and the most devoted and caring medical providers, we do not always have answers for the “whys” in medicine.
You completed your fellowship at Duke in 2009. How did your experience as a fellow prepare you for your current work?
My fellowship training at Duke was an important turning point in my career, and it opened many doors for me. The program provided excellent training in every way – it allowed me to be independent and develop strong clinical skills, taught me to critically evaluate evidence and apply it, and fostered my interest in clinical research. I attribute my accomplishments in academic medicine to the strong foundation laid during fellowship training and am very grateful for it. Learning from neonatologists like Dr. Tanaka, Dr. Bidegain, Dr. Cotten and Dr. Goldberg was a priceless experience that I continue to cherish.
What’s one memory from your time as a fellow that stands out the most?
The highlight of fellowship was working with Dr. Goldberg! We all aspired to be his “favorite fellow.” He is an absolutely wonderful clinician, researcher, educator, mentor and role model for fellows and took great care to ensure that we had the best possible fellowship experience. Watching him up close when he is at a bedside trying to save a baby’s life or comfort a family during the most difficult times was very inspiring to me when I was a fellow.
What’s the biggest change you’ve seen in the field of neonatal-perinatal medicine since you completed your fellowship training? What changes do you see coming over the next decade?
In neonatology I have seen a series of small changes result in big improvements in patient outcomes. The emphasis on quality improvement to achieve the best possible outcomes or match the outcomes of a high-performing center has been very rewarding to watch.
Fetal interventions to address some of the morbidity related to congenital anomalies well before the baby is delivered have been fascinating to watch.
Some things I’m hopeful for are: Improved capability for non-invasive monitoring of infants in the NICU, better point of care diagnostic tools for both common and rare neonatal conditions, the therapeutic potential of stem cells for treating lung and brain injury in neonates, and genomic medicine for improving precision healthcare.
Ultimately, the allure of artificial placenta and artificial womb technology may be the biggest game changer for improving outcomes related to prematurity.
What advice or words of wisdom do you have for early-career neonatologists or fellows interested in neonatal-perinatal medicine?The fellowship experience can be a key turning point in your career, so choose wisely and set high standards for the type of training program you will choose.
Don’t be afraid to ask questions. There is so much that is still unknown in our field and we need all the imagination and curiosity each one of us can bring to the table in order to answer the hard questions and discover the next big “game-changing” therapy or intervention that can improve the care of newborn infants around the world.
Invest your time wisely and make sure you develop a healthy relationship with work early on. It’s really easy to lose sight of your personal well-being while you are immersed in training or focused on taking care of others. But the key to longevity and sustainability in medicine may be realizing that work and life are not mutually exclusive concepts and figuring out a way to integrate them in your own unique way that allows you to find fulfillment in both.
What passions or hobbies do you have outside of work?
I love hiking and just being out in nature as much as possible. Sadly, I developed this appreciation for the outdoors after leaving North Carolina and wish I had taken advantage of it more during fellowship. I also love to travel around the world and experience new places, food and culture. My recent (pre-pandemic) “fun trips” included Mexico City, Paris and Montana!
I also love geeking out on a good home improvement project and taking care of plants in my small patio garden. I’m a novice baker and try to bake cookies for my staff during difficult weeks. Most importantly, I love spending time with my family and doting on my 4-month-old nephew who brings so much joy to me and my family during these trying times!