CME INDIA Presentation by Professor (Dr.) Shibendu Ghosh, Professor of Medicine, JIMSH, Kolkata; Vice-president API headquarters & Dr. N. K. Singh, MD, FICP, FACP, FRSSDI, Editor: www.cmeindia.in, Dhanbad.

 The world will not soon see another Kanu Chatterjee.

In Memoriam: Kanu Chatterjee, MD (1934–2015)

• Dr. Kamalendu K. “Kanu” Chatterjee was 81 when he died on Wednesday, March 4, 2015 at the University of Iowa Hospitals in Iowa City. He was suffering from   pancreatic cancer.

Unusual Journey

• Dr. Kamalendu was born March 1, 1934 in India.
• He completed medical school at R. G. Kar Medical School in Calcutta, India.
• Then he went on to receive his cardiovascular and internal medicine education in England. He received his medical degree from the Royal College of Physicians in London in 1965.
• From England he later moved to Los Angeles, CA and worked at Cedars Sinai for several years. At Cedars-Sinai Medical Centre in Los Angeles, he served as director of inpatient cardiology until 1975.
• During his 4-year tenure at Cedars-Sinai, Kanu achieved a mythical status as a dedicated, hardworking, and brilliant clinician. He had outstanding bedside diagnostic skills and great empathy for his patients.
• His outstanding performances led to a position with the University of California at San Francisco. At the University of California, he worked as director of the cardiac care unit and associate chief of cardiology.
• He started a career in teaching and shaped the careers of many future cardiologists.
• In San Francisco, he married Docela “Docey” Edwards on May 9, 1975.
• From 2001-2009 he served as Director for the UCSF Chatterjee Centre for Cardiac Research – named in his honor.
• He remained at UCSF for 34 years, during this period he became the Ernest Gallo Distinguished Professor of Medicine and was formally selected as a Master Physician.
• In 2009, he and his wife Docey moved to Coralville and started his career with the University of Iowa.

His Family

• Dr. Chatterjee is survived by his wife of almost 40 years, Docey Edwards Chatterjee; his son, Suvendu Chatterjee, and daughter-in-law, Geetanjali, of Delaware; his grandson, Soumendu Chatterjee; and several siblings.
• Samuel Johnson said about Oliver Goldsmith, “He touched nothing that he did not adorn,” this is so true about him.
• He was preceded in death by his parents and in-laws, Dave and Doris Edwards, Dale Edwards and Dreda McGill.

Why He needs to be remembered?

• He has been a reviewer and served on editorial boards for many publications, including the Journal of the American College of Cardiology, Circulation, the New England Journal of Medicine, the International Journal of Cardiology and others.
• He was a prolific writer and researcher.
• He has published and edited hundreds of papers, as well as dozens of books and individual book chapters.
• Kanu published more than 300 papers, edited 6 books.
• He received numerous awards, including the prestigious 2014 Herrick Award from the American Heart Association, gifted teacher award from the ACC in 1990,
• He got Presidential Honor for Excellence from the ACC in 2015; alas the latter came posthumously.
• His numerous scientific contributions included a role in the development of vasodilator therapy for acute and chronic heart failure, defining the role of hemodynamic monitoring using the Swan-Ganz catheter in acute myocardial infarction and heart failure, and describing repolarization changes (cardiac memory) following cardiac pacing, just to name a few.
• He is the recipient of numerous teaching awards, including the Kaiser Award for Teaching, the Excellence in Teaching Award and the ACC’s Gifted Teacher Award.

What did he enjoy when not practicing medicine?

• He had too many hobbies.
• He loved listening to Mozart and Indian classical music.
• He was fond of watching sports quite a bit, but did not play them.
• He once said – “I am a rabid, avid fan of the 49ers. I also watch tennis and golf. I do not play golf; I used to play tennis, but not anymore. I also try to read, and most of the time I end up reading journals and manuscripts. I do not get much time to read when I am at work at the hospital.”

Wings away from Cardiology

• He once shared – “I was going to go into biochemistry, but my father said no. He actually made it clear that I needed to go into medicine. We were born in Bangladesh and we were refugees to India. When we were in Bangladesh at that time, my father had a close physician friend. He must have influenced my father to tell me to go into medicine, but I really wanted to go into biochemistry.”

The biggest successes in Kanu’s specialty

• It happened in phases.
• When in Cedars Sinai in 1971 and the end of 1974 what made him proud was working with the Swan-Ganz catheter when he did many studies demonstrating the hemodynamics.
• When he was in London, he worked at St. George’s Hospital in the late 1960’s, and he was the first person to report on post-pacing T-wave changes, which is now called “memory.” That was his discovery.
• When he moved to the University of California at San Francisco, many people were working with him and he worked on vasodilators.
• His group was the first to demonstrate that oral hydralazine and nitrates can be used to treat chronic HF, which later become a standard treatment.
• He was the first to report the beneficial effect of sodium nitroprusside in severe mitral regurgitation.

Bhagavad Gita showed the path

• The Bhagavad Gita was the inspiration and philosophy he followed to his entire life.
• The last CD he bought was by Ravi Shankar.
• He used to listen to the music of Rabindranath Tagore.

A few months before Kanu’s death

• One of his known doctors, one day, listened to a patient’s heart, and knew that the examination required a master. Then he went to Dr. Kanu’s office. His physical examination was meticulous and leisurely (but quick) as he quietly described each finding.
• The patient had membranous subaortic stenosis, aortic regurgitation with an Austin-Flint murmur, and a patent ductus arteriosus.
• Several days before his death, a group of cardiology fellows visited him at his residence. One of the fellows told the others that Kanu was one of the world’s greatest cardiologists. Kanu quietly said, “I have no regrets. I have had a full life.” A fellow said the moment was most poignant, as the silence was deafening.

What is the best advice Dr. Kanu ever received?

• He remembers – “The best advice I have received in my career and life from mentors and colleagues, and even from my wife is to be honest and not be critical. Do for others rather than for yourself.”

Indian born doctor’s Guru

• He said – “Jeremy Swan, MD, and William Ganz, MD, really taught me a lot. That certainly does not mean that other people have not taught me anything, but they stand out in my mind.”

Big man’s Life Style needs to be followed

• He revealed – “I exercise regularly. I used to jog but do not do that anymore. I went for a walk this morning because there were no patients, and walked just over five miles at 30 minutes per mile, which is pretty good for my age. As for diet, we have a diet of fruits, vegetables, fish and chicken at home, but my diet tends to get changed a bit when I travel.”

What he predicted for the next 10 years?

• Worth to ponder his statement- “I believe that the within the next 10 years, two things will happen. The technology in terms of intervention will not go away, no matter what we say. It will be superseded by basic understanding of the disease, including the molecular cardiology. That will actually take a great leap forward, and once we understand molecular biology and how the cell works and why we have the disease, that will be it. I am not sure stem cells are going to be it — maybe, but they are going to need help. The advances in molecular cardiology and basic understanding of disease are going to be important. For example, in the area of HF, we know the maximum that we can do now. We have no further advances in terms of understanding of the disease, so that is what needs to happen in other areas.” (Credit-Eric Raible)

CME INDIA Remembers

• On Wed., March 4, the world lost a great man and a spectacular cardiologist who defined much of what we do today.
• His scientific contributions are epic and he is personally responsible for a huge body of literature that has impacted modern cardiology.
• Dr. Chatterjee’s greatest legacy are his students. They have spanned generations, disciplines, states and countries and of course professional societies including the ACC.

CME INDIA Learning Edge

Concept Dr. Kanu initiated

Are There Differences in Pathophysiology and Ventricular Remodeling Between Systolic and Diastolic Heart Failure?

By Dr. K. Chatterjee. Medicine University of Iowa, Medicine University of California, San Francisco, CA, USA.

• There are considerable differences in morphology, functional derangements and left ventricular remodelling.
• Differences in morphology: In systolic heart failure, the ventricle dilated and spherical in diastolic heart failure it is ellipsoidal and non-dilated.
• Functional: In systolic heart failure, contractile function and ejection fraction is reduced. Left ventricular volume /mass ratio is increased and wall stress is increased. In diastolic heart failure, myocardial stiffness is increased and the ejection fraction is preserved Contractile function is maintained. Left ventricular volume mass ratio is decreased and wall stress is decreased.
• Remodelling: In systolic heart failure, myocyte hypertrophy is eccentric, myocyte length is increased. The extracellular matrix is disrupted and the collagen fibers are thin. In diastolic heart failure myocyte hypertrophy is concentric. The extracellular matrix is disorganized but the collagen bundles are thick.
• Listen to Dr. Kanu Chatterjee: https://youtu.be/MWe-CqsWaaM

CME INDIA Tail Piece

Some illuminating comments

1. David Pearce, Professor of Medicine (Nephrology, UCSF) – As a Renal Fellow at UCSF, I had numerous interactions with Dr. Chatterjee, mostly in the CCU. His understanding of CV hemodynamics was unsurpassed, and extended to include deep insights into the role of the kidneys in CV disease. He didn’t simply provide knowledge, but rather tools for approaching clinical problems. Most of all, he did all this with an extraordinary level of kindness and respect, which further helped open young minds to his beautiful teaching. I visited with him on a trip to Iowa recently, and it was a joy to be reminded of his kindness and thoughtfulness, and to see his continued teaching. Deep condolences to the Chatterjee family.
2. Richard Jacobs – I was an “intern” at UCSF in 1974 and Dr. Chatterjee was truly legendary. His emphasis on the physical examination was an art that he was determined to not let students forget in the age of emerging technology. He could predict auscultation findings simply by palpation–and once he put his stethoscope over the heart, he could predict hemodynamics with amazing accuracy. He was kind and gentle and treated all with the utmost respect regardless of title or position–a wonderful individual and role model.
3. John Haughom – Just learned that one of the most influential professors in my clinical training passed away at 81. I developed a deep and lifelong passion for medicine while training at UCSF. Many great clinicians gave me that gift. Kanu Chatterjee was among the best. The highest compliment anyone can receive is that their life made a difference. His did. While a part of me wants to be sad, most of what I feel is gratitude. It is my privilege to have known him. May he rest in peace.
4. Kaikobad Irani, MD University of Iowa – I didn’t know Kanu very long but in the short time I did he struck me as a genuinely compassionate person whose accomplishments as a clinician and teacher belied his modest and unassuming personality- a rarity in academia today. He will be greatly missed by his colleagues at Iowa and elsewhere.
5. Dr. Saroj Pramanik, Professor of Surgery, Kolkata Medical College (Retd.) – Dr. Chatterjee was my classmate, we studied in R. G. Kar Medical College from 1950 to 1955, worked together in the same hospital. He was a very nice fellow. I miss one of my best friends. May his soul rest in peace.
6. Jane Rutledge – I worked in “Dr. Chatterjee’s CCU” at UCSF 1980-88. He was a caring human being as observed in his interactions with his patients and the entire staff. He would call the charge nurse every evening and inquire about his patients and his residents. I graduated from the University of Iowa and was a little bit jealous when I heard that he was moving to Iowa City. We missed him then and now we will miss him even more. May he rest in peace.
7. Candido Anaya – I had the opportunity to spend a month as a visiting med student with Kanu. I had no idea at the time how lucky I was to be exposed to such one of a kind physician. I remember the fellows in the CCU would try to trick him and present the Valvular cases with the wrong diagnosis. They once presented a HCOM as MR and it took him 2 seconds to lift stethoscope and ask the fellow “are you sure?.” He once asked to me listen to a pulmonary HTN case and tell him about the murmur. I came up with a very wrong guess and he told me: “there is no point in guessing…learn it.” I never forgot those words. I called him 15 yrs later when I became Chief of Hospital Medicine, and invited him to come give us a Grand Rounds. He came to New York and the residents loved his lecture and we all enjoyed spending time with a true hero in Cardiology. I shall never forget Kanu.

References:

1. Prediman K. Shah, William Parmley and Donald Heistad A Gentle Giant of Cardiology Originally published 23 Jun2015 https://doi.org/10.1161/CIRCULATIONAHA.115.017540 Circulation. 2015;131:2236–2237
2. Quotes on Oliver Goldsmith.http://www.samueljohnson.com/goldsmith.html#1608
3. For Kanu Chatterjee, MD, music, medicine and G keep his life centered (healio.com)
4. Kanu Chatterjee, MBBS, FACC: Remembering a Teacher, Colleague, Mentor and Friend – American College of Cardiology
5. Willerson JT. In Memoriam: Kanu Chatterjee, MD (1934–2015). Tex Heart Inst J. 2015 Aug;42(4):303-4. doi: 10.14503/thij-15-5436. PMID: 26668982; PMCID: PMC4567112.
6. University of Iowa Hospitals and Clinics, Department of Internal Medicine

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