By Josh Stripling, M.D.

LetterstoTinsley2 InterviewwithAlumni Photo Ashita Tolwani Dr. Ashita Tolwani is a name well known amongst residents, students, and faculty at UAB; she’s the attending you want around when a patient is in need of continuous renal replacement therapy (CRRT). 

Dr. Tolwani was recently featured in the December 27, 2012 edition of the NEJM as the author of the Clinical Therapeutics Review article, “Continuous Renal- Replacement for Acute Kidney Injury”. She is a life-long UAB supporter having completed medical school, residency in Internal Medicine, and fellowship in combined Nephrology and
 Critical Care training all at UAB.  

She has been on faculty here since 1999. She completed an 8 year stint as the Nephrology Fellowship director and is currently the Associate Director for ICU Nephrology. Along with her numerous teaching commitments she continues to be an avid researcher in the clinical uses of CRRT as it relates to acute kidney injury and has made UAB a pioneering institution in the use of citrate anticoagulation for CRRT. If you don’t find her rounding with the Nephrology consult service or giving lectures throughout the world you may be able to find her in her office developing routines for the numerous Zumba classes she teaches throughout the community.

Where did you find your interest in combining Nephrology and Critical Care medicine?

Initially I just wanted to do Critical Care but Dr. (David) Warnock felt I would be well suited as a Nephrologist. I asked if I could do a combined Nephrology and Critical Care fellowship, which had not been done before. Doing a combined fellowship allowed me the opportunity to handle a little bit of everything in internal medicine and still be able to do many procedures that attracted me to critical care in the first place. With this I have been able to find my academic niche in ICU Nephrology that has allowed for many new career opportunities.

What are your current areas of research?

My research focus is on the clinical aspects of CRRT in the treatment of acute kidney injury in the ICU and more specifically with the use of citrate anticoagulation. UAB has been a pioneering research institution in CRRT and we currently have 25 CRRT machines providing over 5,000 patient days of treatment a year. There is even a group in Australia that has named their anticoagulation protocol, “The Modified Alabama Protocol” based on protocol that was developed at UAB.  

When you are not working what do you like to do as a hobby?

My first passion is dance. I completed my honors thesis in college on classical Indian dance and have even danced professionally.  Right now I am currently teaching Zumba at a couple of places around Birmingham. There are many days when I close my office door and work on my Zumba routines after hours.

What is the best part about working at UAB?

The ability to be innovative at UAB is unprecedented and it is something that does not occur anywhere else. There is also an amazing feeling of collaboration here as well. Everything that I have done here has been a group effort. At UAB if there is something that you are willing to do there is a way to get it done.

Who were the people that most influenced you during your training at UAB?

Dr. Edwin Rutsky is someone that comes to mind who was a big inspiration to me. Not only was he a great clinician but tolerated nothing but the highest level of care for patients. Dr. Cecil Coghlan, in cardiology, taught me how to really focus on the patient and improved my clinical exam skills. Dr. Kirk Avent, Dr. Michael Saag, and Dr. Pete Pappas taught me critical thinking skills, as well as many other attendings in the Infectious Disease Department. Dr. Mike Waldrum (now CEO of the University of Arizona Health Network), who developed the 5 levels of DNR care in the ICU at UAB, was also very influential to me during my critical care training and taught me how to tell a patient or family member bad news in a very direct but professional manner All of these physicians were great role models and taught me compassion, patience, and humility, and the importance of continuous self-examination and self-improvement. They also taught me to be strong, vocal and proactive in patient care.

What is one story from residency that you do not mind sharing?

Housestaff still talk about a “rumor” of an intern getting stuck with a needle from an HIV patient at Cooper Green Hospital years ago.  It wasn’t a rumor but a true story; and the person who “got” stuck, was me.  It was Christmas Day of my intern year, and after admitting a patient with HIV, I stuck my finger with an infected needle while obtaining an arterial blood gas. I tried to re-cap the needle after I obtained the blood, and the needle went through the cap into my gloved finger. My upper level resident immediately placed my bleeding finger under running water and called Dr. Saag that very minute, who spoke to me on the phone and calmed me down. I was started on AZT, which I had a hard time tolerating due to significant side effects. Fortunately, I was not infected. It was the most frightening time of my life. However, it made me stronger as a person, and I felt equipped to handle anything after that! I have very many bitter-sweet memories of Cooper Green and felt that Cooper Green really enhanced my clinical skills and provided a great learning experience.

On a lighter note, I was also in the last group that was able to experience an overnight residents’ retreat at Camp Dismukes where I honed my golf cart driving skills, but I will leave it at that!