When people ask -- and they do ask -- where Deepali Kumar and Atul Humar's clinical and research interests diverge, the two scientists answer patiently. Both physician-scientists at the University of Alberta in Edmonton, Canada, Deepali and Atul are a couple, and both are specialists in transplant infectious diseases. "My interest is in herpes viruses in transplant patients," Atul says. "And my main interest is in vaccines and improving vaccine responses in transplant patients," Deepali says.

Instead of focusing on the differences between them, Deepali and Atul embrace the similarities. They can cover each other's patients, deal interchangeably with administrative issues, even manage each other's research projects when necessary. The flexible arrangement allows them to spend as much time as they can with their three children, ages 4, 6, and 8. They think they are the only couple in the world working together on transplant-related infectious diseases. And working together, they say, is their unique strength as physicians and researchers. "Working together is really synergistic," says Deepali, who is 37. "It's really the collaboration that produces good science."

Separate -- but similar -- paths

The similarities between Deepali and Atul go deeper than their subspecialty. Both were born in India and came to Canada as small children. They both grew up in Ottawa in academic families: Deepali's parents are professors in the business school at Carleton University, and Atul's father is a professor of engineering, now emeritus, at Carleton. Their parents met and become friends through the tight-knit East Indian community in Ottawa. Deepali and Atul met through their families' connections when she was 18 and he was 22 but lost touch as they went their separate ways.

This is part of an article series for CTSciNet, the Clinical and Translational Science Network, an online community. These articles are published on both Science Careers and within CTSciNet.

When they first met, Deepali was starting a biology degree at Carleton with the intention of going on to study medicine. "I don't think I ever wanted to do anything else," she says. After 2 years of undergraduate work at Carleton, Deepali moved straight into medical school at the University of Ottawa. (Only a few Canadian medical schools require a bachelor's degree before beginning medical school; most require 2 to 3 years of undergraduate course work.)

During her first year of medical school, in 1992, she decided to pursue a research project examining whether new compounds were cytotoxic to cells from HIV patients. It was a short project, but it led to a thesis that earned her a bachelor's degree while in medical school. Importantly, it solidified her interest in research and HIV. "I was very certain I would do HIV medicine," she says.

After a residency in internal medicine at the University of Ottawa, Deepali set off for the University of California, San Diego, for a fellowship in infectious diseases. Her plan was to pursue a research career in HIV medicine in the United States. But when Deepali arrived in San Diego in 1999, clinical HIV medicine was rapidly changing. Highly active antiretroviral therapy (HAART) had been around for a few years and seemed to keep HIV in check. For physicians, treating HIV had evolved into managing a patient's antiretroviral drugs, the side effects of HAART such as diabetes, and the psychological effects of the disease.

The success of the new drug cocktails also meant that patients' immune systems rebounded and they could fend off infection. "I realized I was interested in HIV because they were getting all of these opportunistic infections because their immunity is compromised," Deepali says. "It's great the way HIV [medicine] has evolved, but it just wasn't for me. I wanted to manage the acute infections. That's where my interest was."

Decisions

Meanwhile, back in Canada, Atul had recently joined the University of Toronto Department of Medicine to start the university's first transplant infectious diseases program. Like Deepali, Atul had done his undergraduate work at Carleton, gone to medical school at the University of Ottawa, and did his internal medicine residency at the University of Ottawa. Early in his residency, he knew he wanted to focus on transplant infectious diseases. "At that time, there [were] hardly any people practicing or doing research in that area, so I saw it as a real opportunity," says Atul, who is now 41.

He started doing some lab research in malaria during his infectious diseases fellowship at the University of Toronto, and toward the end of it he went to Boston for a few months to train with transplant infectious diseases physician Jay Fishman at Massachusetts General Hospital. When he returned to Toronto, he decided to get more research experience by pursuing a master's degree focused on molecular diagnostics of herpes viruses in transplant patients. Soon after, he got the position on staff at the university.

At about that time, Deepali was finishing her residency and preparing to go to San Diego, and each of them learned that the other was pursuing infectious disease specialties. They got reacquainted, grew closer, and then carried on a long-distance relationship after Deepali left for California. "I guess we didn't date," Deepali quips. "We just decided to get married."

So Deepali moved back to Canada, where she continued her training with another fellowship year at McMaster University in Hamilton, followed by a master's degree at the University of Toronto, sponsored by the Canadian Institutes of Health Research. In 2004, she joined the staff the University of Toronto in the Division of Infectious Diseases, working with Atul on transplant infectious diseases. "We did all our clinical work together and all our research together as well, so it worked out very nicely," Atul says.

A unique specialty

Deepali Kumar and Atul Humar's flexible arrangement allows them to spend as much time as they can with their three children (pictured above, from left) Saurav, age 6; Sapna, age 8; and Sonika, age 4.

Transplant patients receive powerful drugs that suppress their immune systems and are therefore subject to infections that people with fully functioning immune systems can fight off easily. As physicians, Deepali and Atul see transplant patients to treat and prevent such infections. As researchers, they study how infections develop and how they can be prevented in people with suppressed immune systems. They work together on nearly all their research projects, but each has unique interests: Atul studies how herpes viruses such as cytomegalovirus cause disease in immunocompromised people, and Deepali studies how transplant patients respond to vaccines. "The work we do is very translational," Atul says. "It has a direct clinical relevance in that it's aimed at improving outcomes in transplant patients who develop infections."

Atul and Deepali established themselves at the University of Toronto, looking after transplant patients and developing both lab-based research projects and clinical trials. "They make a perfect couple to do research. You really feel they have a special relationship," says Oriol Manuel, a physician with the Transplant Infectious Disease Program with the University Hospital of Lausanne in Switzerland. Manuel did a fellowship in transplant infectious diseases with the couple in Toronto and Edmonton. "Atul always has good ideas and thinks about what new projects we can do. Deepali is very active [and] knows everyone at the hospital. She knows how to put Atul's ideas into practice. They are both very complementary."

Meanwhile, they had three children between 2001 and 2005. "We decided that there's no right time to have kids, so we should just have them. It's kind of the 'fly by the seat of your pants' approach," Deepali says, laughing. After a few years, they began to consider moving to a smaller city. "We really liked working in Toronto; we just wanted to have a little more balance between work and family," Atul says. "It became hard to juggle the demands of work and family at the same time." Given that their specialty requires working at a large transplant center, there were few candidate cities.

Fortunately, the University of Alberta in Edmonton -- a smaller city than Toronto -- offered both of them positions plus lab space. They moved there in 2007, and Atul is now the director of the transplant infectious diseases program and an associate professor, and Deepali is an assistant professor in the Division of Infectious Diseases. Each spends about one-third to one-half of their time seeing patients and teaching. The rest is spent on research -- in the lab, enrolling patients in clinical trials, or meeting with the research coordinator.

Work-life balance

The move has given them the work-life balance they were looking for. Their house is 5 minutes from the hospital and the kids' school is close by, so they spend less time commuting. Their similar, complementary abilities and interests help them manage the workload and balance it with their home life. "If there's a patient issue that arises and needs to be urgently seen, either one of us can cover for the other," Atul says. "If one person is in a meeting, then the other person can see the patient," Deepali adds.

They both travel fairly frequently, though usually independently. But each year, both Deepali and Atul attend (and usually present at) the American Transplant Congress. Depending on where the meeting is, they either drop their kids off in Ottawa with family or take the kids -- and Deepali's parents -- with them to the conference. The conference travel and the shop talk at home seem to have made an impression: "My kids know all these terms like 'transplant infectious diseases' and 'H1N1,' " Atul says. In fact, their 6-year-old son has declared that he wants to be a transplant infectious diseases doctor.

They are unquestionably successful at balancing work and family, but they readily concede that their situation is unique. Being in the same field makes things easier than they would be for other dual-career couples, and they both grew up with strong role models for balancing family with the demands of academic life. Another critical factor is their university's Academic Alternate Relationship Plan, which offers them a portion of their salary not tied to patient care and so gives them protected time to do research.

Still, they put a lot of effort into juggling their clinical schedules, research projects, professional responsibilities, and personal lives. "We do work at this," Deepali says. "We really, really try to get everything done at work. I don't take an hour lunch break. It's very difficult to chitchat in the hallway; I just don't have that time. You just have to put the blinders on and get the day's work done."

"We made some changes in our careers specifically so we could have a work-life balance," Atul adds. "We made a conscious decision that work is really important and family is really important. I think unless you make that conscious decision, you won't succeed."

Photos courtesy of Deepali Kumar and Atul Humar.

Kate Travis is the editor of CTSciNet, the Clinical and Translational Science Network, and Science Careers contributing editor for North Europe.

Kate Travis is the editor of CTSciNet
10.1126/science.caredit.a1000022