How I became a pediatric nephrologist

As a child I wanted to be an astrophysicist. I was so into it that once I got a stiff neck for three days from star-gazing on a winter night. Times were different back then: television was scarce and the Internet was not yet developed, and only in its very early stages in my adolescent years. So, apart from playing outside with my friends, I took apart clocks, tried to build jackpot machines, sketched new propulsion systems for cars and spaceships (antigravity, baby!), and worked out a formula to calculate the distance to the visible stars (my older sister gave me a push into more advanced mathematics). Those were just a few of the things I did back then. I was curious about the world, about technology, and I spent hours in my imagination, daydreaming about discovering something new. One of my childhood heroes was Roald Amundsen, and I was impressed by his persistence in reaching parts of the world where no one had been before. He had a drive that could achieve anything with just his bare will! That spirit lingered in me in the years to come, and pushed me into creativity, and away from any stagnation.

At the end of high school my parents persuaded me to go to medical school and I trusted their better judgment. They were doctors; my sister was a student in med school at that time, and they believed it was a natural path for me. It is important to mention that my childhood was challenged by a war conflict in which we found ourselves, and that period significantly impacted everything afterwards. Several years after the war ended, as my high school education was about to end, I was troubled by the financial strain my dreams of going abroad, preferably to the USA, for education, would impose on my family, and didn't want to make a fuss about my wishes. I was a hard working student and I could enroll into med school with scholarship in Croatia. I decided to follow the path my parents chose for me. Maybe this sounds odd now, and you may say I should have followed my dreams. For some years I thought about my decision, but I feel that this path is one of the paths of positive contribution I could bring to people around me. I knew I will always stay the curious kid, no matter if I changed the perspective or the subject. That's just life, I suppose.

Eventually, in 1999, I enrolled in the School of Medicine, University of Zagreb in Croatia, and after graduation I started a PhD program. My PhD thesis investigated noninvasive tools for measuring the impact of chronic disease on the child and the family. I am convinced this research gave me a strong foundation in something I would need again and again: how to evaluate whether a new tool measures what it claims to, and how to compare it against a gold standard. In parallel with my PhD I got my residency in pediatrics and later a fellowship in pediatric nephrology, which I immediately loved because I could see the effect of what I did quickly — there was a clear logical chain from cause to symptom to treatment.

Years later, after fellowship and several years in the outpatient clinic, I started noticing the same patterns in patient after patient. Ivana, a good friend of mine, who is now a pediatric neurologist, visited my bladder outpatient clinics as a part of her residency and once said, “you should tape-record what you say.” There was definitely a pattern in what I did to successfully treat my patients. My treatment plans could be prescribed in a standardized manner and would probably lead to treatment success. If I wanted to do this remotely, I needed a tool to recognize which patient needed which recommendation, and to track treatment success during the follow-up period. With some experience in outpatient clinics I quickly became curious about the etiology of overactive bladder, and I did extensive literature research to find out what the published reports said. My questions mostly remained unanswered. I needed to conduct my own research to find my answers. That noticing is where the diary story begins.