The Gift of More Time Together: James Kulig ’03 on the Work and Calling of Pediatric Cardiology

In this conversation, Kulig reflects on the calling that led him to pediatric cardiology, the challenges and joys of caring for critically ill children, the promise and limitations of emerging healthcare technology, and how his Gordon experience helped him understand his faith, his gifts, and his God-given purpose.

When did you first realize your calling was in the healthcare field?

I started thinking about it back in high school. My mom was a nurse, so growing up, I was always kind of surrounded by the medical field. At the time, I wanted to become a doctor, but it was my junior year of high school, I think, when I spoke with a family friend who was a neurosurgeon. I told him, “I don’t know if I want to be a PA. I think I want to be a doctor.”

And he said, “Do you want to have a family?” I thought that was a strange question when I was 16 or 17 years old, and I said, “Yeah.” He said, “Do you want to see your family?” Again, I was like, “Yes?” And he said, “Be a PA.”

So, I had always been interested in healthcare, but that was the moment when I thought, “Okay, this is my path.”

You work in interventional cardiology at Boston Children’s Hospital, helping some of the youngest patients through critical moments. What first drew you to this specialty, and what continues to energize you about the work you’re doing today?

When I was in high school, I was a pediatric home health aide for my summer jobs, so I always liked working with kids. Going into PA school, I thought I was going to do pediatrics.

Halfway through my first year, we were introduced to cardiology, and I fell in love with it. I was like, “Oh no.” So me, just being a simpleton, was like, “I’ll just put the two together—pediatric cardiology.” And I thought, “That’s what I want to do.”

I ended up working with adults for the first 10 years of my career before I circled back around to pediatrics. But cardiology just made sense to me. When you’re learning about the human body, you have to learn about every system and every disease, and cardiology just felt natural. I understood it almost immediately, without much effort. In comparison, there were other subjects that were just a slog to learn, get through and understand. It wasn’t like that with cardiology. It came very easily to me.

I enjoyed the physiology of it. I enjoyed learning about the diseases of the heart—which is weird to say—but you have to like what you do, and you learn pretty fast what you like and what you don’t.

In addition to caring for patients, you serve as a training and quality improvement coordinator. What do you find most rewarding about helping develop the next generation of healthcare professionals and improving systems of care?

Someone trained me at some point and passed a lot of knowledge on to me, and I like that, hopefully, I can pass that on to the next generation. Generation to generation, doctors come through, PAs come through. At some point, I’m not going to be there. And 20 years ago, somebody was in my seat thinking, “I’m not going to be here.” So, if we want to improve care, this is how you teach. We don’t want to continue to reinvent the wheel and make up new ways to do things when it comes to kids, people’s lives, and their health.

For me, I enjoy teaching. I also enjoy processes that make doing your job easier. I like looking at projects and saying, “There’s a way to do this better and more efficiently”—better for the clinician and with better outcomes for patients as well. I think it’s one of the gifts I’ve been given: a love for efficiency and being able to look at something, sift through it, and find a more efficient, better way to do it. Overall, it’s better for everybody—not just the clinician, but the patients as well.

What are some of the barriers you see to providing quality care, and how have you worked to address them?

Oh, my goodness. Honestly, it’s paperwork, regulation, and overregulation. Someone once said to me, “Medicine is the best job in the world, except for the paperwork,” and no truer words have been spoken. If clinicians could just treat patients, they would be very happy. That’s what we want to do, but every patient you treat comes with 45 minutes of paperwork and documentation. It’s brutal. There are regulations to follow when you really just want to care for the patient.

You only have so many hours in a day. You either spend those hours connecting with the patient and caring for the patient, or you spend them doing paperwork. And you see that across medicine. It’s not just at Boston Children’s Hospital; it’s across the board.

One example of how I’ve tried to address that is working alongside one of our physicians to create a better reporting system. It’s more efficient and streamlined, and it takes a lot of the busy work out of the process. Whereas before it might take an hour to an hour and 15 minutes to complete a report, we’ve cut that down to about 35 to 45 minutes.

The reporting still has to be done, but we’ve really streamlined it and made it as efficient as possible. We’ve also automated the billing in the background, which makes things more efficient for me and for the attending physicians. It’s less work for the clinicians and ultimately gives us more time to focus on caring for patients.

How does working with children differ from working with adult patients, and what have those experiences taught you?

Working with kids is energizing because sick kids are still kids. You walk around the hospital, and they’re the same kids as your kids. Adults can be burdened with life by the time they get older and they’re sick. There’s a lot more involved. But kids are always kids. 

They teach you perspective in two ways. Number one, I’m an adult, and maybe my burdens aren’t as heavy as I think they are. Here’s this kid who has been sick their whole life, and they’re okay. And here I am, a healthy adult complaining about something.

It also gives you perspective on your own kids. One of the first things I learned was how having a sick child is such a burden. You see it in the parents. They want to take away their kid’s sickness. They want to be there for them, but they can’t take it away.

That’s another meaningful part of working with kids. As a parent, I understand that burden. I can’t take away the sickness either, but I can help their child get better, which in turn, hopefully helps the parents feel better, too.

As healthcare technology and cardiac care continue to evolve, what developments in interventional cardiology are you most excited about, and how could they improve patient care?

Well, the answer is AI, unfortunately. Not AI in the sense that it’s going to diagnose and treat, because I don’t think it’s ever going to be that way. But rather, AI in systems that can help you, again, be more efficient.

There’s a nuance to medicine that only comes with experience, and AI isn’t going to be able to replicate that. There’s a term, “clinical judgment,” where the data, the disease and the labs may tell you one thing, but your experience tells you, “Something doesn’t seem right. Something’s missing here.” There’s no substitute for experience.

But, there is new technology that can help us build better heart models. There’s a system we looked at a couple of years ago that creates a 3D model where you can put on glasses and virtually implant certain things. It’s that kind of technology that is going to help surgeons plan future surgeries and help us plan future interventions by giving us more accurate models.

In theory, that’s going to improve patient care through better planning, shorter surgeries, shorter procedures and better outcomes. If you know the answers to the test walking in, combined with the skill that the physicians I work with already possess, it’s one more leg up. There’s less guesswork. 

That’s especially important because every kid is different. That’s what’s interesting about pediatric cardiology. There are certain diseases, but within each disease, there’s a spectrum. Congenital defects happen during the formation of the heart, so there are so many variables: When did it happen? How severe is it? Are there other comorbidities? Is the heart rotated five degrees to the right or 10 degrees to the left? That stuff matters when it comes to surgery, management, and how we perform an intervention.

With adults, it’s relatively easy to create a study that works because there’s less variability. With kids, every case is a little bit different, so it’s harder to say, “This works in this patient population.” There aren’t as many studies in kids, and there’s so much variability.

That’s where I think AI can help. It should be able to take CTs, MRIs, outcomes, and all of that big data and sort through it better than we can. It can look at all those variables and say, “Here are the trends.” I think that’s probably where it’s going.

How does your faith shape the way you approach your work in medicine?

Oh, my goodness. It’s why you do what you do, right? Meeting people where they’re at and understanding that they are God’s creation. God created this person, and I’ve been given a gift and a passion to help people.

I think faith is interwoven throughout all of medicine. If you look biblically, God healed physical ailments and, through that, was able to intervene spiritually. It’s a unique opportunity. You’re seeing people at their lowest and their most vulnerable, sometimes staring down death.

My faith also gives me an understanding of why I was created. God created me with a purpose. I feel blessed to be somebody who was able to recognize, “This is what God made me to do,” and to pursue it and be able to do it. That helps every day during the grind and the long hours. I can say, “Okay, God has me here for a reason, because this is who He created me to be.”

Growing up, I was soundly criticized for my lack of sensitivity and emotion. I struggled with that for years, thinking something was wrong with me. But during my medical career, I’ve come to understand it differently—not as a lack of emotion, but as an emotional steadiness that allows me to do this work. I’ve realized, “Oh, no. That’s not a problem. That’s how God made me.”

I can be sensitive to patients and their families, but I work with children on death’s door every single day. You have to be able to remain steady and be able to do what you need to do for these kids.

That steadiness doesn’t always serve me in the same way in every part of life. If I take that attitude home to my kids and my wife, for example, it doesn’t necessarily serve me well there. But in medicine, it’s part of the reason I can do my job. I’ve learned that this is how God made me for this purpose. I know that fully.

You’ve talked about the emotional steadiness it takes to care for critically ill children—to remain sensitive to patients and their families while still being able to do your job in difficult moments. What other qualities are necessary for someone working in your field?

You’ve got to be a workhorse. It’s long hours. It’s hard hours. And you have to be okay living on the edge. I actually had this conversation with my boss today. There’s a little bit of an adrenaline junkie in all of us. We’re doing procedures on really sick kids, pushing the envelope, doing more and trying to be better all the time. You’ve got to have a high motor.

You also have to be okay stepping out and doing something without knowing exactly how it’s going to turn out. It’s probably a step above just being calm under pressure. You actually have to thrive under pressure.

And you have to be okay if things don’t go right. You have to own it. You’ve got to own the successes, and you’ve got to own the failures and learn from them. You have to be introspective and be able to say, “Hey, we did this, and it did not turn out well. What can we do better?” We do a lot of that in our department.

What brings you the greatest joy in your profession?

I think it’s that there are problems that can be solved, and solving those problems helps kids live a better life or a longer life.

If we can fix the problem completely, there’s joy. There are some children who aren’t going to survive. We know this. But for those kids, maybe we can give them five birthdays, five Christmases, and five summer vacations. It’s unfortunate, and it’s terrible, but if I can do that for somebody, I think that’s important. There’s joy in knowing that you can give that kind of gift to somebody. Five Christmases is better than zero, because there’s joy for that family in those five Christmases.

 If we can give a family more of that time together, there’s joy in that.

You graduated from Gordon in 2003 as a kinesiology major. How has your Gordon experience influenced the way you approach patient care and leadership in your career?

 I think the Gordon experience really shapes you. I got a good education, and it prepared me well for grad school, for sure. But it also gives you a foundation for how to view your profession and your life through a faith that you make your own at Gordon.

Were there any professors, mentors or experiences at Gordon that particularly shaped the person and healthcare professional you are today?

Dr. Givens and Dr. Iltis were the two professors in my department who really pushed me and challenged me to be a little better than I was. They were caring, they were kind, but they also recognized that I wasn’t doing the things I should be doing as far as effort and attitude, and they called me on the carpet for that.

I really appreciated those two men at Gordon for helping shape my understanding of, “Okay, this is what it means to be an adult. This is what it means if you’re going to do this sort of thing going forward.”

What advice would you give to current or prospective Gordon students who are considering a career in healthcare?

Get as much experience as you can, at all levels. Shadow as much as you can, even in areas you may not think you want to pursue, because you just don’t know.

I started off as a nurse’s aide, which, on the totem pole, is at the bottom. But I got to see how things work at the bedside. Get as much bedside experience as you can. Work in hospitals, be an EMT, shadow PAs. That’s the stuff that helps a lot when you’re thinking, “What am I going to do?” Healthcare is a big world. The more you can see, the more you can say, “This is what I like. This is what I don’t like.”

You also have to figure out who you are, and I think experience helps you do that. Learn what you like, what you don’t like and what drives you. Do you like being on the cutting edge? Do you like things a little slower? 

Go experience it. Does it energize you, or do you walk away thinking, “I am never walking into this place again?” Go watch a surgery. Did you faint because you saw blood? Well, maybe that’s not for you. Or are you looking at a heart thinking, “That’s awesome?” You learn pretty quickly. That’s how you start figuring out who you are.