The Only One in the Room: Dr. Devi Nair

When people ask what it is like to be a woman in interventional electrophysiology, I tell them the truth: for most of my career, I was the only one at the table. Not the only woman in the EP lab; nurses, techs, and coordinators have always been the backbone of every EP lab I have worked in, but the only woman standing in lead, with the catheters in her hands.

That has changed. It has not changed enough. Cardiology remains one of the least gender-balanced fields in medicine, and the procedural subspecialties EP, interventional, structural are the narrowest part of that funnel. We are not short on talented women entering medical school. We lose them somewhere between the classroom and the lab. I have thought a lot about where that loss happens, and I no longer believe it is mostly about ability or even about ambition. It is about permission, the quiet, cumulative sense of whether a room expects you to be in it.

The room does not hand you authority... Early on, I learned that being introduced as the physician did not always mean being received as one. Families would look past me for the doctor. Reps would walk me through a device I had been implanting for years before they were assigned to it. It is tempting to treat those moments as insults to be absorbed, and for a while I did. What changed things was not becoming louder. It was becoming useful in ways that were difficult to argue with. Do the hard case. Take the referral no one wants. Publish the data. 

Competence is not a shield against bias, and I will not pretend it is, but over time it makes you harder to talk around. I would say the same thing to any young woman in cardiology today: build something that is verifiably yours. A skill set, a program, a body of work. Credentials can be dismissed. Outcomes are stubborn.

Build where you are... I did not build my career in a coastal academic center. I built it in Jonesboro, in northeast Arkansas, in a community hospital that most people would not have picked for advanced arrhythmia care or clinical research. That turned out to be the point. The patients who most need cardiac ablation, stroke prevention, and rhythm management are not always concentrated in a handful of famous zip codes. They are mostly in rural counties, driving two hours for a follow-up visit, deciding between a medication and a light bill. Bringing trial-level care to them was the whole reason to stay. Being a woman shaped that decision more than I realized at the time. When you are not the default candidate for the traditional path, you look harder at the paths nobody is guarding. There is real freedom in that. Some of the most interesting work in medicine is happening in places that were never supposed to be doing it.

The question underneath the question... When young women ask me about a procedural career, the question they actually want answered is rarely about ablation. It is about whether a life fits around it. Mine does. My husband, Manu, and I have raised two sons, one now in college, one in tenth grade and still at home for a little while longer. I have taken call through birthdays. I have come home from long cases with nothing left to give and been met with a house that needed me anyway. There were stretches where the honest accounting was that something had to give, and often it did. I will not sell anyone the idea that this is balanced. It is not balanced; it is negotiated, constantly, and the terms change every year. What made it possible was not superhuman scheduling. It was a partner who never treated my career as the optional one, and children who grew up understanding what their mother does and why she leaves in the middle of dinner sometimes. That last part matters more than I expected. My sons have watched a woman run a lab, lead trials, and be told no and go anyway. Whatever else I have built, that is the version of normal they carry into the world.

What I would tell someone starting out... Take up the technical space. Say yes to the complex case, the new platform, the trial nobody has run before. Procedural confidence is built through repetition, and women are too often offered the safe case and the administrative role instead. Find people who advocate for you when you are not in the room. Mentorship gets talked about far more than sponsorship, and sponsorship is the one that moves careers. Some of mine came from men who simply decided my work deserved a bigger platform. Be that person for someone else. I try to be, for the young women coming through our EP lab and our research group. Do not audition for belonging. You will spend a career waiting for a moment of arrival that never arrives. The work is the belonging.

Still counting... I still walk into meetings where I count the women in the room. I look forward to the year I stop noticing, because the number is too high to bother counting. Until then: to the women in our community who are training now, choosing specialties now, weighing a procedural career against the family they want, you do not have to choose the smaller life. It is demanding, and it asks a great deal of everyone in your house, and it is worth it. There is room at the table. Some of us have been holding it open for you. Walk in like the room was built for you. Then build a bigger one.

Dr. Devi Nair is the Chief of Cardiac Electrophysiology & Research at the St. Bernards Medical Center.