The first time I met Nat was in the fall of 2006 at the annual Pittsburgh cardiology fellows’ retreat at the Nemacolin Woodlands Resort and Spa. I was a second-year cardiology fellow; enthusiastic, eager, and thrilled just to be there. Beyond the lively chaos of Echo Jeopardy in which I was a participant, the highlight of the weekend was the keynote lecture by Dr. Natesa Pandian. He spoke about 3D echocardiography, showing breathtaking images of the mitral valve at a time when 3D echo was still new and almost futuristic.
People who know Nat understand his gift: the ability to take extraordinarily complex ideas and distill them into something clear, elegant, and intuitive. His lessons stayed with you long after the talk ended.
After Echo Jeopardy, I approached him with questions. He remembered me and encouraged me to visit him at Tufts, where he and his team had pioneered many innovations in 3D transesophageal echocardiography. I accepted the invitation and arrived in Boston in January in the middle of a brutal winter. Just a month earlier, I had returned from Germany after learning cardiac CT from Dr. Stephan Achenbach, another emerging imaging technology at the time.
That month with Nat was transformative. I absorbed the nuances of 3D echocardiography, but Nat was equally curious about the CT knowledge I brought back. Imagine that one of the giants of imaging sitting with me, being a fellow, asking questions and learning from me as much as he was teaching.
We often went out for dinner after work, and even to a Celtics game – he was a proud Bostonian and a devoted Celtics fan.
That month marked the beginning of a relationship that grew far beyond student and teacher. Nat became my mentor, guide and a dear friend. He believed in my potential and nudged me toward an academic path. In many ways, that belief continues to shape the trajectory of my career.
After my advanced imaging fellowship in New York, when I joined as junior faculty, he invited me to speak at his annual echocardiography conference in Austria , which he cohosted with Dr Hans Nesser—the magical St. Wolfgang conference. Nestled among mountains and lakes, it was a place to think deeply about imaging, about solving clinical problems, about the art of echo, CT, MRI, and more.
True to Nat, the emphasis was always on cases—real clinical puzzles. The academic discussions always had to translate into practical, take-home wisdom. And true to Nat, he didn’t ease me in gently. In my first year, he gave me not one or two but nine talks. It was his unmistakable way of saying, “I believe in you. You can do this.” And because he believed, I did.
For years, he continued to teach, challenge, nurture, and encourage me even when I didn’t write as much as he hoped (a guilt that persists). He shaped my academic path and my love for imaging. He cared deeply about the physician I was becoming, but equally about the human being I was becoming. I shared many of my personal challenges with him; he always responded with warmth, compassion, and wisdom. He watched my son Manu grow from a toddler to a young adult, meeting him exactly where he was—playful with a child, philosophical with a teen, always kind.
His generosity was legendary. Once, during an ACC conference, our group took a cab, and he tipped the driver $100. The joy on that man’s face and on all of ours was unforgettable.
“You can’t change someone’s whole life,” he told me, “but you can make their day happy.”
That was Nat: a giver of random acts of generosity that lifted the world a little each time.
At St. Wolfgang, even in the early years when the conference barely broke even, he insisted on hosting beautiful faculty dinners, nights filled with friendship, ideas, laughter, and connection. A highlight was the infamous bad-jokes night. While I loved listening, I always worried he would call on me to tell one. I started collecting bad jokes in a private list—a habit that continues to this day.
He believed in bringing people together, in nurturing a family of imagers and cardiologists who supported one another.
Nat’s mentees and collaborators remain connected today, frequently sharing cases and life updates on WhatsApp. One thing he did not like, however, was group-chat formalities. He once wrote, in classic Nat fashion:
“On behalf of everyone in our forum, I wish all of you a Happy New Year.
No need to respond. I know you all wish the same.
– Nat.”
He was a master editor……crisp, clear, practical. A man of science, yes, but also grounded in everyday common sense.
Another defining quality was his authenticity and frankness. He spoke the truth plainly—sometimes bluntly—and it didn’t always land well. But it never mattered to him. He held himself to high standards and expected the same of others.
He adored Italian food, Italian music, Italy itself. “Molto bene,” he would say—his famous refrain—“molto… molto bene.”
He loved people and travel, and countless colleagues have stories of adventures with him. I was fortunate to share a birthday trip with Nat, Maurizio, and others in Rajasthan. We visited palaces, glamped under the desert sky, and created memories I cherish. On one train ride, freezing in an overly air-conditioned compartment, he searched for anything to use as a blanket. We had none—but we had just purchased a long skirt, a lehenga. Teasingly, I offered it to him—and he wrapped himself in it, to the amusement of every passenger. That playful, mischievous spirit was pure Nat.
Nat was also a philosopher, offering practical, pithy wisdom. We would spar about metaphysical ideas. I often argued for ritual and spiritual discipline. He would joke that he could don religious robes, start preaching, and we could found a new-age spiritual commune.
When I think of Nat, the qualities that stay with me are:
- His boundless energy and unrelenting curiosity,
- His immense generosity and genuine care for people, and
- His ability to speak the raw truth—even to power.
Nat, you are an inspiration.
You shaped my career, my purpose, and my understanding of what it truly means to be a teacher. I hope I carry even a small part of your legacy in how I teach, how I lead, and how I care for others.
Your favorite song was Frank Sinatra’s “I Did It My Way.”
And like that song—
You lived your life, and you left this world, your way.
Random Musings of a wandering heart doctor 