Dr. Nancy Ascher is a transplant surgeon at the University of California San Francisco and the first woman to perform a liver transplant. She has served on the Presidential Task Force on Organ Transplantation, Surgeon General’s Task Force on Increasing Donor Organs, and Secretary of Health and Human Services Advisory Committee on Organ Transplantation and has been featured on The Surgeon’s Cut on Netflix. Besides her impressive surgical skills and dedication to her patients and community, Dr. Ascher is known for her talent and grace both in and out of the operating room.
Dr. Ascher was the first female Chair of the UCSF Department of Surgery. She continues to perform live liver donor and transplant recipient operations at UCSF in addition to advocating for physician wellness and ethical transplant practices around the world. She is a strong supporter of women in surgery and partially attributes her ability to navigate such an intimidating environment to watching horror movies as a child! Given her unprecedented legacy in transplant surgery and strong representation of women in medicine, I was eager to learn how she became a trailblazer in a world where female surgeons were an anomaly, her thoughts and reflections on her career, what life looks like for her now, and who she is outside of medicine.
Q: How have you grown as a teacher throughout your career?
A: “I want to answer the question of how I’ve grown as a mentor… I think I really have a sense of where [fellows] are in terms of how their hands work, how their brains work, and how it all works together, so I try to individualize my approach… You can’t give advice based on what’s going on with your life at that moment or what your biases are… because you’ve really got to be dispassionate about seeing what’s going on in somebody else’s experience. The main questions I get has to do with their interpersonal relations… I think I used to put more of myself into advice and I don’t do that anymore.”
Q: What is your favorite hobby outside of surgery?
A: “I am an art aficionado and I collect art and study art. For me what makes art interesting is when you combine it with the historical relevance and the history of a specific art movement. I collect works on paper and things that stretch from Rembrandt and Goya to modern works. It’s actually an interest that my daughter picked up on… she became an art dealer, so it is an interest that we share. I also like to read a lot. I’m kind of a reading nut, about a book a week.”
Q: I read that you once did a liver transplant that lasted 24 hours. What extended the case so much? How did you push through that?
A: “I remember that case very well. This was an 18-year-old young man with Budd-Chiari. He had seven previous surgeries and was sent to UCSF for a transplant. His abdomen was so difficult… He just bled from everything. Even though it was an incredibly difficult case with a 104-liter blood loss, which is perhaps as much as I’ve lost throughout the rest of my career.
I remember at one point I thought I was going to lose this kid and I went out to talk to his mother, and she said to me, ‘You’re a mother too. You go back in there and save my son’. So that’s what happened. And he survived… He is still alive and healthy now.”
Q: What does a “day in the life” look like for you now?
A: “I wake up early because I feel better if I get my exercise done before I start my day. So, I get up 4:30-5:00AM, have my coffee and tea, check my email, and look at my patient records… then exercise… If I have a case, I get to the hospital at 6:30AM. The day itself may be outpatient clinic, inpatient, rounds, or procedures. At the end of the day, I figure out if my daughter needs help with her two little children. So instead of doing administrative stuff as chair, I have administrative stuff as grandmother.”
Q: How do you balance such a demanding work schedule?
A: “I don’t believe in balance. I think you have to get used to imbalance and chaos… If you’re okay with that, I think this field is fantastic. You’ve got to roll with it – every part of what we do as transplant surgeons has these little… bumps and you’ve just got to get used to it… Relax with it and just go…
As a woman, I felt like I wanted a say in things. I wanted a chance to express my own ideas about what a department should look like, what support for one another should look like… and so that’s really what motivated me… The fact that we’re able to do this is so cool.”
Q: Is there anything you specifically want to talk about?
A: “I’m still passionate about international work but again I feel like it’s really hard to judge what other people are doing. I’ve been really concerned about modification of the human body and paying donors… and not forgetting what poverty means throughout the world and how one might get out of poverty… And we cite the fact that donors don’t get good care and they get taken advantage of and nobody’s following them up… But then we’ve got to ask ourselves ‘What if the system worked so they really got good care? And they really were followed up?’
I was a kidney donor, so I know you can live many years being a kidney donor and it’s no big deal, but we hear these people… who say ‘I can’t work’ or ‘My life is ruined’… Is their life ruined because they don’t have the medical care or because of the whole societal thing? I feel like I am constantly questioning this moralistic stance that we take. I’m nervous about that a little bit, and I think we have to explore it further. And I’ll leave you with what I tell all my students: I want more from you. I want you to do great.”