Dr. Nancy Ascher

Anya Greenberg (MS3):  Thank you so much for taking the time to share your wisdom with those following in your footsteps.  To start - what are you most proud of personally or professionally?

Dr. Nancy Ascher:  Well, I was of the generation that took transplant from a dream to a clinical reality. The generation before mine came up with new techniques and immunosuppression therapies that, theoretically, could allow for liver transplant to work. It fell upon the next generation to actually make it work -- to turn it into a clinical reality and to make a difference in people's lives. When I first started doing liver transplants, the one-year survival was 20%. Thinking back on those years, it's quite remarkable that we pushed ahead, but we were able to figure out so much from the standpoint of immunosuppression, infectious disease, surgical technique. Now the one-year survival after liver transplant is 95%, and I'm proud of that. I’m also proud of the young people, my trainees, who came along during this time and who are now leaders themselves.

And, I’m proud that I made it happen while retaining some degree of humor and not taking myself too seriously. I think this is particularly important for young women as they're getting their chops and growing into positions of authority. As I think about the women I admire, I see this trait among them.

 On a personal note, I'm proud of my family and the relationships I have with my kids and my partner. That is so important, really, really, really important.

Anya:  Who do you admire?

Dr. Ascher: Ruth Bader Ginsburg, of course. But I also have to say Sandra Day O’Connor. Even though I didn't agree with her politics, the very fact that we saw a woman in that position was so important. Also Margaret Thatcher. Many of us in California didn’t necessarily agree with her politics, but we saw in her a person who spoke her mind and who was able to manage a very difficult situation with integrity, talent, and charisma. I also admire Angela Merkel, who is trying to lead a country based on science, not politics or emotion.

Anya:  I really appreciate you sharing the things that you're most proud of -- they are quite admirable achievements, and you have truly transformed the field. My next question is, what inspired you?

Dr. Ascher: When I was looking at residencies, I wanted to go into a field that I would be excited about, one in which I would be stimulated by discovery and wonder. The field of transplant, when I came upon it, was in its nascency. There was proof of concept -- transplants had been done -- but they didn't really work.  They “worked” but there was hope for something even better. That's why I gravitated toward transplant. In fact, 40 years later I'm still interested in it. I still find it fascinating. Becoming a live donor surgeon for liver transplant meant relearning the liver anatomy, and that has been interesting to me even after all these years! I'm so fortunate to get to go to work every day and do something interesting, and to be able to help people, and to be able to share that scary, horrible time people are facing in their lives. When people are facing death and real illness, it's hard not look to your doctors for help and it's great to be one of those doctors who can help. I feel really, really, really lucky that I picked the right field for me.

Anya: What helped you along the way -- who or what did you rely on to get to where you are now?

Dr. Ascher: I had support from my family. I didn't ever feel like I couldn't do something. My parents instilled the notion that if you work hard, you can achieve anything and everything. My dad was a doctor and my mother a teacher, so I was inspired by academic medicine. I had mentors all along the way. I learned what to do and what not to do from my mentors. I paid attention to what people I admired did and what people I didn't admire did so I could do it differently, do it better. That was equally important to me and I value those lessons even though they may not have been direct.

Anya: Can you elaborate a bit about mentors, and the role mentorship played?

Dr. Ascher:  Well, in the old days we didn't really call them “mentors.”  They were people from whom I learned. For example, Dr. Najarian. I really liked the way that he talked to patients. He was a very imposing figure, but when he talked to patients he brought it to their level, and I paid attention to what he was saying at that level.  But, I didn't like the way he did his surgeries.  We've got to take different things from different people and not assume that we need to be a mirror image of a mentor. We can take one, two, or ten things from someone. It's supposed to be fluid.

And, it may be through a formal or informal relationship. The idea is to keep your mind open so that you can learn from people. I learned from you when we worked together when you were in hospital administration!

Anya: Ha!

Dr. Ascher:  Seriously, we learned from each other, right? That was a very interesting relationship.

Anya:  Absolutely! Thank you for saying this, it means a lot to me. As a follow-up to that, how do you decide what to take from others as you are establishing who you are as a surgeon, as a doctor, as a professional?

Dr. Ascher:  I think you first have to form your ethical place, your center of gravity, your morality. Then try stuff on and see what works for you.  You can relate it to parenting: there may be conventional “do’s and don'ts” for parents, but with the caveat that it has to fit you.  Just like you can't take somebody else's clothes and put them on if they don't fit you.  You have to see if what you’re taking from someone fits with your personality, your values, your moral compass. But I think developing that moral compass is the main thing at the beginning.

Anya: Has your moral compass changed over time?

Dr. Ascher: I don’t think that my moral compass has changed that much. I hope I stood up for the same things in the past that I stand up for now.  But certainly the way I go about it has changed.

Anya: What is something that you wish you had known during training that you now know?

Dr. Ascher: People think that they are fully formed when they finish training. But in fact, that's not true. It's not as though one day you're a trainee and the next day you're grown up. It's an evolutionary process.  I learned a lot after I was completely done with training as an attending and I continue to learn now, which is pretty great. Being a “life-long learner” is real. This is really important to keep in mind. 

People sometimes feel like they have to know everything, and if they don't know the answer to a question as an attending that is somehow shameful.  But in reality, it is what it is -- let's just go find out the answer!  So, I think it's important for people to understand that they're not done when they're “done.”

Anya:  That resonates with me quite a bit, especially in my own trajectory as I'm shifting careers.  What is your approach to stay a lifelong learner?

Dr. Ascher:  I am a lifelong learner in the areas in which I'm interested -- I have to confess that I'm not a lifelong learner about everything in medicine.  I don't keep up with many things.  But in those areas that I love and that I am passionate about, I can’t help myself from wanting to learn more. For example, I am interested in art and part of what I love about art is the history, the scholarship.  I love learning about artists in the context of what the global politics and social mores were at the time.  To me putting things in context is really helpful. It's the same with medicine and transplantation.

Anya:  On the topic of art, do you do art or do you enjoy looking at others’ art?

Dr. Ascher: I draw.  And, I am a mediocre draftsman, but my patients have no trouble understanding when I draw them a beautiful picture of what I plan to do to them!  But seriously, I draw but I can't say that I'm an artist. I collect art, I study about art, and I'm very interested in art.

Anya: What is your personal drawing modality?

Dr. Ascher: My personal preference is charcoal and pen. But what I collect is very eclectic.  I have artwork that ranges from the sixteen hundreds to contemporary art. I collect works on paper.  I have Rembrandt and other Old Masters prints but also contemporary art by Andy Warhol, David Hockley, Anish Kapoor and Chuck Close, who's very unpopular because of his approach to women. So I'm interested in a lot of different things.

Anya: A true art connoisseur! Any other hobbies or passions that you have outside of medicine?

Dr. Ascher: I love peloton.

Anya: I love that!  Is this a COVID19 hobby or were you into it before?

Dr. Ascher: It predated COVID19. It’s been wonderful for me. The only mistake I made was not buying Peloton stock!

Anya: Having so many different interests and passions, what would you have done if not surgery?

Dr. Ascher:  I think I would have either been an art restorer or an art dealer.  Art restoration is, of course, totally in line with what I do for a living. Dealing art a little less so, but I might try my hand at that as well.  Maybe I would be a museum Director.  Or, I would be a florist. I have a garden too -- it's not a traditional garden, it’s a non-sun garden, so it’s very limited, but very green and very beautiful.

Anya:  It’s been delightful to hear so much about you! My last question is, what words of wisdom would you like to pass on to those following in your footsteps, a group of women aspiring to go into surgery or starting their surgical careers?

Dr. Ascher:  This is such an opportune time. We have always been there waiting for the rest of you. We have encouraged the rest of you.  And now it's really your time to come along. I think these next 10 years are going to be incredibly important for women moving up in all the surgical specialties.  I look at the task with optimism.  It is happening and it will continue to happen, and I think it is really an opportunity for us all. At the same time, this shouldn't be in a vacuum of just “female supremacy.”  It has to be in the context of working with our male colleagues. Actually, it's about meritocracy, not about women getting ahead. It's about people who are willing to work hard, who are well-equipped and committed, and who are able to do the work to get ahead.  I voted for affirmative action but I had to soul search a little because the truth is, we want to even the playing field but don't want special favors.

Anya:  Right! I want to be somewhere because I deserve to be there.

Dr. Ascher:  Exactly.  So, I've been really mixed about it. When I said you've got to develop your moral compass first, that's what I'm talking about. So I did vote for affirmative action because I want the ability to get to the table to be the same so that the differentiator can be based on individual achievement.

Anya:  Is there anything that we didn’t cover that you would want to leave us with?

Dr. Ascher:  There is a lot of information about the role of gender out there. For example, Heather Sarsons did a study looking at Medicare referral data to female and male surgeons, showing that referring physicians view patient outcomes differently based on the surgeons gender. What that data shows is that while we have a lot of work to do with our male colleagues, we also have a lot of work to do with our female colleagues.

 I voted for Hillary Clinton, but I didn't like her because I felt that she didn't represent us well.  But isn't it wonderful that we can find women we can get behind without judging them differently or holding them to a different standard than we hold men?  So the women-woman dynamic is as important as the man-woman dynamic.

 I have always felt that the advances we made for women could and should also apply to our male colleagues. That they would add to greater overall understanding, camaraderie, and interaction. If the idea were to just let women get ahead without paying our dues, then we would be in a very dangerous situation.  We have to be cognizant of that. That’s what was so brilliant about Ruth Bader Ginsburg. The cases she took on were as much fighting for men’s rights as they were for women’s rights, but in the end the fight was for gender equality.

It's great that there’s a group part of the Muriel Steel Society supporting women medical students, but we have to recognize what that means for male colleagues and responsibilities to us all.

Anya:  On behalf of the Muriel Steel Society Medical Student Committee, thank you so much for taking the time to share your inspiring story and your words of wisdom!