Models and Mentors
In Conversation with Bertha Chen, MD
Dr. Bertha Chen is an assistant professor in the Department of Obstetrics and Gynecology and chief of Gynecology at Lucile Packard Children’s Hospital. In addition to working in clinic, performing surgeries and running a research lab, she contributes to several international health projects in Central America and Africa.
After graduating from UC Berkeley with an undergraduate degree in chemical engineering, you came to Stanford for medical school. Why medical school? Why Stanford? And what did you do during the three years between college and medical school?
It’s a long story because I never intended to go to medical school! My main interest was engineering. I went straight from college to work for a start-up in Silicon Valley, and it was a great experience. I got a lot of hands-on experience, really got into the business end of it. At that time, I had some very good friends still in the chemical engineering department [at Berkeley]. They came to me because I had the entrepreneurial experience in starting up a company, and asked if I was interested in working with them to build a biotech company. I thought it was an interesting idea, and wanted to read up on it to assess the feasibility. So I started looking into the biological sciences and realized that it’s actually pretty interesting! I wasn’t interested in the biological sciences because nobody in my family is in medicine, or in biotechnology. But the more I explored it, the more I realized that in order to succeed in biotechnology, one has to get a medical degree. At that point I had the money, and the time, so I decided to go to medical school.
I chose Stanford because of its proximity to biotech firms, and also because Stanford has a long-standing tradition of working with industry and being involved in biotechnology research.
You must have enjoyed your time at Stanford, as you stayed at Stanford to do your internship and residency in obstetrics/gynecology (…and you’re still here!). How did you decide on this field? What appealed to you about continuing your training at Stanford?
This is kind of a funny story because, here again, I had a difficult time deciding whether I was going to do residency or not, because my main intent was still to go into industry and do research and start a biotechnology company. But when I did clerkships, I really started interacting with people, taking care of patients, and I realized I could do both. I needed to have enough clinical experience to really understand what physicians need and what patients need.
There’s a big difference between textbooks and seeing patients. The textbooks are sometimes very esoteric, but when you’re studying it, it’s the world to you. You think it’s really important. But when you go and actually see patients, the majority of that information is not that crucial. You end up finally understanding what truly is crucial, and what works in reality and in people’s lives - what’s practical and what’s not. And when I did clinicals I realized that, in order to come up with a project that could really help patients, I needed to understand these aspects of clinical medicine. I think you become a better researcher by understanding the practical elements.
Initially I wanted to go into pediatrics or surgery, but somehow happened to take a rotation in Ob/Gyn and I realized how interesting it is - it really covers a lot of different types of physiology. The physiology of pregnancy is rather poorly understood, and incredibly fascinating. Although at first I was opposed to the idea of going to Stanford (I came from Berkeley, and thought there was no way I was going to be seen at Stanford!) but I decided to continue my training here because I felt the opportunities for research were very rich. It’s great that people here have the freedom to explore, and to make something out of an idea they come up with. I’ve seen that happen to medical students, residents, and faculty, which is really nice.
You currently serve as an assistant professor in the Department of Obstetrics and Gynecology, as chief of Gynecology at Packard Children’s Hospital, and as director of the Urodynamics Clinic (you must be busy!). Can you describe for us a typical workday? How do spend most of your time?
Every week it changes. I run a basic science lab too, and that takes up a significant amount of my time. I also have a very heavy patient population, and do a lot of surgeries. Because I specialize in urogynecology and pelvic surgery, I need to see enough patients and do enough surgeries to keep up my surgical skills.
In terms of scheduling, I spend one day a week in surgery and two and a half days in clinic, and those days are fixed. The day that I have for research can get shuffled a lot. I can spend a full day in my lab, or it may get filled up with administrative stuff and teaching responsibilities. It’s kind of my play day where I can shuffle things back and forth.
Can you tell us a little about your research interests?
Right now in my basic science lab we are studying extracellular matrix turnover and metabolism in the pelvic tissues. We’re looking at this in the supportive ligaments because, in women, damage to these ligaments is what causes pelvic floor dysfunction problems like prolapse and incontinence. We’re also using the same technology to investigate fibroids [benign uterine smooth muscle tumors] because, if you look at a fibroid, the majority of the tumor is extracellular matrix, like collagen and elastin. So we’re using the same kind of technique to look at how fibroids evolve, how they grow and change. Fibroids are actually a very common problem - up to 70% of the population has fibroids. 30% of those will show up as abnormal bleeding, or a palpable mass, or pain & pressure. Most of the time, people end up with a hysterectomy because of the bleeding issue. In fact, of all the hysterectomies done in the United States, a third of them are done for fibroids.
What do you like most about your job?
When you go into medicine, you find different types of personalities. There are the types of personalities that enjoy doing one procedure over and over again, and getting really good at it. These people are wonderful to have because they become excellent surgeons, excellent radiologists, etc. Then you have the other type of personalities that like to do a lot of different things at the same time, and I think I’m in that category. Most Ob/Gyns are the same way - they’re doing deliveries, surgeries, and they have clinic. For me, there are a lot of things I really enjoy about my job. When the research is going well, I think that’s the best thing. When clinics are going well, I think that’s wonderful. But at the end of the day, I really enjoy taking good care of patients. If I do a good surgery, the patient recovers well, feels satisfied about her surgery, knows it was a good decision, and she feels better. I think that’s just a wonderful thing, something that you can’t replace. It’s the personal satisfaction of knowing that this person is walking a way with a really good result.
What do you see yourself doing ten years from now?
That’s a very good question. I think, unfortunately, I’m going to have to give up something, because everything I do takes up a lot of time. The thing I enjoy, probably more than research, is working with students. It gives me a lot of satisfaction. I think medicine is one of those fields that you cannot teach in a classroom – a lot of medicine is taught be doing it yourself, seeing patients. But it’s also important to have good mentors, who can point you to what might be a valuable experience, what might not, what is going to give you the most exposure. I think as I get older, that’s much more my role because I’ll have enough experience and have done enough medicine to know how to guide students in whatever they do. I also think going abroad is a very good experience for young people, whether they’re in medicine or not. It just gives you much more of an appreciation for how things are done in other parts of the world. I’d like to spend more time fostering that, and providing more mentorship.
We’ve heard that you speak both Chinese and Spanish fluently, and that you’ve traveled extensively with medical teams to do service work abroad. How did you learn these languages? Can you tell us more about your experiences abroad?
I was very fortunate to be born with those languages. My family is Chinese so I speak it at home, and I grew up in Central America, in Guatemala.
I have worked in Guatemala with a small foundation called La Familia, based in San Francisco. It started because this gentleman, who is a builder, was traveling around in Central America, landed in a little town in Guatemala. He met an Italian priest, head of the local parish, who was working really hard to build schools and provide social services for the community. The builder saw how hard the priest was working, and how little the town had, so he asked if there was anything he could do to help. The priest said they really needed a hospital. Years later, the builder got together with some wealthy friends who decided to do it! They built a tiny hospital down there, and formed this foundation. There are physician teams going down every three months to do the surgeries that are necessary for the community. They have enough funding to hire a local internist, a family practitioner, who is there year-round.
Originally I went with the team just to check out the situation, and then we went a couple times with residents to teach them how to do these surgeries. They still go once every other year, but the program is well-established enough that I don’t need to continue going.
I’m working now on a project in Africa treating vesicovaginal fistulas [a connection or hole between the bladder and the vagina]. This condition, which causes constant urine leakage through the vagina, is a result of problematic delivery. Because they don’t have access to hospitals, a lot of these women are delivering at home. Very often they’re teenagers because they get married at 12, 13 years old, and the pelvis is not well developed. Sometimes you see these ladies laboring for days, the baby dies and they can’t deliver. It’s really a tragedy. What happens in these situations is that the head gets stuck so tightly that it’s basically compressing the bladder onto the pubic bone. Eventually the tissue dies and, when the bladder heals, you’re left with a hole. These women often become ostracized; they become homeless because their husbands have abandoned them and they don’t have jobs or any means to work. In Ethiopia you see lots of these homeless women on the streets and highways.
We’ve been going to Eritrea, which is north of Ethiopia ( Eritrea used to be part of Ethiopia but they become independent about ten years ago). We’re collecting data from our outcomes, and we’re also submitting a grant to the UN to do educational programs and prevention. Eventually we want to expand it to include programs to educate the doctors there to do these repairs, so that they can be self-sufficient. There’s still a lot of work to do but I think it will be fantastic. There’s definitely room for students to go and do projects. The only thing I don’t feel good about at this point is the safety. I didn’t feel very safe when I was there, so we have to wait a little bit so we can make sure that’s not an issue.
Has it been a challenge to balance your career in obstetrics/gynecology with a life outside of medicine? What do you do to maintain this balance in your life?
At some point you have to come to the realization that you cannot do everything. I think the sooner you reach that realization, the better. In my mind, it’s better to pick two or three projects that you like the most, that are the most important to you, and do them well, rather than do a dozen projects and do none of them well. Because I’ve seen that happen with some of my colleagues. It’s bad for your reputation, bad for your personal health, bad for the people who are relying on you. You need to make a choice about what’s most important for you in your life. If other things come up, just remember that there will always be other opportunities, and don’t be afraid of offending anybody. Just say you’re overcommitted, and when you’re less busy you’d be happy to take it. That’s really the key. I have children, and I know I’ve given up a lot at work because of my family. I don’t take as many trips as I used to, I don’t go to Guatemala anymore even though I love going, I don’t do as much administrative work, I’ve cut back on my research to focus on one particular area. It’s because I have made a decision that my children are very, very important to me.
A recently published article in the Science Daily describes how you worked with a team of Stanford medical specialists to care for Koko the gorilla! How did you get involved in this project?
That was really fun! It was the Gorilla Foundation, and I did it because a friend and colleague, who actually does a lot of the animal anesthesia, asked me to come along. It wasn’t something I was actively involved in, but if students are interested in this kind of thing I can direct them to the appropriate places to start.
Interview by Lauren Cochran
