VUMC Reporter Profile: Determination, work ethic mark Chescheir’s path

VUMC Reporter Profile: Determination, work ethic mark Chescheir’s path

If Nancy Chescheir hadn't snatched a mollusk out of the ocean on a spring break trip to the Florida Keys in 1975, she might be scuba diving off a research ship or working in an aquarium somewhere today as a marine biologist.

But that one tiny snail-like creature she held in her hand was at least partially responsible for Chescheir tossing aside a chosen career in marine biology, and instead launching on a trajectory that has led her to become one of the country's most respected leaders in maternal-fetal medicine. It's been a journey that at age 50, brought her to Vanderbilt as chair of Obstetrics and Gynecology and the first woman chair of a clinical department in the Medical School’s 129 years.

Chescheir was a junior at the University of North Carolina when, during a skin-diving trip, she plucked the mollusk from the ocean and showed it to her teaching assistant, who studied it closely. He told her it was the first time this particular mollusk had ever been observed. A zoology major confident that marine biology was the path her life was supposed to take would have been thrilled. Chescheir simply thought, “this is the most irrelevant thing.

“My teaching assistant was just over the top about the mollusk, named it right there while we were paddling in the water, and catalogued it,” she recalls. “All of a sudden I realized this was not the thing for me.”

Chescheir went back to UNC and got a 20-hour-a-week job washing dishes in a lab that's emphasis was on the study of bysinnosis, more commonly known as a cotton worker's lung disease. “That's where I got the bug,” she says. “Even though I just washed the dishes, I was involved in the lab meetings and the PI would come in and talk about the disease. I attended the grand rounds. I just kind of got hooked.”

During her senior year in college, she applied to several medical schools, but didn't get invited to a single interview. At her graduation, she received a Bachelor of Science degree in zoology, and her father told her, “I think I just paid for an undergraduate degree for the world's most educated beach bum.”

Still determined to get into medical school, she went to work for the Environmental Protection Agency at Research Triangle Park doing air quality work in a research lab and worked as a volunteer for the next year and a half at an emergency department in Chapel Hill. When she reapplied for medical schools, she was more prepared, and got invited for several interviews. She ultimately ended up at UNC, her top choice.

Moving around

Chescheir, who turned 50 this year, was born in Garden City, N.Y., where her parents both grew up. Her father, John Custer, was a mechanical engineer who worked for the same company his entire life, and eventually ended up running the company. He was involved in building the third tube of the Lincoln Tunnel in New York, and his job took him all over the country with civilian defense contracting.

Chescheir's mother, Jean, was an artist who spent her life raising her children, allowing her husband to concentrate on his career. She painted, made collages and crafted her own Christmas cards each year. “She kept all those creative genes to herself,” Chescheir said.

One gene that her mother may have passed on was the propensity to develop heart disease at an early age — she died in March 2003 of the disease after suffering her first heart attack in her 50s. “That's one of the reasons I'm passionate about women's health,” Chescheir says. Her father, who retired in Chapel Hill before her mother's death, plans to remarry.

As a child, Chescheir, her parents and brother, John, now an engineer in Indiana, moved around quite a bit, living in Iowa, California and Texas before they settled in Lexington, Ky., when Chescheir was in the second grade. She remained there until she graduated from Tate's Creek High School.

Although her mother was what was called in Chescheir's childhood a housewife, she also was her daughter's greatest cheerleader for having both a career and a family. “My parents sent me and my brother off to college and told us they were happy for us to go, but to come out with something we could have a life with, not with just an interest.”

Her mother's father, who died when Chescheir was very young, believed women should not go to college, that they should stay home and raise their families, that too much education was a bad thing. Her mother, an intelligent woman with great critical thinking skills, completed only a year of junior college.

“When I went off to college it was very clear to me that she wanted me to have more in the way of education, in the way of a career than she did,” she said. “But she was also conflicted, because I remember letters she wrote me in college, talking about how she had real concerns about the changing values for women in our society and what women with careers were giving up. It was clear to her there was a trade off.”

Medical school and a circuitous route to Ob/Gyn

When Chescheir left her job in 1978 at the EPA to go to medical school, her replacement ended up being her husband, George “Chip” Chescheir III, who today works for North Carolina State on a contract basis, traveling back and forth from Nashville to Chapel Hill. They were friends for a while, and married when she was a third-year medical student at UNC.

When she began medical school, she had no interest in Ob/Gyn. In fact, she remembers thinking it would be the last specialty she'd choose.

But during the summer between her first and second years of medical school, she participated in a program funded by primary care at UNC, which put medical students into community settings throughout the state so they could get a taste of primary care. For eight weeks, she lived in an empty patient room in a hospital in Piedmont, N.C., and worked with different physicians each week, including a surgeon, internist, pediatrician and obstetrician.

“The whole process of delivery was fascinating, but what got me were the two Obs, who were toward the end of their careers,” Chescheir said. “Out of 10 deliveries they only made it into the hospital for two, and those were the only two patients with private insurance. The others were Medicaid patients. Of the two they saw, they only spoke once to the mother, and the quote was, 'would you please put your ass on that table?'

“I was pretty angry at the way they were treated,” she recalls. “It was the summer of 1979 and my feminism was sort of at its peak. The patients weren't in any danger, the nurses did a fabulous job, but it wasn't the humane treatment those patients deserved.”

So she chose Ob/Gyn, where she would make sure that her patients were treated with concern and respect. When she entered her residency she intended to go into gynecology oncology — a third-year medical school rotation had piqued her interest — but she found she took her patients home with her way too much. So she turned to maternal fetal medicine.

Chescheir applied to 15 residency programs, but ended up matching at her first choice, and remained at UNC. She and her husband had their first child, Alex, during her third year of residency.

She had “an obstetrician's nightmare pregnancy,” developing preeclampsia, and had her son by C-section. She returned to work as the chief Ob/Gyn resident, decided to do a fellowship in maternal fetal medicine, and had her second son. “There's never a good time (to have children during training),” she said. “You have to decide what's best for your family.”

Chip was working on his Ph.D. in engineering at this point and could normally have afternoons free if either of the boys were sick. Chescheir would get someone to cover for her at the hospital in the mornings, and then would return to the hospital in the afternoon when her husband came home. “It was totally a team effort.”

By the time she finished her fellowship in 1988, UNC wanted her to remain in Chapel Hill. Staying in North Carolina was the right thing to do for their family, she said. After coming there as a college student in 1973, Chescheir remained at UNC until she left this year to come to Vanderbilt.

Her time at UNC was chock-full of experience.

Chescheir has had a clinical care emphasis in prenatal diagnosis by ultrasound, the care of multiple gestations and fetal abnormalities and growth problems. She also has strong interest in, and has published frequently about, women's health issues such as preventive care and cardiovascular health and domestic violence.

At UNC she was deeply involved in the school's educational and clinical missions, serving as associate dean for the Curriculum, acting chair of the Department of Obstetrics and Gynecology from 1996-1997, and director of the fetal surgery program, beginning in June 1999. In fact, she and others in the program traveled to Vanderbilt in 2000 and 2001 to train with Joseph Bruner, M.D., and Noel Tulipan, M.D., who had one of the strongest fetal surgery programs in the country. And the two Vanderbilt physicians went to Chapel Hill for UNC's first two cases in December 2001.

Chescheir also has been a program scientist at the National Institute of Child Health and Development, a division of the National Institutes of Health, working with the fetal surgery trial. She resigned that position because of conflict of interest issues when she accepted the Vanderbilt position in 2004, since Vanderbilt is one of the lead participants in the NIH fetal surgery trial.

Downplaying gender

Shortly before coming to Vanderbilt, Chescheir had interviewed elsewhere to become the first woman chair in either a clinical or research department at that institution. “The people I interviewed with made such a big hoopla that it would change the way meetings were conducted, it would change the culture. They were very blatant about the fact that I would be destroying the 'all boys club.'” She wasn't chosen for that position.

And shortly after that when she got a call about the Vanderbilt chair from Steven Gabbe, M.D., dean of the Vanderbilt University School of Medicine, she hesitated. She has known Gabbe since the late 1980s from their work with the American College of Obstetricians and Gynecologists.

“My mother had just died, I had just lost this position at this other institution, and I said I wasn't ready. He asked me to come and look.”

She did, and met with many different people who made it clear that Vanderbilt is a “terrific” place to be, and who assured her there's a plan to grow the women's health program. “The institutional will is here and the resources are here, and there is a wonderful foundation that Drs. (Steve) Entman (who stepped down as chair of Ob/Gyn in 2004) and (Lonnie) Burnett had built into this place. It became clear this would be a very good move for me.”

Chescheir is “uniquely qualified” to be chair of Ob/Gyn, Gabbe said. “She's experienced in curriculum issues, medical student and resident training, and is one of the best obstetricians in the country. She has amazing people skills and is sensitive to the needs of patients and their families. With her interest in fetal surgery, it all blended perfectly with what we were looking for.”

Chescheir says the fact that she is the first woman clinical chair is nice, but not something she wishes to focus on. “It's great it happened, but I know I wasn't chosen because of my gender. It's time Vanderbilt did it, but it (the fact that she is a woman) shouldn't make much of a difference.”

After spending 80 percent of her academic time on the clinical side throughout her academic career, Chescheir was reluctant to give that up when she came to Vanderbilt. She focuses about 20 percent of her time on the clinical side, and takes call two nights a month. “Labor and delivery at night is an interesting place,” she said. “You learn a lot about the way things work, what the culture of the place is, and I feel very strongly I shouldn't be asking people to do things I'm not willing to do.”

Since coming to Vanderbilt she has been named the Betty and Lonnie S. Burnett Professor of Obstetrics and Gynecology, named after Lonnie Burnett, M.D., the Frances and John C. Burch Professor of Obstetrics and Gynecology, who led Vanderbilt's department for 19 years beginning in 1976. He is credited with expanding the department and breaking through barriers that existed between Vanderbilt and the Nashville community.

She has lofty plans in store for the department — changes she hopes will result in the increase of patients and growth in the department.

She plans to grow the research focus and the faculty and expand some of the subspecialty areas. Change can be difficult, she says, but not so bad once the pain is over. And, in a pretty funny analogy for an obstetrician, she says, “the only person who really likes change is a baby with a wet diaper.”

Ted Anderson, M.D., associate professor of Obstetrics and Gynecology at VUMC, had been in private practice in Nashville since he completed his residency in Vanderbilt in 1999. He was looking at joining the faculty of another medical school when Chescheir called him shortly after she arrived at Vanderbilt.

“We met at Starbucks and she talked about her vision for where she wanted to see the department go, and we talked about my goals. It became obvious the two (her goals and his) were overlapping,” he said. “She has an infectious enthusiasm and an incredible vision of greatness for this department. I share her vision and I'm fully confident in her ability to lead us there,” he said.

Chescheir is also a true believer in what advanced practice nurses have to offer. Nurses, in Nancy Chescheir, have found a wonderful advocate.

“I don't think I appreciated nurses until I was out of my residency,” Chescheir says. “Many doctors, particularly those fresh out of medical school, have to prove themselves — 'I'm the doctor. I know how to do things.' I ran into an awful lot of nurses who made it very clear that that in fact, was not the case,” she says, laughing.

“Over time I've gained the maturity and insight to realize that health care is a team effort. I just finally got it. While doctors are the one in the traditional setting, setting a treatment plan, it really is a much stronger, robust plan when there are nurses on board.”

Chescheir is a strong advocate for the nurse midwives who deliver patients at Vanderbilt University Hospital. “An awful lot of wonderful obstetrical care can be provided by nurse midwives,” she said. “Their care is much more patient focused and more holistic. This is a normal process women are going through, most of the time, with normal healthy outcomes, and in general childbirth is over-medicalized.”

And Chescheir realizes the implication of what she's saying — that she, in fact, might be talking herself out of a job.

“It's a legitimate thought, but with the cost of health care, as much of normal health care that can be provided by advanced practice nurses, the better. They can deal with the vast majority of normal preventive health and routine care.”

Bonnie Pilon, D.S.N., professor of Nursing and senior associate dean for Practice in the Vanderbilt School of Nursing, meets frequently with Chescheir and likes what she sees.

“Nancy is an absolute collaborator, from her vision in leading on down to getting the work done every day,” she said. “She believes very much in the normal OB domain of nurse midwives. You can say it, but not act on it. She lives it.”

Pilon says there is no professional competition between Chescheir and the advanced practice nurses. “It's not there. The absence of any tension about professional roles allows us to synergize all the time. It's a think tank on wheels, moving from one venue to the next. She seeks ideas, listens to what you say, and bounces ideas off of everyone. She's conquered inclusiveness. She's changing us in small ways and in big ways.”

Wife, mom, photography enthusiast

Chescheir, who just returned from a 25th anniversary trip with her husband to Spain, enjoys traveling — she and her family have been to the Virgin Islands, Russia, Helsinki, Paris, Italy and Hawaii to name a few.

Another hobby is photography. She takes online photography courses, like a recent one on composition, to expand her knowledge of the art. She also enjoys food (eating and cooking) in her free time, and works out four to five times a week.

She is immensely proud of her sons, both of whom are following in their father's engineering footsteps. Alex, 21, is a junior at Rensselaer Polytechnic Institute, pursuing biomedical engineering, and Stuart, 18, is a freshman at Virginia Tech, also considering biomedical engineering.

Stuart said although he and his brother always were aware that their mother had important responsibilities at work, her priorities were always crystal clear. “She hired a nanny when we were five, but it was a just-in-case thing,” he said. “She came home every day, cooked, hung out with us, and we had normal family activities. It was obvious she had a hard job, but it was also obvious that we were her first priority.”

Asked to describe the woman he calls “one of my best friends” isn't an easy task for Stuart. He laughs for a minute, then puts it simply: “My mom is a lot like me. She's ambitious; she's stubborn; and she will speak her mind whether you like it or not,” he says. “But there's one difference: she's learned to hold her tongue a lot better than me. But she's had 50 years of practice.”