Elaine Tseng was 18, just about to start college at MIT after taking a fantasy road trip from her native North Carolina to the West Coast. It was on a beach in South Carolina that fond memories were abruptly replaced by a nightmare. Nauseated and vomiting, her heart on a pounding tear, she ended up in an emergency room. The ER doctors found nothing major wrong with her, but when she returned to her native state, her doctors found what those in the ER had missed -- viral myocarditis. Tseng was transported to Duke University by helicopter and spent two weeks in the hospital, waiting to see if she would recover -- or if she would need a heart transplant.

"I was told at the time that among those with myocarditis about one third die, one third recover and one third have chronic disease," Tseng says. "I was among the lucky third who completely recover."

As a result of her disease, Tseng got a crash course in cardiology and acquired an intense interest in the subject. "I probably would have done engineering or something if this hadn't happened," Tseng says. "But I had good doctors at Duke and I decided I would go into cardiology."

Those plans changed somewhat when Tseng was actually in medical school at Harvard, where she found enjoyment in the surgery rotation. She spent a month during her third year at Brigham and Women's Hospital being schooled in cardiac surgery, a field that combined her interests in cardiology and surgery.

Tseng trained in general surgery and cardiac surgery at Johns Hopkins University. Strangely enough, Tseng then suffered a second bout of myocarditis. This time was much scarier than the first, Tseng recalls, because she now knew enough to understand the risks of the disease. Having a second case of myocarditis after recovery is also "incredibly rare," she says. "I think I am even a reportable case, and they will probably publish it at some point." Once again, Tseng recovered completely.

Fellowships at Johns Hopkins followed. Tseng joined the UCSF faculty in 2002. In addition to her work as a cardiac surgeon at the UCSF Medical Center, Tseng investigates the mechanisms of neurologic injury after cardiac surgery, and methods to protect against such damage. Although she does many specific types of cardiac surgery, her "true love" is aortic surgery. "It's technically challenging and fun to do, especially if you are doing valve-sparing aortic root replacement surgery," Tseng says. "If we had an aortic center I would love that."

Demands of surgery

As a fairly recent surgical trainee, Tseng has a somewhat different perspective on being a women in cardiac surgery than some of her older female colleagues. "It's different now than it used to be -- there's much more of an acceptance now" of women cardiac surgeons, Tseng says. "There's never been as much an issue with other physicians as there has been with patients, who are sometimes not used to having a woman surgeon."

Whether a physician goes into surgery or not now depends more on personality than gender, Tseng feels. "If you are a woman in this field you have to be aggressive, but that's basically what a surgical personality is," Tseng says. "The nature of surgery is that it is an active endeavor in which you actively do something that can make someone better or worse, and you see the results right away."

Being aggressive as a surgeon, however, doesn't have to mean being difficult or unpleasant personally, Tseng says. As someone who was rather shy in medical school, Tseng was heartened to be trained by David Adams, who was both a good surgeon and an "excellent human being," she says. "Adams was very nice, and I thought that if someone this nice can do this [surgery] that I could too."

Over time Tseng has become less shy and has adopted a more stereotypically "surgical" personality, but she doesn't know whether she acquired that by being in a surgical environment or whether it was something that had always lurked inside her.

If she were to give advice to women thinking about doing surgery, Tseng would tell them how time-consuming it is. "I would have liked to have known starting out how your life gets absorbed by it," she says. With a training period that can last ten years or more, surgeons often find it difficult to balance life, work and family, she says. "When I was starting [surgical training] at 26, I really didn't think about the fact that I would be in my mid-thirties when I was done."

Even after training, surgery continues to dominate her life. Although Tseng has been in San Francisco for almost a year, she says she hasn't had much time to explore or enjoy the city -- or even to get her own house in order. "Right now I am studying for the boards, but eventually I would like some time to fix up the house and get the garden working."