Pulling Back the Curtain on Transplant: A Surgeon’s View of Kidney Donation, Matching & What’s Next

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DR. SHLOMIT SCHAAL: Hello, I'm Dr. Shlomit Schaal and I'm the Chief Physician Executive at Houston Methodist. Welcome to our webcast Women in Surgery, where we highlight some of the best surgeons at Houston Methodist, all of them just happen to be women. And today I have the great pleasure of hosting Dr. Stephanie Yi.

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She is a Pancreas and Kidney Transplant Surgeon and also the Director of the Kidney Transplant program here at Houston Methodist. Welcome, Dr. Yi. DR. STEPHANIE YI: Thank you for having me. DR. SCHAAL: I am pleased to have you. Tell me, how did you become to be a transplant surgeon? DR. YI: That's a great question. Mentorship really is what drove me to transplantation. I did my residency training and my fellowship training here, and from day one as an intern,

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Dr. Osama Gaber was my mentor. Just randomly selected, randomly paired. And I can -- I guess you can say the rest is history. DR. SCHAAL: So before that you had to elect to become a surgical resident. So that's even, you know, kind of okay well, before becoming a transplant surgeon, you became a surgeon. How did that happen? DR. YI: So that was completely unexpected as well. I went into my third year of medical school putting surgery completely last in my clinical rotation

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because I thought, "There is no way I'm ever going to be a surgeon." DR. SCHAAL: Why did you think that? DR. YI: Well, I just figured I didn't, you know, to be honest, I didn't know too much about surgery. I had seen some surgeries as a college student, you know, just kind of feeling around what I think I may like in medicine. But, so when you're planning your schedule for medical school, you're gonna try to aim for putting your most competitive rotation as your third rotation right before you start

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applying for residency. And so I thought the last one is usually the one you just need to get over with. And that was surgery for me. And lo and behold, I did my surgery rotation and I absolutely loved it. It was horrible because it derailed every plan that I had. DR. SCHAAL: So what did you want to be? DR. YI: I thought I would be like a neurologist. I really thought it was fascinating that they just -- all the pathways and the brain stuff. I just thought it was really amazing. And I did my rotation in neurology,

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I thought it was okay. You know, I thought, "Okay, well, I'll learn a little bit more about it when I'm a resident." And then I went into surgery, zero expectations, just thinking I just need to get through this and then I'll be a fourth year medical student, I'll be applying for residencies and I absolutely fell in love. DR. SCHAAL: So what was it about surgery and that rotation that made you fall in love with surgery? DR. YI: I just didn't -- I never imagined how fascinating it could be. I never imagined how just amazingly,

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just, tactile things were, and how the surgeons weren't just technicians, but they actually were physicians too. They had to know everything there was to know about what they were doing. I found that I was actually okay with my hands, I didn't pass out in the operating room. And my rotation would go by like that. Like every day I would look at the clock and be like, "Wow, the whole day is done already." And that had never happened to any rotation that I was in. And I just remember talking to some of the surgeons

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that I was rotating with and getting a lot of advice about, okay, so what do I do now? Like this is not anything that I -- I'm a planner, completely a planner. This -- Completely derail. I had sub-Is that were all scheduled in other fields and stuff like that, and away rotations, and I had to completely change all of that because I had found this love for surgery. And it wasn't even like I liked any particular part of surgery I just, I loved it. And an interesting story is as a resident,

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as a medical student, I actually saw my first kidney transplant having known nothing really about transplantation, and I thought that was just amazing and it kind of stuck with me. But it was a very small part of my rotation and so never really thought much about it until I started my residency. DR. SCHAAL: So residency you did here at Houston Methodist? DR. YI: Yup. DR. SCHAAL: How long is the residency here? DR. YI: The residency here is five years. You can elect to do like a one or two year research

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fellowship if that's something that is interesting to you. DR. SCHAAL: During those five years or extra? DR. YI: During the five years. Well and it's extra, sorry. So, it could either be in-between the five years or you can add it on before or after. DR. SCHAAL: Did you do that? DR. YI: I did one year. I did an Outcomes Fellowship here at Methodist as well under Nelda Wray and Carol Ashton, who are some of the more predominant outcomes researchers. They've since retired, but I learned a lot about

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outcomes research and really kind of thinking about data and we were pretty productive that year, which was great. DR. SCHAAL: Fantastic. DR. YI: And then in the residency you can also elect to do other things like get your MPH or your MBA, things that I -- DR. SCHAAL: You have time for that? DR. YI: I did not, but people can, if that's what they elect to do. DR. SCHAAL: And people do? DR. YI: And people do, yeah. If that's something that benefits them and their long-term career goals. DR. SCHAAL: Wow. Because I always imagined a surgery residency as being a full time -- more than a full time job,

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that you don't time to do anything else. DR. YI: Well, you do have to carve out that extra year or two, but you're right, it can be pretty time consuming and pretty demanding. DR. SCHAAL: So, how hard was it to change your plans, you said your planner, and then get into that spot? How competitive it was? And the second part of that question is, still surgery is in the mind of most a very manly, you know, superhero profession,

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was it hard for you to get in? DR. YI: You know, I think I was pretty lucky. Obviously, I matched, I interviewed in different places. I was able to get interviews. I think that's the first step when someone is interested in pursuing surgery for residency. And I matched in one of my top choices so I was pretty fortunate for that. But in terms of, like, the manliness of the profession, I think, you know, I went to medical school a while ago, and the ratio

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of boys to girls in our class was nearing more the 50% mark. So, I think there was already a shift in the number of women in medicine... DR. SCHAAL: Okay. DR. YI: When I was there. And I had a couple great mentors in medical school that were women surgeons. And so that already started to kind of play into to my thought process. But one of the things, I would say, that really connected me to Methodist was when I interviewed for residency and Barbara Bass was the Chair

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and I was like, there is a woman and she is the Chair! DR. SCHAAL: We interviewed her for one of our episodes. Yes, this is coming up, but great. So you saw a woman as a Chair of the Department of Surgery, okay. DR. YI: And I was like blown away. I was like, "This is amazing." I -- she was just -- She had such an amazing vision for Methodist Hospital and for the training program. And I think that's really what made me rank Methodist high on my list. I think coming in I didn't really have that expectation

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to do that, but when I met her and I met the faculty and I met just Methodist Hospital in general, that was another real big moment for me because it really kind of confirmed, or reaffirmed, what I wanted to do. DR. SCHAAL: So five years of residency plus another year of outcome research, six years and then you go to fellowship? DR. YI: I did. DR. SCHAAL: Okay, so tell me more. DR. YI: So, at the time I was thinking, "Well, I wanna be a kidney transplant surgeon.

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There is a fellowship program at Methodist, and interestingly Dr. Gaber was the program director so it was pretty -- a nice transition. I did apply to other places, but at the end of the day I really wanted to stay here and train with the people that were really influential in my decision in wanting to pursue transplant. DR. SCHAAL: So tell us a little bit about kidney transplant. I mean, I don't know if everybody can imagine, you know what it is like, you know, what do you have to do as a surgeon? Do you work alone? Do you work with a team?

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How is that whole process working? DR. YI: So, kidney transplantation is a multidisciplinary field. It has surgeons, obviously, it has nephrologists, it has medicine physicians, it has coordinators, social workers, dietitians. Every aspect of medicine that you can think of goes into kidney transplantation. There are an alarmingly high number of people in this country and worldwide with end-stage renal disease. DR. SCHAAL: What is the major reason for that?

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DR. YI: Most of the time it's due to diabetes, sometimes hypertension, although we don't know if hypertension is just a byproduct of the end-stage renal disease, but a lot of the time it's from diabetes, which is also on the rise here in America. So we have more and more patients that need, that are on dialysis and/or need a kidney transplant. DR. SCHAAL: So before somebody needs a transplant, is there opportunity to stop the disease in early stages?

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DR. YI: There are. I think preventative medicine, in my opinion, is the really big way to go. I mean, certainly there are people with kidney diseases that are genetic and they're predisposed to it, but there is an overwhelmingly large number of people that acquire the disease. And I think there's a lot of room for improvement in that sense. DR. SCHAAL: How so and do you see that in other countries? DR. YI: Yeah. So, I think we see a little bit of it in countries that are not as obese as America.

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DR. SCHAAL: Mm-hmm. DR. YI: In terms of how we can try to start changing that, there's always been a big push for many years, you know, for people to eat better and exercise. Those campaigns aren't as effective. Interestingly, we had a big nephrology conference here in Houston, the ASN, as well as the George P. Noon conference that we host here at Methodist. And there were a few speakers talking a lot about the use of GLP-1s which we know is like Ozempic and other types of weight loss/diabetes medications.

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DR. SCHAAL: So this is -- These medications have been in use for the last several years, do you see a drop in kidney transplant or not yet, it's too early? DR. YI: I don't know if we're gonna see a big drop right now, but I think there's some early data suggesting that improving one's overall health from a metabolic standpoint can improve the progression of chronic kidney disease. And even though I love doing kidney transplants

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and getting people new kidneys, I would love to see more for people to not get to that point. DR. SCHAAL: Yeah. How many kidney transplants do we do here every year at Houston Methodist? DR. YI: We do almost 300 kidney transplants a year. A lot of what we do are also from living donors, so we do a lot of living donor kidney transplant. DR. SCHAAL: So, what's the difference? DR. YI: So, living donor kidney transplants are kidneys that are coming from a live donor, someone that may or may not know you that want to donate.

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And they'll donate one kidney and that will go to a recipient. The other part is the deceased donor kidney transplant. Those are people who don't have a living donor and they sit on a waitlist. And if there is a deceased donor somewhere either locally or nationally and they match the person on the waitlist, then they'll get what's called the deceased donor kidney. DR. SCHAAL: So when you say match, what do you actually match? DR. YI: So they match blood type,

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and they also match kind of what we call immunologic matching, which is an antibody profile from the potential recipient to the donor. And then there's waitlist time. So, obviously if you just made it on to the waitlist, you're probably gonna wait a while because you're gonna be on the bottom of the list, versus someone who's been on dialysis for a lot longer, they'll be higher up on the list. DR. SCHAAL: So, you know, I'm thinking about, you know, your typical patient. So, your typical patient is probably has kidney

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disease and a lot of other diseases. Am I right to assume that? DR. YI: There's definitely multiple disease etiologies that we see in our patients, more so with other organs as well. So, they may have kidney disease, but they can also have heart disease, liver disease, autoimmune disease. DR. SCHAAL: So, you're getting them and then that's where the team comes to envelope them and assess them and get them the best treatment,

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not only the kidney treatment, but every other specialty. This is what we do here at Houston Methodist? DR. YI: This is what we do here. And it's amazing because we have so many great specialists in all of these fields. It really makes our job -- I don't wanna say easy, easy, but it makes it a lot more accessible, especially for these patients. DR. SCHAAL: So, how do you coordinate all that care? There are people that coordinate that? How does that work? DR. YI: We have coordinators and we work very closely with our nephrologists. It's really a team effort between the nephrology teams and the surgeons to really kind of provide

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this really complex multidisciplinary care. DR. SCHAAL: And how many transplant, kidney transplant surgeons, we have here? DR. YI: We currently have three full-time kidney transplant surgeons. One of them is also a surgeon scientist, which is amazing because there's a lot of things within the field of transplantation that is new. For example, learning immunosuppression, how we can try to prevent rejection, identifying our outcomes, seeing what we can do

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as a center to provide the best outcomes for patients, both on the medical side and the surgical side. So, we have a surgeon scientist on our team and then we just recently hired one of our prior fellows. DR. SCHAAL: Oh, fantastic. So the team is growing to meet patient demand. And is kidney transplant done only here in terms of Houston Methodist or is it done somewhere else in our system? DR. YI: We do it only here at Methodist main. A lot of our patients may come from the other outside hospitals or get referred from our

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referring partners in the community. DR. SCHAAL: So, it doesn't make sense to have a kidney transplant in every single hospital? You need one center? DR. YI: It's -- Yes. I think just because of the resources that are required and our teams are all here as well. DR. SCHAAL: And you said that there are two options, major two options. I, you know, I'm reading in the news that there's another option, we'll talk about it later, but basically the major things is either deceased donor or a live donor. What do you prefer?

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DR. YI: I prefer living donor because number one, we know about the donors. You know, oftentimes the deceased donors there's only so much information we can get. And then number two it's scheduled, we can plan for it. If the recipient gets sick, we can postpone it, reschedule. If we need to do a little more workup on a recipient just to identify an issue or to make sure we have the appropriate care afterwards, we can plan for these things. So, living donation, I think is really a great way to get people transplanted

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and get them quickly. Because once you have a living donor, you can go. DR. SCHAAL: Right. But is it safe to live with one kidney? DR. YI: Absolutely. Our living donors have done well. They are thoroughly screened, so -- and they sit through a multidisciplinary review board just like the recipients do to make sure that it's safe for us to take them through donation and that the risk of developing end-stage renal disease in their lifetime is relatively -- DR. SCHAAL: Does that happen or no? DR. YI: I'm sure it can happen.

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DR. SCHAAL: But you make sure that you take them. And then how old are they, the donors? Is there an age, kind of, bracket that you use? DR. YI: Well, we only do adults here. DR. SCHAAL: Yes. DR. YI: So they have to be 18 or a legal adult. And we've done donors all the way up until their 80s. It really just depends on their overall health and their kidney function. DR. SCHAAL: So an 80-year-old kidney can be good for transplant? DR. YI: It can, yeah. Absolutely. DR. SCHAAL: Amazing. DR. YI: Obviously depending on the person. DR. SCHAAL: Yes. No, but it's interesting to know

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that there's really no age limit for the donor. I didn't know that. That's interesting. So, what about these news that we are all reading about transplant from non-humans? DR. YI: Yes, the pigs. So, as you know, transplantation, I feel like it kind of goes in waves. You know, we've talked about this like many years ago, 20-30 years ago, and it kind of took a brief pause and now it's back on the upsurge. I think any way for us to get organs for people that are already in the position of having

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end-stage renal disease is the way to go. I mean, we need to figure out how to get this somehow. You know, our current system of waiting for someone to pass away, or trying to conjure up more living donors, that has been relatively stagnant over the years, despite a lot of programs and policy changes and initiatives from different groups to try to promote donation. So, xenotransplant meaning, getting, you know, organs from non-humans is on the upsurge because

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of genetic sequencing and the ability to edit genes. As you can imagine, the problem of putting a pig organ into a human is not only is it, you know, non-human to human, but the risk for rejection can be quite high. And so that's where the gene editing comes to play. There are several studies and trials that have been going around and new pigs to come where additional genes-- DR. SCHAAL: So, is the genetically modified

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pigs that are really grown for the purpose of taking their kidneys for transplant in human? And has this been successful or not? DR. YI: I think some of the early work had showed promise, is what I understand. DR. SCHAAL: Okay, you don't think that you're gonna do this anytime soon. DR. YI: I mean, I would love for our center to participate somehow. I mean, there's -- We're not trying to say our patients are gonna be test subjects, but there's clearly patients that just can't get transplants.

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And so while they're waiting either they die or we try to give them an opportunity. DR. SCHAAL: With kidneys. Still people die from end-stage renal disease while waiting for transplant? This still happens? DR. YI: Yeah. And so if there's a group of patients that we can find where they're willing to try something, which is kind of how these other centers were able to recruit patients, then that would -- that could be really interesting, especially as the technology kind of advances and there's new -- DR. SCHAAL: So, these patients that get new kidneys,

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they have to take immunosuppression for life. DR. YI: Yeah. DR. SCHAAL: Did immunosuppression become better over the years since you've been doing it? Did it become less aggressive and more livable with and, you know, more safe? DR. YI: So, I think so there's one thing in transplantation that we quite haven't cracked the code on and that's how to get people rejection-free over their lifetime. DR. SCHAAL: Mm-hmm. DR. YI: Immunosuppression is still a pretty harsh drug.

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It's not as bad as what it was a long time ago, before some of the newer agents like tacrolimus and some of these, like, what we call CNIs or calcineurin inhibitors have come out. But it's been many years since something new has really come out. And so, to answer your question, I think we've seen stronger immunosuppressive agents in the sense that we haven't personalized the regiments yet for people because we don't have that yet. I think that would be a really great next phase.

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I did work on some research in the RI with some of our immunology teams and there's some fascinating work they're doing on single cell sequencing, trying to see how we can identify the genetic sequencing of that particular rejection pattern in that individual. And if we can find some kind of marker that can tell us, okay, too much immunosuppression or maybe try this immunosu -- a different type of immunosuppression, that can really eliminate problems

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that a lot of our patients face when it comes to immunosuppression, like concurrent infections and stuff. But, you know, I feel like it's coming and that's gonna be -- DR. SCHAAL: Okay, good, good. So, you're optimistic that new medications are coming? And then actually a crack of the code, you said. Is right now everyone is gonna have rejection at some point at some level? DR. YI: Not necessarily, but intrinsically I just, it's, you know, that's the downfall of transplantation. DR. SCHAAL: Uh-huh.

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DR. YI: You know, we put a foreign thing in somebody and we have to try to suppress the immune system. But I think the overwhelming majority of people do fine. We just haven't done it so that we don't have to worry about it and these patients do have to take immunosuppression for the rest of their lives. DR. SCHAAL: So, you talk about the team, and your major role in the team is actually to do the surgery. What have -- what has changed over the years in the surgical technique? Has it become easier, better? I don't know. You use robots? DR. YI: Yes. So, we were really good

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at doing this operation open. And so the next iteration is a more minimally invasive approach. So, I do both the donor surgeries on the living donors as well as the kidney transplant implants. DR. SCHAAL: Okay. DR. YI: From a living donor standpoint, I think it's been laparoscopic since the 90s. So, it's been a minimally invasive approach a long time ago. Patients would have this humongous incision that would extend from the front all the way to the back. And you know, it's quite uncomfortable. DR. SCHAAL: That's the donor. DR. YI: That's the donor.

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But these people are amazing. Like they just -- They love their loved ones so much, they would do anything. Nowadays, we do small little laparoscopic incisions and a slightly larger incision just to pull the kidney out and patients do great. We've also started doing robotic donor nephrectomies as well, so that's removal of the kidney, but using the robot, and that's been a nice adjunct to our tool kit. We always wanna have a tool kit so we can -- DR. SCHAAL: So you are now operating with robots as well? Was it hard to convert?

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DR. YI: Not to -- I started doing it when I was a fellow. I started learning to use a robot a little bit as a fellow and was able to adopt it into my practice. DR. SCHAAL: Is there an advantage to the robot in living donors? DR. YI: I think so. I mean, I feel very comfortable doing it laparoscopically, but for some donors I think the robotic approach is nice. The instruments kind of triangulate a little differently and there's a little more flexibility in the laparoscopic -- in the robotic arms compared to the laparoscopic arms. And so, for some patients that could be very beneficial.

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DR. SCHAAL: So, I bet that surgery, you know, you have a living donor, you really need like zero complications, if that's possible. That's what you're aiming for? DR. YI: Yeah, that's the 100% the goal in living donor surgery. And you know, people who don't -- volunteer to be a living donor are just the most amazing patients I work with. And they're completely selfless. They come into this operation that they don't need that is only full of risk for them, in terms of physical risk, but they're just are so invested of helping save someone's life.

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DR. SCHAAL: And this is not necessarily family members, correct? DR. YI: No, it could be friends, it could be a friend of someone of a friend, and it can also be people who we call non-directed, meaning they just feel so inspired to want to donate. They don't have anybody in mind and they just come forward and say, "I would like to donate my kidney." DR. SCHAAL: Wow. DR. YI: And then we find it a recipient for them. DR. SCHAAL: Amazing. Okay, so that's the donor part of the surgery, then what do you do with the kidney after you take it out?

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DR. YI: Yeah so, the recipient part of the surgery is -- DR. SCHAAL: Hold on, what do you do with the kidney? You put it in the refrigerator? What do you do? DR. YI: Yeah no, the kidney comes out and we flush the blood out and cool it down pretty rapidly. We use saline with some heparin here. You can also use what we call preservation solutions. And the key is just to get the kidney cool, then we kind of clean it up and get the vessels all exposed so we can sew it into the recipient. And then the kidney goes to the recipient room. DR. SCHAAL: Immediately? Oh, so the recipient is waiting

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in the next room? DR. YI: Mm-hmm. DR. SCHAAL: And who does this? DR. YI: So, it is two different teams. DR. SCHAAL: Okay. DR. YI: So that, you know, both patients don't have any compromises. But -- So, what normally happens on a living donor day is you -- I'm normally doing the living donors for most of the cases, and then we'll have another transplant surgeon like Dr. Osama Gaber, who also likes to do a lot of the living donors, so he'll be the recipient surgeon. Once the recipient is cleared for surgery then we actually start with the donor first.

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And the surgeries are kind of staggered, so after the donor's gone to sleep then I usually have the recipient team roll with the recipient. So, then the recipient goes to sleep with the anesthesia, gets some lines placed, and then the surgeon for the recipient will get the area all set up to where the kidney's gonna go. So, they make incision, they dissect out the iliac vessels. DR. SCHAAL: Do they take a kidney out or no? DR. YI: No, we leave all the kidneys in. DR. SCHAAL: You leave it there? You never take it out? DR. YI: Unless they have really big polycystic kidneys and we would need to take it out at the time of.

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But that's a very rare occasion. DR. SCHAAL: So, normally you leave it there, you just need to add another kidney? DR. YI: Which is a very crazy part of kidney transplantation compared to other transplant organs. Other transplant organs, there's only one place where those organs can go, right? The heart can only go one place. The lungs can only go in one place. The liver can only go in one place. The kidneys, we can be creative. [Laughing] We actually put it down in the pelvis on the iliac vessels, which are the vessels that, as you know, split off into the legs. DR. SCHAAL: So, you put it in a different orientation?

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DR. YI: Yeah, we can. And it doesn't matter which laterality of kidney you get, we can put it on either side. It doesn't matter. DR. SCHAAL: Okay. DR. YI: Yeah. DR. SCHAAL: And then you connect everything, the blood vessel, how do you do that? DR. YI: Yeah so, once the kidney's cooled off on the donor room, it gets handed off to the recipient team. The recipient team takes the kidney back into the recipient room and then they clean up. So there's a renal vein, there's a renal artery and there's the ureter. They're all stapled off and that's how we're able to get it out of the donor. And the staple lines get cut off and then they

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bring it to the patient and then we have the, usually it's the right or left, it doesn't matter, but normally the right side on the external iliac artery and vein. And we actually do what's called an end-to-side anastomosis using the iliac vessels in the recipient with the transplanted kidney. And because we're lower down near the pelvis, we're also next to the bladder and so we can sew the ureter directly onto the bladder. So we don't have to disconnect the old kidneys, we don't have to go searching for anything else. It's all just right there. DR. SCHAAL: Uh-huh, interesting.

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And you make a hole in the bladder? DR. YI: Mm-hmm. DR. SCHAAL: Interesting. And this is done by robots as well? DR. YI: We can, yes. We started our robotics program here a couple years ago. We did the first robot kidney here at Methodist, which I hear is also the first one in the Texas Medical Center, which was exciting. A lot of other centers have started to pick that up as well, just because it seems to give us another opportunity to get to patients that are maybe a little larger than would be safe to do open. So just trying to reach more patients. DR. SCHAAL: Amazing. Well, this is sounds amazing and thank you for describing

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in such detail so we can imagine this. I also know that you're also a pancreas transplant surgeon. So, how is that different? How often is that surgery? Who is that for? DR. YI: Yeah. So, pancreas transplantation is not as common. It used to be for really brittle Type 1 diabetics, but we've able to, as a transplanting pancreas community, extend that criteria to almost -- certain types of Type 2 diabetics.

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But basically, it only comes from a deceased donor, at least in our center. And we sew it in in a very similar fashion as the kidney. The pancreas has a blood vessel supply that we have to extend and then we sew it into the iliac -- DR. SCHAAL: You take the entire pancreas from the deceased donor? DR. YI: Yeah. DR. SCHAAL: The entire. DR. YI: The entire pancreas and it also includes part of the duodenum that is at the head of the pancreas, that comes out of the donor as well. DR. SCHAAL: Mm-hmm.

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DR. YI: And so when we sew up the pancreas to the iliac vessels, there's a portal vein which is like a venous drainage, and we will extend that if we need to with additional vein from the deceased donor. And then we have the splenic artery and the SMA, the superior mesenteric artery, which comes off of the pancreas as well for the blood supply. And we can get a wide -- iliac vessels from the donor. Again, this is a deceased donor, and we'll create a Y-graft onto these two arteries so then we just have one additional

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connection onto the iliac, or you can go up a little higher. DR. SCHAAL: So, why is it not as common? You said the main reason is diabetes. Why is it not as common, the surgery? DR. YI: Not every diabetic qualifies, but not every donor, I have to admit, right now, is a pancreas donor. DR. SCHAAL: Uh-huh. DR. YI: So it's a little selective. And -- DR. SCHAAL: Why is that? The pancreas doesn't -- is not as resilient as the kidney or? DR. YI: Well, unfortunately we have a larger

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patient population. You know, obesity is on the rise, a lot of patients with metabolic disease. DR. SCHAAL: So, the pancreas is not as healthy as the kidney? DR. YI: It's not as healthy. DR. SCHAAL: Wow, I didn't know that. Okay so, how can you keep your pancreas healthy? What do you need to do? DR. YI: That's a good question. Lots of healthy living, good checkups and exercise. It all is part of this metabolic syndrome that we see in patients. DR. SCHAAL: Well, it's a very inspiring to sit here and listen to you. And I know that, you know, you're doing all of that,

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which sounds amazing and very time consuming, but I know you also have, you know, a private life. So, tell us a little bit about that and how you balance, if there is a balance. DR. YI: So I am, I'm married. I have a wonderful husband, we're both from California originally. He came out to Houston for me when I matched here for residency. He was finishing up business school in California, and decided to set sail here since I was here

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and he found a job here in Houston, which was great. DR. SCHAAL: How proud is he? DR. YI: I hope he's really proud. [Laughing] I'm certainly very proud to have him because he's very supportive. I mean, I have a very demanding career, he has a very demanding career, but somehow we make it work and I think that's really a testament to him and his ability to really be supportive despite. DR. SCHAAL: Yeah, it sounds like your schedule is a little bit less predictable.

31:00–31:30

DR. YI: A little less predictable, yes, but his schedule was -- It can be quite challenging, too. He travels sometimes for work. He doesn't travel as much as other people in his field, possibly, but yeah, we do try to make it work. DR. SCHAAL: And you have also children? DR. YI: I do. I have two. I have a daughter who just turned ten and I have a son that's gonna turn eight in January. DR. SCHAAL: So, when you were pregnant and you were operating when you were pregnant? DR. YI: I was. So I was -- I had my daughter when I was a fellow. DR. SCHAAL: Uh-huh.

31:30–32:00

DR. YI: Which I'm not sure -- Obviously you can't plan life. We thought we planned it well and that it was very challenging, but I think it was, it was great. My -- I had a lot of support with family to help out once, you know, I have a little baby, but you have to get back to work, yeah. DR. SCHAAL: But you had to carry her while doing the surgery. How tough this is? I'm asking because my daughter's pregnant and I'm like, "Oh, this is very difficult." DR. YI: Yeah, yeah. I guess we just made it work, right. DR. SCHAAL: Okay. [Laughing] DR. YI: Yeah. I remember the -- When you have your first child

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it's always like, who knows what's gonna happen? And I think -- But it was fine, I didn't go into labor in the operating room or anything. And I think there was a period where I was like, "Okay, I think there's probably a time where maybe I shouldn't be doing as much." And then for my son I was an attending already and I remember thinking, "Oh the first one went fine, so no problems. I'm gonna just do everything." And I did. I worked all the way up until I had my son, but it was a funny story because I was still operating and I think I operated the day that my

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water actually broke. And I was hanging out in my office and all of the assistants knew that I had my, like, to go bag in my trunk in case, you know, I was ever gonna go into labor. And I was gonna have my baby at Methodist 'cause I'm like, I operate in Dunn 6 and that's where our labor and delivery is, so if anything happens you can just wheel me, you know, across the hall. And so I was sitting in my office thinking, "Well, I wonder if I should go home?" You know? And I just had this weird feeling like maybe I shouldn't go home yet. And I wasn't dri -- I was like way too big.

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And my dad was visiting because he was hoping to meet his new grandson. DR. SCHAAL: Yes. DR. YI: And he came to pick me up and we went to my house and then my water broke. And so I just -- We turned around, came right back. And I remember I was walking back to work and people were like, "What are you doing here?" And I was, like, holding my suitcase and just kind of walking back. DR. SCHAAL: I'm coming back to work. DR. YI: I'm coming back to work! Yeah, just -- We were just kind of -- Our bodies are so resilient, it's really amazing. DR. SCHAAL: Fantastic. And what do these little kiddos think about their mom, that superhero mom that does fixes and really

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saves lives of people? DR. YI: I mean, I think they are very understanding with what I do. I mean, there was definitely times where I am not home, or I'm not there to see them do certain things and you know, it just -- You know, as a mom you feel guilty that you're not always there to see them. DR. SCHAAL: I know. Don't tell me. I have four kids. I know about guilt. DR. YI: You know, but they're very understand -- They're really great kids and they're very understanding and they know "Well, mom's going out and she's gonna do a surgery

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and she's gonna help out," and, you know. And I think that for me, that's really great and I really hope that I can set a good example for my kids. DR. SCHAAL: Yeah. And I think everybody that is listening probably or watching us today feels the passion that you have towards your profession. And it's really inspiring to see how you manage it all. Any advice for someone who might be in medical school that watches us today and thinking, "Maybe it's for me, but it sounds a little bit intimidating and I know

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you know, it's amazing and progressing and it saves people's lives." Any advice? Any words of wisdom? DR. YI: Yeah, I would say number one, try it. Like, if you're just worried about what if it's too busy, I don't think I'm gonna do it. You'll never find yourself in that place. I feel like I did that a lot when I was in medical school, I was like, "I'm never gonna go into surgery, so what's the point?" And then you try it and you're just like, you know, it really opens your eyes. Like, "Maybe I was wrong about that."

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So, always try something because you never know. And then number two, always ask for help, because I think people are gonna more often wanna help you than not. And I think that was a really great piece of advice my dad actually gave me, because I remember when I decided I think I wanna do surgery, you know, I was in medical school and I talked to my dad. My parents are not in the medical profession, but my dad just said, "Well, why don't you just ask some of these attendings, you know, because people usually wanna help you.

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They're not there to not help you." And I always thought that that was a really great piece of advice because that was really what I noticed was, yeah, people were there to help me and give me advice and kind of see what they can do to help me get to what I thought I wanted to do. DR. SCHAAL: You know, I've been interviewing women surgeons, amazing, such as yourself, and I know that here, at Houston Methodist at least, we have a community of women surgeons and that actually helps just to see that there are other women doing that.

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Having families, having lots of patients, working very hard, doing incredible work and still, you know, shining. It's amazing. Thank you for what you do. DR. YI: Thank you. And look at you, I mean, thank you. [Laughing] DR. SCHAAL: Thank you, Dr. Yi, you've been so inspirational. I really enjoyed our conversation. Thank you for being here. DR. YI: Thank you for having me. DR. SCHAAL: And thank you for watching. We'll see you next time in another episode of Women in Surgery.