In this episode of “People of UT,” General Audio Staffer Jessica Mathew sat down with Dr. Celeste Sheppard, a maternal and fetal medicine specialist, clinical associate professor at Dell Medical School, and founder of the nonprofit Tiny Hearts Project. They discussed the interests that shaped her career and what inspired her mission to improve detection of congenital heart disease.
Narrated and edited by Jessica Mathew. Cover photo courtesy of Celeste Sheppard. Music by VelarioMusic (on Pixabay).
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Mathew: For one Austin physician, years of caring for patients led to a question that would take her work beyond the examination room: How could she help more clinicians recognize heart conditions before a baby is born? She turned that question into a nonprofit dedicated to improving prenatal detection of congenital heart disease by offering effective ultrasound training. Since its founding in 2016, the organization has trained more than a thousand clinicians in the United States and strives to continue expanding its reach. My name is Jessica Mathew, and I’m a general audio staffer for The Daily Texan. In this episode of “People of UT,” I sat down with Dr. Celeste Sheppard, a maternal and fetal medicine specialist, clinical associate professor at Dell Medical School, and founder of the nonprofit Tiny Hearts Project. We discussed the interests that shaped her career and what inspired her mission to improve detection for congenital heart disease. Her story begins at 17, during a summer with her grandfather in a west Texas hospital.
Sheppard: When I was 17, I volunteered or spent a summer with my grandparents. My grandfather was a general practitioner in a small west Texas town, and I worked in the hospital and observed him do some procedures, and one of the most formative things that I observed was a (cesarean section) that he did. And I remember the sort of marvelous, unbelievably, sort of, magical thing about going into a room with three people and coming out with four. Like, it was just wonderful to see a baby being born.
Mathew: As I listened to Dr. Sheppard describe the wonder she felt as a 17-year-old girl in the operating room, it was clear that her love for medicine had fostered very early on, and continued to persist decades later. In 1985, Dr. Sheppard graduated from Wellesley College with a bachelor’s degree in art history. During our interview, she shared some valuable words of advice for current student listeners who may feel a bit nervous to take an unconventional path to achieving their professional goals.
Sheppard: Well, my single bit of advice is to follow your heart and do what is most interesting to you. There’s no time in your life that is anything like the college experience. In college, the way I thought about it as an undergraduate was that my job was to learn as much as I could and to learn to think and to take advantage of this, sort of, marvelous array of new ideas and new fields that I hadn’t been exposed to at all in high school or in my life otherwise. And I never for a minute regretted doing, uh, an art history degree or- I was very close to doing an English degree. I would encourage anybody to do that because it cultivates your mind and it cultivates who you are. And those are the things that will make you a success, whether it’s in professional school, or as a teacher or as a politician- like who knows. But cultivating your mind and your sense of self and your sense of your, um, world around you. But really you’re finding out your place in the world and you’re finding out who you are.
Mathew: Not only did her art history degree provide room for self-discovery, when it came time to apply for medical school, Dr. Sheppard made some surprising connections to ways art history and medicine go hand in hand.
Sheppard: I usually tell this story with sort of a tongue in cheek, but it’s actually quite true. So I wrote my medical school application essay on why art history is the perfect preparation for medical school. In art history, for example, um, you learn to look critically and thoughtfully about whatever is the object in front of you, or in some cases, the concept. So to look carefully, analytically, so to speak, and then begin to synthesize, um, put together the thoughts and the pieces and the context of this piece to come to a deeper understanding. But that’s what medicine is, right? We look at, um, we take a history and we do a physical exam, which is very analytical. It’s very systematic if you do it right. We collect lab studies, we collect a bunch of information, and then begin to synthesize that into a concept of what’s going on with this patient and how we might help her or him. And never mind the fact that it’s really wonderful fun to encounter a work of art that is appealing to you, that is sort of thrilling in some way, in the same way that is really wonderful to meet somebody who comes, in my case, comes to me, um, as a patient. I love learning about them. I love learning about their lives and their perspective, and I try to, um, you know, bring the skills and the sort of body of knowledge that I have to, um, help solve the problem or soothe the pain or, um, sort of work with her.
Mathew: This love for problem solving followed Dr. Sheppard into her time at UT Southwestern Medical School, where she grew a fascination for maternal and fetal dynamics.
Sheppard: During medical school, and um, I was really interested in the dependency. So you have one sort of person whose person’s physiology is inside another, and there- um, one is dependent on the other. Sometimes their needs are sort of in conflict. So I thought those problems- solving the problems of how to, um, take care of the fetus and the mom were really interesting problems. In medical school at Southwestern, we had the advantage of having a great deal of experience observing deliveries and taking care of healthy pregnancies, as well as very complicated pregnancies, and I found those complications really interesting and gratifying to, um, be able to take care of successfully.
Mathew: Dr. Sheppard goes on to describe how her interests narrowed down even further and led her to specialize in prenatal screening.
Sheppard: I found looking at ultrasound and performing ultrasound really fascinating. And of course, it’s extremely visual. And so it was the visual, um, using sort of visual acuity and some deliberate ways of looking that seemed really to be, like, that was my jam. That was very gratifying to me. It was really fun. And over the years, my practice has really, um, narrowed to doing prenatal ultrasound pretty exclusively for the last decade or so.
Mathew: Caring for patients with high-risk pregnancy not only requires a strong understanding of medicine, but also just as equally requires a lot of patience and empathy. During our interview, Dr. Sheppard shared a meaningful piece of advice that she applies to her own clinical practice, that also holds up just as well outside the hospital.
Sheppard: I think one of life’s important lessons for everybody, and certainly has been for me, is to recognize the impulse to make a judgment or an assessment or, um, summarize what somebody else is thinking or feeling or doing, um, without really recognizing that we have no idea what’s going on in that person’s life, what the background is or what their context is. And so, this applies- anything as pragmatic as a patient may show up late for her appointment. And I’m- you know, somebody may remark, ‘Well, she just doesn’t- whatever. She’s not doing it right. She doesn’t care.’ Well, we have no idea. But what I remind people all the time is, we can’t judge her based on how prompt you like to be. But I think the lessons that apply really broadly in life is not to assume that someone else’s experience, um, is like yours. And that actually there’s a fairly common, um, personal coaching term that I think is really relevant, which is, it’s very much more helpful to lead with curiosity or to sort of, um, hold your own discomfort internally while you’re finding out more about what’s going on than- than sort of starting with, um, a judgment or, um, a sense of, ‘You didn’t do it right. You’re not taking your insulin. You know, why- you need to be taking your insulin.’ Well, you know, when we get into sort of an oppositional thing with a patient, that assumes that we know that her resources are exactly like yours are and you would be taking it so, why isn’t she? Million reasons why that’s not the case. And I think it’s important in doctoring to- before even having that conversation that becomes sort of, ‘You’re not doing what I told you to do. Why aren’t you?’ To start with an observation that’s- that’s more, um- well, that’s less, uh, judgment-laden.
Mathew: And leading with curiosity is exactly what caused Dr. Sheppard to start Tiny Hearts Project back in 2016.
Sheppard: I realized that I wanted to do something more. You know, I was, at that time, in a private practice seeing patients all day every day, and that was very rewarding, but I felt like, um, I- I felt like I needed to do something more with this experience that I had gained. And so I did a little self-reflection and thought about, ‘What do I- what are the things I love to do?’ And I love to scan myself. I love to look at the fetal heart, which is a complex, um, moving target inside the fetus. And then I actually was, um, in a presentation. I don’t think I realized this until I heard someone else talk about the low- really low detection rates for congenital heart disease. And I thought, well, ‘How is that possible?’ Well, that led to a little bit of inquiry into, in fact, a very complex question of how is it that the case. But I realized that there were some contributors to the low detection rates of congenital heart disease that were amenable to an intervention with some advocacy and some, um, education, a little bit of training and some sort of supportive, um, exhortation. Like, we can do this better and we should. And one of the things that occurred to me is that we spend a lot of our, sort of, um, medical economic, um, dollar pie chart. We spend a lot of money on prenatal ultrasound. And one of its main purposes is to detect abnormalities so that families can plan and get care for these babies. And I realized that this was- this had become a really low-value intervention if we weren’t doing the best job we could. So all that sort of came together and I decided, um, that I would make an attempt to, um, form an entity that could offer this kind of advocacy and training. There is a charity that’s based in London called Tiny Tickers, which, uh, was formed by- in the late 90s, by a couple of pediatric cardiologists who also recognized that the detection rate was very low in prenatal ultrasound. And so I approached the- um, one of the founders of Tiny Tickers. I walked right up to her after I heard a presentation one time, introduced myself and said, ‘I want to do something just like that in the States and I live in Texas.’ And she said, ‘Oh, that’s wonderful. I’ve just moved to Houston and you should talk to my husband.’ So I went to Houston. I took her and her husband to dinner and I told them I wanted to do this. And they’re like, ‘Great, let’s go. Let’s do it.’
Mathew: But what exactly is congenital heart disease? And why should we care about it? According to the Cleveland Clinic, congenital heart disease is an issue with one’s heart structure that disrupts the normal flow of blood and is present at birth. Heart defects are the leading cause of birth-defect-associated infant illness and death, according to the (Centers for Disease Control and Prevention) in 2025. So given its importance, why exactly do we experience low detection rates for CHD in the United States?
Sheppard: There are many, many, many factors that contribute to low detection rates. The ones that Tiny Hearts is most focused on, um, are the ones that are most susceptible or most amenable to intervention. And those have to do with kind of the immediate experience of doing- of performing scans. So it’s an operator-dependent skill and it is in fact, for fetal imaging, it’s especially complicated because you’re looking at structures inside a fetus who’s moving all the time, inside a woman who is moving a lot of the time and certainly breathing and doing a little wiggling. And the fetus can be in any of an infinite variety of positions and so you have to adapt to, um, moving around- moving your transducer around so that you can get the right image for the anatomy. So there are some really important kind of adaptational skills, sonography skills that we can teach that can help sonographers acquire the, um, the right images at the right plane and with sort of optimal features. There are bigger, um, sort of, it’s- there’s a- it’s an onion of- of, sort of, layers of- of ways in which the system, uh, can be improved. One of them is most people- um, many people doing fetal imaging don’t, uh, don’t know how important it is to detect, particularly, congenital heart disease. We know that outcomes are better for children who are detected prenatally, so there are a lot of, um, compelling reasons why we really need to do this. This needs to be a priority in our practices and so forth, but many people are unaware of that. Also there are many sonographers and physicians who have not had much training in, um, in particularly cardiac screening. And so we can offer that training and we can- we can advocate for it. These are the images you need for a complete scan; here’s how to acquire them; here’s how to make them look, you know, clear and, um, easily interpretable. There are some other factors, um, that actually are much more broadly discussed in the radiology literature which have to do with why we make interpretive errors.
Mathew: To prove just how easily detection errors can occur, Dr. Sheppard briefly described a well-known study that tested just that.
Sheppard: There was a very famous paper a number of years ago, um, by a man named Jeremy Wolfe, who’s an experimental psychologist at Harvard. And he- he wrote this marvelous paper, um, showing, uh, I think they were chest X-rays, images to a group of radiologists and asking them to find the abnormalities. And in each of these he had put one or two little gorilla cartoons, like a little, um, figure that was clearly not part of the X-ray. And a large proportion of those gorillas in these images were not noticed- weren’t detected. So, um, so there are recognition, uh, sort of lapses. There also are, um, interpretive lapses. So we might see something and think, ‘Oh, I see that thing. I see this is a little bit bigger than it usually is, but it’s fine. It’s normal.’ So there may be a, um, sort of a cognitive error of minimizing something that’s a little bit out of the ordinary. So there are lots of levels of, um, how- how, um, missed, um, diagnoses occur. But those are things that when brought to an audience who’s listening and eager to learn about this, they- we can teach them how to acquire the images. We can teach them where to look for the important, um, anatomic features.
Mathew: Tiny Hearts Project helps sonographers and physicians practice both parts of that process: acquiring images and interpreting what they see. For Dr. Sheppard, hearing how participants use those lessons brings the purpose of her work into focus.
Sheppard: It’s incredibly gratifying for our learners. They love our courses because they leave feeling much more confident, quite empowered by not only acquiring, um, better images, but interpreting them and feeling much more confident in finding, um, normal anatomy that they can feel confident saying this is normal and something that’s abnormal. You know, I think- when I feel the most optimistic is at the end of the day of one of our courses, when everybody has stayed until the bitter end of the day and they all want to talk about it, and they want to run up to me and say, ‘This is amazing, I can’t wait to use these techniques.’ I have had, actually very recently, a participant who, um, came to one of our courses and then she came to one of my short courses that I just do hands on training, just sort of me and some model patients on this Saturday morning. She came back to that and she said, ‘I want to tell you that right after I got back from the course, my manager, my boss or my supervisor brought me into the office and said, “What have you done? Because your images are so much better, and your exams are so- so much better. What happened to you, and can you- can you make that happen with everybody else in the office?’’’ And she said, ‘I told him I came to this course and I learned these things.’ And so I thought it was very gratifying to me that, um, here was a real testimonial, somebody who really did take those lessons home and I- this was the first time I’d really heard that kind of feedback about it. I- you know, my professional skill improved so much and she was so thrilled and so, of course, I was very thrilled and so it’s incredibly gratifying to hear people who are doing this work every day, um, come back and tell me, ‘This was amazing, I feel so much better, I know so much more, I’m so much more aware of how important this is and I am going to commit to doing this high-quality exam every single time.’ I just love hearing that.
Mathew: As participants share what they’ve learned with colleagues, the courses are reaching new audiences. Tiny Hearts Project is building on that momentum to raise awareness for low detection rates and make training more accessible, with plans to offer free lectures online.
Sheppard: Well we’ve posted advertisements for our courses in, um, sonography, um, pages on Facebook and other areas. We have, um, a number of colleagues around the country who are kind of sonography influencers. They often promote our courses. I think that there actually has been a butterfly effect, so to speak. So, um, we don’t have right now necessarily a national platform, but we are working very hard right now to, um, build a curriculum that will be online and available for anybody. I think there is some real advantage to coming to our courses in person, but, um, the basic information is really needed everywhere worldwide, in fact. And so we’re looking forward to putting some of our, um, lectures online that would be available for free for anybody who, uh, is interested in looking at sort of high-quality training in these basic techniques.
Mathew: This accessibility that Dr. Sheppard is striving for still comes at a price that can be challenging to keep up with for small organizations like Tiny Hearts Project.
Sheppard: The thing that is practical and pragmatic is that it is a nonprofit. It’s not a foundation. So we don’t have $5 million, you know, that’s sort of supporting us all along. This has been mostly supported by me and my family and friends who’ve donated, and, um, that- we have had some educational grants for our programs that have come from industry, from the companies that make ultrasound machines. And that’s been tremendously valuable to us because we can’t do it without them.
Mathew: Building Tiny Hearts Project has given Dr. Sheppard experience with both the rewards and the responsibilities of pursuing a mission. For listeners who feel a similar urgency to start an initiative, she offered some advice to avoid burnout.
Sheppard: Although I’m very glad I did what I did, I- I did it because there was nothing- there was no other entity out there doing this work in this way. There are a number of companies who provide, um, continuing education courses for profit, but that, um, that can be unaffordable for many people. So there really wasn’t anybody doing anything like what Tiny Hearts Project is doing. But the advice that I’d have for somebody else who feels really, sort of, passionate and very mission driven is to find some other people who are doing it, because it is so much easier to do it as a group or to contribute to a group that’s doing something very similar, and then maybe you can branch out or expand their mission. It’s much easier to do this with others than alone. And so I, totally, I would absolutely encourage anybody who wants to solve an important problem with their passion and interest and innovation and energy. I absolutely support that, um, sort of, pursuing that- that mission, because it’s incredibly rewarding. But what I would say is, find other people who are doing that work and jump on. That way you don’t have the whole responsibility on only your shoulders.
Mathew: And help from various ultrasound educators and partnered institutions is how Dr. Sheppard turned Tiny Hearts Project from a concept to an established organization that has positively impacted dozens of American sonographers and physicians.
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Mathew: This episode is a production of The Daily Texan Audio Department. More episodes can be found on your streaming platform of choice or check us out on thedailytexan.com. That’s t-h-e-d-a-i-l-y-t-e-x-a-n-.-c-o-m. This is Jessica Mathew, general audio reporter for The Daily Texan. Thank you for listening.
