February 15, 2024 • 33 mins
Have you ever found yourself at a career crossroads, where your heart leads you down a path you never anticipated? That's the story Dr. Maria Iliakova tells us as she takes us through her extraordinary journey from an aspiring lawyer to a compassionate and skilled bariatric surgeon. Her candid revelations about personal trials, an eating disorder, and the allure of the operating room not only shed light on the intricate world of bariatric surgery but also on the resilience of the human spirit.
Dr. Iliakova doesn't hold back as she peels back the curtain on the intense, emotional landscape of patient care in the field of surgery. From the highs of a successful transplant to the lows of patient loss, her narrative highlights the emotional investment surgeons make in their patients' lives. Listen to how a pivot into bariatric and minimally invasive surgery wasn't just a career move—it was a leap towards maintaining those vital patient connections that make medicine such a rewarding profession.
This episode isn't just about the technical prowess of a surgeon; it's a profound look into the battles of weight management and the stigma surrounding it. Dr. Iliakova takes us through her personal and professional growth during her fellowship in the midst of a global pandemic, emphasizing the need for empathy, listening, and a shift in how society discusses weight and health. Her unique perspective as both a physician and a patient advocates for a more informed and compassionate healthcare conversation on obesity and health. Join us for a heart-to-heart on the transformative power of a surgeon's touch and the deep human connections at its core.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Core Bariatric's podcast, hosted by
bariatric surgeon Dr MariaIliakova and TMA LaCose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatric podcast doesnot offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Speaker 2 (00:27):
So my name is Maria Iliakova and I am a bariatric
surgeon.
Thanks for everyone who'slistening to our podcast.
Typically, we record both TMAand me together, but this one is
going to actually be a personalone that I record on my own,
and the reason why is becauseI'm going to be talking about
being a bariatric surgeon andwhy I chose this path and what
(00:49):
so far I'm learning on it.
So, just to get started, Ireally love a couple of things.
One I'm lucky enough to lovesurgery.
That's my favorite place to bein the world Feel the calmest,
feel the most collected, feelthe most at ease when I'm
actually operating and get tosee the inside of someone's body
(01:09):
and get to sometimes rearrangethings or help fix things.
It just seems like the calmestplace in the world and I love
doing it.
The other things that I loveare enabling people to live
lives that they want to.
I think there's no greater giftin the world than being able to
participate in changingsomeone's life for the better
(01:31):
and being able to help peopleget to goals that they set for
themselves.
So that's a super fun part ofthis job as well.
I really like tough challenges,and this kind of work is full
of them, from figuring out howto get people in the door, how
to help people learn aboutbariatric surgery and weight
(01:52):
management and all of thecomplicated things that go along
with that, whether it'smetabolism or endocrine changes
or medications or the surgeriesthemselves, or even maybe
arguably the harder things likemental health changes and
physical changes that people aregoing to experience and how to
deal with those.
So it's just a field in whichthere's a really big
(02:14):
intersection between theindividual and challenges that
people face, but also challengeswe face as a society, as a
culture, and what we're doing tochange that and to update that
as we go.
Another thing that I really,really love is learning, and
this field of weight management,bariatric surgery, healthcare
(02:34):
in general, is constantlyevolving.
It is impossible not to learnon a daily basis, and I feel
like I'm the luckiest person inthe world because I get to
interact with people who teachme something.
Pretty much in every time I getto talk with them or get to
work with them, there'ssomething that comes to mind
like oh, why are we doing thisprocess this way?
(02:55):
Or when patients tell me youknow, I'm using this kind of app
to help me with this, or youknow what would be a good idea?
What if restaurants hadbariatric menus on them so
constantly?
This is something where I feelmentally stimulated and it's
something that constantly,constantly keeps my mind
thinking and working well afterhours and well into my vacations
(03:18):
and into my downtime, to thedistress sometimes of my family
and loved ones.
But, yeah, it's an area thatit's really really easy to
become kind of obsessed with,honestly, because there's so
much learning to be done.
So I actually do want to sharea little bit about myself.
I am not from a medical familyoriginally.
My family and I actually camehere from Russia when I was
(03:38):
little, so I am an immigrant,but I came so young that really
obviously I'm an American andgrew up here.
My culture is this one and mylanguage is this one, but I was
also lucky to be exposed to adifferent culture as well, with
a different language anddifferent food and different
community things like that.
So I feel like I get to belongto multiple communities and a
(04:01):
lot of intersectional parts ofthat.
It's fun to not be from amedical family, in a way,
because they're always my testcases.
Anytime I'm doing something new, I get to pitch it to them and
see what their reactions are.
It's also been really fun totalk with them as news comes out
, for instance, about ozempic orweight medications, or even as
(04:24):
surgeries are changed andthere's updates that sometimes
reach into the news or roboticsurgery, for instance, reaches
into the news.
It's really fun to talk with myfamily about them and to be a
resource for them aboutsomething that's otherwise kind
of challenging to understand.
Honestly, of course, though,this comes with being the family
resource for all the rashes andall the sniffles and everything
(04:45):
like that, but that's not aterrible thing.
In my family, we always reallyvalued education and impact on
community.
My mom and my grandpa,especially, really taught me to
always be in a mindset to helpothers, to help figure out how
to volunteer for things, how toenable other people in my
community, and to really take alot of time and to develop those
(05:10):
kinds of relationships.
This is definitely a field inbariatrics where it's very
relationship based, and thekinds of things that you're
doing really don't make sense ifyou disengage from the
community that you're in, soit's a very community based
practice.
I also did not take the moststraight path into becoming a
bariatric surgeon.
In fact, some would say Ialmost stumbled into this in
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some ways.
I didn't want to be a doctorinitially.
I wanted to be a lawyer, likemy mom, and got into undergrad
and started to do some research,really fell in love with
science and biology andchemistry classes and did some
research and just found thatmore and more exciting and
learned about something calledan MD PhD program, which you may
(05:55):
or may not have heard of, butit's basically a program that
allows you to do research and todo medicine and kind of
combines all those worlds.
I've always been a prettycurious person.
I love to know how things workand why things work the way that
they do and what's out there tobe learned next.
So that sounded like a dreamjob for me to be able to be a
doctor and a scientist.
(06:16):
I will say I had no freakingclue what either of those
professions do, let alone whatthose professions do together,
but it definitely propelled meforward and I did pretty well in
undergrad, got to do a reallyfun research fellowship in Spain
in genetics and proteinresearch and then started an MD
(06:37):
PhD program in Kansas City,where I'm from.
I actually did very poorly inthe beginning of medical school
and really put my entire medicalcareer at risk at that point.
It was a pretty low time in mylife.
I was in a pretty challengingrelationship personally and I
also developed an eatingdisorder at that time.
Those things really took a tollon me as a person.
(07:00):
The structure of medical schoolwas pretty different from what
I had been doing before, whichis more creative and more chart
your own course, and all of thatcollided for me and really
disabled me for a while frombeing able to participate in my
life and being able to takecharge and have agency to be
(07:21):
successful.
So I actually repeated a yearof medical school, took an extra
year to do that and thatprocess, I will say, while one
of the hardest times of my life,I am probably most grateful for
, and the reason why is becauseit helped me reassess what was
most important to me, and whatwas most important to me was a
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couple of things to be ofservice to others, to find
something that was verypurposeful and meaningful to do
in the world, and also somethingthat was going to be
challenging and fun at the endof the day and while it did not
feel that way at the time, therest of the course really makes
up for it, I would say.
(08:05):
So I was lucky enough to beable to finish a medical school
and, during that time, had nointention of being a surgeon.
You have to believe me that allof these things, looking in
hindsight 2020, it kind of seemslike oh, of course, you do
certain undergrad degrees andyou do certain research things
and you do certain medicalschool things, and then you
(08:26):
become a surgeon and then youbecome a bariatric surgeon and
it all seems pretty linear.
But it really never was, and Ihad a really interesting
experience with one of theresidents that I worked with.
So in medical school, you dobook learning and you also do
hands-on learning, and duringthat hands-on learning process
you get to rotate into differentfields.
(08:48):
So when I was on my surgeryrotation, I had a really
fantastic resident who was yearsahead of me, many years ahead
of me at the time, and she justwas super nice.
One day I probably hadforgotten my sneakers and it was
a day in the OR, so I was inhigh heels, and being in high
heels in the OR never a goodcombination.
(09:09):
You get teased, it's reallyuncomfortable, you have to wear
little booties over your shoes.
It's just kind of a disasterand she gave me her OR shoes,
her crocs, and it seems like areally small thing now but at
the time it was such a kind signof acceptance and sign of being
shown away and it really made ahuge outsized impact on me At
(09:34):
the time.
I was also able to seetransplant surgeries and
participate in those as a medstudent and just got really
inspired.
I think that was the first timethat I finally felt like I
belonged in medical school andit really really struck a chord
with me.
But doing surgery at that timewas pretty competitive.
It changes year to year butmedical students actually go
(09:55):
through something called a matchprocess in order to become
residents in a given specialty.
That process does not have alot of.
It's not very empowering unlessyou are a really good student
and have really excellent scoreson all of your exams.
You kind of get selected into aprogram more than you get to
choose what program to go into.
(10:16):
And I was really smitten bysurgery but had a record that
was going to make it prettydifficult for me to actually
become a surgeon and match intoa surgery residency.
So I didn't.
That first year out of medicalschool I actually had a it's
called a preliminary role andthat means a temporary role.
So I only had a job guaranteedfor one year out of the full
(10:39):
five that I would need to trainto be a surgeon after medical
school.
And you're probably thinking,wow, that seems really tough or
that seems really unfortunate,but actually I shared that boat
with about a thousand otherstudents across other medical
schools in the country.
So while it felt very scary andvery alone at the time, it was
(11:01):
something that actually quite afew people go through and that
was a helpful reminder to methat, while things were
certainly not perfect, I wasbeing given another chance.
It wasn't a no, wasn't a closeddoor, it was just a door that
was going to be, you know,needing a little bit more of a
shove in order for me to getthrough it.
So I did surgery that year as apreliminary resident at a
(11:26):
program in Illinois and felleven more in love with the
process of surgery and gettingto do what we were doing with
treating people and kind ofmaking these binary impacts, I
would say, on people.
So basically, when somebodyeither needs surgery or they
don't, that's a yes or no inmany cases, and the outcome that
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they have is either good or bad.
In many cases there's not a lotof gray area in some aspects to
surgery.
There's a lot of gray area insome fields and ultimately I
landed in one that has a lot ofgray area, but some of the
things that we were doing, liketrauma or some of the acute care
surgery, really was just kindof more black and white, and I
(12:07):
actually did enjoy that.
That was a really tough year,though, because I knew at the
end of it I wouldn't have apathway to becoming a surgeon.
So I reapplied that year intosurgery programs and was very
lucky to actually get into aprogram in Kansas City, and that
was very much in part due tothe support and training and all
of the kindness from all thepeople that I trained with in
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Illinois at a program calledCarl Foundation Hospital and
really loved the people there,really appreciated how much they
gave to me and the fact thatthey gave me a chance honestly
to actually become a surgeon forreal.
So that was great.
I was completely on the moonwhen I got into the program in
Kansas City.
That was the program at theUniversity of Missouri, kansas
(12:50):
City and my hometown, so thatwas great.
I was going to have some homecooking and have that accessible
to me all the time, much to theapproval of my family, but also
when they realized I actuallywouldn't be around that much
sometimes disappointment of myfamily.
And I got to actually see somefriends outside of residency and
medical school when I was backin Kansas City.
So for me that was just areally, really fun homecoming
(13:13):
and at Yung KC I had a fantastictime.
It was also very, verychallenging because the hours
you work are no joke.
Sometimes you're working onpaper 80 hours a week, but
sometimes more, certainlysometimes less, but overall it
was very, very challengingbecause even when you're not at
work, this is kind of an allconsuming job and when you're
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learning how to do it it's evenmore consuming in some ways,
because you want to be the best,you want to understand what
you're doing, You're constantlytrying to learn more and more.
It really feels like you'redrinking from a fire hydrant all
the time.
So that was a reallychallenging but really fun part
of my life too, and it did feellike every day I was learning
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and becoming better, and even ondays when there were really big
struggles or I had made amistake or failed, there was a
next day and there was going tobe growth out of those things.
So that was, overall, anextremely wonderful experience
in my life and I'm reallygrateful to the folks at UMKC
for training me and supportingme and enabling me to move on to
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the next step from there.
And the next step that I took.
There again, you're kind ofnoticing a pattern, but I don't
really do things in astraightforward fashion.
I had really been inspired bytransplant surgery as a medical
student when I did my rotationthere and that had kind of
latched itself in my brain Inmedical school.
I actually wanted to dotropical diseases and to help
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treat people who had HIV andother infectious diseases and to
find treatments for that andpotentially even cures for that.
I was really thinking I wasgoing to go down that route and
transplant cut echoes of that.
You get to treat people whohave bad kidneys, bad livers and
you get to give them a newchance at life.
It really seemed much biggerthan life to me and really
(15:05):
dramatic.
In some ways it seemed like itwas the hardest thing I could
have chosen and I remember thosesurgeons being some of the most
respected and best surgeons ina way.
Wherever I was training andjust really wanted to be part of
that world, I loved theresearch that was part of it.
I loved the impact on people'slives.
I loved the fact that you gotto work with all kinds of really
(15:25):
smart people where, honestly,you were always, or I always
felt like I was the dumbestperson in the room in a way,
because everyone else was sobrilliant and just loved it.
I loved the patients.
Remember actually getting agift from one of the patients
that I got to treat when I wason a transplant rotation as a
resident and I was called to theclinic for one of the
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transplant surgeons and wedidn't typically go to their
clinics, so I thought I was inmassive trouble and, on the way
there, kept reviewing oh my gosh, what did I do, what did I say,
who did I say it to or whatcould I have possibly done?
And when I got there, thepatient had was giving me a
signed copy of his mom'scookbook and cried, hugged me,
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and I just completely broke downtoo, because that was.
It was very, very sweet to getacknowledged that way in the
role of a resident, which isreally a while you are a doctor
by that point and while you aretraining to be a surgeon, you're
in more of a supportive role atthat point than you are the
direct surgeon treating someone,and that just really latched
into me and it really felt verymeaningful and was something I
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wanted to feel more and wantedto have those kinds of
relationships with my patients.
So transplant surgery reallywas the thing I wanted to do.
I actually did an extrarotation when I was at the end
of my residency in my fourthyear and did an extra rotation
in transplant surgery so that Icould essentially audition in a
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way.
We did not have a fellowship,which would be the next step for
training to be a transplantsurgeon in our program, but
those folks knew everyone thatdid and I really wanted to make
a good impression and learn asmuch as I could so that with my
dream of becoming a transplantsurgeon, I could walk into my
fellowship and really know atleast a thing or two, which in
hindsight was was naive, butthat is definitely how I thought
(17:14):
at the time.
I realized, while I loved thefeeling when things went well, I
really felt devastated whenthings didn't.
And unfortunately, withtransplant surgery sometimes
you're treating really sickpatients and sometimes even
despite the best efforts, thebest team, the best surgeries,
the best everything, peoplesometimes die and people
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sometimes don't get better orpeople sometimes get really sick
again and I had a difficulttime dealing with that.
I had to come to terms with thefact that even though I really
loved the ups, I really couldn'thealthily handle the downs.
It took me more than a coupleof months to come to that
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realization.
It was actually when I wasapplying for fellowship programs
, that next step of training tobe a transplant surgeon, that I
realized I couldn't.
I was right on the verge ofapplying and literally could not
make myself put in, even startmy applications, and so kind of
scrambled at that point becauseit was a little bit of a crisis
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of identity.
I had envisioned that futurefor myself for over five years
at that point, really had doneeverything I could to make that
possible for myself, and all ofa sudden I wasn't sure I wanted
to do that anymore and I thought, okay, well, I can be a general
surgeon, that's wonderful,that's good, I can do that
without needing to do afellowship and just finish out
(18:42):
my residency.
Or I could do something else.
And I realized I really didwant to do something specialized
.
I really loved that feeling ofconnecting with a patient so
much that I could continue tosee them after their surgery and
I could continue to be involvedin what was going on in their
life and I could make a biggerimpact than to do the surgery
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and that be one and done.
I really enjoyed that feeling.
I realized in talking to one ofmy mentors, dr John Price, who
was a really amazing mentor tome during that time, that there
is another field that kind ofhas echoes of these good vibes
of transplant surgery and alsowere some of the most respected
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and you'll excuse the language,but the most badass of the
surgeons I worked with, andthose were the bariatric and
middle and invasive surgeons.
Those were the ones that weredoing bypasses and sleeves and
fixing problems and they werereally the ones that a lot of
the other surgeons would go towhen things were going wrong or
when they needed help or theyreally just knew how to do
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things and you had to do thingsreally well.
And I had always really enjoyedthose rotations, enjoyed those
surgeries, loved working withthose people, and it kind of hit
me that oh, there is anotherthing I can do and it has a lot
less of the downside andpotentially even more upside
than what I had initiallyplanned to do.
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So I scrambled a little bit.
I didn't have any reallyresearch in that field, hadn't
really prepared myself to applyas a very competitive candidate
for fellowship, so it was kindof a long shot.
But I was really grateful thatthe folks at UMKC and the folks
in our program at St Luke'sespecially, where we had a
fellowship program, reallyrallied around me for that
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application and made it possiblefor me to have enough
interviews to actually matchthat year.
Actually that we did interviewsfor for fellowship was COVID.
Covid hit that year, so got todo about five I think five
interviews before the world shutdown, and that was kind of
drastic because nobody had donevideo interviews up to that
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point for fellowship.
And how the heck do you get asense of the next step in your
life in a realistic way online,when that was new to everyone,
instead of visiting in person?
I know now that's that's reallycommon and that's how a lot of
interviews are done.
But several years ago that wasnot uh and it was not to the
point where we were stillscrambling in March that year um
of 2020 to figure out whichinterviews would be in person,
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which ones would not.
And yeah, that was kind of aninteresting time altogether, but
uh was lucky enough to matchagain.
It's a match process.
So you choose, uh, the programsthat you interviewing and you
rank them, and then the programsrank you and hopefully there's
a match somewhere in the middlethere and was lucky enough to
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match into a program in NewJersey at a place called
Hackensack and it was over themoon again.
So kept on getting luckyDefinitely throughout the years.
There's a huge element of luckin my story that can't be
overstated.
And so from Yom Kasey I got totransition to becoming a
bariatric fellow and had areally fantastic co-fellow, so
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there were two of us Um.
Her name's Adriana Mahalik andshe's just one of the best um
surgeons I've ever worked with.
Really fantastic influence onme that year and that year
really got to dive into thistopic of bariatric surgery and
weight management andmedications and surgery and the
before and after of surgery.
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My brain was just completely onfire.
It was like learning how to doeverything from scratch again,
from the technical things insurgery to the the people skills
.
Because instead of this beinglike a gallbladder surgery or a
knee surgery, where somebodyreally has an obvious benefit
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from surgery versus not,bariatric surgery is absolutely
a choice and it's an option forpeople.
It's not a requirement by anymeans.
It's not a trauma, it's not acancer surgery, nothing like
that.
Certainly it has a lot ofbenefits for some people, but
there was actually an aspect ofsales and marketing and all of
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these things that can be eithergood or bad or somewhere in
between and got to experienceall aspects of that that year
and start to be exposed to thatthe more business side of
medicine and really grew a lot.
I hadn't really leaned into alot of educational experiences
outside of training beforefellowship but got to be part of
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a couple of professionalorganizations in a more involved
way, started really trying togrow my relationships with other
people who did this to othersurgeons, other nurses, other
administrators, other leaders,other leaders listening to
patients and starting to form alot more of a relationship with
the people that I was treatingthat year as well and a lot more
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listening.
I think I had been so focusedin the past probably 10 to 15
years of my training on tryingto drink from that fire hose and
learn as much as I could andthen demonstrate that I could do
it, prove to other people thatI could do things that for me it
was kind of a step a little bitof a sideways step, honestly,
to start listening a lot more.
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Through that process was veryhumbled to learn that I really
didn't understand the experienceof going through something
that's complicated for peoplevery well and that I needed to
do a lot more listening as Iwent ahead through that
listening.
Especially that year, it reallydawned on me that while I kind
of stumbled into this field andagain was really lucky enough to
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land in it, wait and waitmanagement is something
extremely personal to me.
Like I mentioned earlier, I diddevelop an eating disorder in
medical school and that wasbinge eating disorder to the
point where it disabled me fromparticipating in my social life
at all.
There were days that I didn'tgo to my classes in medical
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school or go to my requiredactivities and lab and things
like that, because I felt toofat, I felt too ugly, I felt too
disgusting.
I think a lot of people canrelate to that.
That, for me, lasted for years.
It was very difficult to getunder control and I do think a
lot of people can relate to thefact that an eating disorder is
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never really gone, it's nevercompletely zero, it's always
lurking there in the backgroundand it does certainly help to
have stress managed and to havehealthy lifestyle going on.
But it's just something that'salways present, unlike other
addictions, maybe to alcohol orto drugs or things like that you
can stop using or smoking, forinstance, you can stop doing
(25:41):
those things altogether.
But eating and how you viewyour body those things never
leave.
Those things are always present.
So it was just really difficultfor me to deal with that and it
took years for me to get thatunder any level of control.
Weight and how people perceiveweight, how people perceive
their bodies, the morality thatsurrounds our perceptions of
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weight and how we talk about itin our society are very personal
to me.
I have struggled with themmyself.
I have a lot of empathy forother people in this area,
because it really doesn't matterwhat size you are or how
clothes look on you or what youeat or how you move your body or
(26:25):
any of those things.
The way that we talk aboutweight is very unhealthy in our
society.
It's very judgmental.
It's based on shaming andblaming.
Not only is that a bad way totreat people, but it's also not
based on science and it's notbased on reality.
So the more that I didbariatrics, the more that I got
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to participate in surgeries andhelp people go through this
process, the more I realized howincredibly important it is to
start shaping the conversationabout how we understand this
field too, not just to be asurgeon that shepherds people
through the process one by one,which is, I think, my duty, but
(27:09):
also to actually contribute toother providers' understanding
of surgery and weight andmetabolism, certainly in the
bigger picture, helping toreduce how guilty people feel,
the stigma around weight, theway that we treat it being seen
as a priority, being seen asjustice, being seen as something
(27:30):
that people don't have todeserve.
People should not have to gothrough the hoops that they do
in order to access basic caresurrounding weight management.
That it's really something todedicate a life to.
I really think this is one ofthe most important things in the
world.
So after fellowship, I got ajob at a community hospital in
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Iowa City called Mercy Iowa City.
I came to Iowa after myfellowship and got to develop a
robotic program there, which wassuper fun, and got to grow a
practice there and really wouldsay that this was the most
learning I've ever done in ashort amount of time.
From how does it really workwhen you're the one that's
(28:17):
responsible for making sure thatthe right things happen in the
OR, that you have the righttools, that you have the right
people, that you know whatyou're doing, that you are
learning from mistakes as you goand that you are cool under
pressure.
I wouldn't say I got all thosethings right all the time, but
certainly it is an enormous testof those abilities and an
improvement over time.
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It also really, really showedme how important it is to get it
right for my patients in theclinic, because there's
something that Tammy actuallytold me not too long ago.
She is very open about the factthat I did her bariatric
surgery last year in November.
She's done extremely, extremelywell afterwards and just, I
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think, is just one of thestrongest people that I know,
very inspiring to me.
I remember her telling me thatthe five minutes before she met
me, that she was waiting in ourwaiting room before her first
visit, was probably the worstfive minutes of her life.
That just hits me to the core,because it should not be back
(29:23):
that Coming to a doctor's officeto get care for a medical issue
should never make somebody feelashamed or bad or hurt or
embarrassed.
It should feel empowering andenabling and safe and supportive
.
The whole idea behindeverything that I've learned and
(29:47):
everything that I do now is tofix that problem, to make sure
that people understand they arewelcome, they don't have to
deserve the care and that it'sgood care that they're going to
receive.
It's the best care that I canpossibly provide that they're
(30:07):
going to receive.
It's worth it because I alsosee my family in my waiting room
Not literally, of course, but Ithink that would actually be
unethical.
But what I mean by that is thisis how I would hope my family
members were treated, or I weretreated If I were a patient in
(30:30):
this situation.
It's how I wish somebody hadtalked to me about weight when I
was younger.
It's how I wish other peoplehear a message now that weight
is not a moral issue.
Weight is sometimes a healthissue.
Sometimes it's not, and thatwhen people seek care for weight
(30:51):
whether it's in order to comeoff of diabetes medications or
to treat infertility or just tobe able to get up off the ground
and back on it with theirgrandkids to play with them,
whatever the reason may be thatthey don't have to deserve the
care, they are going to receivethe care, no matter, and that
(31:13):
care is going to be provided.
That's the goal In being abariatric surgeon.
I didn't expect it would besuch a patient kind of advocacy
field.
Maybe I should have realizedthat sooner, but I am so
thankful and so lucky that Ilanded in this role because I
think it's much, much biggerthan me.
(31:33):
It's much bigger than the field.
I thought it was in the sensethat it's one of the most
important things that we've gotto get right, which is how we
treat people for weight, andthat it's not just about weight,
it's about overall health, it'sabout metabolism, it's about
how people's endocrine systemswork.
It's about allowing people toget access to care, definitely
(31:57):
more than the 1% of people thatwould qualify that currently do.
That was an unbelievablestatistic for me.
I learned that about a year,probably a year and a half ago,
that less than 1% of people whoqualify for bariatric care ever
reach it, ever access it.
If we only had 1% of people whohad heart attacks getting heart
care, that would be a nationalproblem that we all are worried
(32:21):
about.
Or if only 1% of people withcancer got cancer care, that
would be an outrage.
I think it's an outrage thatfewer than 1% of people who
qualify get care for weight andweight management and their
metabolism.
So that's something that we canchange, and that's something
that I will be dedicating mylife to doing.
I really can't think of a moreimportant thing to do.
(32:43):
I am really grateful to begiven the chance and the
opportunity to learn every dayand to get to work with Tammy,
who has taught me so much morethan really any class or I would
even say, residency orfellowship or any of those
things, maybe even combinedabout the human aspect here and
how important it is to get thehuman aspect right in order for
(33:06):
people to do well long term withbariatric surgery or just in
general and getting any accessto bariatric care.
So with that, I'm going toclose out the episode and really
appreciate that people havelistened.
I hope that we continue tobring you things that are worth
listening to and worth hearing.
Know that you are too, so I'dlove to hear your comments, your
(33:29):
thoughts about your ownjourneys, any questions you may
have directly for me as abariatric surgeon.
I'm really grateful that you'rehere too.
So thank you and I'll see younext time.
Welcome to Core Bariatric's podcast, hosted by
bariatric surgeon Dr MariaIliakova and TMA LaCose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatric podcast doesnot offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Speaker 2 (00:27):
So my name is Maria Iliakova and I am a bariatric
surgeon.
Thanks for everyone who'slistening to our podcast.
Typically, we record both TMAand me together, but this one is
going to actually be a personalone that I record on my own,
and the reason why is becauseI'm going to be talking about
being a bariatric surgeon andwhy I chose this path and what
(00:49):
so far I'm learning on it.
So, just to get started, Ireally love a couple of things.
One I'm lucky enough to lovesurgery.
That's my favorite place to bein the world Feel the calmest,
feel the most collected, feelthe most at ease when I'm
actually operating and get tosee the inside of someone's body
(01:09):
and get to sometimes rearrangethings or help fix things.
It just seems like the calmestplace in the world and I love
doing it.
The other things that I loveare enabling people to live
lives that they want to.
I think there's no greater giftin the world than being able to
participate in changingsomeone's life for the better
(01:31):
and being able to help peopleget to goals that they set for
themselves.
So that's a super fun part ofthis job as well.
I really like tough challenges,and this kind of work is full
of them, from figuring out howto get people in the door, how
to help people learn aboutbariatric surgery and weight
(01:52):
management and all of thecomplicated things that go along
with that, whether it'smetabolism or endocrine changes
or medications or the surgeriesthemselves, or even maybe
arguably the harder things likemental health changes and
physical changes that people aregoing to experience and how to
deal with those.
So it's just a field in whichthere's a really big
(02:14):
intersection between theindividual and challenges that
people face, but also challengeswe face as a society, as a
culture, and what we're doing tochange that and to update that
as we go.
Another thing that I really,really love is learning, and
this field of weight management,bariatric surgery, healthcare
(02:34):
in general, is constantlyevolving.
It is impossible not to learnon a daily basis, and I feel
like I'm the luckiest person inthe world because I get to
interact with people who teachme something.
Pretty much in every time I getto talk with them or get to
work with them, there'ssomething that comes to mind
like oh, why are we doing thisprocess this way?
(02:55):
Or when patients tell me youknow, I'm using this kind of app
to help me with this, or youknow what would be a good idea?
What if restaurants hadbariatric menus on them so
constantly?
This is something where I feelmentally stimulated and it's
something that constantly,constantly keeps my mind
thinking and working well afterhours and well into my vacations
(03:18):
and into my downtime, to thedistress sometimes of my family
and loved ones.
But, yeah, it's an area thatit's really really easy to
become kind of obsessed with,honestly, because there's so
much learning to be done.
So I actually do want to sharea little bit about myself.
I am not from a medical familyoriginally.
My family and I actually camehere from Russia when I was
(03:38):
little, so I am an immigrant,but I came so young that really
obviously I'm an American andgrew up here.
My culture is this one and mylanguage is this one, but I was
also lucky to be exposed to adifferent culture as well, with
a different language anddifferent food and different
community things like that.
So I feel like I get to belongto multiple communities and a
(04:01):
lot of intersectional parts ofthat.
It's fun to not be from amedical family, in a way,
because they're always my testcases.
Anytime I'm doing something new, I get to pitch it to them and
see what their reactions are.
It's also been really fun totalk with them as news comes out
, for instance, about ozempic orweight medications, or even as
(04:24):
surgeries are changed andthere's updates that sometimes
reach into the news or roboticsurgery, for instance, reaches
into the news.
It's really fun to talk with myfamily about them and to be a
resource for them aboutsomething that's otherwise kind
of challenging to understand.
Honestly, of course, though,this comes with being the family
resource for all the rashes andall the sniffles and everything
(04:45):
like that, but that's not aterrible thing.
In my family, we always reallyvalued education and impact on
community.
My mom and my grandpa,especially, really taught me to
always be in a mindset to helpothers, to help figure out how
to volunteer for things, how toenable other people in my
community, and to really take alot of time and to develop those
(05:10):
kinds of relationships.
This is definitely a field inbariatrics where it's very
relationship based, and thekinds of things that you're
doing really don't make sense ifyou disengage from the
community that you're in, soit's a very community based
practice.
I also did not take the moststraight path into becoming a
bariatric surgeon.
In fact, some would say Ialmost stumbled into this in
(05:33):
some ways.
I didn't want to be a doctorinitially.
I wanted to be a lawyer, likemy mom, and got into undergrad
and started to do some research,really fell in love with
science and biology andchemistry classes and did some
research and just found thatmore and more exciting and
learned about something calledan MD PhD program, which you may
(05:55):
or may not have heard of, butit's basically a program that
allows you to do research and todo medicine and kind of
combines all those worlds.
I've always been a prettycurious person.
I love to know how things workand why things work the way that
they do and what's out there tobe learned next.
So that sounded like a dreamjob for me to be able to be a
doctor and a scientist.
(06:16):
I will say I had no freakingclue what either of those
professions do, let alone whatthose professions do together,
but it definitely propelled meforward and I did pretty well in
undergrad, got to do a reallyfun research fellowship in Spain
in genetics and proteinresearch and then started an MD
(06:37):
PhD program in Kansas City,where I'm from.
I actually did very poorly inthe beginning of medical school
and really put my entire medicalcareer at risk at that point.
It was a pretty low time in mylife.
I was in a pretty challengingrelationship personally and I
also developed an eatingdisorder at that time.
Those things really took a tollon me as a person.
(07:00):
The structure of medical schoolwas pretty different from what
I had been doing before, whichis more creative and more chart
your own course, and all of thatcollided for me and really
disabled me for a while frombeing able to participate in my
life and being able to takecharge and have agency to be
(07:21):
successful.
So I actually repeated a yearof medical school, took an extra
year to do that and thatprocess, I will say, while one
of the hardest times of my life,I am probably most grateful for
, and the reason why is becauseit helped me reassess what was
most important to me, and whatwas most important to me was a
(07:45):
couple of things to be ofservice to others, to find
something that was verypurposeful and meaningful to do
in the world, and also somethingthat was going to be
challenging and fun at the endof the day and while it did not
feel that way at the time, therest of the course really makes
up for it, I would say.
(08:05):
So I was lucky enough to beable to finish a medical school
and, during that time, had nointention of being a surgeon.
You have to believe me that allof these things, looking in
hindsight 2020, it kind of seemslike oh, of course, you do
certain undergrad degrees andyou do certain research things
and you do certain medicalschool things, and then you
(08:26):
become a surgeon and then youbecome a bariatric surgeon and
it all seems pretty linear.
But it really never was, and Ihad a really interesting
experience with one of theresidents that I worked with.
So in medical school, you dobook learning and you also do
hands-on learning, and duringthat hands-on learning process
you get to rotate into differentfields.
(08:48):
So when I was on my surgeryrotation, I had a really
fantastic resident who was yearsahead of me, many years ahead
of me at the time, and she justwas super nice.
One day I probably hadforgotten my sneakers and it was
a day in the OR, so I was inhigh heels, and being in high
heels in the OR never a goodcombination.
(09:09):
You get teased, it's reallyuncomfortable, you have to wear
little booties over your shoes.
It's just kind of a disasterand she gave me her OR shoes,
her crocs, and it seems like areally small thing now but at
the time it was such a kind signof acceptance and sign of being
shown away and it really made ahuge outsized impact on me At
(09:34):
the time.
I was also able to seetransplant surgeries and
participate in those as a medstudent and just got really
inspired.
I think that was the first timethat I finally felt like I
belonged in medical school andit really really struck a chord
with me.
But doing surgery at that timewas pretty competitive.
It changes year to year butmedical students actually go
(09:55):
through something called a matchprocess in order to become
residents in a given specialty.
That process does not have alot of.
It's not very empowering unlessyou are a really good student
and have really excellent scoreson all of your exams.
You kind of get selected into aprogram more than you get to
choose what program to go into.
(10:16):
And I was really smitten bysurgery but had a record that
was going to make it prettydifficult for me to actually
become a surgeon and match intoa surgery residency.
So I didn't.
That first year out of medicalschool I actually had a it's
called a preliminary role andthat means a temporary role.
So I only had a job guaranteedfor one year out of the full
(10:39):
five that I would need to trainto be a surgeon after medical
school.
And you're probably thinking,wow, that seems really tough or
that seems really unfortunate,but actually I shared that boat
with about a thousand otherstudents across other medical
schools in the country.
So while it felt very scary andvery alone at the time, it was
(11:01):
something that actually quite afew people go through and that
was a helpful reminder to methat, while things were
certainly not perfect, I wasbeing given another chance.
It wasn't a no, wasn't a closeddoor, it was just a door that
was going to be, you know,needing a little bit more of a
shove in order for me to getthrough it.
So I did surgery that year as apreliminary resident at a
(11:26):
program in Illinois and felleven more in love with the
process of surgery and gettingto do what we were doing with
treating people and kind ofmaking these binary impacts, I
would say, on people.
So basically, when somebodyeither needs surgery or they
don't, that's a yes or no inmany cases, and the outcome that
(11:46):
they have is either good or bad.
In many cases there's not a lotof gray area in some aspects to
surgery.
There's a lot of gray area insome fields and ultimately I
landed in one that has a lot ofgray area, but some of the
things that we were doing, liketrauma or some of the acute care
surgery, really was just kindof more black and white, and I
(12:07):
actually did enjoy that.
That was a really tough year,though, because I knew at the
end of it I wouldn't have apathway to becoming a surgeon.
So I reapplied that year intosurgery programs and was very
lucky to actually get into aprogram in Kansas City, and that
was very much in part due tothe support and training and all
of the kindness from all thepeople that I trained with in
(12:29):
Illinois at a program calledCarl Foundation Hospital and
really loved the people there,really appreciated how much they
gave to me and the fact thatthey gave me a chance honestly
to actually become a surgeon forreal.
So that was great.
I was completely on the moonwhen I got into the program in
Kansas City.
That was the program at theUniversity of Missouri, kansas
(12:50):
City and my hometown, so thatwas great.
I was going to have some homecooking and have that accessible
to me all the time, much to theapproval of my family, but also
when they realized I actuallywouldn't be around that much
sometimes disappointment of myfamily.
And I got to actually see somefriends outside of residency and
medical school when I was backin Kansas City.
So for me that was just areally, really fun homecoming
(13:13):
and at Yung KC I had a fantastictime.
It was also very, verychallenging because the hours
you work are no joke.
Sometimes you're working onpaper 80 hours a week, but
sometimes more, certainlysometimes less, but overall it
was very, very challengingbecause even when you're not at
work, this is kind of an allconsuming job and when you're
(13:34):
learning how to do it it's evenmore consuming in some ways,
because you want to be the best,you want to understand what
you're doing, You're constantlytrying to learn more and more.
It really feels like you'redrinking from a fire hydrant all
the time.
So that was a reallychallenging but really fun part
of my life too, and it did feellike every day I was learning
(13:57):
and becoming better, and even ondays when there were really big
struggles or I had made amistake or failed, there was a
next day and there was going tobe growth out of those things.
So that was, overall, anextremely wonderful experience
in my life and I'm reallygrateful to the folks at UMKC
for training me and supportingme and enabling me to move on to
(14:19):
the next step from there.
And the next step that I took.
There again, you're kind ofnoticing a pattern, but I don't
really do things in astraightforward fashion.
I had really been inspired bytransplant surgery as a medical
student when I did my rotationthere and that had kind of
latched itself in my brain Inmedical school.
I actually wanted to dotropical diseases and to help
(14:42):
treat people who had HIV andother infectious diseases and to
find treatments for that andpotentially even cures for that.
I was really thinking I wasgoing to go down that route and
transplant cut echoes of that.
You get to treat people whohave bad kidneys, bad livers and
you get to give them a newchance at life.
It really seemed much biggerthan life to me and really
(15:05):
dramatic.
In some ways it seemed like itwas the hardest thing I could
have chosen and I remember thosesurgeons being some of the most
respected and best surgeons ina way.
Wherever I was training andjust really wanted to be part of
that world, I loved theresearch that was part of it.
I loved the impact on people'slives.
I loved the fact that you gotto work with all kinds of really
(15:25):
smart people where, honestly,you were always, or I always
felt like I was the dumbestperson in the room in a way,
because everyone else was sobrilliant and just loved it.
I loved the patients.
Remember actually getting agift from one of the patients
that I got to treat when I wason a transplant rotation as a
resident and I was called to theclinic for one of the
(15:46):
transplant surgeons and wedidn't typically go to their
clinics, so I thought I was inmassive trouble and, on the way
there, kept reviewing oh my gosh, what did I do, what did I say,
who did I say it to or whatcould I have possibly done?
And when I got there, thepatient had was giving me a
signed copy of his mom'scookbook and cried, hugged me,
(16:07):
and I just completely broke downtoo, because that was.
It was very, very sweet to getacknowledged that way in the
role of a resident, which isreally a while you are a doctor
by that point and while you aretraining to be a surgeon, you're
in more of a supportive role atthat point than you are the
direct surgeon treating someone,and that just really latched
into me and it really felt verymeaningful and was something I
(16:30):
wanted to feel more and wantedto have those kinds of
relationships with my patients.
So transplant surgery reallywas the thing I wanted to do.
I actually did an extrarotation when I was at the end
of my residency in my fourthyear and did an extra rotation
in transplant surgery so that Icould essentially audition in a
(16:51):
way.
We did not have a fellowship,which would be the next step for
training to be a transplantsurgeon in our program, but
those folks knew everyone thatdid and I really wanted to make
a good impression and learn asmuch as I could so that with my
dream of becoming a transplantsurgeon, I could walk into my
fellowship and really know atleast a thing or two, which in
hindsight was was naive, butthat is definitely how I thought
(17:14):
at the time.
I realized, while I loved thefeeling when things went well, I
really felt devastated whenthings didn't.
And unfortunately, withtransplant surgery sometimes
you're treating really sickpatients and sometimes even
despite the best efforts, thebest team, the best surgeries,
the best everything, peoplesometimes die and people
(17:38):
sometimes don't get better orpeople sometimes get really sick
again and I had a difficulttime dealing with that.
I had to come to terms with thefact that even though I really
loved the ups, I really couldn'thealthily handle the downs.
It took me more than a coupleof months to come to that
(17:59):
realization.
It was actually when I wasapplying for fellowship programs
, that next step of training tobe a transplant surgeon, that I
realized I couldn't.
I was right on the verge ofapplying and literally could not
make myself put in, even startmy applications, and so kind of
scrambled at that point becauseit was a little bit of a crisis
(18:21):
of identity.
I had envisioned that futurefor myself for over five years
at that point, really had doneeverything I could to make that
possible for myself, and all ofa sudden I wasn't sure I wanted
to do that anymore and I thought, okay, well, I can be a general
surgeon, that's wonderful,that's good, I can do that
without needing to do afellowship and just finish out
(18:42):
my residency.
Or I could do something else.
And I realized I really didwant to do something specialized
.
I really loved that feeling ofconnecting with a patient so
much that I could continue tosee them after their surgery and
I could continue to be involvedin what was going on in their
life and I could make a biggerimpact than to do the surgery
(19:04):
and that be one and done.
I really enjoyed that feeling.
I realized in talking to one ofmy mentors, dr John Price, who
was a really amazing mentor tome during that time, that there
is another field that kind ofhas echoes of these good vibes
of transplant surgery and alsowere some of the most respected
(19:25):
and you'll excuse the language,but the most badass of the
surgeons I worked with, andthose were the bariatric and
middle and invasive surgeons.
Those were the ones that weredoing bypasses and sleeves and
fixing problems and they werereally the ones that a lot of
the other surgeons would go towhen things were going wrong or
when they needed help or theyreally just knew how to do
(19:46):
things and you had to do thingsreally well.
And I had always really enjoyedthose rotations, enjoyed those
surgeries, loved working withthose people, and it kind of hit
me that oh, there is anotherthing I can do and it has a lot
less of the downside andpotentially even more upside
than what I had initiallyplanned to do.
(20:08):
So I scrambled a little bit.
I didn't have any reallyresearch in that field, hadn't
really prepared myself to applyas a very competitive candidate
for fellowship, so it was kindof a long shot.
But I was really grateful thatthe folks at UMKC and the folks
in our program at St Luke'sespecially, where we had a
fellowship program, reallyrallied around me for that
(20:31):
application and made it possiblefor me to have enough
interviews to actually matchthat year.
Actually that we did interviewsfor for fellowship was COVID.
Covid hit that year, so got todo about five I think five
interviews before the world shutdown, and that was kind of
drastic because nobody had donevideo interviews up to that
(20:52):
point for fellowship.
And how the heck do you get asense of the next step in your
life in a realistic way online,when that was new to everyone,
instead of visiting in person?
I know now that's that's reallycommon and that's how a lot of
interviews are done.
But several years ago that wasnot uh and it was not to the
point where we were stillscrambling in March that year um
of 2020 to figure out whichinterviews would be in person,
(21:15):
which ones would not.
And yeah, that was kind of aninteresting time altogether, but
uh was lucky enough to matchagain.
It's a match process.
So you choose, uh, the programsthat you interviewing and you
rank them, and then the programsrank you and hopefully there's
a match somewhere in the middlethere and was lucky enough to
(21:36):
match into a program in NewJersey at a place called
Hackensack and it was over themoon again.
So kept on getting luckyDefinitely throughout the years.
There's a huge element of luckin my story that can't be
overstated.
And so from Yom Kasey I got totransition to becoming a
bariatric fellow and had areally fantastic co-fellow, so
(21:59):
there were two of us Um.
Her name's Adriana Mahalik andshe's just one of the best um
surgeons I've ever worked with.
Really fantastic influence onme that year and that year
really got to dive into thistopic of bariatric surgery and
weight management andmedications and surgery and the
before and after of surgery.
(22:20):
My brain was just completely onfire.
It was like learning how to doeverything from scratch again,
from the technical things insurgery to the the people skills
.
Because instead of this beinglike a gallbladder surgery or a
knee surgery, where somebodyreally has an obvious benefit
(22:42):
from surgery versus not,bariatric surgery is absolutely
a choice and it's an option forpeople.
It's not a requirement by anymeans.
It's not a trauma, it's not acancer surgery, nothing like
that.
Certainly it has a lot ofbenefits for some people, but
there was actually an aspect ofsales and marketing and all of
(23:03):
these things that can be eithergood or bad or somewhere in
between and got to experienceall aspects of that that year
and start to be exposed to thatthe more business side of
medicine and really grew a lot.
I hadn't really leaned into alot of educational experiences
outside of training beforefellowship but got to be part of
(23:24):
a couple of professionalorganizations in a more involved
way, started really trying togrow my relationships with other
people who did this to othersurgeons, other nurses, other
administrators, other leaders,other leaders listening to
patients and starting to form alot more of a relationship with
the people that I was treatingthat year as well and a lot more
(23:46):
listening.
I think I had been so focusedin the past probably 10 to 15
years of my training on tryingto drink from that fire hose and
learn as much as I could andthen demonstrate that I could do
it, prove to other people thatI could do things that for me it
was kind of a step a little bitof a sideways step, honestly,
to start listening a lot more.
(24:08):
Through that process was veryhumbled to learn that I really
didn't understand the experienceof going through something
that's complicated for peoplevery well and that I needed to
do a lot more listening as Iwent ahead through that
listening.
Especially that year, it reallydawned on me that while I kind
of stumbled into this field andagain was really lucky enough to
(24:32):
land in it, wait and waitmanagement is something
extremely personal to me.
Like I mentioned earlier, I diddevelop an eating disorder in
medical school and that wasbinge eating disorder to the
point where it disabled me fromparticipating in my social life
at all.
There were days that I didn'tgo to my classes in medical
(24:53):
school or go to my requiredactivities and lab and things
like that, because I felt toofat, I felt too ugly, I felt too
disgusting.
I think a lot of people canrelate to that.
That, for me, lasted for years.
It was very difficult to getunder control and I do think a
lot of people can relate to thefact that an eating disorder is
(25:17):
never really gone, it's nevercompletely zero, it's always
lurking there in the backgroundand it does certainly help to
have stress managed and to havehealthy lifestyle going on.
But it's just something that'salways present, unlike other
addictions, maybe to alcohol orto drugs or things like that you
can stop using or smoking, forinstance, you can stop doing
(25:41):
those things altogether.
But eating and how you viewyour body those things never
leave.
Those things are always present.
So it was just really difficultfor me to deal with that and it
took years for me to get thatunder any level of control.
Weight and how people perceiveweight, how people perceive
their bodies, the morality thatsurrounds our perceptions of
(26:04):
weight and how we talk about itin our society are very personal
to me.
I have struggled with themmyself.
I have a lot of empathy forother people in this area,
because it really doesn't matterwhat size you are or how
clothes look on you or what youeat or how you move your body or
(26:25):
any of those things.
The way that we talk aboutweight is very unhealthy in our
society.
It's very judgmental.
It's based on shaming andblaming.
Not only is that a bad way totreat people, but it's also not
based on science and it's notbased on reality.
So the more that I didbariatrics, the more that I got
(26:48):
to participate in surgeries andhelp people go through this
process, the more I realized howincredibly important it is to
start shaping the conversationabout how we understand this
field too, not just to be asurgeon that shepherds people
through the process one by one,which is, I think, my duty, but
(27:09):
also to actually contribute toother providers' understanding
of surgery and weight andmetabolism, certainly in the
bigger picture, helping toreduce how guilty people feel,
the stigma around weight, theway that we treat it being seen
as a priority, being seen asjustice, being seen as something
(27:30):
that people don't have todeserve.
People should not have to gothrough the hoops that they do
in order to access basic caresurrounding weight management.
That it's really something todedicate a life to.
I really think this is one ofthe most important things in the
world.
So after fellowship, I got ajob at a community hospital in
(27:51):
Iowa City called Mercy Iowa City.
I came to Iowa after myfellowship and got to develop a
robotic program there, which wassuper fun, and got to grow a
practice there and really wouldsay that this was the most
learning I've ever done in ashort amount of time.
From how does it really workwhen you're the one that's
(28:17):
responsible for making sure thatthe right things happen in the
OR, that you have the righttools, that you have the right
people, that you know whatyou're doing, that you are
learning from mistakes as you goand that you are cool under
pressure.
I wouldn't say I got all thosethings right all the time, but
certainly it is an enormous testof those abilities and an
improvement over time.
(28:37):
It also really, really showedme how important it is to get it
right for my patients in theclinic, because there's
something that Tammy actuallytold me not too long ago.
She is very open about the factthat I did her bariatric
surgery last year in November.
She's done extremely, extremelywell afterwards and just, I
(29:02):
think, is just one of thestrongest people that I know,
very inspiring to me.
I remember her telling me thatthe five minutes before she met
me, that she was waiting in ourwaiting room before her first
visit, was probably the worstfive minutes of her life.
That just hits me to the core,because it should not be back
(29:23):
that Coming to a doctor's officeto get care for a medical issue
should never make somebody feelashamed or bad or hurt or
embarrassed.
It should feel empowering andenabling and safe and supportive
.
The whole idea behindeverything that I've learned and
(29:47):
everything that I do now is tofix that problem, to make sure
that people understand they arewelcome, they don't have to
deserve the care and that it'sgood care that they're going to
receive.
It's the best care that I canpossibly provide that they're
(30:07):
going to receive.
It's worth it because I alsosee my family in my waiting room
Not literally, of course, but Ithink that would actually be
unethical.
But what I mean by that is thisis how I would hope my family
members were treated, or I weretreated If I were a patient in
(30:30):
this situation.
It's how I wish somebody hadtalked to me about weight when I
was younger.
It's how I wish other peoplehear a message now that weight
is not a moral issue.
Weight is sometimes a healthissue.
Sometimes it's not, and thatwhen people seek care for weight
(30:51):
whether it's in order to comeoff of diabetes medications or
to treat infertility or just tobe able to get up off the ground
and back on it with theirgrandkids to play with them,
whatever the reason may be thatthey don't have to deserve the
care, they are going to receivethe care, no matter, and that
(31:13):
care is going to be provided.
That's the goal In being abariatric surgeon.
I didn't expect it would besuch a patient kind of advocacy
field.
Maybe I should have realizedthat sooner, but I am so
thankful and so lucky that Ilanded in this role because I
think it's much, much biggerthan me.
(31:33):
It's much bigger than the field.
I thought it was in the sensethat it's one of the most
important things that we've gotto get right, which is how we
treat people for weight, andthat it's not just about weight,
it's about overall health, it'sabout metabolism, it's about
how people's endocrine systemswork.
It's about allowing people toget access to care, definitely
(31:57):
more than the 1% of people thatwould qualify that currently do.
That was an unbelievablestatistic for me.
I learned that about a year,probably a year and a half ago,
that less than 1% of people whoqualify for bariatric care ever
reach it, ever access it.
If we only had 1% of people whohad heart attacks getting heart
care, that would be a nationalproblem that we all are worried
(32:21):
about.
Or if only 1% of people withcancer got cancer care, that
would be an outrage.
I think it's an outrage thatfewer than 1% of people who
qualify get care for weight andweight management and their
metabolism.
So that's something that we canchange, and that's something
that I will be dedicating mylife to doing.
I really can't think of a moreimportant thing to do.
(32:43):
I am really grateful to begiven the chance and the
opportunity to learn every dayand to get to work with Tammy,
who has taught me so much morethan really any class or I would
even say, residency orfellowship or any of those
things, maybe even combinedabout the human aspect here and
how important it is to get thehuman aspect right in order for
(33:06):
people to do well long term withbariatric surgery or just in
general and getting any accessto bariatric care.
So with that, I'm going toclose out the episode and really
appreciate that people havelistened.
I hope that we continue tobring you things that are worth
listening to and worth hearing.
Know that you are too, so I'dlove to hear your comments, your
(33:29):
thoughts about your ownjourneys, any questions you may
have directly for me as abariatric surgeon.
I'm really grateful that you'rehere too.
So thank you and I'll see younext time.
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