Episode 4: Dr. Maria Iliakova's Journey to Bariatric Surgery

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.

Transcript

Speaker 1: 0:00

Welcome to Core Bariatric's podcast, hosted by bariatric surgeon Dr Maria Iliakova and TMA LaCose, bariatric coordinator and a patient herself. Our goal is building and elevating our community. The Core Bariatric podcast does not offer medical advice, diagnosis or treatment. On this podcast, we aim to share stories, support and insight into the world beyond the clinic. Let's get into it.

Speaker 2: 0:27

So my name is Maria Iliakova and I am a bariatric surgeon. Thanks for everyone who's listening to our podcast. Typically, we record both TMA and me together, but this one is going to actually be a personal one that I record on my own, and the reason why is because I'm going to be talking about being a bariatric surgeon and why I chose this path and what so far I'm learning on it. So, just to get started, I really love a couple of things. One I'm lucky enough to love surgery. That's my favorite place to be in the world Feel the calmest, feel the most collected, feel the most at ease when I'm actually operating and get to see the inside of someone's body and get to sometimes rearrange things or help fix things. It just seems like the calmest place in the world and I love doing it. The other things that I love are enabling people to live lives that they want to. I think there's no greater gift in the world than being able to participate in changing someone's life for the better and being able to help people get to goals that they set for themselves. So that's a super fun part of this job as well. I really like tough challenges, and this kind of work is full of them, from figuring out how to get people in the door, how to help people learn about bariatric surgery and weight management and all of the complicated things that go along with that, whether it's metabolism or endocrine changes or medications or the surgeries themselves, or even maybe arguably the harder things like mental health changes and physical changes that people are going to experience and how to deal with those. So it's just a field in which there's a really big intersection between the individual and challenges that people face, but also challenges we face as a society, as a culture, and what we're doing to change 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 in general, is constantly evolving. It is impossible not to learn on a daily basis, and I feel like I'm the luckiest person in the world because I get to interact with people who teach me something. Pretty much in every time I get to talk with them or get to work with them, there's something that comes to mind like oh, why are we doing this process this way? Or when patients tell me you know, I'm using this kind of app to help me with this, or you know what would be a good idea? What if restaurants had bariatric menus on them so constantly? This is something where I feel mentally stimulated and it's something that constantly, constantly keeps my mind thinking and working well after hours and well into my vacations and into my downtime, to the distress sometimes of my family and loved ones. But, yeah, it's an area that it'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 share a little bit about myself. I am not from a medical family originally. My family and I actually came here from Russia when I was little, so I am an immigrant, but I came so young that really obviously I'm an American and grew up here. My culture is this one and my language is this one, but I was also lucky to be exposed to a different culture as well, with a different language and different food and different community things like that. So I feel like I get to belong to multiple communities and a lot of intersectional parts of that. It's fun to not be from a medical family, in a way, because they're always my test cases. 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 to talk with them as news comes out, for instance, about ozempic or weight medications, or even as surgeries are changed and there's updates that sometimes reach into the news or robotic surgery, for instance, reaches into the news. It's really fun to talk with my family about them and to be a resource for them about something that's otherwise kind of challenging to understand. Honestly, of course, though, this comes with being the family resource for all the rashes and all the sniffles and everything like that, but that's not a terrible thing. In my family, we always really valued education and impact on community. My mom and my grandpa, especially, really taught me to always be in a mindset to help others, to help figure out how to volunteer for things, how to enable other people in my community, and to really take a lot of time and to develop those kinds of relationships. This is definitely a field in bariatrics where it's very relationship based, and the kinds of things that you're doing really don't make sense if you disengage from the community that you're in, so it's a very community based practice. I also did not take the most straight path into becoming a bariatric surgeon. In fact, some would say I almost stumbled into this in some ways. I didn't want to be a doctor initially. I wanted to be a lawyer, like my mom, and got into undergrad and started to do some research, really fell in love with science and biology and chemistry classes and did some research and just found that more and more exciting and learned about something called an MD PhD program, which you may or may not have heard of, but it's basically a program that allows you to do research and to do medicine and kind of combines all those worlds. I've always been a pretty curious person. I love to know how things work and why things work the way that they do and what's out there to be learned next. So that sounded like a dream job for me to be able to be a doctor and a scientist. I will say I had no freaking clue what either of those professions do, let alone what those professions do together, but it definitely propelled me forward and I did pretty well in undergrad, got to do a really fun research fellowship in Spain in genetics and protein research and then started an MD PhD program in Kansas City, where I'm from. I actually did very poorly in the beginning of medical school and really put my entire medical career at risk at that point. It was a pretty low time in my life. I was in a pretty challenging relationship personally and I also developed an eating disorder at that time. Those things really took a toll on me as a person. The structure of medical school was pretty different from what I had been doing before, which is more creative and more chart your own course, and all of that collided for me and really disabled me for a while from being able to participate in my life and being able to take charge and have agency to be successful. So I actually repeated a year of medical school, took an extra year to do that and that process, I will say, while one of the hardest times of my life, I am probably most grateful for, and the reason why is because it helped me reassess what was most important to me, and what was most important to me was a couple of things to be of service to others, to find something that was very purposeful and meaningful to do in the world, and also something that was going to be challenging and fun at the end of the day and while it did not feel that way at the time, the rest of the course really makes up for it, I would say. So I was lucky enough to be able to finish a medical school and, during that time, had no intention of being a surgeon. You have to believe me that all of these things, looking in hindsight 2020, it kind of seems like oh, of course, you do certain undergrad degrees and you do certain research things and you do certain medical school things, and then you become a surgeon and then you become a bariatric surgeon and it all seems pretty linear. But it really never was, and I had a really interesting experience with one of the residents that I worked with. So in medical school, you do book learning and you also do hands-on learning, and during that hands-on learning process you get to rotate into different fields. So when I was on my surgery rotation, I had a really fantastic resident who was years ahead of me, many years ahead of me at the time, and she just was super nice. One day I probably had forgotten my sneakers and it was a day in the OR, so I was in high heels, and being in high heels in the OR never a good combination. You get teased, it's really uncomfortable, you have to wear little booties over your shoes. It's just kind of a disaster and she gave me her OR shoes, her crocs, and it seems like a really small thing now but at the time it was such a kind sign of acceptance and sign of being shown away and it really made a huge outsized impact on me At the time. I was also able to see transplant surgeries and participate in those as a med student and just got really inspired. I think that was the first time that I finally felt like I belonged in medical school and it really really struck a chord with me. But doing surgery at that time was pretty competitive. It changes year to year but medical students actually go through something called a match process in order to become residents in a given specialty. That process does not have a lot of. It's not very empowering unless you are a really good student and have really excellent scores on all of your exams. You kind of get selected into a program more than you get to choose what program to go into. And I was really smitten by surgery but had a record that was going to make it pretty difficult for me to actually become a surgeon and match into a surgery residency. So I didn't. That first year out of medical school I actually had a it's called a preliminary role and that means a temporary role. So I only had a job guaranteed for one year out of the full five that I would need to train to 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 other students across other medical schools in the country. So while it felt very scary and very alone at the time, it was something that actually quite a few people go through and that was a helpful reminder to me that, while things were certainly not perfect, I was being given another chance. It wasn't a no, wasn't a closed door, 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 get through it. So I did surgery that year as a preliminary resident at a program in Illinois and fell even more in love with the process of surgery and getting to do what we were doing with treating people and kind of making these binary impacts, I would say, on people. So basically, when somebody either needs surgery or they don't, that's a yes or no in many cases, and the outcome that they have is either good or bad. In many cases there's not a lot of gray area in some aspects to surgery. There's a lot of gray area in some fields and ultimately I landed in one that has a lot of gray area, but some of the things that we were doing, like trauma or some of the acute care surgery, really was just kind of more black and white, and I actually did enjoy that. That was a really tough year, though, because I knew at the end of it I wouldn't have a pathway to becoming a surgeon. So I reapplied that year into surgery programs and was very lucky to actually get into a program in Kansas City, and that was very much in part due to the support and training and all of the kindness from all the people that I trained with in Illinois at a program called Carl Foundation Hospital and really loved the people there, really appreciated how much they gave to me and the fact that they gave me a chance honestly to actually become a surgeon for real. So that was great. I was completely on the moon when I got into the program in Kansas City. That was the program at the University of Missouri, kansas City and my hometown, so that was great. I was going to have some home cooking and have that accessible to me all the time, much to the approval of my family, but also when they realized I actually wouldn't be around that much sometimes disappointment of my family. And I got to actually see some friends outside of residency and medical school when I was back in Kansas City. So for me that was just a really, really fun homecoming and at Yung KC I had a fantastic time. It was also very, very challenging because the hours you work are no joke. Sometimes you're working on paper 80 hours a week, but sometimes more, certainly sometimes less, but overall it was very, very challenging because even when you're not at work, this is kind of an all consuming job and when you're learning how to do it it's even more consuming in some ways, because you want to be the best, you want to understand what you're doing, You're constantly trying to learn more and more. It really feels like you're drinking from a fire hydrant all the time. So that was a really challenging but really fun part of my life too, and it did feel like every day I was learning and becoming better, and even on days when there were really big struggles or I had made a mistake or failed, there was a next day and there was going to be growth out of those things. So that was, overall, an extremely wonderful experience in my life and I'm really grateful to the folks at UMKC for training me and supporting me and enabling me to move on to the next step from there. And the next step that I took. There again, you're kind of noticing a pattern, but I don't really do things in a straightforward fashion. I had really been inspired by transplant surgery as a medical student when I did my rotation there and that had kind of latched itself in my brain In medical school. I actually wanted to do tropical diseases and to help treat people who had HIV and other infectious diseases and to find treatments for that and potentially even cures for that. I was really thinking I was going to go down that route and transplant cut echoes of that. You get to treat people who have bad kidneys, bad livers and you get to give them a new chance at life. It really seemed much bigger than life to me and really dramatic. In some ways it seemed like it was the hardest thing I could have chosen and I remember those surgeons being some of the most respected and best surgeons in a way. Wherever I was training and just really wanted to be part of that world, I loved the research that was part of it. I loved the impact on people's lives. I loved the fact that you got to work with all kinds of really smart people where, honestly, you were always, or I always felt like I was the dumbest person in the room in a way, because everyone else was so brilliant and just loved it. I loved the patients. Remember actually getting a gift from one of the patients that I got to treat when I was on a transplant rotation as a resident and I was called to the clinic for one of the transplant surgeons and we didn't typically go to their clinics, so I thought I was in massive 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 what could I have possibly done? And when I got there, the patient had was giving me a signed copy of his mom's cookbook and cried, hugged me, and I just completely broke down too, because that was. It was very, very sweet to get acknowledged that way in the role of a resident, which is really a while you are a doctor by that point and while you are training to be a surgeon, you're in more of a supportive role at that point than you are the direct surgeon treating someone, and that just really latched into me and it really felt very meaningful and was something I wanted to feel more and wanted to have those kinds of relationships with my patients. So transplant surgery really was the thing I wanted to do. I actually did an extra rotation when I was at the end of my residency in my fourth year and did an extra rotation in transplant surgery so that I could essentially audition in a way. We did not have a fellowship, which would be the next step for training to be a transplant surgeon in our program, but those folks knew everyone that did and I really wanted to make a good impression and learn as much as I could so that with my dream of becoming a transplant surgeon, I could walk into my fellowship and really know at least a thing or two, which in hindsight was was naive, but that is definitely how I thought at the time. I realized, while I loved the feeling when things went well, I really felt devastated when things didn't. And unfortunately, with transplant surgery sometimes you're treating really sick patients and sometimes even despite the best efforts, the best team, the best surgeries, the best everything, people sometimes die and people sometimes don't get better or people sometimes get really sick again and I had a difficult time dealing with that. I had to come to terms with the fact that even though I really loved the ups, I really couldn't healthily handle the downs. It took me more than a couple of months to come to that realization. It was actually when I was applying for fellowship programs, that next step of training to be a transplant surgeon, that I realized I couldn't. I was right on the verge of applying and literally could not make myself put in, even start my applications, and so kind of scrambled at that point because it was a little bit of a crisis of identity. I had envisioned that future for myself for over five years at that point, really had done everything I could to make that possible for myself, and all of a 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 a fellowship and just finish out my residency. Or I could do something else. And I realized I really did want to do something specialized. I really loved that feeling of connecting with a patient so much that I could continue to see them after their surgery and I could continue to be involved in what was going on in their life and I could make a bigger impact than to do the surgery and that be one and done. I really enjoyed that feeling. I realized in talking to one of my mentors, dr John Price, who was a really amazing mentor to me during that time, that there is another field that kind of has echoes of these good vibes of transplant surgery and also were some of the most respected and you'll excuse the language, but the most badass of the surgeons I worked with, and those were the bariatric and middle and invasive surgeons. Those were the ones that were doing bypasses and sleeves and fixing problems and they were really the ones that a lot of the other surgeons would go to when things were going wrong or when they needed help or they really just knew how to do things and you had to do things really well. And I had always really enjoyed those rotations, enjoyed those surgeries, loved working with those people, and it kind of hit me that oh, there is another thing I can do and it has a lot less of the downside and potentially even more upside than what I had initially planned to do. So I scrambled a little bit. I didn't have any really research in that field, hadn't really prepared myself to apply as a very competitive candidate for fellowship, so it was kind of a long shot. But I was really grateful that the folks at UMKC and the folks in our program at St Luke's especially, where we had a fellowship program, really rallied around me for that application and made it possible for me to have enough interviews to actually match that year. Actually that we did interviews for for fellowship was COVID. Covid hit that year, so got to do about five I think five interviews before the world shut down, and that was kind of drastic because nobody had done video interviews up to that point for fellowship. And how the heck do you get a sense 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 really common and that's how a lot of interviews are done. But several years ago that was not uh and it was not to the point where we were still scrambling in March that year um of 2020 to figure out which interviews would be in person, which ones would not. And yeah, that was kind of an interesting time altogether, but uh was lucky enough to match again. It's a match process. So you choose, uh, the programs that you interviewing and you rank them, and then the programs rank you and hopefully there's a match somewhere in the middle there and was lucky enough to match into a program in New Jersey at a place called Hackensack and it was over the moon again. So kept on getting lucky Definitely throughout the years. There's a huge element of luck in my story that can't be overstated. And so from Yom Kasey I got to transition to becoming a bariatric fellow and had a really fantastic co-fellow, so there were two of us Um. Her name's Adriana Mahalik and she's just one of the best um surgeons I've ever worked with. Really fantastic influence on me that year and that year really got to dive into this topic of bariatric surgery and weight management and medications and surgery and the before and after of surgery. My brain was just completely on fire. It was like learning how to do everything from scratch again, from the technical things in surgery to the the people skills. Because instead of this being like a gallbladder surgery or a knee surgery, where somebody really has an obvious benefit from surgery versus not, bariatric surgery is absolutely a choice and it's an option for people. It's not a requirement by any means. It's not a trauma, it's not a cancer surgery, nothing like that. Certainly it has a lot of benefits for some people, but there was actually an aspect of sales and marketing and all of these things that can be either good or bad or somewhere in between and got to experience all aspects of that that year and start to be exposed to that the more business side of medicine and really grew a lot. I hadn't really leaned into a lot of educational experiences outside of training before fellowship but got to be part of a couple of professional organizations in a more involved way, started really trying to grow my relationships with other people who did this to other surgeons, other nurses, other administrators, other leaders, other leaders listening to patients and starting to form a lot more of a relationship with the people that I was treating that year as well and a lot more listening. I think I had been so focused in the past probably 10 to 15 years of my training on trying to drink from that fire hose and learn as much as I could and then demonstrate that I could do it, prove to other people that I could do things that for me it was kind of a step a little bit of a sideways step, honestly, to start listening a lot more. Through that process was very humbled to learn that I really didn't understand the experience of going through something that's complicated for people very well and that I needed to do a lot more listening as I went ahead through that listening. Especially that year, it really dawned on me that while I kind of stumbled into this field and again was really lucky enough to land in it, wait and wait management is something extremely personal to me. Like I mentioned earlier, I did develop an eating disorder in medical school and that was binge eating disorder to the point where it disabled me from participating in my social life at all. There were days that I didn't go to my classes in medical school or go to my required activities and lab and things like that, because I felt too fat, I felt too ugly, I felt too disgusting. I think a lot of people can relate to that. That, for me, lasted for years. It was very difficult to get under control and I do think a lot of people can relate to the fact that an eating disorder is never really gone, it's never completely zero, it's always lurking there in the background and it does certainly help to have stress managed and to have healthy lifestyle going on. But it's just something that's always present, unlike other addictions, maybe to alcohol or to drugs or things like that you can stop using or smoking, for instance, you can stop doing those things altogether. But eating and how you view your body those things never leave. Those things are always present. So it was just really difficult for me to deal with that and it took years for me to get that under any level of control. Weight and how people perceive weight, how people perceive their bodies, the morality that surrounds our perceptions of weight and how we talk about it in our society are very personal to me. I have struggled with them myself. I have a lot of empathy for other people in this area, because it really doesn't matter what size you are or how clothes look on you or what you eat or how you move your body or any of those things. The way that we talk about weight is very unhealthy in our society. It's very judgmental. It's based on shaming and blaming. Not only is that a bad way to treat people, but it's also not based on science and it's not based on reality. So the more that I did bariatrics, the more that I got to participate in surgeries and help people go through this process, the more I realized how incredibly important it is to start shaping the conversation about how we understand this field too, not just to be a surgeon that shepherds people through the process one by one, which is, I think, my duty, but also to actually contribute to other providers' understanding of surgery and weight and metabolism, certainly in the bigger picture, helping to reduce how guilty people feel, the stigma around weight, the way that we treat it being seen as a priority, being seen as justice, being seen as something that people don't have to deserve. People should not have to go through the hoops that they do in order to access basic care surrounding weight management. That it's really something to dedicate a life to. I really think this is one of the most important things in the world. So after fellowship, I got a job at a community hospital in Iowa City called Mercy Iowa City. I came to Iowa after my fellowship and got to develop a robotic program there, which was super fun, and got to grow a practice there and really would say that this was the most learning I've ever done in a short amount of time. From how does it really work when you're the one that's responsible for making sure that the right things happen in the OR, that you have the right tools, that you have the right people, that you know what you're doing, that you are learning from mistakes as you go and that you are cool under pressure. I wouldn't say I got all those things right all the time, but certainly it is an enormous test of those abilities and an improvement over time. It also really, really showed me how important it is to get it right for my patients in the clinic, because there's something that Tammy actually told me not too long ago. She is very open about the fact that I did her bariatric surgery last year in November. She's done extremely, extremely well afterwards and just, I think, is just one of the strongest people that I know, very inspiring to me. I remember her telling me that the five minutes before she met me, that she was waiting in our waiting room before her first visit, was probably the worst five minutes of her life. That just hits me to the core, because it should not be back that Coming to a doctor's office to get care for a medical issue should never make somebody feel ashamed or bad or hurt or embarrassed. It should feel empowering and enabling and safe and supportive. The whole idea behind everything that I've learned and everything that I do now is to fix that problem, to make sure that people understand they are welcome, they don't have to deserve the care and that it's good care that they're going to receive. It's the best care that I can possibly provide that they're going to receive. It's worth it because I also see my family in my waiting room Not literally, of course, but I think that would actually be unethical. But what I mean by that is this is how I would hope my family members were treated, or I were treated If I were a patient in this situation. It's how I wish somebody had talked to me about weight when I was younger. It's how I wish other people hear a message now that weight is not a moral issue. Weight is sometimes a health issue. Sometimes it's not, and that when people seek care for weight whether it's in order to come off of diabetes medications or to treat infertility or just to be able to get up off the ground and back on it with their grandkids to play with them, whatever the reason may be that they don't have to deserve the care, they are going to receive the care, no matter, and that care is going to be provided. That's the goal In being a bariatric surgeon. I didn't expect it would be such a patient kind of advocacy field. Maybe I should have realized that sooner, but I am so thankful and so lucky that I landed in this role because I think it's much, much bigger than me. It's much bigger than the field. I thought it was in the sense that it's one of the most important things that we've got to get right, which is how we treat people for weight, and that it's not just about weight, it's about overall health, it's about metabolism, it's about how people's endocrine systems work. It's about allowing people to get access to care, definitely more than the 1% of people that would qualify that currently do. That was an unbelievable statistic for me. I learned that about a year, probably a year and a half ago, that less than 1% of people who qualify for bariatric care ever reach it, ever access it. If we only had 1% of people who had heart attacks getting heart care, that would be a national problem that we all are worried about. Or if only 1% of people with cancer got cancer care, that would be an outrage. I think it's an outrage that fewer than 1% of people who qualify get care for weight and weight management and their metabolism. So that's something that we can change, and that's something that I will be dedicating my life to doing. I really can't think of a more important thing to do. I am really grateful to be given the chance and the opportunity to learn every day and to get to work with Tammy, who has taught me so much more than really any class or I would even say, residency or fellowship or any of those things, maybe even combined about the human aspect here and how important it is to get the human aspect right in order for people to do well long term with bariatric surgery or just in general and getting any access to bariatric care. So with that, I'm going to close out the episode and really appreciate that people have listened. I hope that we continue to bring you things that are worth listening to and worth hearing. Know that you are too, so I'd love to hear your comments, your thoughts about your own journeys, any questions you may have directly for me as a bariatric surgeon. I'm really grateful that you're here too. So thank you and I'll see you next time.