I remember that process very, very vividly because I was the first person to apply to a plastic surgery integrated program in about 10 years from the University of Iowa. So it was very stressful. 

It was very complex. I also applied to general surgery as a backup because at that time it was a little less competitive than plastic surgery, and it's an alternative way to get to plastic surgery. If you want to, you can always do a fellowship, after general surgery. We call that the independent model. Match day was really scary because you find out your match and everybody's all excited, but I didn't know what specialty I'd matched into. You get an envelope that says you've matched, but I didn't know if I had matched in general surgery or plastic surgery. So that week was terrible for me, where it was really fun for all my classmates. But then I matched into my number one choice and it became a very, very, it was the happiest day of my life. I tell my husband, it was way better and will forever be better than our wedding day or probably anything else.

There are a lot of things. When I came into medical school, I knew I wanted to do surgery and people always chime in “You'll change. You'll change. Know everybody changes their mind.” 

And I thought, “Hmm, I don't think so. I've always really liked working with my hands doing projects.” I really came to medical school to enter surgery. So narrowing it down to plastic surgery, as opposed to other specialties, I liked the breadth. You get to see kids, you get to see adults, you get to work on literally every part of the body. 

But what I also liked is you kind of get what you put into it. And I remember talking about this in a lot of my interviews, too. If you're taking out somebody's gallbladder, you either take it out successfully or you don't, there's really no in-between. It's kind of like a pass-fail class, if you will. But in plastic surgery, you can tell a lot of difference between maybe doing something 70% perfectly and doing something, you know, 98% perfectly.  How much work you put in, your finesse really contributes to the final result.

Oh, Galveston. It's the place where if you want to go to a beach and you live in the state of Texas, this is where you come. It has a New Orleans feel. Kind of a French vibe, if you will. Mardi Gras is really big here. It's just a neat place to be. It's kind of the opposite of a college town in that you get all these people here for the summer, but then it gets dead the rest of the year, but now it's good. And I love Texas, you know. I loved Iowa and I have so much pride for Iowa, but it was kind of funny moving to Texas because Texans are, you know, the “Kings” of state pride. So it's nice to be in a state where everybody's proud of their roots.

Last weekend, I went surfing with one of my co-residents, which is definitely not anything I got to do in Iowa. You can do so much outside for so long here, which is really nice. My husband and I work on our house a lot. We were able to afford a house here. No problem. I hang out with my co-residents a lot. I hang out with the general surgery residents. I hang out with the plastic surgery residents. There are lots of things to do on the island, but then you can also go to Houston and to literally anything you could ever imagine.

Plastic surgery used to be where you would do five years of general surgery, and then you would go on and do three years of plastic surgery. They call that the independent model, but it is essentially doing a plastic surgery fellowship. They just don't call it a fellowship.  

They have these independent programs where you just do all of the general surgery and plastic surgery condensed in the six years. So that was the route I liked. We spend most of our first year on general surgery rotations. Second-year, we spent six months on general surgery rotations. And now as a third year,  I'm just exclusively in plastics with a couple of electives like Dermatology and oral surgery, which relate to plastic surgery.

And I've loved it. I love being in plastic surgery. It’s what I want to do. General surgery was fun here. It's not a very malignant general surgery program at all. They love having the plastic surgery residents on because we have a history of having pretty good surgery residency. So the general surgery faculty really like having us on service. 

You get to do a lot on the general surgery rotations. So I decided, I want to take out a gallbladder. I want to repair a hernia. So I was able to operate a lot. I loved it. And now I have a little bit more appreciation for all of the surgery patients go through to get to the point where they need a plastic surgeon.

It's hard because it's just so different from medical school. There's just a lot more behind-the-scenes work you deal with. As a resident, you deal with a lot you just weren’t aware of as a medical student, for example, the fatigue of your pager going off again and again and again. 

We take home call as plastic surgery, which is wonderful. Because you don't have to be in the house all the time, whenever you're on call, but at the same time, you don't get a post-call day. So if you take in-house call, you get the next day off. If I have a really bad call where I have to go into the hospital multiple times, I only get around two hours of sleep. I still have to go to work the next day and do whatever I was scheduled for.  However, our program has been really good about it. They have supported me. I don't know. It's just, it's just different, but it's also different in a very rewarding way.

Oh, that's a good one. Working with people is always going to be a part of your job and you're working with your other co-residents and you're working with other teams and there's so much coordination of medical care that you have to do as a resident. And especially in plastic surgery, you know, if a surgical oncologist wants to cut something out, well, then you have to come in, you have to close it. Well, okay. Do you need certain labs before this patient comes? What date works? All that little stuff is challenging and surprising.

Yea. The first thing that comes to mind--I was thinking about this on my drive home today--was work-related because there is this patient who's in the hospital and he has skin cancer on his leg. It needs to be removed. The patient's young, but he doesn't have medical insurance. And Texas is very different and whatever state you wind up doing a residency in will be, I'm sure different from Iowa. It is very, very difficult to get Medicaid in Texas unless you're a child. And in Iowa, I feel like lots of people, lots of adults have Medicaid and that's just something that's very different here. So this man has no health insurance whatsoever. So he's not funded and we've ordered an MRI for him, but an MRI is going to be really, really expensive. So trying to figure that out; what is the right thing to do here? So it's challenging and it's different. One, it's something you never deal with as a medical student. And two, I think it's something that differs in Texas probably from Iowa. I don't remember having to make medical decisions based on insurance coverage in Iowa. And I don't know if that was just because I was a medical student and I was so far removed from it. Or if we just had, you know, a Medicaid program that catered a little more widely to the adult population. So that's something that's been on my mind.

I think I'm going to tell M4’s something I did that I think everybody needs to do and that is to have someone else also make a rank list for yourself when you match. So for me, it was my husband. He was my boyfriend at the time. They remember how you feel at that program. Because when I sat down, I kind of tried to finalize my rank list. I remember I was thinking, “Well, you know, this program was really, really good. I got this interview at this prestigious place,” and my husband looked at me and he said, “No, Maria, you hated it there.” You have to be true to yourself. You're going to try and talk yourself into a decision that you think you should make. And I think someone that's close to you is going to be honest and truly remember how you felt after that program.