I’m not originally Texan, I grew up in Oklahoma and I got out of Oklahoma as quickly as I could. I am the 5th child of eight. I have five brothers and two sisters. I’m kind of the middle child and middle daughter. My dad was an insurance claims adjuster, my mom was a travel agent. They didn’t make a whole lot of money but prioritized sending us to Catholic schools. The expectation was always that I would go to college, and that I would go to the University of Tulsa. But I didn’t really want to go to Tulsa. I didn’t want to live at home, so I only applied to out-of-state colleges. I don’t think my parents ever found out about that! I chose to come to San Antonio and went to St Mary’s University for a few reasons. I also liked the opportunity to live away from home. Though my parents were worried about the costs of going to an out-of-state college, I got a scholarship through my father’s company which essentially paid all of my tuition and fees. So I was able to move out for college.
I knew I wanted to go to medical school eventually. I liked the idea of helping people, the idea of being my own boss. I chose to go to medical school in San Antonio, but I didn’t go to medical school right away. I taught high school in San Antonio for a year before going to med school. At the time, there weren’t that many med schools in Texas but there were still considerably more schools than in Oklahoma. So after weighing all my options, I thought that working as a teacher for a year would be best. I was kind of a pioneer in taking a gap year, as my family didn’t fully agree with my decision. My brother was pursuing a PhD at the time and did not believe that I would want to go back to school after working for a year. The pushback, however, made me more determined to show him that he was wrong. After my gap year, I began medical school at the Long School of Medicine here in San Antonio.
Going into medical school, I thought I wanted to be a primary care physician. I liked the idea of taking care of people throughout their lives. Then, in my very first clerkship in the third year, I did Surgery as my very first clinical rotation and I loved it. The thing that made me love surgery was anatomy, which was hands down the best class I took in medical school. I’m not saying that just because that’s what I teach now! I loved Anatomy, and surgery is applied anatomy if you ask me. Additionally, growing up we didn’t have a lot of money so I often made my own clothes. I did a lot of stuff with my hands and so I thought, “Maybe I want to be a surgeon.” I tried to compare every other clinical rotation with how I felt during my surgery rotation. I asked myself if I could see myself in that specialty for the rest of my life. In doing so, I found that I liked the idea of a specialty where I got to do something actively to help a patient. With surgery, I like seeing a problem somebody comes in with, like appendicitis, and you take out their appendix and they’re basically cured. I love that about surgery.
I got married at the end of my second year of medical school, and my husband is not a physician so making decisions was a little different than if I decided by myself. He was always very supportive, so when I realized I liked surgery, he assured me that we would figure things out. Looking back, it was the best decision I could have made because I love surgery. I kind of did my general surgery residency in a couple of places. I initially was at a Yale-affiliated program for a couple of years. Part way through my second year, the head of the program here in San Antonio called me and said, “Hey we’re short, we’ve lost a few of our residents and we’re wondering if you want to come back.” My husband and I were both from San Antonio, so it was not a hard decision to make. So I finished my general surgery residency in San Antonio. I didn’t really decide I wanted to do plastics until I was in my fourth year of general surgery residency. When exploring plastic surgery, I found that I loved hand surgery. I loved the intricacies, I loved the mechanics of the hand. I factored that into my decision-making process and went for 2 months during my fourth year to Duke and spent time with a microvascular surgeon in plastic surgery who later came on faculty here. And the kind of things that he did were incredible. I loved every minute of it. Some of my fondest memories of residency are not in general surgery but in plastic surgery. Looking back on it, I realize I wasn’t nearly as happy as a general surgeon. I found my calling in plastic surgery.
After seven years of residency, I realized that my favorite surgery to do by far was breast reconstruction. It was a way for me to see a problem, find a way to fix the problem, and change the patient’s life and that kind of brought me back around to why I went into medicine to begin with. And so I eventually went into private practice, focusing on breast reconstruction surgery. I set up my own practice in San Marcos, Texas, a fairly small town between San Antonio and Austin and they didn’t have a plastic surgeon at the time. I also had a job offer for an academic position at Texas Tech El Paso as the plastic surgery faculty. I didn’t choose Academia early on because I’m very independent. I wanted to be my own boss and set my own schedule without the “publish or perish” pressure of academia. By that time, my husband had his MBA so he helped me to set up a practice. He was essentially my office manager throughout my private practice but otherwise, I’m not sure I could have done it. I didn’t have a business background.
I loved what I was doing, I loved plastic surgery and I loved breast reconstruction. They’re my favorite patients and to be honest I’d still be doing that today had I not had an accident and broken my shoulder, which pretty much was like an ACL injury for a pro basketball player ending. My injury required three surgeries on my shoulder. I was like, “Okay, it’s not ever going to be the same.” While I could have still done surgeries, the breast reconstruction procedures at the time were difficult. I was so sore afterwards for a long time and it took me longer to do the procedure than it had prior. Instead of breast reconstructions, I did procedures that didn’t require going to the operating room, as well as workers comp. It paid pretty well but I hated it because it felt like I wasn’t doing anything.
I started reflecting and, to be honest, that was a pretty dark time because it’s like “My career is done, what am I going to do?” But I wasn’t ready mentally to retire. My twin sons were in fifth grade when I had my accident, I wanted to keep working. My practice was very important to me, it was also like my child. My patients were very important to me. In a small town, a lot of my patients had become friends and so I had a relationship with these people. Though it felt good to continue providing non-procedure services, lots of days went by when I wished I was still operating. I told myself, there’s gotta be something else! I made a list since I’m a list kind of person, and I thought… “how can I use my training and experience?” My first thought was, “I could go into radiology…” but I didn’t want to go through residency again. I started to reflect more, and I remembered how I started off teaching high school. One of the things I valued in plastic surgery was the teaching aspect. I would tell patients what their problem is, how the procedure would work, and how they’ll get back to normal form. This communication aspect was something I also loved doing, but I knew I didn’t want to teach high school again. That got me thinking about teaching anatomy so I reached out to Dr. Linda Johnson, one of the course directors for anatomy at Long School of Medicine, to see if she needed any help. Dr. Johnson knew me previously and she readily agreed.
While maintaining my private practice in San Marcos, I volunteered as an adjunct-faculty for the anatomy course. Eventually, as Dr. Johnson reached retirement, I took over as a co-director of the course. I felt like I had two full-time jobs, and I also joined the admissions committee which added a whole other layer of workload in the fall. But, I told myself early on that if I lost my passion for doing something, I’d probably retire. As a surgeon, as a physician, and now as a teacher, I’m very lucky to love what I do. I eventually quit my practice in 2018 to join UTHSCSA full time. I love that I get to see students from the interview stages and then through each year of medical school. I get to have somewhat of a relationship with young people! You always need to ask, where do you see yourself being the happiest? I truly believe that no matter what specialty you choose in life, if you are doing something that you love, you will find the ability to be your own boss.
Story by Vyshnavi Gade
Photos provided by Dr. Occhialini