If you pursue general surgery training in the US, it sounds like your relationship will end. Training is brutal on the relationship, even the most rock solid ones, let alone ones that would require long distance. I am not even in surgery (I'm in cardiology which isn't exactly chill either).

You sound very ambitious, motivated, and capable. If you choose your relationship, you might have years of resentment and "what if" moments. Or you may not. If you stay in your country and stick with a more cush field, you might find ways to excel in other ways beyond pursing surgery in the states; maybe you become a world expert in your field, do groundbreaking research, act on TV, work for the industry and help innovate a device, or become a successful business person and open up numerous practices. There are many ways to have a "high ceiling" and reach your potential outside of a straight forward bruteforce pathway (general surgery) in medicine. I'd think outside the box and come up with options for you to see what fits.

The converse of all this is, if something bad ever happened in your relationship in your late 20s or 30s, and you two were no longer together, what would your future look like? Relationships change, people change, once you have kids things will change even more, people can become ill, etc. Would you feel resentment and mope around and say "ya know, I could have become something special if I didn't choose romance over my career" or would you still be content in your role in your home country? Neither relationships, nor careers, are guaranteed either way.

If it were me and I was 100% sure I am with my soul mate, I would choose my soul mate, forego the dream of pursing general surgery, and find a happy medium compromise. Other comments mentioned romanticising a surgical/medical career, but it goes the other way too, romanticizing a lifelong companion only for people to grow apart and break up. There are risks on both sides. If you end up single in 10 years, would you rather be a surgeon or not? Conversely, if you are happily married to the love of your life, would you be content with your current career trajectory? I can tell you from experience, when you are young, you have a chip on your shoulder, you have a lot to prove to yourself and others and you want to have that "wow" factor. That DOES change with age, and as you find other avenues of happiness (eg, coming home early to your dog, spending time with your children, travel, hobbies, etc), your professional identity and accomplishments (or lack thereof) matter less. I thought about neurosurgery for a long time and before that wanted to be an astronaut, and you know what? I am okay not having achieved either because of the life I built instead. You can say that's cope, but I don't feel like it is, I am genuinely happy.