Blaming Anesthesia: What the Mica Miller Story Leaves Out

Jackie (00:00):
Maybe you could be a little weird for a day or two when the anesthetic's wearing off, but to claim that that changed her forever, I find that hard to believe.

 

Dr. Chang (00:15):
You are listening to Secret Services where we discuss the procedures nobody admits to, but everyone's curious about. I'm your host, Dr. Christopher Chang.

 

Jackie (00:25):
So we're going to take it back to something we discussed in the headlines. So on September 4th, a jury deadlocked and a Plymouth judge declared a mistrial in the Lindsay Clancy case.

 

Dr. Chang (00:36):
Oh yeah, saw that.

 

Jackie (00:37):
Six days earlier, Netflix death of a pastor's wife landed and did numbers. And its central claim made by the husband to Micah Miller's siblings is that her mental illness started with a strange reaction to anesthesia during her breast dog. Both cases put surgeons and anesthesiologists inside a story and most medical training never prepared them for. So when a case like Clancy hits the news cycle, does it change what patients start asking at consults specifically about their own psych history or whether they can still have surgery?

 

Dr. Chang (01:06):
Well, I haven't had that come up lately, but this was pretty recent news. And a lot of the consults were planned months ago, so the people we see today have been sort of indicative.

 

Jackie (01:18):
Right. It might be the influx coming in.

 

Dr. Chang (01:21):
We could ask the lead team or the PCC group what they're hearing on the phone because they're probably having those conversations with patients on the phone about maybe things that are more current like mental health and that kind of thing.

 

Jackie (01:33):
Yeah. I will say not the Lindsay Clancy, but I feel like there's more coverage from TMZ about all of these patients having these huge surgeries in Mexico and passing away or influencers having mommy makeover, something goes wrong. So I will say when stuff like that happens, we hear a lot about it from the patients.

 

Dr. Chang (01:58):
Especially when it's an influencer, like that lady in Ohio, I feel like that was pretty talked about in the consultations or the pre-op area a lot.

 

Jackie (02:05):
I will say one thing for me personally after this Lindsay Clancy trial that stuck with me is, I mean, they beat it into your head in nursing school, but how important documentation is.

 

Dr. Chang (02:16):
Yeah.

 

Jackie (02:18):
They had the one nurse that worked with Lindsay Clancy on the stand, and she had incredible documentation and was able to run through everything perfectly. And everyone was like, "What a good example. What an awesome nurse." And then you have the one psychiatrist that they kind of really grilled into because they were reading her notes and she was saying, "Well, no, no, no, that's not what I meant." And they're like, "But that's what you wrote. So your notes are not what you mean or what you're trying to say. You need to be deliberate with what you document." So I think for me, it was just a nice little refresher like, "Hey, you've been out of school for 15 years now. Remember how important documenting is."

 

Dr. Chang (03:00):
Yeah. I remember doing psychiatry in medical school and you would write essays because the interaction with the patient is all the conversational and some of those patients can talk forever and they seem like they're making sense. But then when you go back, you're like, wait, this person, if you read this to somebody who was not in the conversation, they'd be like, "This person is totally off the rocker." But in the moment you feel like you follow their logical steps to whatever their hallucination is or the schizophrenic idea might be. And anyway, the documentation is very, very long.

 

Jackie (03:36):
I'm sure, yeah. It's way more difficult with a psych patient because flight of ideas, just trying to get it all down. But just a good reminder in general, it also helps you out too as a provider. If they come in a few years later, if you took good notes, it's really easy to jump back into the conversation with them. Absolutely. Just a nice little reminder. Back to the psych thing in anesthesia, we have an anonymous question. My mom is in her 60s and has had two major surgeries under general anesthesia. Both times she came out of the OR saying she was 'not herself for weeks afterwards. She's now scheduled for a facelift and my whole family is nervous. Should we push back or is this a real thing surgeons actually know about and plan for?

 

Dr. Chang (04:20):
Well, this is a good question because this happens. It happened to a patient of ours recently who was a little bit confused after surgery and fortunately came back to her normal self. But I think that first of all, before surgery, we talked about this, you have to have a medical clearance. We try to check everything off. We try to review all the medicines and any kind of history of anything that's happened before under anesthesia as this question asks. So two things can happen. You can go through the anesthesia and have a different reaction, maybe not have these bad effects, maybe go through sales super smoothly. That could be because you are different, because the anesthesia they gave you was different, could be the amount of time you're under is different. So there's a lot of reasons why you could have a better experience. But that being said, should you let the anesthesiologist and the care team and the perioperative team know?

 

(05:17):
Yeah, absolutely. You should tell them. But if there's no medical or concrete or documented reason why you can't go forward, you're also going to be cleared for surgery in most cases.

 

Jackie (05:27):
Correct. Yeah. So they say post-op cognitive dysfunction. Is it a real diagnosis? How common is it after cosmetic surgery? It's not necessarily different because of cosmetic. It would be like any general anesthetic you get. Our anesthesia providers, we try to get a good history. In general, even if you've never had any symptoms like this, anything you felt or can report back from the last time you had general anesthesia is helpful to us.

 

Dr. Chang (05:57):
Oh, I get nauseous after anesthesia.Okay. Then we'll give you a special anti-nausea patch or whatever.

 

Jackie (06:03):
Yeah, because anesthesia, it's tailored to each person. And so the more background we have, the more information we have to put your puzzle pieces together, the better outcome you're going to have.

 

Dr. Chang (06:13):
Yeah. Think about the patients who are like, "Oh, last time it took me forever to wake up from anesthesia." It means you're snoozing like a baby for three hours. It's like, okay, well that means you're sensitive a little bit to the medicines and we're going to be conservative and not snow you because we want you to be able to wake up and talk and hear their post-op instructions and be able to go home and sleep in your own bed.

 

Jackie (06:35):
Right. We're very successful when patients tell us these things ahead of time. We have a lot of patients that tell us last time it took me hours to wake up. And so we can change the anesthetic plan. You'll still be getting general anesthesia, but we can give you a different cocktail of medications and people will wake up amazingly and they'll be like, "This is totally different than last time."

 

Dr. Chang (06:59):
Well, that's the other thing is that our group and our practice is focused on ambulatory outpatient surgery.

 

Jackie (07:04):
Exactly.

 

Dr. Chang (07:05):
So we're dealing with healthy people. We're trying to make sure that you are comfortable, but that you can wake up and still function and get back to recover quicker. In a hospital, you may get somebody who just knocked out a cardiac patient that they're going to keep them in the ICU intubated for the next two days or something, and then they might get in their shift and come over to you. And for them to change those gears or the parameters of how they get you going may be a little bit challenging for them to kind of adjust.

 

Jackie (07:32):
I do say that, our providers here, that's what they are skilled at. They have great backgrounds with hospital anesthetics, but they're very skilled at the outpatient. And so they know how to tailor the anesthesia so you're not feeling like crap all day. And it's different than a procedure you may have had in the hospital where they already knew they were going to keep you overnight so they can hit you with a lot of stuff.

 

Dr. Chang (07:53):
They want you to be comfortable. So they may knock you out and then you'll be like, okay, I don't want to do anything and can't move for the whole night.

 

Jackie (08:01):
And then as far as what does a plastic surgery practice do differently for a patient with documented psych history versus one without, it doesn't totally change your anesthesia plan, but that's why we ask ahead of time what meds you're on. There may be some that interact more heavily with anesthesia that we'll get together and tell you maybe you need to stop this medication a couple days before surgery or don't take this heavy sedative the night before surgery because that will absolutely affect you the next day waking up. So it's really just for us just having a good conversation and tailoring it to each person. But none of it's going to make it so you can't have surgery. We'll just change the plan to fit you best.

 

Dr. Chang (08:46):
Right. Exactly. So back to Clancy. We recorded this Clancy episode a few weeks ago and now they announced the mistrial. So from the OR side, does anything about that case sit differently for you now that it's revealed that the jury kind of had a little bit of a difficulty or maybe it's your perspective that the jury was pretty clear? I don't know. I think that -

 

Jackie (09:12):
I don't know.

 

Dr. Chang (09:14):
There's a little controversy with the mistrial.

 

Jackie (09:16):
I went down the rabbit holes of the conspiracies. I don't know. I mean, I think just in general, it's disappointing to see a mistrial. I think they're going to have another court date to decide where exactly Lindsay Clancy will be, but last I heard, she'll probably just still be in this mental health facility hanging out. So I think it is frustrating that they couldn't come to a consensus.

 

Dr. Chang (09:43):
Yeah. So it was on the 4th earlier this month that the judge declared a mistrial in Lindsay Clancy's case after the jury deadlocked over seven days and the defense argued postpartum psychosis and a lone juror reportedly held out. Six days earlier, Netflix released Death of the Pastor's Wife, a three-part documentary about Micah Miller, the South Carolina pastor's wife, found dead in April of 2024. Her siblings say on camera that her husband, John Paul Miller, told them that her mental illness began after a strange reaction to anesthesia during a breast augmentation. Both stories are landing at the same time and both ask overlapping questions about women, surgery, medication and who gets believed.

 

Jackie (10:32):
Well, first I want to say it's crazy to me, and we don't know. We don't know what was actually happening behind closed doors for the jury's deliberation, but they're claiming that the guy who held out admitted he had reasonable doubt, but still wouldn't budge on letting her get off on the postpartum psychosis, which I think just kind of opens up the question where do you draw the line? Because I mean, I see both sides. At some point I could argue anyone who's murdering anyone is psychotic or they had an episode. So at what point -

 

Dr. Chang (11:11):
A normal person wouldn't do that.

 

Jackie (11:12):
Correct. Right. So how do you say, "Well, they had good intentions, but they still did it." I don't know. It is tough and I think it's hard for a random jury to make that choice, but it is just frustrating that he admitted that there was reasonable doubt.

 

Dr. Chang (11:30):
This guy's a little strange because I heard that. I mean, these are all rumors, but I heard that he obviously didn't have an open mind. Had already made u his mind. He couldn't produce arguments and then he just wouldn't interact with the rest of the jury pool.

 

Jackie (11:45):
Yeah. I heard he was on his phone, but then I also heard that he was taking the exercise bands and was imitating how the children were killed. I don't know. It just seems like -

 

Dr. Chang (11:56):
He doesn't seem like a great pick for the jury selection.

 

Jackie (11:59):
Exactly.

 

Dr. Chang (11:59):
Plus, I heard that he has a history of domestic violence and he's getting to get evicted for not paying his rent. And he's not exactly the most upstanding citizen from what I've heard.

 

Jackie (12:11):
I think as the average American.

 

Dr. Chang (12:14):
Is this the average American?

 

Jackie (12:15):
No, but I'm saying I think when you think you're going to have a jury of your peers, I think you would think that they vet these people well, especially for a high profile case like this. So it was shocking for me to find those things.

 

Dr. Chang (12:29):
But somebody said when they unearthed that later on, they might've claimed a mistrial anyway, even if he had agreed with their other jurors.

 

Jackie (12:37):
My fear is that, okay, now everyone's been exposed to this story. How are you going to find an unbiased jury at this point? How is this not just going to end in a mistrial again?

 

Dr. Chang (12:50):
You'd have to find people like my dad who have no touch, who are out of touch with everything in social media world.

 

Jackie (12:54):
Which is a jury of a bunch of old people. But then you have my grandma who is addicted to court TV, so she probably obsessed with stories like this.

 

Dr. Chang (13:04):
All right. So then fill me in on the Pastor's Wife documentary. You've seen some of it?

 

Jackie (13:08):
Another crazy one. All of it. Another crazy one everyone should watch. This girl, she starts dating this pastor in Myrtle Beach.

 

Dr. Chang (13:18):
Is she part of the congregation or meets him outside of that?

 

Jackie (13:20):
Part of the congregation. She's a singer. She seems like a normal person. And then apparently -

 

Dr. Chang (13:28):
Big age gap or not really?

 

Jackie (13:29):
I think there was a bit of an age gap.

 

Dr. Chang (13:32):
Okay. So she falls in love with him.

 

Jackie (13:34):
Falls in love with him. She gets a breast aug. And then it's very clear throughout the entire show that this guy is insane and manipulative, and he tweaks religion for her to sleep with him multiple times a day. It's not farfetched to think that he encouraged her to get this breast aug. And then -

 

Dr. Chang (14:00):
Or forced her essentially.

 

Jackie (14:01):
Right. And then they claim that her mental health. So ultimately she ends up committing suicide because of everything that he puts her through. So did she even ever want this breast aug? Unclear. So it's like, was she having actual reactions to anesthesia? Was she even having these side effects or is he just claiming it?

 

Dr. Chang (14:26):
But what happens in the mental illness side? It says that she started behaving differently or something.

 

Jackie (14:32):
Yes. Almost like a postoperative psychosis.

 

Dr. Chang (14:36):
But what examples of what was she doing that. Did he claim she was crazy, but she wasn't actually crazy or what happened?

 

Jackie (14:43):
That's kind of what I think. He said she was going into manic episodes and acting differently after the breast augmentation, but it was immediately after. It's not like. So I.

 

Dr. Chang (14:55):
So manic episodes in the hyper sexual thing or because there was all that stuff too, right?

 

Jackie (15:04):
I think she just wasn't being his personal slave, and that's why. So another thing that he does, which is insane, is later on in the show, he starts injecting her with testosterone so that she will have more libido to keep up with all the sex he wants to have. And then she was a singer in the choir.

 

Dr. Chang (15:28):
But her voice is going to drop.

 

Jackie (15:29):
Yes. Yes. She was having difficulty. And so everyone else is just thinking, "Oh, she's sick. Oh, her voice is just cracking," when really it was because of the testosterone.

 

Dr. Chang (15:40):
And she could get facial. I mean, that's what people do when they're doing gender transitioning is they'll take testosterone. She's going to get facial hair.

 

Jackie (15:52):
So that's what I'm saying.

 

Dr. Chang (15:53):
Acne. Seems like a bad idea. Have the pastor inject you with -

 

Jackie (15:58):
I'm not saying I don't think it's impossible to have maybe some anesthesia-induced psychosis. I don't know. Maybe you could be a little weird for a day or two when the anesthetic's wearing off, but to claim that that changed her forever, I find that hard to believe. And also, I just feel like what is being left out of this story? If this man was injecting her with testosterone, when did that start? Had he already been doing that? Are there other things in her body that are causing this?

 

Dr. Chang (16:35):
I mean, sometimes we see couples that come in together for a surgical consultation and it seems like the husband or the boyfriend or whatever is a little pushy sometimes or they don't straight up say, but you know that there's a lot of looking over for approval to the companion seat essentially. And so sometimes you don't know what kind of conversation they're having in the car or the bedroom or the dinner table when they're talking about those things, but you definitely do see a little bit of that sometimes. You try to protect the patient. Sometimes we'll ask the patients to come in alone and then we don't bring in the companion until after we've had the initial intake discussion and Christine will do that.

 

Jackie (17:16):
Well, that's what's interesting. The narrative around both of these people has been completely controlled by the husband. You have the Lindsay Clancy trial. Patrick is saying she said all these things to him. Every single person that was on the scene when she jumped out the window said she was nonverbal. So we're all basing it off of what Patrick's saying. And then this claim that Micah Miller is going into this psychosis after her breast dog, it's like, would she say the same or is he just saying it? I mean, I think that ultimately she did, but I think it was because he was just so controlling. And I mean, any man that's injecting you with testosterone. So he would preach to the choir that women need to satisfy their husbands. If not, they're going to cheat. He was cheating on her. There's speculation that Patrick Clancy was cheating on Lindsay. I don't know.

 

Dr. Chang (18:11):
There could definitely be a lot of. I mean, also injecting testosterone maybe could affect her mood where she was -

 

Jackie (18:17):
That's what I was thinking.

 

Dr. Chang (18:18):
You can be aggressive when you have androgens and stuff like that, and maybe her mental health was affected by the testosterone too. I mean, you never know these things, aside from being in an abusive relationship, which is of course stressful to your mental health.

 

Jackie (18:31):
Well, one last question before we wrap this up. Has there ever been a situation where you didn't trust the emotional dynamic around the patient, not necessarily the patient themselves, that has made you want to decline to operate? Like maybe an overbearing husband, unsafe situation?

 

Dr. Chang (18:50):
Yes. Yes, definitely. Definitely. I wish Carey were here because Carey would remember she's got a memory for these guys, especially when it's awkward and you're like, "This guy's got to get out of here." I remember having to get pretty firm with somebody to say, "Hey, listen, I need her to tell me what she's looking for. I can't have you speaking and answering every question when I'm speaking to the patient like this and the answers are coming from over here." I'm like, "I really have to make sure that these are your thoughts and not his thoughts." And I do remember it was a little tense because I was interjecting in this conversation, but it didn't feel right to have somebody really pressing. And it's one of those things where I have the responsibility to really make sure we're doing the right thing here and that we're taking care of the patient first. So I do remember that was a very significant consultation or maybe post-opera visit. I forget what it was.

 

Jackie (19:48):
Well, we'd love to hear your comments about Lindsay Clancy, also about Micah Miller, and you guys should all watch that documentary, Death of a Pastor's Wife, because it's crazy and super interesting.

 

Dr. Chang (20:00):
You guys watch it, leave us some comments, and then we'll get in for the next episode. All right guys, take care. See you next time.

 

Jackie (20:05):
Thank you.

 

Dr. Chang (20:06):
Thanks for listening to Secret Services, the podcast where we see everything and say nothing except right here. I'm Dr. Christopher Chang, double board certified plastic surgeon located in Tysons, Virginia. Follow us on TikTok @congressionalpsurgery or on Instagram @congressionalplasticsurgery. To send us a classified message or to hear more episodes, go to secretservicespodcast.com. Links to everything we talked about on today's show are available in the show notes. Oops, patient's here. We got to go.