When The One Who Loves You Can't Handle Your Decision

Dr. Chang (00:04):
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. We're back. Got a new setup, a new background and a new guest. Carey, welcome to the show.

Carey (00:22):
Hello.

Dr. Chang (00:22):
Are you excited to be here?

Carey (00:23):
I'm so excited to be here.

Dr. Chang (00:25):
Well, we had to break you in.

Carey (00:27):
Yes.

Dr. Chang (00:28):
So Carey's been a huge part of the practice for a long time, right?

Carey (00:32):
Seven years.

Dr. Chang (00:33):
Oh my God. Yeah, as one of the OGs, you've done a lot in the office. Why don't you tell everybody the different things you do?

Carey (00:43):
So my main thing is I am the esthetician at Congressional Plastic Surgery. So I do a lot of the lasers, the skincare, but I also help Dr. Chang with post-ops, follow-ups, pre-ops. It's a great way to meet patients and then also connect with them and let them know about the other things that we do in the office, not just surgery, but it's front to back and it's a lot of fun, a lot of different things every day.

Dr. Chang (01:16):
Yeah. I mean, you're part of the face of the practice. I think you've met hundreds and hundreds of patients in many different clinical avenues, right?

Carey (01:24):
Right. Yeah.

Dr. Chang (01:25):
So it's great to see them as clients of your own as well. So today we're going to talk a little bit about that interaction maybe of what it's like in the room with the patients when they have questions and during recovery or before surgery even. But also what happens to those around them and companions and loved ones and friends that are trying to be there to support them, right?

Carey (01:50):
Oh, yes.

Dr. Chang (01:51):
So we'll start with kind of a story. A movie star was told that she needed a double mastectomy and the person who fell apart in the room wasn't her. It was her husband. And so what happens to a patient's decision when the people who love them can't handle it or they react differently than the patient themselves? So Sharon Stone is the movie star who, I don't know if you saw this, but I feel like it, I'm not sure if it was an old interview, but it was an old experience from a number of years ago and she was being interviewed and she gave this description of being told or thinking about having a double mastectomy, planning to have a double mastectomy and her husband really got upset about it in front of the doctor in the middle of this consultation where they're trying to deal with this new diagnosis of a tumor.

Carey (02:41):
Yeah. I definitely think that the companion, whether it's spouse, boyfriend, friend even, their attitude definitely affects the way that the consults go, the way that the post-ops go, follow-ups, even if they are just sitting there silently, you can just tell there's a different energy in the room. And there are times where the companion seems to be more concerned about the surgery or more concerned about the results than the actual patient. And that is definitely a frustrating appointment because you're trying to have the conversation with the patient and the partner keeps chiming in or they keep giving their opinion on what size they think they should go, how it looks and sometimes you just want them to leave.

Dr. Chang (03:42):
Yeah, I know. Well, I know exactly how you feel because I've been in this situation. I think that we want patients to have support. We want the people around them to be their champions and their cheerleaders, but sometimes you also want the patient to speak up for themselves. And it's frustrating because I don't really want to hear what he's got to say or she's got to say. I want to hear what you have to say. And there's some patients that don't speak up for themselves that are a little timid or mousey and then you feel like you're talking through their interpreter or something because they're the spokesperson.

Carey (04:22):
Right. Yeah.

Dr. Chang (04:23):
It's awkward.

Carey (04:24):
Exactly.

Dr. Chang (04:25):
It's a strange dynamic sometimes. Sometimes you're like, how well do you know this other person? I often say when I'm in the consultations that the companion seat is the most difficult seat to be in the room. Let's say you're with your wife or your girlfriend and she's trying on sizers to decide what size of breast implants she'd like to have that might fit her goals or she's getting examined for a tummy surgery or anything like that. If you're the companion sitting in the side of the room, you're there because they want your input and they want your opinion, but it's difficult because you don't want to say something and be judgy, but some people say too much and it's sort of like they're taking over and they're being too opinionated. So it's sort of like a lose, lose, lose situation.

Carey (05:16):
Yeah. What I've come to notice in these pre-ops, because I really don't go into the consultations. So a lot of times it sounds like the patient might come by themselves to the consult and then they bring their ... And then once they decide, okay, we're going to do the surgery, we're going to go forward with it, then that's when the spouse or partner comes along. And especially for breast dogs, I can guarantee you every time someone brings their spouse or partner into a breast dog pre-op, the implant size always goes up. The husband is always like, "Oh, well, if you're going to go under, you might as well do, get it a little bit bigger." And then it kind of just-

Dr. Chang (05:58):
You're giving the boys a bad name. Come on. What if she is saying in the car or in the other conversations, "Should I go bigger?" And they're just encouraging them because they're nervous about it. Maybe some of the guys are a little forward with their suggestions, but maybe they're just trying to be reassuring. But either way-

Carey (06:19):
No, but then I'm also the one that encourages them to go bigger. I say it to everyone. I say, out of all the years I've been doing this, all the pre-ops that I've done, I've never had a patient come into their post-op appointment and say, "I should have gone smaller." So it's not that the men are wrong, but they definitely do encourage the size up.

Dr. Chang (06:41):
Right, right. We're not trying to blame the men for pushing their agenda, although some probably do have a little bit of an agenda.

Carey (06:49):
But I will say, I was just thinking of a very recent situation where the patient was kind of borderline, "Do I need to do a full lift? Do I not? " And the husband seemed to be very vocal, kept asking about the scars for a lift and a part of me was just kind of like, "Drop it. You're making her more self-conscious about these scars. And if you want a great result, yeah, you'll have the scars, but we do everything in our power to minimize those scars for the patient." But I do think the husband really got in her ear and then it was kind of this back and forth of like, "Well, can we maybe not do a lift?" And I felt really bad and I kind of was just like, "This is the moments where I want to say, get the heck out of here."

Dr. Chang (07:40):
Yeah. Well, this leads in, sometimes we look at anonymous questions that we've received. So we picked up a private anonymous question that sort of suggests the companion was giving a hard time. So we'll get your reaction to this.

Carey (07:53):
Okay.

Dr. Chang (07:54):
So my husband keeps saying that he doesn't want me to change and that I'm doing this for the wrong reasons, but I've wanted surgery for 10 years and now I'm second guessing whether I'm even allowed to want it. How do I tell the difference between his concern and control? So how do you tell a genuinely supportive partner from one who's steering the decision, kind of like what you were saying there?

Carey (08:20):
I mean, I always say, who cares what your spouse thinks? If you want to do it, you do it. It's not his choice. And I think a lot of times, yes, of course if you love this person, you don't want them to change drastically. Let's say for rhinoplasty, for example, they might say, "Well, that's how I met you and I love your nose and I don't want you to change." But if this person is looking in the mirror every day and it's something that's driving them crazy, they're self-conscious about it. They don't like to take photos on one angle because their nose looks crazy. I think it's kind of like just let them be happy and let them do it. And those are the moments you kind of just need to shut up and let them do it.

Dr. Chang (09:11):
Yes.

Carey (09:12):
I do not-

Dr. Chang (09:13):
You're a champion for women's power or patient autonomy.

Carey (09:17):
No, I don't think you should let your partner tell you what you can and can't do.

Dr. Chang (09:21):
Well, this is interesting because this kind of reflects back to one of the early episodes Jackie and I did. We were reviewing a Reddit post where she had been talking about getting Botox or had gotten Botox and her husband was a little irritated that she was getting Botox and they had a big discussion about it and basically she didn't do it for a while. Then she went and got it and he saw the charge and he was like, "Well, what was this? " And he threatened to divorce her because she went and got Botox again. All right.

Carey (09:49):
Oh my God. Botox?

Dr. Chang (09:52):
The eye roll was severe. But it was like, am I the asshole for considering divorce over this? And it was just sort of like it's not so extreme that she's going to completely change her faith and become a different person if you love somebody or you care about somebody and they're just trying to take care of themselves, you should support them. I think that's really what we're hoping for.

Carey (10:15):
Well, you know how much I love Botox. So I have family members that they say the same thing. They're like, "Well, my husband doesn't want me to get Botox." And I say to them all the time, I'm like, "Your husband won't even know if you have it. Botox doesn't change the way you look. It just relaxes, helps reduce the appearance of fine lines and wrinkles." I was like, "He won't even know that you had it done." It'd be one thing if they're coming in and getting three syringes of filler put in their face, then he would know. But overall, a man would never know if you have Botox.

Dr. Chang (10:48):
Women will often say in the office or in anything, "Oh, I cut five inches off my hair." Men won't even notice that.

Carey (10:53):
Exactly. They won't notice the Botox, but they definitely will notice the charge on their card if it's ...

Dr. Chang (10:58):
Ah,

Carey (10:59):
Yes.

Dr. Chang (10:59):
That's the other secret. Well, some people break up the charge and they go, "Put $200 here. But let me pay this in cash. Let me write the check for this.

Carey (11:06):
And I agree.

Dr. Chang (11:07):
Sneaky.

Carey (11:08):
Yeah. If you can afford it, I get it. If financially you really shouldn't be doing it and you do it anyways, then he has every right to be mad at you. But one, if it's your own money, do as much Botox as you please. And two, yeah, get so many ways around it. Get a credit card he doesn't know about paying cash. Cash is king.

Dr. Chang (11:33):
You want all the insider tips who to ask at the office, all the moves.

Carey (11:37):
There's always a way to get more Botox.

Dr. Chang (11:41):
Well, have you ever had a time when you feel like you should tell the patient, "Just come back without your spouse or your husband. Just we can have a much better conversation about this".

Carey (11:53):
Yes, I do remember it was a couple and I remember every time we saw her on the schedule, we all would roll our eyes, not because of her, but because of him. And I think it got to the point where one day you did have to say, it was a follow-up and you did have to say, "I am not talking to you. I'm talking to her. I need to know how she feels about this.

Dr. Chang (12:17):
Oh, I do remember that. I do remember this.

Carey (12:21):
It was at the old office.

Dr. Chang (12:22):
Years ago, but it was difficult because he wouldn't even let her speak about that. And I also feel that she didn't feel empowered to speak about it too. So she was kind of reserved, but it's difficult when you feel like you're not talking to the patient.

Carey (12:40):
Right. And then there were times where I feel like even maybe after that, after you said, "I need you to back off and let me have this conversation," I feel like he stopped coming and then she was lovely. And she was pleasant and we didn't find her annoying. I remember the appointments used to be dreaded.

Dr. Chang (13:06):
I mean, I had a conversation with a difficult patient recently who was very dominating over, wouldn't let the patient have the conversation with our office, with the staff and it was a mother just really controlling everything and it made it very, very difficult.

Carey (13:25):
But yeah, I would say it's a little trickier when it's a mother child dynamic,

Dr. Chang (13:32):
Especially- But this was an adult child though.

Carey (13:34):
But that's what I was about to say. It's one thing when they're little. I mean, yeah, we see younger kids for certain things, but no, that to me is like, okay, and Jackie even made a good point about it. She was like, "That patient is 18. We don't have to talk to the mom if we don't want to, " type of thing.

Dr. Chang (13:53):
Right. You're responsible to communicate with the patient and the mother can be available if the patient consents, but it's really, you're talking to an adult.

Carey (14:03):
Yeah.

Dr. Chang (14:04):
So getting back to the sort of teaser and the story, so Sharon Stone had this big lump in one of her breasts. She went to a doctor and they said, "Well, we should remove this. This could be a cancer." And they said, "What about the other side?" And so she said, "I would like you to do a bilateral mastectomy to move both breasts because I don't want to worry that I have this chance of having breast cancer." It's so much anxiety. And so then her husband basically at the time, her ex- husband now, but he said this was ridiculous. And he stormed out of the room and angry that she had basically made this decision on her own and he was upset about it, not really that the cancer might kill her. And the surgeon had to collect him, told him to sit down and try to reassure him that if more patients had made decisions like hers, that more women that he had been seen as patients would be alive.

(15:01):
The tumors did turn out actually to be benign, not really cancerous, but still was scary. And breast cancer affects one in eight women, so it's very common. So anyway, I don't know if you have any thoughts about that, but ...

Carey (15:14):
Well, I mean, makes sense, he's her ex- husband now.

Dr. Chang (15:18):
Yeah. Okay. That's the perfect way to wrap. That's perfect.

Carey (15:21):
That is crazy. I get worked up about a husband telling a wife she can't have Botox, let alone him telling her, "Don't remove your breasts when it might be cancerous."

Dr. Chang (15:34):
I mean, I'm going to give him a little bit of a, "Okay, it's an emotional situation. It's a scary thing. Maybe he just lost it for a minute." But yeah, ultimately in the grand scheme of things, it's totally inappropriate, obviously.

Carey (15:49):
Yeah, very inappropriate.

Dr. Chang (15:51):
But anyway, we love having you. Thank you, welcome to the show. We'll have you here more often and love to hear insider perspective because my perspective and your perspective, although they're aligned most of the time, sometimes you can give us a clue as to what's going on. So we'll see you back.

Carey (16:11):
Perfect.

Dr. Chang (16:11):
If you guys have any questions about anything we talked about on the show, you can see us in the show notes or leave us a comment and like and subscribe. Thanks for listening to Secret Services to 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.

(16:53):
Oops, patient's here. We got to go.