Pursuing me and every plastic surgeon in this life and, I fear, in the hereafter is the all-too-frequent statement from a postoperative patient: “Doctor, someone asked me why I have more swelling on one side of my face than the other” (a week after face lift).
This theme has infinite variations and fugues (subterfuges): “Someone I know had the same operation and she never had this happen to her” (this could refer to anything).
“Someone told me that you did her friend— Betty Perfekt—and she looked better in two days than I do now at two months [really 5 weeks] after my operation!” This last sentiment is diabolical because it comes as a pseudocompliment but with a definite complaint.
In defense, you cannot say: “Not really. You are wrong. Mrs. Perfekt really did terribly.”
Another unacceptable variant would be: “Oh, but Mrs. Perfekt was only 42; you are 72; she needed just a freshening up; you required a total overhaul. With you, I had to remake a face that bore the brunt of seven decades of wear and tear. Your operation was not a rejuvenation but a resurrection.” At this the patient may seize your hand and kiss it, realizing that if it were not for you, she might still be dead or even worse, ugly.
Invoking “someone” or “a friend” may simply be an indirect way for a patient to register dissatisfaction. Although in some instances the mysterious “someone” or unnamed “friend” does not really exist, my protective paranoia has led me to conclude that out there lurks an army of “someone” and “friends” who are ready, willing, more than able, even enthusiastic, to wage guerrilla warfare against you and your patients.
Elsewhere I have written1 about the wellknown phenomenon that occurs after aesthetic operations in which “friends” of the patients are diabolical assassins who delight in shooting verbal harpoons into your already surgically wounded patient.
Imagine the average woman 3 days after an eyelidplasty or rhytidectomy, who looks at her self in the mirror, and then goes into the throes of agonal anxiety. Looking back at her is this swollen, blue-black, perhaps humanoid, but definitely misshapen face, which she purchased for several thousand dollars in the hope that she would look better than she did when she entered your office for the first time. She may even have the transient delusion that you did not do the operation, but that Mike Tyson did. The doorbell rings and in comes her best “friend,” Killer Karen, who gasps audibly, puts her hand to her face, and tries to recover (not too delicately, of course):
“Oh, I am sorry. It just slipped out. You look so … different! What I mean is, did he [meaning you] do that to you? I thought he was supposed to be the best.”
Everyone’s plastic surgeon is supposed to be “the best”; our specialty is unique because all of us are “the best.”
But if you thought that Killer Karen was dangerous, the apogee is Murderous Mary, who has more victims to her credit than did Attila the Hun. She is also a “friend” of your patient, just as Brutus was to Caesar. This hydrogen bomb in a skirt exclaims, as if she had not planned it, “Oh, Joan, when are you going to have your face lift?” That these killings occur everywhere in the United States at almost any hour but yet have been unrecorded in crime statistics exceeds my comprehension. If the so-called friend does not murder your patient, he or she definitely engages in torture, the kind that supposedly disappeared in the fifteenth century but has managed to survive, even flourish, within country clubs, health centers, and shopping malls. After having observed for many years these severe woundings, I must conclude that the problems of Beirut are not confined to Beirut. Continuing in that same Middle East mood, I am convinced that the most skillful artisans of oriental rugs are clumsy all thumbers compared with those who verbally weave tapestries of treachery.
A real friend is a person who genuinely is glad if you win the lottery. This criterion certainly winnows the ranks of those whom we consider friends, at least, most of the time.
But who am I to whine about lack of kindness and support for my patients and myself in a world where most people think that the Ten Commandments were meant for somebody else? For anyone who doubts the tyranny of the selfish over the unselfish, let him or her consult the daily newspaper.
The reality is that even the most skillful plastic surgeons who try to remain aloof eventually have to deal with other human beings, not just colleagues and patients, but others who may impinge on their patients and, consequently, on themselves. Since it is almost impossible to know when and from where one is going to be shelled, one must be constantly prepared. Allow at least 25 minutes in every day to repair the damage that “friends” of your patients have inflicted. Do not lose your composure by stamping your feet, shouting four-letter words, or even allowing your eyes to bulge. Try to nod sympathetically and then, quietly, begin your rebuttal. It is not unusual under these circumstances to develop ventricular tachycardia as you attempt desperately to reassure your patient. You will have the same feeling of accomplishment as would a Bush fund-raiser after having solicited Dukakis for a contribution.
How could I, a basic optimist (with admittedly a strong streak of cynicism), end this editorial so hopelessly? I offer therefore the following advice: Perform aesthetic operations only on recluses or on those forever condemned to solitary confinement. Operate only on those who, when given your specially prepared form, leave blank the part requesting them to list close friends and family. Look for those few whose hearing is so poor that they will never be aware of their ‘friends’” comments. Admittedly this restricts your procedures to a very select group, but exclusivity does have its benefits. Like the Communist bloc of yesteryear, your patients will hear only you.