Going under general anesthesia is always a leap of faith. When you're knocked out for an operation, you have no choice but to trust your doctors completely.
Yet a disturbing essay published Monday in the journal Annals of Internal Medicine shows that doctors sometime betray that trust in shocking ways.
The article exposes behavior so "disgusting and scandalous" that the publication's editors were concerned it could damage the reputation of doctors in general. But in the end, they argue in an editorial, the essay's power to spark discussion about a little-discussed topic and expose a dark part of medical culture outweighed the risks.
The essay, written by an anonymous physician, tells the stories of two female patients who were abused by their doctors while they were under general anesthesia.
The author heard about one of the cases through one of his medical students, who is called "David" in the story. The student was assisting with a vaginal hysterectomy -- a surgery to remove a woman's uterus through her vagina -- for which the patient was under general anesthesia. David said that the attending physician was cleaning the patient's pelvic area when he looked over at him and said "I bet she's enjoying this," and winked.
David recalled this incident in class with shame and revulsion, though he also admitted that he initially laughed at the physician's lewd comment. David then asked his teacher, the author, if he had ever witnessed something similar, prompting the author to describe a similar experience during his own time in medical school -- one even more scandalous than David's.
The author had just helped deliver the baby of a Hispanic woman he calls "Mrs. Lopez" when he noticed that she was bleeding profusely from her vagina. The doctor on duty determined that the patient was suffering from a uterine condition and needed to be anesthetized. Once she was unconscious, the doctor started performing a uterine massage -- the standard treatment for the condition -- and managed to stop the bleeding, saying, as he did, "Atta girl. That's what I like. A nice, tight uterus."
Then, he started to sing "La Cucaracha" and danced around in tune with the song -- with his hand still inside the patient. The author of the essay regretfully admits that he joined in, before an anesthesiologist scolded both and called them assholes.
This essay is the latest in a series of similar allegations leveled against doctors in recent years. In 2014, a doctor in Syracuse, New York, was suspended from duty and fined $10,000 after a government investigation revealed his habit of slapping patients and calling them derogatory names while they were under general anesthesia.
And in June, a jury awarded $500,000 to a man who sued his anesthesiologist for mocking him mercilessly while he was anesthetized for a colonoscopy. The anesthesiologist, Dr. Tiffany Ingham, called the man a "retard" and "a wimp" and speculated, baselessly, that he had syphilis, tuberculosis, Ebola and hemorrhoids -- without realizing that the man had unintentionally recorded audio of the entire operation.
Such a recording is, of course, rare. Most victims of this type of abuse, including those described in the anonymous essay, never learn about it. But Dr. Daniel J. Cole, the president-elect of the American Society of Anesthesiologists, said that doesn't make it any less egregious.
"Whether the patient is aware or not, every patient deserves to be treated with dignity and respect -- as if you were my mother, my father, my sister, my brother," Cole said in an email to The Huffington Post. "The trust a patient has in their physician to have their best interests at heart must not be compromised."
Cole said that he had never personally witnessed such shocking conduct, and added that it's impossible to say with any authority how common it is.