Please note that this post has a strong content warning for rape, sexual assault, mutilation, and medical assault.
I’m in the process of preparing for surgery in June, which seems to require reams of paperwork and endless discussions with people in white coats who suck out your bodily fluids and wave devices at you. The surgery dance is a long and often graceless one that ends with being heaved onto a metal table in a cold OR while a surgical team assembles around you to watch, looming from above while the bright lights dazzle you. I’m excited about the surgery, but also afraid; and not for the reason people seem to think I should be.
Complications do occur while under anesthesia. You can have an adverse reaction to anesthetic agents or other drugs used during surgery. The surgeon could damage an internal organ or nick a vessel. The power could go out and the backup generator might not kick in. Equipment might malfunction. Weird things happen in operating rooms sometimes and in some cases they are entirely out of control of the medical team. This isn’t what I’m afraid of.
What I’m afraid of is the vulnerability created by anesthesia.
Hypnotic, dissociative, and paralytic agents are used in anesthesia. You’re not just unconscious but disconnected. Many medications are specifically designed to limit memories of the procedure, which is intended to prevent trauma, but it does more than that. It creates a memory hole, a dark place which anything can fill, and the thing about dark places is that sometimes scary things hide inside of them. Dark draws darkness.
People are sexually assaulted, mutilated, and abused while under anesthetics, and sometimes this abuse is allowed to continue as serial rapists and other assailants move through different medical facilities while patient complaints are ignored. This is what I am afraid of. I fear the thought that I might be assaulted, that my body might become an object of humour and mockery and amusement. I fear the potential that I may never know about it, and that if I do, I may be powerless to take action, because victims of medical assault are rarely believed when they attempt to file complaints.
A blind Lakota elder was mutilated while under anesthesia and a nurse nervously alerted him, advising him to have a friend examine his surgical site and take photos. A nurse anesthetist sexually assaulted patients and videotaped it in Georgia. An anesthesiologist in California assaulted multiple patients. Graeme Reeves, ‘the Butcher of Bega,’ mutilated hundreds of women in surgery. A dentist partially anesthetised and raped his assistant. Nonconsensual pelvic exams on anesthetised patients are routine at teaching hospitals, as Cara Kulwicki recently reminded me.
There comes a time when your mind goes into overload and shuts down, which is what mine starts to do when I think about medical assault, particularly of patients under anesthesia, but the sensory input just keeps coming. It’s not enough for people to abuse patients who are putting their lives and bodies in the hands of people who claim they will take care of them. Anesthesia fetishism is real and there are thousands of videos of anesthetised patients being assaulted and mutilated; some are available for a fee, and others can be viewed for free, distributed through the black market by doctors and other medical professionals.
Acting and enthusiastic consent for role play are one thing, but these are clearly not the case in the vast majority of these videos, if any. These are real people, overwhelmingly women, who were assaulted while under anesthesia, under the ‘care’ of medical providers, in a place they thought was safe. And they may have no idea that they were assaulted, let alone that it was videotaped and shared with the world. That the kindly surgeon or anesthetist or scrub nurse who checked in so thoughtfully after the surgery committed a profound violation.
Those same drugs that make a patient utterly vulnerable, unable to fight back, unable to remember, unable to clearly articulate experiences of assault, those same drugs are used as a weapon on patients who report assaults under anesthesia. The defense to sexual assault charges is that the assault must be ‘a hallucination.’ Scholarly papers like ‘Sexual hallucinations during anesthesia and sedation‘ underscore this. Anesthetic agents lend themselves extremely well to gaslighting as a faltering, confused, and tangled mind attempts to make sense of something, to find an explanation for lacerations or bruises or marks that shouldn’t be there.
And this is what I fear, deeply, and will fear until the moment the mask goes over my face. It’s what I will fear when I am in recovery, and it’s what I will fear for years afterwards, because I will never truly know what happened while I was unconscious and vulnerable in that operating room, or groggy in the recovery area. I think about asking a trusted doctor friend with hospital privileges if it might be possible for her to stay with me, but I don’t know if that will be allowed. And I know that asking for an escort marks me, singles me out.
After all, I have nothing to be afraid of. I’m in the hands of trusted medical professionals. They trained for this.
This is a fear that many people consider to be irrational. They rush to assure me that the vast majority of medical professionals are ethical, upstanding people who would never commit these kinds of crimes, let alone tolerate them. They tell me that medical professionals would be appalled to know that a patient might be afraid of being assaulted while under anesthesia, that patients under anesthesia are treated with extreme care and sensitivity. They tell me that I can’t let a few bad apples ruin the bunch.
But the thing is, I am the one going under anesthesia. And I am still afraid. Because bad apples and outliers and statistics equal real people and real lives. And I am a real person with a real life and thus I experience real fear.
And I am afraid. Not of poor surgical outcomes or unexpected reactions to anesthesia but of this, the dark place where the dark things hide and there’s no lightswitch.
8 Comments
In a law class on reproductive technology, we were visited by the head of the fertility department at a large local hospital. We discussed the ethical problems that come up in her work, including whether or not to implant embryos of a deceased partner when the surviving partner asks to. The doctor made mention of a recent case, where a mother wanted to take possession of her brain-dead son’s semen so she could find a surrogate to provide her with grandchildren. In all the argument about what to do with the semen extracted from the brain-dead man, I asked about the actual extraction, and why we weren’t even considering the morality or ethics of extracting reproductive material from a patient who was unable to consent. The doctor seemed utterly baffled as to what could possibly be wrong with it. Her casual attitude to performing the procedure has permanently altered my perspective on doctors, something I don’t say lightly as the daughter of two physicians. Sanctioned medical sexual assault honestly scares me more than the other kind.
Oh, I went under general anaesthetic when I had some teeth removed, if only because my anxiety at a dental office was just too much. I wouldn’t have been able to get through it otherwise.
The sexual assault thing was first on my mind! I had heard all about this kind of assault when I was younger and it really stuck with me. And so I was alone with a young surgeon in a room with doors. It was the first dental examination room I’d ever seen with lockable doors and it scared me.
I shared this concern with a couple of close friends, and of course they laughed and brushed me off.
I’m sure I was safe and the procedure itself was quite pleasant, but the fear was pretty real. I don’t think it’s so irrational.
I’m sorry you’re experiencing this dread. That sounds awful (and perfectly reasonable).
If perpetrators are filming people under anesthesia, why not victim’s advocates too? Why is filming a surgery not as routine as filming a traffic stop? Is it simply not being pushed, or would it be a violation of the medical professionals somehow?
After kittywrangler’s comment, I sat stunned a moment. I remember after my uninsured emergency appendectomy, I requested the video of the procedure over a decade ago. They said it had been destroyed/erased/whatever. And suddenly I am gooseflesh from head to toe, never having considered the matter further.
I am so sorry for your dread. I wish I had something more useful to add. I wish this wasn’t just one more way we are at risk at every vulnerable moment.
I had my wisdom teeth out under a general anaesthetic. When I woke up, there was a little blood in my underwear, but no pain or bruising or anything. I’ve always wondered if anything happened. I asked the dentist about it and he said he didn’t know any reason why it might be, which actually made me less suspicious – if it was his fault, surely he’d have said something about cramping side-effects of the surgery something? And I think someone told me it’s compulsory to have a female assistant present when a woman is under general in Australia. But still, I think about it sometimes.
I am a medical student during my clinical years, and actually planning to go into anesthesia. And even so, I’ve often thought to myself that if I ever had to have surgery, I would be incredibly anxious about the vulnerability of being put under. I had never considered the sexual assault aspect, since I train at a busy academic medical center in a large city, so there is never an occasion when a patient in an OR is not surrounded by at least 5 staff members. (Sidebar: you could try getting your surgery at a place like that, s.e.) Rather, I was thinking about something else you touched on, the idea of being made the object of mockery, especially since the people in ORs are my (soon to be) colleagues. I struggle with a lot of anxiety, which usually manifests itself as extreme self-consciousness; being out cold, naked, under bright lights, on a table surrounded by a room full of people, is terrifying.
One thing to try to cheer you up: The advent of new drugs and new patient monitoring technology, serious complications and death from anesthesia is actually extremely rare these days. It used to be that the biggest risk of surgery was going under; this is no longer the case:
“That said, anesthesia-related deaths have decreased over the last 25 years from two per 10,000 anesthetics administered to one per 200,000 to 300,000. The American Society of Anesthesiologists says a person is more likely to be struck by lightning than die from anesthesia-related complications.”
http://articles.chicagotribune.com/2012-01-11/health/ct-x-0111-anesthesia-safety-20120111_1_anesthesia-drugs-anesthesiologists-inhaled-gas
Also: It is true that on my OB/GYN rotation, I would routinely give women pelvic exams after they were under and before the surgery began. But that’s because it is a standard part of pre-op prep for most gynecological surgeries. Uteruses come in all shapes in sizes, and can be angled at varying degrees inside a woman’s body. The surgeon does the exam to manually map out where the patient’s organs are in order to plan an approach and avoid complications (ie, she needs to know if the patient’s uterus is retroverted before inserting a probe, or the surgeon could risk perforating the uterus). The exam is done after anesthesia to avoid causing the patient more anxiety. In fact, on many occasions OR time is booked specifically to do a pelvic exam while the patient was anesthetized because otherwise the exam could not be performed. These women were unable to tolerate getting the exam while awake in the office (ex: adult women with Down syndrome).
For these reasons, I wish there were allowances made for patient advocates to be IN the operating suite during the procedure. Not hovering over the table and asking questions, but just sitting quietly at a safe but observable distance, and within earshot of the surgeon(s) and techs.
My (now ex-)employer had several doctors who would not proceed with surgery until the patient’s family members had been brought in to discuss the preop and postop procedures, expectations, etc. I found that offensive in the extreme – I am 43 years old, I don’t need my mommy’s permission to have surgery and in fact I prefer to keep my family at arm’s length from my medical issues to the greatest extent possible. But it would definitely be nice to have someone present as an advocate for me when I am unable to advocate for myself. The OR staff might still make unkind remarks about my physique amongst themselves after the procedure, but at least with an advocate in the room I wouldn’t need to worry about inappropriate touching, exposure, or being an object of immediate and direct ridicule.
It’s never made sense to me how the same doctor can refuse to perform a surgery until you’ve hauled in your spouse, parents, kids, or whoever (and some of the doctors in the group I was recently laid off from would, and DID, refuse surgery for people who didn’t feel it was any of their family’s business whether or not they had a knee replacement or a ligament reconstruction), but that SAME doctor would be appalled and scornful, and absolutely unyielding, if you asked to have an advocate (friend, family, or professional stranger) in the surgical suite during the procedure.
Very best wishes with your surgery!
I was quite nervous about my surgery two years ago, for the very same reasons you listed here. In my case, though, a nurse friend sat through the whole shebang and told me later what I’d missed and it was such a comfort. Please ask if you can have someone you trust in the room.