It's the type of story that makes stomachs churn and no patient wants to believe is true. But an anonymous essay published Monday in the Annals of Internal Medicine sheds light on an important, little-talked-about issue: doctors acting inappropriately while their patients are under anesthesia.
In the essay, entitled "Our Family Secret," the author writes of two experiences where physicians acted out with heavy undertones of misogyny, racism and sexual assault. The editors of the journal said they decided to publish it not because such behavior is common, but because it's important that doctors should not remain silent when they witness misconduct.
The events came to light while the author, a doctor, was teaching a medical humanities course to senior medical students. He asked the students, "Do any of you have someone to forgive from your clinical experiences? Did anything ever happen that you need to forgive or perhaps still can't forgive?"
One student answered by recounting a story in which he witnessed, and didn't stand up to, a surgeon's inappropriate behavior while a patient was under general anesthesia for a vaginal hysterectomy. The student said that while the surgeon was prepping the unconscious patient's vaginal area for the procedure, he looked at the student and said 'I bet she's enjoying this,' with a laugh and wink.
Clearly still affected by the situation, the student called the surgeon a "dirtball," but admitted that at the time, he laughed along because he didn't know what else to do.
The author then told the class his own story of a time he found himself in a similar situation. He was a third-year medical student and had just helped deliver a baby girl. But something went wrong and the woman, called Mrs. Lopez in the essay, was gushing blood.
The resident doctor took charge and requested an anesthesiologist put the patient under. In order to stop the bleeding, the doctor performed what's called an internal bimanual uterine massage, placing his hand inside Mrs. Lopez's vagina and pressing a fist against the uterus. "The guy saved her life," the author recalls. But as the bleeding eased, he writes, the doctor said something like "Atta girl. That's what I like. A nice, tight uterus."
He then recounted something even more horrifying: The doctor raised his free hand in the air and started singing "La Cucaracha," shuffling so it looked like he was dancing. The author admitted he started laughing and humming along before the anesthesiologist yelled at them to stop.
The essay is short in length but powerful in its message: This type of inappropriate behavior happens and needs to be addressed by the medical community. That's the reason Dr. Christine Laine, Editor in Chief of the Annals of Internal Medicine, said she decided to publish it.
In an accompanying editorial, she and top members of the editorial team explained their reasoning. "We all agreed that the piece was disgusting and scandalous and could damage the profession's reputation," they wrote. "Some believed that this was reason not to publish the story. Others believed that it was precisely why we should publish it."
"This incident is clearly at the far end of the spectrum of inappropriate behavior," Laine told CBS News. "Some of the editors thought that publishing it would suggest that this behavior is common among physicians and would damage the profession's image."
But on the other hand, she explained, "not publishing it would exemplify the profession's reluctance to call out colleagues who act unprofessionally. It would metaphorically be dusting their bad behavior under the rug."
The editors took the rare step of publishing the essay anonymously to protect the identities of all those involved, primarily the patients.
The ultimate goal of the essay, Laine said, is open discussion about this important issue and to empower physicians to speak up if they witness fellow doctors acting inappropriately. "It's important to acknowledge that these kinds of things happen, even if they happen rarely, because that's too often," she said. "And we should always be prepared so that the next time we find ourselves in these situations, we can hopefully be more like the anesthesiologist in the story and cut the behavior immediately."
Laine emphasized that the behavior described in the essay is extremely uncommon and that patients should not be afraid to see their doctors or undergo medical procedures.
Instead, she hopes that revealing these stories will help prevent such behavior from happening in the future. "Publishing this piece and shining a light on this bad behavior I think should signal to patients that we're taking responsibility and providing a context in which we can talk about ways to make this happen less often," she said.