Late last month, a jury in Virginia ordered an anesthesiologist to pay an anonymous man half a million dollars for defamation, medical malpractice, and punitive damages. The man, known as “D.B.” for the purposes of the trial, had accidentally recorded audio of his colonoscopy on his cell phone, making himself an unexpected and reluctant party to the conversation that happened while he was under anesthesia. It was not a nice conversation. The anesthesiologist called him a “wimp” and a “retard,” mocked his weight and his genitals, and gleefully announced she was writing a false diagnosis of hemorrhoids on his chart. The doctor joined in, instructing an assistant to lie to D.B. and tell him he’d already spoken with the doctor but had forgotten because of the sedation.
It’s a strange case and a strange way to apply laws about defamation, but as a juror remarked after the trial, “we ha[d] to give him something, just to make sure that this doesn’t happen again.” That it happened even once is horrifying. Here was a man in a position of pure vulnerability—naked, unconscious, with strangers pushing foreign objects into his body. It’s the kind of thing millions of years of evolution scream at you not to allow. It’s the kind of thing traumatized, mentally ill people think malevolent aliens from outer space have done to them. But D.B. couldn’t probe himself, so he had to trust medical professionals to do it for him. He had to trust them, and they dramatically violated his trust.
What happens to us when we’re under anesthesia? General anesthesia (usually, ideally) makes you completely unconscious. It’s a confounding biological state, simultaneously sci-fi and fantasy, both a miracle of modern medicine and a sort of magic spell. It’s built into our mythology—the lotus-eaters of the Odyssey, the numbing wine Jesus refuses on the cross—but anesthesia as we know it wasn’t worked out until the twentieth century. Now it’s almost commonplace, a routine procedure you see often on TV and in movies. They stick a needle in your vein, and you’re out, and you have no idea what’s happening until they wake you back up.
anesthesia is a confounding biological state, simultaneously sci-fi and fantasy, both a miracle of modern medicine and a sort of magic spell.
I was under general anesthesia myself just a few months ago, during my last semester of graduate school. I was getting an endoscopy, the slightly less unpleasant version of D.B.’s colonoscopy, where they shove the camera down your throat instead of into your colon.
I’d scheduled the procedure very early in the morning so that I’d have time to make it to class in the afternoon. But when I arrived, they didn’t have any record of my appointment, or the two appointments after mine. Extra paperwork. Delays. In pre-op a couple hours later, dressed in a hospital gown, with an IV in my arm, I started to get nervous I wasn’t going to make it to my class.
As my designated post-anesthesia driver, my boyfriend had to wait around with me, and I felt guilty for making him miss work. He assured me everything would be fine, as usual, and I didn’t believe him, as usual.
I asked the nurses if we could hurry things along.
“Are you sure you want to go to class after this?” they asked me. “It’s a bad idea. What if you fall asleep? What if you act strangely? You might make a bad impression on your professor. Why don’t we give you a local anesthetic but not put you all the way under?”
But I absolutely did not want to be awake while they unspooled a tube down my throat and into my stomach. “Put me all the way under,” I said.
“Are you sure?”
“Are you sure?”
Clearly, they thought I was acting rashly and probably rudely, but they did what I asked. I went directly from the operating room to campus, performed totally normally in class, and then went home and conked out for several hours. My boyfriend was right, as usual: everything turned out fine.
I’ve been interpreting this story as a personal victory, albeit a minor and somewhat petty one. I understood my body and its limits better than the strangers at the hospital. Through sheer force of will, I made my brain do what I wanted it to do, even though the nurses doubted my abilities. Me: 1, nurses: 0. Now, after reading about D.B. and his ordeal, I wonder what the nurses said about me while I couldn’t hear them, what judgments they might have passed. Who does this bitch think she is? Maybe the score is more like me: 1, nurses: 10.
The last time I was under anesthesia before the endoscopy was four or five years ago, when I had a single wisdom tooth removed. It was a tricky surgery. The location of the tooth meant there was a risk of nerve damage. They anticipated removing just the top part of the tooth and leaving the roots where they were, to minimize that risk. They called it a “coronectomy”—removal of the crown. I remember feeling the anesthesia hit, a pleasant metallic chill that rolled through my body. I said, “Oh!” out loud. And then—I was waking up. I was told that the surgery went better than expected, and they were able to remove the roots without touching the nerve.
a pleasant metallic chill rolled through my body. I said, “Oh!” out loud.
From my perspective, it was basically magic: I feel asleep with a problem, and when I woke up, it was solved. I recovered quickly. It was a good experience. I doubt anyone involved was talking shit about me while I was under.
But it wasn’t magic. The problem didn’t just disappear. While I was asleep, people who I didn’t know peeled back the flesh in my mouth and dug around inside. They sucked my blood, cut my bone, broke my tooth to pieces, and came within centimeters of my nerve. They were inside my body—inside my face—in a very literal way.
My boyfriend was my designated driver that time, too. Same boyfriend, different city. I don’t remember this, but he says that after surgery, as the anesthesia wore off, instead of any of the drug-induced loopiness you see on YouTube, I just apologized endlessly. I was sorry I was groggy, I was sorry I needed help walking out the front door, I was sorry he had to miss work to drive me, I was sorry sorry sorry. There was something so humiliating, I guess, about even a very positive anesthesia experience. Sorry about all the spit and blood I couldn’t control, sorry about my body’s sloppy attempt at growing a tooth, sorry you had to touch the wet, twitching interior of my face. Sorry to push that sort of intimacy on a set of strangers, to make them responsible for my well-being, even my life. If I could have, I would have pulled my own tooth, without forcing anyone to deal with my bodily functions, without giving anyone the chance to sideswipe my nerve or say horrible things about me while I was asleep. If I could have, I would have relied on no one but myself.
The reason I only had one wisdom tooth removed that time is that I’d had the other three out a few years before. (They left the last one in because of the risk of nerve damage, but eventually it started hurting too badly not to take it out.) I was twenty-one years old, on winter break during my senior year of college. I was staying in my hometown, but with my boyfriend, not my parents. Same boyfriend, third city.
This first wisdom-tooth removal did not go as well as the second one eventually would. I came up from under the anesthesia in almost tectonic pain, as if some subterranean plates in my head had shifted. They had, in a way—the technical term used to describe wisdom teeth coming in is “eruption.”
I also woke up, to my surprise, with a bruise ringing my left eye. I’ve been told by more than one dentist since that this means the tooth was simply located relatively high up in my jaw, and that it’s not a big deal. But it sure seems like a big deal when you have a black eye and no memory of how it got there. My sister likes to tease me by saying I must have annoyed the dentist so much that he punched me in the face while I was unconscious. It’s not as funny after hearing D.B.’s anesthesiologist talk about wanting to do just that.
How do any of us ever willingly submit ourselves to this kind of vulnerability
There is a paradox at the heart of our relationships with our doctors. We have to trust them, and at the same time, we can’t possibly trust them.
How do any of us ever willingly submit ourselves to this kind of vulnerability, even without hearing about what happened to D.B.?
And then there’s that other vulnerability, the one I haven’t mentioned yet. The one where I had to—augh!—let my boyfriend take care of me after the surgery. We hadn’t been together very long at that point, maybe a year and a half. We’d never lived together for more than a night at a time. I still wore makeup around him all the time, still pretended I listened to cool bands I didn’t really listen to. But there I was, crabby and stupid with pain, fading in and out of consciousness, unable to shower or even to take my antibiotics when I was supposed to. And there he was, bringing me bowls of ice cream, helping me to the bathroom when the Vicodin made me vomit, driving me to the pharmacy when the Vicodin proved inadequate and I had to get even stronger painkillers. He pulled the soggy, blood-stained gauze pads out of my mouth and replaced them with clean ones, and I felt like the coolest, handsomest boy in the world was changing my tampon for me. It was awful.
If I could have done it all for myself, I would have. I would’ve driven myself home and woken myself up when it was time to take my antibiotics. I would’ve kissed myself on the forehead and told myself everything would be all right. But instead, I had to rest my emotional weight on my boyfriend—and, though I didn’t want to test whether he would, he held me up. And we’ve been holding each other up for almost a decade now.
There is a paradox at the heart of our relationships with our doctors. We have to trust them, and at the same time, we can’t possibly trust them. Anesthesia crystallizes this problem. When we’re under sedation, we leave ourselves open to damage, both physical and emotional, in the name of health. Sometimes things go terribly wrong. Surgeries get botched, mistakes are made, or people take our vulnerability as an opportunity to unleash vitriol at us.
But that’s the same thing we do every day with our loved ones. We put our hearts in the hands of fallible, imperfect human beings, and we just have to trust they won’t get crushed to red pulp. When people betray our trust, like D.B.’s anesthesiologist did, it’s viscerally, nauseatingly painful. But if we never risked that vulnerability, we’d never know what it’s like to be supported, to be genuinely cared for, to be stitched up and sent home healthier than before.
Lauren O'Neal is a freelance writer and editor in San Francisco. Her work has appeared in publications like Slate, the Hairpin, and the Rumpus, where she was formerly the assistant editor. She is an associate editor at the literary magazine Midnight Breakfast.