To sleep perchance to dream

The accusations against Dr. George Doodnaught are as disturbing as they are bizarre. The Toronto anesthesiologist has pleaded not guilty to molesting 21 female patients, who range in age from 25 to 75. While the women lay consciously sedated on the operating table, the 64-year-old allegedly kissed them, groped their breasts and even forced them to perform oral sex, all while hidden behind the sterility drape that divides the anesthesia station from the surgery.

Anyone who has spent time in an operating theatre knows there are nurses, cleaners and doctors buzzing in and out of multiple exits and entrances. So far, with few exceptions, witnesses who worked with Dr. Doodnaught testified he was a sought-after specialist with a good reputation. The prosecution is charging the hospital was engaged in a coverup.

Dr. Doodnaught’s defence: that the medications used to anesthetize his patients caused “sexual fantasies.” The drugs—including midazolam, ketamine, propofol and sufentanil—were given to patients in different doses to allay their anxiety and produce amnesia. The side-effects: the erotic and violent hallucinations these patients are confusing with reality.

It turns out there is an entire literature dedicated to the study of hallucinations and dreams during surgery—particularly sexual ones. “Sexual hallucinations have been reported since the advent of anesthesia,” begins a 2003 review article in the journal Anesthesia. In the late 1800s, the authors write, the use of chloroform in anesthesia was prohibited because of cases where women used “obscene language” while on the drug.

For decades, the medical community agreed that witnesses should be present when doctors give patients mind-altering drugs to avoid false harassment allegations. A 1992 review article in the dentistry journal Anesthesia Progress looked at the effects of benzodiazepines (such as midazolam) for sedation during surgery. The author, a Northern Irish doctor named John Dundee, discussed case studies in which female patients vividly recalled being sexually harassed by their dentists. “In 13 of 16 of the reported events, where patients and attendants were questioned closely, nothing improper could have occurred. In 11 of these, others were present throughout, while two events were physically impossible.” Some of the dentists who were working alone—that is, without witnesses—lost their licences.

The 2003 review article outlined a series of allegations and convictions involving “wandering hands,” “fondling” and forced oral sex. In Ottawa, in 1986, an emergency doctor was acquitted of a charge that he asked a patient to squeeze his penis while she was coming to after a surgery. A Norwegian plastic surgeon was tried in the Oslo High Court for masturbating nine patients who were on midazolam and fentanyl while he performed breast surgeries. A nurse who witnessed the surgeon at work helped to get him acquitted.

While the medical community doesn’t know exactly how anesthesia works, or why it causes hallucinations,, the authors point out that patients may be confused by routine touching during an operation. “Stimuli to the chest such as the removal of ECG electrodes, elbows rubbing the chest while the operator is working in the mouth or on the face have resulted in accusations of breast fondling.” Most cases on record involved female patients and male practitioners, though there are reports of the inverse. Most articles conclude that sexual hallucinations or fantasies are an infrequent, though noteworthy, side-effect of a range of drugs in anesthesia and sedation.

Erotic dreams under the effect of many anaesthetic drugs including Propofol have been known anecdotally if not formally studied in anaesthesia.  This is more likely if drugs are used in sedative rather than anaesthetic doses; patients do not usually  (should not) dream under anaesthesia.  It is possible that patients may dream while coming out of anaesthetic given that most of us lighten up patient while the residents are watching the wound heal, in the hope that the patient will wake up quickly  and we can empty our bladders and have a coffee.  Given low level of most of conversation which occurs in the OR which patients can sometimes hear, it is not surprising that they may have sexual fantasies.

The case against the unfortunately named Dr. Doodnaught raises some questions.

1. If the patients are just dreaming about sexual assaults, why was he the only person in the hospital accused.  Is there something innocently different about his technique?
2. There is a mention of him attempting oral sex with a patient during an abdominal hysterectomy.  Given that most people intubate their hysterectomies which involves muscle relaxation that is relaxation of ALL the muscles it is how to see how this happened?  It is possible that this could have been a spinal with IV sedation but this is stretching things.  Maybe I am not enough of a pervert but I am stumped as to how one would accomplish this.
3. Is he such a nice guy that everybody in the OR is willing to cover up pretty disgusting behaviour by him or did he just piss off the wrong OR nurse?

Don't know all the facts and like most cases involving the legal system and the press, I suppose I never will.