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Medical Dreams & Nightmares

As mentioned earlier, both my parents are psychoanalysts. Maybe that’s one reason why I am preoccupied by dreams, my own and those of others. Those who’ve read Spellwright won’t be surprised; dreams and the discovery of their meanings figure prominently in the plot. But, not to worry, I don’t go in for aggressive analysis of dreams.

In my opinion, most dreams, like most stories, don’t require analysis; they require retelling.

If a friend has a humorous or frightening dream, it’s often the verbalization of it (rather than any external examination of the dream in the context of the dreamer’s life) that is satisfying to both parties. I find external, highly detailed analysis of dreams to be much more about the analyzer than about the dreamer. But we mustn’t completely throw out analysis: there’s a baby in that bathwater.

One of the many languages I find beautiful and fascinating is American Sign Language. The ASL sign for dream is performed by placing the right index finger on the forehead, slowly pulling the finger away from the head while rapidity flexing and extending the fingers. (The sign should be seen to be appreciated.) The evocative nature of this sign lies in its ability to dramatize the both the rapid movement of thought inherent to dreams and how those thoughts seem to extend beyond our own minds. The English word “ecstasy” is derived from an Ancient Greek word perhaps best rendered into Latin letters as “Existanai.’ It’s broken into two parts: Exi- ‘exiting’ or ‘outside of’ and –stanai related to a Latin –status ‘to stand’ or ‘to exist.’  Dreams are, to some extent, ourselves outside of ourselves.

Vivid situations make for vivid dreams. For example, puberty. This one classically presents with the “show up for class naked” dream. But there’s also the “suddenly have to take a chemistry midterm you forgot to study for” dream.  They might change slightly as we grow older—substitude ‘work’ for ‘class’ or ‘work-related task’ for ‘midterm’—but otherwise these dreams follow us for most of our lives. In the Odyssey years of my 20s I had versions of these dreams pertaining to being a teacher, a football coach, a technical writer, and so on. But then, in medical school I discovered new, strange, vivid, sometimes frightening, sometimes hilarious flavor of dream.

This first one’s funny but requires a bit of an intro. It belongs to a exhausted Neurology fellow who was on call in the Emergency Department, henceforth the ED (no one says ER unless you’re referring to the TV show). A Neuro doc on ED call lives in dread of being paged for non-neurological maters, usually relating to Things That Are Not Seizures. For example, as I understand it, there is a particular pain peculiar to neurologists who are woken at 3AM to see a seizing (having a seizure) patent who turns out only to be very cold and hence is shivering. The neurologist then puts another blanket on the patient (or more likely tells a nurse to do it) and then will lose an hour of sleep or so to paperwork documenting that this was one of the Things That Are Not Seizures.

So, our sleep-deprived hero fell asleep in the On Call room and then had a dream that she’d was awoken by an urgent page that a patient was in status epilepticus (an unending and dangerous seizure). Our dreamer rushed to the ED, into the patient bay, and discovered the nurses and med students frantically working over a gurney…that held…a fish…that was flopping around on the vinyl cushions.

The medical student tried to “present the patient” (describe what was happening in doctor speak) but was too frightened to make sense. Our dreamer explained, in a calm voice, that it was quite normal for a fish out of water to seem as if it were seizing. But the nurses and physicians kept freaking out. One went to page the dreamer’s attending (i.e. the physician above her on the totem pole). She tried but couldn’t stop them and became terribly embarrassed when her attending showed up and with a frown looked at the flopping fish. He calmly explained that the fish was not having a seizure, that the fish was only out of water, and this was a natural reaction for fish in such situations. This time the nurses and med students listened. With a disapproving tone, the attending told our dreamer that she only needed to put the fish back into water and she should not have wasted his time by paging him. So, shamefaced, she carried the struggling fish to the fountain outside the Stanford hospital and let to go swimming away.

She woke up at 6AM relieved that it had only been a dream.

The next set of dreams are not so funny. If you’re squeamish skip this paragraph: these are the dreams I collected during gross anatomy class, that is to say the dreams I or my friends dreamt when we were spending several hours each day with embalmed corpses. During dissection of the head, a friend admitted to me she had a nightmare about plants growing out of her estuation tubes. After discovering my cadaver’s massive uterine cancer, I had a dream that large glands were growing out of the epicanthal folds of my eyes and sending shocks of pain into the back of my head. The symbolism of both dreams is quite apparent: sights and sounds invading the eyes and ears and causing horror. Another friend dreamt he woke up in his bed to discover it was a giant, unnamed organ and his sheets, which were holding him tight, were actually the organ’s adventia. Finally, when dissecting the penis a friend claimed he felt no revulsion or disquiet, but that night dreamt he reached into his coat pocket, withdrew his own dissected penis, and woke up with tears in his eyes. As upsetting as these dreams were, there was something equally upsetting about their eventual disappearance. The part of us that had sensed the horror of death and disease was sensitive no longer.

So let’s finish with something lighthearted. I dreamt this one last night. Likely it was informed by the neurology fellow’s dream.

I had finished up the Spellwright Trilogy and begun my clinical year. As a third year clerk on an Internal Medicine service, I was desperate to win the approval of my attending, who just so happened to be my current MD/novelist mentor: Abraham Verghese (who’s now on paperback tour for his amazing novel Cutting for Stone).

Day one on service, early AM rounds, Dr. Verghese asks me to go to room B12A and take a full history and physical on a newly admitted patient.

In my dress clogs and with a tie tight around my neck, I clomp in to B12A and discover, lying in bed, an ice-cream sandwich. I’m a little freaked out, but I carefully examine the sandwich and discover it is melting. I’m very worried, by the time I present this patient to Dr. Verghese, the patient will be soft and gooey. I try to write up an order for the patient to be put in the refrigerator in the nurse’s station. However, I’ve been out of the med school writing novels for so long that I’m too slow with the order. In that horribly just-not-fast-enough-motions of nightmares, I fumble with the order until at last the patient is little more than two soggy chocolate wafers sitting in a vanilla puddle. Fortunately, I wake up before I have to tell Dr. Verghese.

No analysis necessary: I’m worried about losing my medical knowledge as I hammer away at these novels. But now that I’ve told you about it, I’m feeling much better. For those of you in medicine, I hope this proves that, yes, there is someone else out there in our strange world who’s as weird or weirder than you. For those of you not in medicine, apologies about disillusioning you about the medical life, reality, and Gray’s Anatomy (though, likely you already figured that one out on your own). And to anyone so moved, I’d love to read in the comments about your weird dreams. Partly because I’m interested, partly because it would provide fodder for my thesis: Most dreams, like most stories, don’t require analysis; they require retelling.

Comments

12 Responses to “Medical Dreams & Nightmares”

  • Oh, I’ve dreamt many times that I accepted a copyediting project and then forgot about it until the day before it was due. :-/

    I think the worst dream I’ve ever had, though, was during a time where I was working incredibly hard at an unfulfilling job. I dreamt that I went to work and worked all day. Nothing interesting happened; there was no imagery in the dream; nothing unusual. I just worked, all day long. And then I woke up and had to go to work. :-/ Can’t tell you how badly that sucked….

  • Those dreams are some doozies! You are right.. that last dream mentioned sounds horrible.

  • I normally don’t remember my dreams. In fact, I only remember them when they are recurring. In medical school, I had two recurring dreams that went away once I realized that they were dreams.

    At first I thought my teeth were falling out or becoming loose. I’d wake up and have all my teeth. It took a while for me to realize that no, my teeth were not becoming looses and tightening again, I was dreaming. That one was about a fear of losing control – control lost.

    The second is part of why I don’t chew gum. I’d have gum stuck in my mouth and no matter how long I’d scrape my teeth and my tongue it would never be gone. There would always be more gum to scrape away. I decided that one was about a fear of having no voice. I think I’m starting to fix that one now.

    • oh sweet heaven, reading this suddenly made me remember a dream i had…i don’t know how long ago, but it was bout my teeth coming out. another friend once told me about such a dream. i bet you everyone has one of these at some point.

  • Commonly I have the ‘haven’t studied for my uni exams or haven’t done my assignments at uni’ dream and suddenly they are happening and I’m completely unprepared. This is despite the fact that I haven’t been at uni for quite some time. It never seems to change to work oriented topics.

    Occasionally I get the big scary amorphous but never seen thing chasing me dream where I’m moving through molasses or can’t do anything to help myself dream. Recently I had a dream where I was in a fight, but I could barely move my arms or defend myself, which I was finding rather frustrating as I am quite capable of punching people when required.

    • my version of that dream involves me being back in high school and about to start a game of (american) football. we’re all ready to take the field for kick off…and i can’t find my helmet. i have to run out on to the field bear headed. back then i had hair, but it wasn’t going to help much 😉

  • It does seems that the dreams that you had while dissecting cadavers were a way to help you manage the reactions you otherwise would have had in waking life.

    I wonder if medical school students who are sleep deprived (and thus have less of an opportunity to dream) find that it takes longer to feel comfortable in those situations.

    • hello marcia! thanks for the great comment. i agree that the dreams do seem to be an extension of a basic reaction to death that we can’t express in the lab (or are very embarrassed if we do). a significant number of classmates reported to me that they never were all that disturbed and never had disturbing dreams. i always wondered if there was some fundamental difference in the way they viewed dissection.

  • Jessica Hekman

    7:47 am Mar-16-2010

    Reply

    When I was taking Gross Anatomy as a first year veterinary student, I woke up in the middle of the night convinced I had lost my anatomy donkey’s liver. I actually hunted through the covers for it, sure it was in there somewhere, before waking up a little more.

    That class was really difficult and I think the dream had to do with my fear of being in a practical exam and being unable to find various parts, though I assure you I was always able to find the liver in real life!

    • oh dear Lord the “walk about exams”!!! i forgot how stressful those were. they would pull out these corpses that were heaven knew how old and divided in to quarters and put two quarters per table often in different orientations, and then stick a pin into this tiny little bit of dried nothing and ask you to name “what supplied it” or some such other cryptic thing that makes you suspect its a nerve when it looks nothing so much as like a vein or whatever. gah!

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