“Every anesthesia patient is an opportunity to see something completely new” – Dr. Emery Brown
“Bernice, wake up, wake-up!”, urged Miranda Shull, a CRNA working at the Stanford Lane Surgery Center. As her attending, I waited for what was coming next, along with the rest of the OR staff, with eager anticipation. The patient was slow to open her eyes, seemingly comfortable in her mental space, after a breast lumpectomy for early breast cancer. Dr. Irene Wapnir, a senior breast cancer surgeon and Stanford professor, and I looked on as the time was near.
“Bernice, open your eyes!” Miranda firmly urged the patient. Slowly, the patient opened her eyes, with a distant look, her brain trying to make sense of her OR surroundings, but finally recognizing where she was. Miranda looked quickly at me, I nodded, and she calmly removed the LMA and quickly suctioned the patient’s mouth, all in a flawless quick sequence of motions.
Miranda then locked gaze with the patient and asked, “Did you dream?”
The patient looked up and smiled, “Oh yes!”
“What did you dream?” continued Miranda, still leaning over the patient.
“I’m walking in redwood trees, just redwood trees, … I’m walking at Henry Cowell State Park, I recognize the place. I’m just walking around and around,” the patient said, now wide awake and glowing in happiness, still on the OR table.
Earlier in the month, as I started working at Lane Surgery Center with breast cancer patients, Miranda in particular had said she had been seeing a lot of her patients dreaming even under general anesthesia, a lot of them Dr. Wapnir’s. As her attending this month, I had seen dream after dream after dream reported from patients with breast cancer after anesthesia, not just Dr. Wapnir’s but every breast surgeon. Was this finally a reliable, reproducible, and scalable way to study and collect data on anesthesia dreams?
As Bernice lay on the OR table reveling in her anesthesia dream, oblivious to pain, nausea or fright that so often plagues surgical patients, Miranda was preparing to move the patient to the transport gurney. “Should I ask her any other questions from the survey?” Our clinical research team had just received IRB approval to administer a formal dream survey, which Miranda had been following. Just a few more questions.
“Bernice”, I leaned over, “were you walking in Henry Cowell with anyone and how long were you walking?” I asked in a calm interviewing voice to a now completely awake patient.
“I was walking with my daughter for days, it seemed like days,” the patient said with a smile. She was quiet for a few seconds with her thoughts and then the smile faded a bit and tears welled up with the impending significance of her dream. “I love my daughter more than anything. Anything.” The OR completely became silent, briefly empathetic in the pain the patient was now feeling.
As Miranda and the surgical residents moved the patient to the PACU, Dr. Wapnir and I started walking down the long halls of Lane Surgery Center, leaving the OR. “How do you do that?” she asked incredulously. I gave a long technical answer about pre-emergence from anesthesia and EEG-guidance in observing dreams.
“I’m really not sure yet what is happening, but I just know we can often see dreaming in your patients,” I confessed with a shrug.
Irene Wapnir, looked at me with giant brown eyes aglow and just laughed, “Whatever you are doing to my patients, when you get you get done with your project, I could use some dreams like that! Just one question. How did you know she was walking at Henry Cowell with somebody else?”
“That’s easy, Irene,” I said, recalling the numerous dreams we had already seen in patients with breast cancer, “Your patients always dream of love, usually kids, spouses, family, friends sometimes even pets.”
We stopped walking the long halls of Lane Surgery Center for a second. “That sounds about right Harrison, knowing my patients, but don’t you think your dream observations may be open to a different interpretation – aren’t you worried about that?”
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On the top floor of the Stanford Cancer Center is the Lane Surgery Center, where every surgical day there are 2-3 OR suites completely dedicated to breast cancer surgery. When including the Cancer Center South Bay surgery center (CCSB) in San Jose, Stanford Health Care probably operates 4 breast cancer rooms every single day. That’s a lot of breast cancer.
A common anesthetic technique for breast cancer in these cases is total intravenous anesthesia (TIVA). One curious side effect reported by patients undergoing general anesthesia for breast cancer in the PACU is that these patients report dreams, lots of them. General anesthesia dreams! Nobody had noticed or seemed to care before.
Now in October, Miranda stood over Bernice on the OR table and her dream of a repeating redwood tree walk, with her beloved daughter. Another breast cancer dream, just another slam dunk for Miranda. She shrugs her shoulders – not a big deal for her. Dr. Irene Wapnir and the rest of the OR grew silent, witnessing a relatively common anesthesia phenomenon that suddenly may be gathering clinical importance.
As I walked with Dr. Wapnir down the hall, Miranda wheeled the grinning patient to the PACU, still reveling in the memory of her dream, continuing our conversation. I explained that patients with breast cancer, largely all women, reported surgical anesthesia dreams about love. Dreams of children, husbands, boyfriends, family, and often of deceased loved ones and sometimes pets (particularly dogs), these women facing surgical mutilation and possible death chose to dream of love. That’s what their anxious minds chose to dream under breast cancer surgery.
Miranda and Cameron Blok-Andersen, also a Stanford CRNA, accumulated the early dream observations with me (as their attending) in these TIVA general anesthesia breast cancer patients. We called these “love” dreams. Breast cancer patients all largely dreamed of “love”. Or, so we thought. Now, I’m not so sure. Dr. Wapnir was fascinated and somewhat troubled by my dream summary of her patient population. I explained that maybe we were witnessing something to akin the “Selfish Gene Theory”; perhaps women, facing mortality, were dreaming of what they were related to, with pets standing in for human genes. Perhaps that was the origin of their dreams?
“Whoa,” said Dr. Wapnir. We stopped in the hall mid-conversation. “Freud and all other the men reporting women’s dreams all got it wrong!” she said with a bit of indignation. “You have to be careful about ‘mansplaining’ a woman’s dreams.” I was somewhat taken aback by her flash of anger; as we continued to chat I admitted we hadn’t seen a single dream related to sex at all in these patients. Not one.
Later that month I was finishing an anesthetic for a patient with breast cancer with Dr. Wapnir. This patient had a different dream story to tell. Despite the familiar texts from family about coming home, I was rapt with attention from this patient’s description of her dream. A Stanford epidemiologist, she was telling me and the PACU staff about her dream of completing her Covid research project. On and on about infection probability and vaccine rates.
“So how does it end?” asked a PACU nurse breathlessly.
“Oh, I finish the project and now I’m partying at a bar with my close friends,” said the patient.
“Were you anxious about getting the project done?” I asked.
The epidemiologist confirmed she was worried her cancer would stop her project from getting done. No boyfriends, husbands or families, loved ones or pets involved. No Freud, no Selfish Gene. Just raw ambition. When I got home, I discussed the case with my wife Candice, how I was confused by the apparent absence of love – why would a patient facing death dream about work?
“Did you ever consider that women may LOVE their work?” asked Candice, a project manager at Apple.
But there is another common dream in these women. Unapologetic dreams of work even with breast cancer, a teacher with her classroom, a public health nurse helping her patients, a state official getting disability payments for needy families. Women-care-about-their-work-dreams.
Miranda is waking up another Wapnir patient, a Silicon Valley executive. Miranda texts me that the patient reports a dream about finishing an important project by the new year. The patient reports how much she “loves her work” with her tech company. Ten minutes later, I go see the tech executive patient in the PACU. As frequently happens, the patients are very awake, alert, and mysteriously happy, like so many dreaming patients, but have no recollection of her dream – dream recall amnesia is common. So I tell the patient about her dream.
“That’s so disappointing,” mused the patient. “I get a great dream and I dream about work, I would have thought I would have had a better dream than that.” The PACU staff laughed but I didn’t. Something felt really disingenuous about her comment.
I went back to the OR where Miranda and Dr. Wapnir were already with the next patient under general anesthesia. I told them that the last patient had trashed her work when we told her about her work dream. Some of the members of the OR team laughed; they had just heard a different story from the same patient. Neither Miranda nor Dr. Wapnir found it funny. “Women so often have to fake their own ambitions,” said Miranda with disgust as she shook her head.
“Now you’ve done it Harrison, you have my patients ‘mansplaining’ their own dreams!” Dr. Wapnir joked, but something again felt wrong.
I realized then my limitations, as a man, to effectively interpret female dreams. What do I know of having to hide ambition, birthing or breast-feeding a child? As a clinical scientist, we are taught to follow facts, not emotions, but what if emotions are the facts? Something needed to change. Perspective matters.
I told Dr. Wapnir that I had recruited two Stanford attendings to join my dream project (Dr. Sara Strowd and Dr. Quynh Diercks), to help us both generate and interpret our dream data. Dr. Wapnir said she appreciated adding female faculty to our project but what she was curious about was why there was so many dogs in these dreams too. As we turned to walk out of the OR as the next patient was still getting prepped for a mastectomy, a female nurse stopped us as we were leaving. “You really see these patients dreaming of dogs, do you see any cats in these dreams?” she asked. I admitted that of the approximately 60 surgical dreams we had documented in these cases to that point, there wasn’t a single cat. “Eight dogs, two horses and no cats.”
As Dr. Wapnir and I walked the halls of Lane yet once again, she continued to muse about dogs.“Dogs are so loyal,” she wondered out loud. “No wonder my patients are dreaming about dogs and not cats.” I stopped her in the hall and suggested that she might want to keep that thought to herself.
“There are a lot of cat owners out there, you wouldn’t want to be accused of ‘dogsplaining’ people’s dreams,” I said, with a masked smile and twinkle in my eye.
Bio
Dr. Harrison Chow is a Clinical Associate Professor at Stanford Department of Anesthesia and an active member of the CSA History Committee . He is the lead researcher exploring clinical applications of anesthesia dreams at The Heifets Lab (https://heifetslab.stanford.edu). He has an upcoming book “Broken-Hearted You : Propofol Dreams of Love, Betrayal and Reconciliation in Silicon Valley” scheduled for release in Spring 2023.
Stanford Ground Rounds Presentation here about Stanford Anesthesia Dream Project : https://stanford.zoom.us/rec/play/paaGPhBIfTUg3_raUSAokemRczmpkVd4dRNWJ84Ph_gy20LYKroKfUHU9puULU7Ey7uTkan9H2rYMGl9.FRsL7wsH8bWBlbGX