Editor’s Introduction: This series is based on a number of patient observations and personal inquiry by Dr. Chow between 2007 and 2009, Dr. Chow has filed a patent with the US Patent and Trade Office regarding the use and application of propofol-based sedation in the production of patient dreams and rapid eye movement or REM sleep.
Karen
“Wow that was amazing!” said “Karen,” a smiling housewife in her 30s, who had just finished having foot surgery and propofol sedation anesthesia. Now resting comfortably in her gurney in the PAR, Karen had that satisfied, nearly sensuous look of a propofol wake-up patient.
“Tell us Karen, what was amazing?” I asked, as the nurses huddled over the gurney. We all knew the dream potential here, and Karen’s excited smile and tone promised one great dream story.
Karen excitedly gushed, “Well I dreamt I had all my kids in my car all quiet in the backseat, and I was driving them to school and I just kept driving and driving…” As Karen spoke, she looked like she had won the lottery, not just performed a mundane task. I could sense the palpable disappointment from the nurses.
“Too bad,” laughed one of the nurses, “You get great dream time and you end up having to drop the kids off at school. You should ask Dr. Chow for a refund!”
Karen described her rather “ordinary” dream further. She had hurriedly prepared her two kids for school and bundled them up into the car. In her dream, she was driving them to school for “hours” but never actually arrives. With a giant smile Karen concluded, “And that was not only great but the best sleep of my life.”
“Karen what would you have been doing if you hadn’t been in surgery today?” I prodded further.
“I would have driven the kids to school,” Karen admitted, “It’s my biggest job of the day, and I was worried about it all night. It kept me up all night, more so than worrying about surgery.”
Dreams like Karen’s, as commonplace as they seem, offer the key to my understanding of propofol dreams, because Karen’s dream pattern, the action or syntax of her dream, is virtually the same for every dreaming patient I see, no matter how routine or fantastical.
There seems to be four basic components to every propofol dream. Firstly, there is an emotional conflict (C), Karen’s fear that her kids would not get to school without her. Secondly, there is a primary actor (A) in the dream, Karen is the active participant in the dream, her kids largely quiet in the back seat of the car. Thirdly, there is an emotional resolution (R) that occurs with the actor (A) that resolves the conflict (C). Often the emotional resolution seems become perpetual, as in this dream where Karen continues to drive for hours. Lastly there is a dream imagery set (S) that the conflict, actor and resolution all reside in drawing from meaningful memories, in this case, Karen’s house and car with her kids. Together a propofol dream functions like a stage play or movie, except the ending is often perpetual.
The syntax might look like this:
Imagery Set (S) [Emotional Conflict (C) + Actor (A) => Emotional Resolution (R)]
or
S [C + A => R]
In Karen’s case, what actually happens in her propofol dream is basically unimportant, but what is of primary importance is how she felt. Emotions, not the imagery, are the producer, director and actors in the propofol dream stage play. In Karen’s dream, she became the primary actor, but her emotions were producing and directing the flow of the play. With her kids safely in her car, her emotional concerns and conflict were resolved.
Lucy
“Lucy,” a middle-aged female in her fifties, who just finished a foot procedure under ankle block and propofol sedation anesthesia, was resting comfortably in the PAR, but awoke crying, but smiling under the tears.
“So where did you go?” I asked, recognizing the now familiar pattern of dreaming under propofol sedation anesthesia.
“When I woke up, I thought I was in Hawaii, on a beach in Hawaii,” recounted Lucy in a smiling, calm voice, “But I realized I was here for surgery. I feel so much better though.”
“Why Hawaii? Do you often go?” I queried.
“We have a lot of fond memories of Hawaii. We used to take our family vacations there, and we had a favorite beach we used to visit. It was safe and fun our kids, particularly my son…he loved that beach, he grew up surfing that beach,” she continued calmly. “But this time it was just me…and my son. Strange, as an adult he’s never been there. He was there surfing, and I just watched him from the beach. He was so happy.”
“How long were you there?”
“We were there for days. No, the whole week, we usually go to Hawaii for the whole week. Strange we stayed on that beach for days, I just kept dreaming that I was watching my son surf on that beach,” Lucy admitted.
“What made you think of your son?”
“Well my son called last night. He’s all grown up now, and he called to tell me he’s moving away from San Jose to take a new job,” Lucy recounted with sadness. “I’m worried. He’s never really been away from me before.”
“Wow!” exclaimed the PAR nurses now gathered around Lucy’s gurney in curiosity. “You got to go to Hawaii with your anesthesia? I’m so jealous.” One of them cheered, “Good job Dr. Chow!”
On the surface, Karen and Lucy had very different dreams, but from an emotional perspective, the two loving mothers had had the exact same dream. Lucy, worried about her son’s move away from San Jose, dreamt of placing him placing him in a safe and happy place – surfing his childhood beach with her. Likewise Karen, concerned about getting her children to school, dreamt of placing them in a safe and happy place – quietly sitting in her car as she drove. Both loving moms had the exact same emotionally satisfying resolution of their dream, putting their children in a perpetually safe and happy world of their emotional choosing.
In Lucy’s dream, the emotional conflict (C) was the concern about her son moving away from her, the actor (A) was Lucy, the imagery set (S) was her family’s favorite Hawaiian beach and the emotional resolution (R) was her son happily and safely surfing on the Hawaiian beach with her.
Lucy later forgot some details of her dream, but called her son by cell phone to tell him how much she loved him. The PAR nurse asked me why I went to the trouble of propofol sedation (admittedly, a hassle). I responded that patients who dream not only seem to feel awake and alert in the PAR but also never seem to have OR recall or post-operative nausea or vomiting (PONV). It’s a pretty neat trick when patients feel better and are often “happier” after surgery than before.
[Next]
Part 1: A Personal Perspective
Part 3: Reconciling the “Nightmare” of Giant Hot Dogs and Surgical Awareness
Part 4: Déjà vu Memories
Dr. Harrison Chow (hchow64@gmail.com) is a practicing anesthesiologist with Group Anesthesia Services (GAS), based out of Good Samaritan Hospital in San Jose California, and is adjunct clinical faculty at the Department of Anesthesia, Stanford School of Medicine.