Well, well. Perhaps sevoflurane has damaged my brain... or perhaps I just have had more sleep since studying less, but I've been dreaming a lot recently.
The one where propofol doesn't work.
I'm in one of the anaesthetic bays at RPA, working with an older consultant who I don't recognise. He's grey and grumpy, constantly muttering under his breath and not talking to me much.
The patient in the bed is a young Chinese woman who doesn't seem to speak English. She has about 10 relatives around the bed, all dressed in white patient gowns with malaligned theatre caps resting comically on their heads. She is talking rubbish in Chinese, and her relatives are trying to talk sense into her "everything will be all right, you are going to have an operation now". Suddenly she sits up, grabs the handrails tightly and tries to jump out of the bed, but her relatives manage to talk her into lying down again.
I ask the consultant if I should ask the relatives to leave, and he snaps can't you see she's terribly encephalopathic! if you ask them to leave she will fall out of bed.
We get ready to anaesthetise her, but he gestures we should not approach with the oxygen mask for fear of making her go mad and get out of bed again. He injects the entire syringe of propofol (at which point I think.. that's a lot of propofol) and we wait for her to fall asleep. Nothing happens, and her relatives look at us anxiously while the patient continues to babble in Chinese. I check the drip and it's running well. The consultant asks for more propofol and I draw up another ampoule, which he gives promptly. I feel nervous that we have given this woman so much propofol, but she continues to grab the handrails, pulling herself up and trying to swing her legs over the side of the bed.
By this point the relatives are looking quite nervous and start talking amongst themselves. The boss shouts at me for more propofol, and I draw up the other 3 ampoules in the box. He injects all 3... and thus the patient has had a whole box of propofol. I start trying to figure out how many milligrams that is... 1g!
As the woman thrashes on the bed, one of the transplant surgeons (MC) walks in and he immediately starts complaining: you morons! how am I supposed to do this liver transplant? under local anaesthesia??
Liver transplant.. liver transplant... I think in the dream, all the pieces falling into place. I say to the boss - she must have a veno-occlusive disorder which has caused liver failure and also blocked the SVC, so the propofol can't get into her circulation no matter how much we give. We need to do an inhalational induction..
He gets very angry and says - inhalational induction for a transplant! that's ridiculous!! and MC says wait a minute, maybe we can just thrombolyse her and not have to worry about the transplant..
Then I wake up.
The one where the world is at war
In this dream, I am standing at a busy harbour port, where there are hundreds of ships small and large. All around me there are people milling around, organising themselves, luggage and crates of stuff. Huge cranes loom in the distance, loading huge warships with containers.
It's night time, the sky is a peculiar inky dark blue and the atmosphere is surreal. Briefly I wonder where I am supposed to be, but I am swept up in a crowd and carried onto one of the giant ships. It looks so impossibly big that I wonder what it's for. I stand on the deck and watch the activity on the port from the other side, filled with this ominous feeling.
And then we pull away to sea, and soon we are in the middle of the ocean, surrounded by complete darkness. I stand for some time, listening to the waves crash up against the sides of the ship. Soon I see lights in the distance, and realise with a start that is the front line of the war. I don't know where this war is, or who the participants are, but I know that is the war.
People run out onto the deck, and organise themselves into groups. I try to anonymously blend into one, and am carried along with my group into a smaller raft like a lifeboat. There are about 10 of us, and we sit solemnly in our raft as we are lowered to the surface of the ocean. We hit the water with a splash, and the waves immediately start rocking our raft with a vicious violence.
We are carried closer and closer to the lights in the distance, and we see that they are huge warships engaged in heavy artillery fire. No one speaks, but we feel absolutely dwarved by these ships, being in such a flimsy little raft. We get so close to one that we are almost about to touch it, and finally a man asks is everyone ready?
Ready for what? I think. Then there is a massive explosion of light and noise, and everything is a white out.
When I wake up from the explosion, I realise I have survived a suicide bombing and I am lying in a hospital bed. I move my limbs and feel that I have no pain. No one is around so I gingerly sit up and feel my face, which feels intact. I swing my legs down and touch the cool tile floor, everything feels fine so I stand up. I feel intrinsically that something is wrong with me but I can't tell what it is.
I walk away from my bed, and as I walk into the corridor outside I am struck by the nauseating smell of rotting flesh and the strong disinfectant that attempts to cover the smell. I sink to my knees, gag and try to vomit, but nothing comes up. I stand up again and walk further down the corridor. At the end of the corridor there is an operating theatre, where a nurse is opening trays of equipment.
Thank god, someone is finally here. She says, and grabs me by the hand.
I'm a patient, I'm not here to work. I protest, trying to get away from her.
She turns around and looks me straight in the eye. Listen love, this is the war. All the anaesthetists in this hospital are no longer with us. We need you to anaesthetise this next patient, or the surgeon will have to do it.... and you don't want that, do you?
I swallow hard as I go into the bay and am faced with a mangled victim, guts hanging out by his side. I am wondering if he's still alive, but he groans weakly and I can see he's still breathing, though shallowly and rapidly. I check my equipment and give him some drugs. As I put the laryngoscope into his mouth, I realise I know who he is, and I'm so shocked that I am temporarily paralysed, unable to move.
The surgeon walks in and says, why have you stopped? he must be dead.
Then I wake up.
The one where propofol doesn't work.
I'm in one of the anaesthetic bays at RPA, working with an older consultant who I don't recognise. He's grey and grumpy, constantly muttering under his breath and not talking to me much.
The patient in the bed is a young Chinese woman who doesn't seem to speak English. She has about 10 relatives around the bed, all dressed in white patient gowns with malaligned theatre caps resting comically on their heads. She is talking rubbish in Chinese, and her relatives are trying to talk sense into her "everything will be all right, you are going to have an operation now". Suddenly she sits up, grabs the handrails tightly and tries to jump out of the bed, but her relatives manage to talk her into lying down again.
I ask the consultant if I should ask the relatives to leave, and he snaps can't you see she's terribly encephalopathic! if you ask them to leave she will fall out of bed.
We get ready to anaesthetise her, but he gestures we should not approach with the oxygen mask for fear of making her go mad and get out of bed again. He injects the entire syringe of propofol (at which point I think.. that's a lot of propofol) and we wait for her to fall asleep. Nothing happens, and her relatives look at us anxiously while the patient continues to babble in Chinese. I check the drip and it's running well. The consultant asks for more propofol and I draw up another ampoule, which he gives promptly. I feel nervous that we have given this woman so much propofol, but she continues to grab the handrails, pulling herself up and trying to swing her legs over the side of the bed.
By this point the relatives are looking quite nervous and start talking amongst themselves. The boss shouts at me for more propofol, and I draw up the other 3 ampoules in the box. He injects all 3... and thus the patient has had a whole box of propofol. I start trying to figure out how many milligrams that is... 1g!
As the woman thrashes on the bed, one of the transplant surgeons (MC) walks in and he immediately starts complaining: you morons! how am I supposed to do this liver transplant? under local anaesthesia??
Liver transplant.. liver transplant... I think in the dream, all the pieces falling into place. I say to the boss - she must have a veno-occlusive disorder which has caused liver failure and also blocked the SVC, so the propofol can't get into her circulation no matter how much we give. We need to do an inhalational induction..
He gets very angry and says - inhalational induction for a transplant! that's ridiculous!! and MC says wait a minute, maybe we can just thrombolyse her and not have to worry about the transplant..
Then I wake up.
The one where the world is at war
In this dream, I am standing at a busy harbour port, where there are hundreds of ships small and large. All around me there are people milling around, organising themselves, luggage and crates of stuff. Huge cranes loom in the distance, loading huge warships with containers.
It's night time, the sky is a peculiar inky dark blue and the atmosphere is surreal. Briefly I wonder where I am supposed to be, but I am swept up in a crowd and carried onto one of the giant ships. It looks so impossibly big that I wonder what it's for. I stand on the deck and watch the activity on the port from the other side, filled with this ominous feeling.
And then we pull away to sea, and soon we are in the middle of the ocean, surrounded by complete darkness. I stand for some time, listening to the waves crash up against the sides of the ship. Soon I see lights in the distance, and realise with a start that is the front line of the war. I don't know where this war is, or who the participants are, but I know that is the war.
People run out onto the deck, and organise themselves into groups. I try to anonymously blend into one, and am carried along with my group into a smaller raft like a lifeboat. There are about 10 of us, and we sit solemnly in our raft as we are lowered to the surface of the ocean. We hit the water with a splash, and the waves immediately start rocking our raft with a vicious violence.
We are carried closer and closer to the lights in the distance, and we see that they are huge warships engaged in heavy artillery fire. No one speaks, but we feel absolutely dwarved by these ships, being in such a flimsy little raft. We get so close to one that we are almost about to touch it, and finally a man asks is everyone ready?
Ready for what? I think. Then there is a massive explosion of light and noise, and everything is a white out.
When I wake up from the explosion, I realise I have survived a suicide bombing and I am lying in a hospital bed. I move my limbs and feel that I have no pain. No one is around so I gingerly sit up and feel my face, which feels intact. I swing my legs down and touch the cool tile floor, everything feels fine so I stand up. I feel intrinsically that something is wrong with me but I can't tell what it is.
I walk away from my bed, and as I walk into the corridor outside I am struck by the nauseating smell of rotting flesh and the strong disinfectant that attempts to cover the smell. I sink to my knees, gag and try to vomit, but nothing comes up. I stand up again and walk further down the corridor. At the end of the corridor there is an operating theatre, where a nurse is opening trays of equipment.
Thank god, someone is finally here. She says, and grabs me by the hand.
I'm a patient, I'm not here to work. I protest, trying to get away from her.
She turns around and looks me straight in the eye. Listen love, this is the war. All the anaesthetists in this hospital are no longer with us. We need you to anaesthetise this next patient, or the surgeon will have to do it.... and you don't want that, do you?
I swallow hard as I go into the bay and am faced with a mangled victim, guts hanging out by his side. I am wondering if he's still alive, but he groans weakly and I can see he's still breathing, though shallowly and rapidly. I check my equipment and give him some drugs. As I put the laryngoscope into his mouth, I realise I know who he is, and I'm so shocked that I am temporarily paralysed, unable to move.
The surgeon walks in and says, why have you stopped? he must be dead.
Then I wake up.
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