Sunday 31 August 2014

Dream: end of the world via Tibetan treasures

The dream starts in a large park. I am standing in the depth of the night, the sky completely dark and illuminated only by shrill manmade lights. I don't instinctively know where I am, but looking around I feel like it's perhaps Southbank in Brisbane. It is a large green space with manmade paths weaving through, and people are everywhere as if it's new years.

But it's not new years, and I realise this is a end of the world party. If everyone knew that they were going to die, wouldn't they want to come here and have fun with their friends before they die?

At first I am alone but soon I see some people I know. I can't remember who they are now, but they are sitting on picnic blankets enjoying food, and they invite me to join them. I chat with them for a while then get up and walk around again. Though there must be thousands of people in the park, I manage to find a few friends to say goodbye to.

Then I see my high school friends and they are all in one group. I wonder momentarily where their partners and other friends must be (we haven't gone back in time because they all look as they do right now). They tell me about an exhibit in a museum of the lost treasures of Tibet. I am excited by this and decide that if the world was to end, I definitely want to see this.

So we start walking there, and along the way I am telling the group stories of the Dalai Lama's escape from Tibet and how he had stored some treasures in Sikkim prior to his actual going into exile. I am recounting stories of how they avoided the guards and soldiers by going over the high mountains, all the while worrying about exposure and hypothermia. As I am getting more animated, we enter a dark building where all the lights have been dimmed. We strain to see as we move forward in a narrow corridor, which barely fits two people at a time.

I look around me to see if I can recognise anything. There are shadows of display boxes in the distance, but it is so dark that I can't make out what's in them. I start to think that perhaps we have gotten to the exhibit too late and it has already been looted.

We emerge into a bright lecture theatre packed with throngs of people. I have lost my friends and can't see them anywhere. First I look for them all around, then I give up and just look for an empty spot. I finally find one in the middle of a row and squish through people to get there.

Just as I sit down the lights are dimmed. I look to my right and it's Andy, Charley, and Henry sitting in a row. Wait a minute, I think, if this is the apocalypse, they must be really good friends to be still sticking together?

The man on the lecture podium names himself as Nakashima. He is a short balding middle aged man with a slightly stooped posture. His voice is quiet and steely as he starts speaking about the end of the world. Emphatically, he tells us that we have all been inflicted with a disease that remains unnamed and unqualified. It is incorporated into our DNA and has been part of our genetic destiny since we were bonobos. No one knows what triggers it, and why we are all dying from it.

Lies! I want to shout. The Japanese are trying to take over the world and they are telling us these lies so we will give up and die. 

Then I wake up. 

Wednesday 20 August 2014

Five pre-exam dreams

Dialysis during war
In this dream, we are at war. It's not clear where the war is, but it instinctively feels somewhere tropical. Everything is green and lush, and the air feels humid and sticky.

I am the commander of a unit, and we are all wearing camouflage gear. We run through the low lying bushes, intermittently meeting enemies and exchanging fire with them. It all seems like a game.

Then it is night and we are back at the army barracks. It is a simple building that looks like a warehouse with high ceilings, the dim lighting provided by several naked lightbulbs. Bunkbeds are lined up down one side, strewn with rough looking blankets.

B is there with a machine that she has propped up on her bed. I walk closer and realise it is a dialysis machine, though much smaller than ones usually in clinical use. She has a fistula on her left forearm, which she is cannulating with the buttonhole technique. She hooks herself up to the machine and it hums with a low frequency. It is the only noise among the dead quiet of the night.

Later she comes up to me and says - I think there is a problem with the dialysis machine, I don't feel well. We discuss this for a while, and I tell her that whilst ideally we should do a Kt/V to figure out her urea clearance we don't have access to those facilities.

Then it is the next day, and the two of us leave the army barracks. she is carrying her dialysis machine and I am carrying some sort of machete. We walk through the fields and I tell her to protect herself and the machine at all costs, but strangely we come across no-one.

We see a subway station and go down some steps. It is a subway station of the No. 9 subway line in Shanghai, and when we first enter it appears completely deserted. The wind travels through the underground gently, scattering small piles of dust and rubbish which have collected. We walk around looking for some sort of entrance to the tracks, wondering if a train would come. Then we realise that there are a number of ATMs around which are still on, their lights flickering intermittently. Then we see people dashing out from the darkness, standing in front of the ATMs for just a few seconds before disappearing back into the darkness.

There is an ominous feeling and my alertness is heightened. We stand next to one ATM waiting for the bank advertisements to change. Then a man comes out from the darkness and says - what are you looking for? these machines are the very last connection we have to the Internet.

Then I wake up.

Tourism in Tonga 
In this dream I am in the Tongan jungle. The foliage is dense and there is barely any light on the jungle floor. The giant tree roots are gnarled and twisted around my feet, tempting me to fall. The mud is thick and black, splattering carelessly onto my clothes. The air has an incredibly intense scent of decay and regrowth, and the whole place feels alive - as if I am inside a giant living being.

Pausing for a second, I can see all sorts of insects scattering around, and I become acutely aware of leeches sliding up my legs, crawling silently as they suck on my blood.

I am with two local men who are dressed in Steve Irwin khakis that look frankly ridiculous on their thick Melanesian frames. They are also wearing explorer hardhats which are comically lopsided on their large heads. Practically bursting out of their ill fitting uniforms, they are both drenched in sweat.

We are traversing a ravine when I slip and almost fall to the bottom. They rush to my aid and I stand up straight again, amused by how overwhelming the environment is, and struck by the feeling of utter isolation.

Thank you so much for coming, they say, clearly the footpath will be very helpful in this part of the track. I chat with them a little more and find out that we are mapping out the route for a walk that will go all the way around the island of Tonga. They tell me that the tourism industry has been failing due to all the tourists going to other pacific islands. They are hopeful that this new exotic challenging walk will bring lots of tourists in.

A walk here? I wonder, looking up at the foliage which is so dense that no trace of the sky is discernible.

Then I wake up.


My face! My face!
In this dream I am rinsing my mouth in the sink in my own bathroom at home. Small flecks of corn come out and I wonder, I must have eaten some corn and it got stuck in my teeth.

With the water running, I keep rinsing and the corn keeps coming. Suddenly they turn into small specks of meat that resemble mince. I am puzzled by this - I haven't eaten meat for months, how did this meat get into the sink?

As I keep rinsing, I wonder if something has happened to my brain and I am not able to perceive the feeling of having food remnants in my mouth - how can this much corn & meat come out and I have no idea where it's stuck?

The specks of meat start getting bigger, and soon they look like blobs of meat. They get bigger still until they look like those stirfry strips you buy at the supermarket.

Just what in the world is going on? I think. I look up at the mirror and realise with a start that my face is disintegrating and the strips of meat in the sink are my face. I try to grab the last strip, a good chunky one as it starts to gurgle down the drain.

My face! My face! I scream silently in the dream. Then I wake up.


A difficult intubation
In this dream, A and I are called urgently by a nurse to Blue ICU. We go into bed 35 and there is a man there who looks very unwell. K is at the top end holding a mask on his face, so we turn around and start getting drugs and equipment ready to intubate him.

Next thing we know, K has already started the intubation without equipment or drugs. With the laryngoscope in his mouth, the patient starts struggling like crazy, trying to punch her with both his arms. She manages to duck the punches in between looking in his mouth, and shouts out for a bougie. The man starts bucking up and down on the bed, trying to squirm away from her. The nurses hand K a coat hanger and she shoves that into his mouth. We watch silently, utterly horrified as she manages to somehow get the tube over the coathanger.

Intubated, the man stops struggling and the chaos seems to have abated. She is bagging him with zest and his colour improves. Then there is water coming out from his mouth, pouring down the side of his neck, over his chest and down onto the ground. The water is coming so fast that the puddle on the ground expands rapidly.

I start to think about the implications of this if the electronic equipment were shortcircuited - or worse, if we were all electrocuted.

What's happening? I shout to K. but she is so engrossed in the bag that she doesn't reply or look up.

My eyes follow the trail of water from the ground up and as it tracks across his body back into his mouth and the bag, I realise the bag is attached to a piece of garden hose. Following the hose away from the patient, I realise that it is attached to the cold water tap, and she is bagging him with tap water!

Then I wake up.




RPA shopping centre
This is a very brief dream where I leave the ICU and walk outside to the foyer. I am looking for a ward (6E2? I can't remember) but when I walk up the stairs RPA has turned into a shopping centre and all the wards have become hidden within shops. I give up looking for the ward and go back down to ICU which looks exactly the same.

Then someone asks me if I've organised the RMO dinner and I say I haven't even thought about it, but it should be easy since we are now in a shopping centre! I go back into the shops and start looking around for restaurants. I come across quite a few but they are all closed.

I feel annoyed and think, what sort of shopping centre is this, nowhere to eat! Then I wake up.


Dream: a few rounds of death

The dream begins in a dark warehouse. I am alone, and instantly aware that I am being pursued. Large crates are stacked all around me, and I am crouching next to some sort of bobcat. Many pieces of machinery are scatteredly haphazardly around, like someone abandoned them in a hurry.

I hear footsteps approaching and silently begin to move. I have no idea where I'm moving to but my feet seem to be taking me away from the footsteps. I stop and wait again. Now there are two sets of footsteps and they are converging upon me. It is so dark that my sense of hearing is heightened.

As they come within a few metres of me I turn around and see that there is a set of shutter doors which swing open like in those old Western movie saloons. I duck quickly under the doors and hide inside the small alcove which is barely larger than a cupboard. As I look out through the shutters, I realise a lightbulb is casting its light directly over the space just outside the doors. I know then that I will see my attackers just in the moment before they find me.

They come closer in silence. As I predicted, they pause in the dim pool of light just outside the shutters. I know they have found me and time seems to stop while they are drawing their guns, in ridiculously slow motion.

The one on the right looks Italian, tall with dark hair and a receding hairline, wearing a black leather jacket. The one on the left looks Southeast Asian, short and stout with a beer gut. As they raise their guns and point directly at me, I think for a moment that I am going to die. I didn't even realise my gun is loaded and in my hands, but at that moment I am acutely aware of the cold steeliness of the weapon. I raise the gun and shoot them both, first the Italian guy in the left chest and then the Asian guy in the left shoulder. The Italian guy falls to his knees and collapses silently in a pool of blood. The Asian guy remains standing, and I try to shoot him again but I have no more bullets in my gun. His weapon drops with a conspicuous clunk to the ground and he remains standing for a while, bleeding profusely, then slowly slumps to the ground.

The whole thing must have not taken more than a minute, but I feel like hours have passed. My heart is racing and my hands are covered in cold sweat. I take out my phone and ring 000. The next moment, ambulance officers have arrived and I am still standing exactly where I was. They check the Italian guy and he is dead. They check the Asian guy and they think he's dead too, but I could see that he's still breathing and rush out of the alcove to tell them he's not dead. When I get closer I see that the bullet must have clipped his shoulder and actually hit his face, and his entire left head is swollen. He has a good carotid pulse and chest rise seems equal, so I tell them to take him quickly to the hospital because he has probably had penetrating head trauma and needs urgent surgery.

Then I am on a ship. It feels like a military warship, though I don't really know why. There certainly aren't any oldies or recreational activities around, and the atmosphere is absolutely sombre. It is still in the depth of the night, and dark stormclouds twirl close to the horizon, threatening us just above our heads. I am all alone on this ship and cannot hear or see anyone.

The sea is angry and the turbulent waves rock the large ship violently. I am struggling to hold onto the railing as I try to find someone so I can find out where I am or what has happened. As I walk forward, the wind starts howling and it feels like knives are slashing my face. Up ahead I can see lights at the front of the ship, and keep struggling to move towards the lights.

It starts to rain, and the droplets seem to be vicious too, falling in my eyes and making the world blurry. As I get closer to the light, I realise there is a huge crowd of people around someone on a makeshift bed.

We must save the general! One man at the head of the bed is shouting.

I stand a few metres away and watch what is going on. There are two men in white coats at the head of the bed who seem to be the doctors, and then there are a crowd of other people at the foot of the bed milling around. I can't tell if any of them are doing anything helpful.

I get closer and realise the man on the bed is the Asian man I shot in the warehouse. His face is grotesquely distorted, and a surgeon is trying to pick outs of fractured skull. Blood has soaked through all the bedding and is dripping onto the ground. I realise with a start that he is not anaesthetised and his eyes are bulging practically out of their sockets. He has an arterial line and the monitor says his BP is 50/30.

Everyone stop! I shout and everyone stops momentarily, looking startled. What's going on? I demand.

The surgeon explains that this is the commander in chief of the army, who has been shot by enemies during a rogue attack. They had done an exploratory craniotomy because his head was so swollen they thought they had to decompress it for intracranial hypertension, but never actually found the bullet. They lost the anaesthetist during the war and thought he was so hypotensive he probably wouldn't remember the surgery anyway.

As he is explaining this the BP starts to slide, and I ask one of the nurses to fetch more blood. She comes back with a bag containing 2 units of packed cells and 2 units of FFP and says that this is all there is left of the blood bank. We give it to him, but the BP remains terrible. As the wind howls I think - this man has actually not died from my bullet but from poor medical management?

The surgeon keeps prying at the swollen brain tissue, trying to escape from the small hole like a mushroom. The monitor makes ominous lower and lower pitch sounds as the BP falls to near zero. 

Then I wake up