Anaesthesia dreams

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.

Dream: driving to work through the sea, and giant purple macaroons

In this dream I am driving to work. I'm dressed in my usual casual clothes so I must be going to do anaesthetics, and I'm driving alone in my little car.

It could almost be a scene from real life, but I quickly notice the differences. There's nothing on the side of the road at all - a landscape completely devoid of features. As such I can't tell where I am or where I'm going. There are also no cars on the road, and no lane markings on the road. It seems to go on forever, just a smooth grey skinny strip of gravel.

Just as I start to feel vaguely bored of this, a foamy wave catches the corner of my vision. I look over to the right but there is nothing there - I feel like I must have imagined it, and continue to drive. Soon it happens again, and again until I start to see little waves washing up on the side of the road. They look so small and unthreatening though, that I am not disturbed by this at all.

As I continue to drive, the waves seem to come a little closer, and soon I can see the sea, a shimmering mass of blue on both sides of the road. I marvel at the genius engineering of this road which allows me to drive through the sea.

Soon the waves start encroaching on the road and I think, hold on! this is not supposed to happen! This is the road, where cars drive. Waves are supposed to stay just where they belong, in the sea. The waves seem to be getting larger with each tide onto the road, and soon I am driving through patches of water, which don't seem to have any pull to them. Though the car doesn't seem to be moving away into the sea, I am alarmed and look up ahead.

I can see only the sea, a tall homogenous blue stillness that I cannot comprehend. I decide to go back home, but as I start doing a 3-point turn, I realise how silly it is to do a 3-point turn in the sea.

I am shifted in the next scene to a country town I do not recognise, but I think it may be in New Zealand. As I wander around I see an old fashioned butcher, a fruit &veg shop and a paper shop. I come to a shop with a sign "Everything is $5!" and decide to poke around inside. It's full of junk like a $2 shop, and I wonder how the price has gone up to $5 so quickly. I pick up a few kitchen utensils but put them back when I realise they are made of brittle plastic. There are a few American soft drinks like Dr Pepper, and bags of snacks I don't recognise. In the bakery section I see these macaroons which look nice, so I pick some up for a closer look. On closer inspection this pair of purple macaroons are positively huge, each the size of a discus and as tall as a big mac. They look grotesque, as if they were macaroon models that have gone wrong.

How do you fit your mouth around these? I think, and then am transported to the next scene within my own ICU. It's 7:30pm and I am trying to handover to the night registrar. We are standing in front of a ventilated patient hooked up to a bunch of things, obviously a complex patient as I am describing whatever it is that's wrong with the patient. After a few minutes I realise there is a look of utter incomprehension in this guy's eyes. I wonder if maybe he doesn't speak English, so I try to speak to him in Chinese, but all the words come out like pidgin.

This man no good, he die soon. Is the equivalent of my words. Then I wake up. 

Dream: seeking a mountain for a Tibetan sunset

I'm travelling in Tibet. The temperature is cool and I am in the mountains, but it's not somewhere I recognise. I'm at the bus station where people seem to be milling around, like they do in bus stations all over the world. There are lots of monks dressed in the traditional deep maroon robes, travelling solo or in groups.

I start talking to a few people who strangely all speak English. They tell me that there has been a massive revolt recently and that the roads are not safe. People are being pulled off the buses and shot randomly by the police. It's not safe to hitchhike, and as a foreigner taking the bus is not really an option.

I walk out of the bus station compound. Outside there is a straight long highway, reaching into the distance as far as one can see, into the fluffy white clouds. The sun is bright and fierce. I decide to walk because that is an option not involving taking a bus or hitchhiking.

As I walk along the highway I am struck by the barrenness of the Tibetan landscape. Hardly any vegetation survives up here, the ground is rubbly and brown. The air feels thin and I can hear my laboured breathing, the only sound in the stillness of my surroundings. No vehicles come up the road, no animals graze on the side of the road, and I am amazed I don't see any pilgrims.

After what feels like a long, long time, I come to a solitary wooden sign announcing the next village. Soon I come to another weather worn sign with a rudimentary map, which I study carefully. I know I want to get to a mountain to watch the sunset, but I'm not sure how far it is. The map shows the road diverging up ahead, with the left side going up to the mountain.

I look at my watch and it's 5pm, the sun is slung lowly on the horizon and I feel strangely energised, like I'm going to make it to watch the sunset! I walk ahead through the village, a collection of mud huts painted bright white with colourful window frames, like many Tibetan villages I have been through.

Further along the road, I see a collection of trees. Trees? I wonder, why are there trees in Tibet? Suddenly I'm amongst the trees, a densely wooded forest. The canopy is so thick that I am surrounded, overwhelmed by the fresh green scent of the forest and completely enveloped by darkness. I can barely make out the road.

After a few more steps, I look at my watch and the time is 8pm. I wonder how I could have taken so long to get to the forest, and acknowledge to myself that the sun has already set and I must go back to the village which I passed.

I come out of the forest and walk back along the barren road, this time in the darkness. In the distance I see the village with a few fires emitting thin trails of smoke, a homely comforting scene. Yet as I get closer, I hear the sound of excited voices. All of a sudden I am worried about a demonstration in the village, or perhaps the police have come to execute people?

I walk into the village and the first few houses seem to be deserted. Then I see a collection of several dozen people crowded around a makeshift platform, on which several people stand clutching microphones.

They call out: Welcome! Try Fanta's new flavour - cherry flavoured Fanta makes your day brighter! They are throwing cans of cherry Fanta into the crowd, and people scramble to catch the cans.

It's a trick, don't do it! I shout silently, and wake up.

Ramen club: Ramen Zundo

The first rule of Ramen club is: one shall eat ramen and only ramen.

Ramen Zundo in World Square is a small space in one of the side alleyways, the shopfront decorated with lanterns that are often seen in Japan. I had the Mount Chashu ramen - couldn't go past the cheesy name! It comes with a choice of base soups, this was the white (original tonkotsu). Black (with garlic oil), red (with chilli miso), soy and double (half tonkotsu with half chicken soup base) are also available.

The roast pork here is quiveringly divine with long strips of jellied fat that slide down well. The ramen base is thick but not as sticky as Gumshara's, stronger in flavour than the average tonkotsu. Though not quite traditional, I really liked how sprouts and cabbage injected some vegetables into the dish.

I like this one. Round one: success.