Now that I have retired from clinical practice, the dreams that I have related to medicine have seemed not only more frequent, but more vivid, or disturbing, or impactful, and certainly more difficult to interpret. In fact, I have given up on trying to interpret these dreams: the meaning behind the dream seems less important to me than the effect they have on my conscious life. I had at least two dreams related to medicine last night. In one, I was somehow back doing my first postgraduate training year despite having been in emergency medicine practice for thirty-four years. A 60 year old, grey-bearded intern, how strange is that? I was on morning rounds, trying to take notes on several patients assigned to me who had been admitted the previous night. I had only a single 3×5 card, and had filled both sides of the card in tiny script with two more patients yet to be presented, and no scratch pad in sight. Suddenly, I was taking an elderly premorbid patient in respiratory distress up to a ‘respiratory distress ward’, and wondering whether the patient should be intubated, or just given comfort care, or so-called ‘expectant care’ as we used to say. Having expressed my thoughts to the attending in charge of the unit, I found myself in a surprisingly heated discussion about the cost of futile death-extending care, and having my own comments in a blog on the subject in the Fickle Finger thrown at me as evidence of my profound ignorance on the topic. An attending had actually read The Fickle Finger? I didn’t know whether to be proud or dismayed: the progenitor of reluctance for any writer who risks putting his or her opinions in print. I woke up, a bit perplexed perhaps, but in some way having this argument over the cost of futile care allowed me to feel a bit better about the application of principles to my medical practice.
The next dream was a doozy. I won’t or can’t go into detail, except to say it was a dream about a critically ill patient whom I had inadvertently hurt more than helped in my rush to address his severe symptoms. I imagine in 34 years of practice there have been more than a couple such patients out of the 100,000 or so that I have treated. In my dream, I told myself that in the calculus of emergency medicine, do no harm was a goal, not an absolute expectation; and that my help to harm ratio was certainly more than good enough to justify having never been sued for malpractice. Actually, I have been sued, once, but it was by a patient whom I never treated, who was seen in a hospital I never worked at, located in one of the few counties in California I have never set foot in, and who was admitted to the hospital three years after I retired from clinical practice. I was dismissed from the suit, and was never deposed, so I don’t count this incident. In truth, though, not having been sued had more to do with pure luck than anything else; and this patient in particular has played a role in my dreams more than a few times. I am ashamed to say I don’t even know if he survived his hospitalization. These dreams also wake me up, and sleep does not return quickly.
The first dream I mentioned in this post is like most of my medical dreams, in part because they often relate to the trials and tribulations of medical training, which I did not enjoy as much as I could have if I hadn’t made the mistake of choosing to live so far from the hospital. Apparently even thirty-four years of practice did not entirely alleviate the anxiety of my first year of clinical training in this dream, but the significance of the dream for me in my wakeful life today was the realization that anxiety was, for me and perhaps for many emergency physicians, an integral part of the practice. The benefit of this realization, which I acknowledge was at least not a new insight for me by any stretch, was that it allowed me to appreciate, once more, the relief of retirement from clinical practice. Take a few weeks off on sabbatical and you will likely experience this same unburdening, if not one similar to it. Most physicians actually experience increasing anxiety after retirement: our sense of self is so wrapped up in our professional lives that, absent the everyday challenges and rewards of medical practice, we get very stressed out over having nothing to stress out about. My advice for medical retirement: have an exit strategy, and don’t get hung up on interpreting your dreams, just experience them as a safety valve, and as a way to keep your sense of self, even if you no longer practice.