The Nightmares Begin

When I started my anesthesia residency, I began having dreams about the operating room. Things would go wrong, and I wouldn't know what to do. I remember one dream in particular . . . the nurse had told me in the hallway that my patient was in the OR, so I ran back to the room to see the patient on the other side of the room from the anesthesia machine. Someone else had given the induction meds, and the patient was apneic. I couldn't intubate yet because the patient had secretions so copious that his/her entire head was submerged in them. I continued to suction but the secretions kept coming. Most of my dreams were of that nature. I would hear the pulsox and EKG sounds continually in my dreams, as I drifted to sleep, and as I woke up, sometimes even while I was awake. This happened every night for the first few weeks, then decreased in frequency so, I think, by the end of my CA-2 year, they had stopped. Until now.

I start my new job on Monday. My level of anxiety has waxed and waned over the past few weeks, ranging from, "I'll be fine. I'm used to some taking care of some of the sickest patients in the Metro. Just think ABCs," to "OH MY GOODNESS! I'M GOING TO BE ALL BY MYSELF! WHAT IF I CAN'T FIND THE SUCTION? WHAT IF I CAN'T INTUBATE? WHAT IF I HAVE TO GO TO THE BATHROOM?" And with the distraction of studying for Boards, I guess I really hadn't given myself a chance to stress out over my new level of responsibility at my new job. But now the Boards are over. Time to stress about something new.

Last night I dreamt that I was supervising a CRNA in a case. For some reason, we were in a basic science lab, preparing not one, but TWO patients. Both patients were on the OR table with monitors applied. I came over to the one patient, and she still had her tourniquet on (from having had the IV placed). I took it off, and her hand started to swell, as if I had just blown a vein. I looked at her other arm, and fortunately she had an IV in place. She opened her eyes and was wide awake, so I decided to give her some midazolam. I tried to draw up the anxiolytic, but it was so thick and goopy that I ended up losing some of it from all my fiddling around with it. So I opened another vial and had the same trouble with that, but between the two opened vials, I was able to draw up an adequate dose. I went to give it to her, but of course I had trouble injecting (since it was so goopy), drew some blood through the IV, and made quite a mess. After cleaning her up, I went to the other patient, and decided it was time for induction (time to put her completely asleep). But there were no meds, no syringes. I asked the CRNA to find me a 20 cc syringe. We couldn't find any. Meanwhile, I was starting to worry that my first patient's midazolam would start to wear off. So I asked from some 10 cc syringes instead. Again, we couldn't find any. I then left the OR to look for any type of syringe so that I could give the patient's their meds. In the hallway, a nurse (who actually was a girl from my high school, who I am fairly certain did not become a nurse) came up to me and said, "The surgeon is pissed that the patient got midazolam before he got to speak with him. And he is pissed that it is taking so long." Both his complaints, of course, are somewhat contradictory, and of course, both my fault. I woke up around then. Not quite the heart racing, rapid panting sort of dreams I used to have during residency, but we shall see. They may come. Monday is my first day, which makes this weekend my last weekend of freedom until retirement. Such a positive outlook, huh?