Posted on July 7, 2012 Updated on July 7, 2012
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By Eric Postal, MD | July 6, 2012
I’ve never been a big believer in taking work home with me. When my hours in a hospital or imaging center come to a close, I enter private life mode, of which I am fiercely protective. It’s my perception that failure to maintain such boundaries leads to unwanted incursion. CME requirements and journal reading, for instance, have laid claim to small chunks of my downtime. Other than that, I’ve been pretty good at defending the fort.
One rampart is a little more prone to breaching: Intermittently, radiology visits me in my sleep.
I claim no exclusivity regarding dreaming about work; I suspect there are very few folks out there who do not. Spend a third of your time in any environment, and your sleeping mind is going to use it for material. Whether or not you believe dreams serve a psychological purpose or are just rehashing mental leftovers from your waking hours, they can be stressful, comforting, or sometimes even inspiring. I happen to enjoy a particularly rich, high-resolution dream life.
For whatever reason, however, my radiology dreams are less than.
Typical dreams about work, school, or other daytime occupations tend to focus on situations, real or fictional, and the other people who populate these situations. They tend to be story-like. The dreamer is like a character in a TV show or movie, or the dream plays out like one while the dreamer passively observes it. A radiologist’s dream might be about a troublesome technologist, or a patient with a bad contrast-reaction.
My radiology dreams are bare-bones, no-frills affairs. There are no characters or situations in them; All I get are imaging studies. Usually CTs. I don’t dream that someone is asking me about a CT, or even that I’m sitting and looking at one. My dream is the image.
It’s never an actual study from my waking life; I suppose I can credit my dreaming mind with a work ethic for actually creating a case. Other than that, though, I’m pretty unimpressed with the experience. I’m definitely unconscious, and getting some kind of physical rest in preparation for the next day — but at the same time, I’m being shown a case, and so of course I try to diagnose it.
The less-than-restful part is that the case is never straightforward, and since the dream has no actual storyline, I never get to find out whether my diagnosis was correct. If I even arrive at one. You see, these dreams aren’t quick, put-up-the-next-case affairs. I see the same image recurrently, throughout the course of a night. Never with a clear sense of having “finished” the case.
Even if I wake up during the night and fall back asleep, the image is typically waiting for me. In the morning, I have the same feeling as when I’ve agonized for the greater part of an hour on an unenhanced belly-scan of a contracted 103-year-old with no internal fat. “Intellectually unsatisfying,” to say the least.
Whatever game my unconscious mind is playing, it’s not exclusive to radiology. I had one of these dreams sometime during early med school (a mess about myasthenia gravis and neuropeptide Y…really, don’t ask), and even the night before an undergraduate organic chemistry final. Instead of radiology images, my “dream” was my chemistry notes; effectively or not, I was cramming for the test as I slept.
Doing unknowns in ACR’s “Case in Point” series merits CME creds. I wonder how I’d go about getting my dream cases approved.
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