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The Human Experience: The Human Experience

Pick a Nice Dream

Camann, William MD

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doi: 10.1213/ANE.0000000000005691
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As an anesthesiologist, part of my daily routine includes inducing an unconscious state in my patients, so they can safely undergo surgery. Before inducing general anesthesia, I always try to say something pleasant to the patient, like “pick a nice dream.....” Sometimes patients don’t say anything in reply, sometimes there may be a few words about an enjoyable location, such as a lovely beach, a peaceful forest, or a fun vacation spot. Then the propofol goes in, and the anesthetic proceeds. Recently, as I was inducing the anesthetic for a relatively healthy patient for a routine surgery, I said my usual “pick a nice dream.....” The patient responded: “You can’t pick your dreams.” Wow. I was, frankly, speechless. In almost 40 years of doing anesthesiology, I had never heard this response. The rest of the anesthetic was uneventful, and I hope the patient had a nice dream, but I could not stop thinking about what this patient said. Is it possible to pick your dreams? l consulted Dr Google, for any information about being able to “pick your dreams.” It turns out much is written on this topic, but the basic conclusion is that it is difficult, or even impossible, to select your dreams. In my reading, I came across the concept of “lucid dreaming.” I had never heard this term before, but I recognized the phenomenon, as it has happened to me. As I sleep, in the middle of a wild, vivid, pleasant or disturbing dream, I am also awake and able to think consciously about the dream. In a lucid dream, one is awake within one’s own dream. Lucid dreaming may, in some circumstances, also allow one the ability to manipulate the dream itself. Roughly 50% of people report the experience of “lucid dreaming”.1 Yet, like most dreams, it is forgotten, gone like a puff of smoke. Lucid dreaming has been featured in philosophy, art and popular culture. References to such dreaming are found in Buddhist practices. In western philosophy, Aristotle, in his treatise “On Dreams,” states “often when one is asleep, there is something in consciousness which declares that what then presents itself is but a dream”.2 More recently, the philosopher Carlos Castaneda’s work “The Art of Dreaming” (1993) explores many aspects of dream states and dream control. In the arts and popular culture, the films Inception (2010) and Vanilla Sky (2001) are based on themes of lucid dreaming. In poetry, Robert Frost’s “After Apple-Picking”, provides multiple insights into the transitions between wakefulness, sleep and dreams, and their proxies for life and death. How will this experience influence my anesthetic inductions? On the surface, not at all. I will continue to say “pick a nice dream” before administering propofol. But from now on, I’ll reflect on this moment in a new way. What is the patient thinking as they go off to anesthetic-induced dreamland? Can they actually pick their dreams? Will they remember their dreams? I ponder, what happens to our soul or spirit while under general anesthesia? These are some of the questions that pull what we as anesthesiologists do every day out of the realm of the routine, and into the expansive realms of curiosity, reflection, and wonder.

REFERENCES

1. Mota-Rolim S, de Almondes KA, Kirov R. Is this a dream? Evolutionary, neurobiological, and psychopathological perspectives on lucid dreaming. Front Psychol. 2021;12:1–3.
2. Baird B, Mota-Rolim SA, Dresler M. The cognitive neuroscience of lucid dreaming. Neurosci Biobehav Rev. 2019;100:305–323.
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