A Patient’s Dream

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This week I did a house call for a ninety year old gentleman who was one of my first patients at the start of my foray into private practice.  Thirteen years ago, when I first met Mr.B, he was a tall big-boned man, who carried himself like a soldier, with immaculately pressed clothes, and clean shiny shoes. He was then 77 years old, recently widowed, and had a rich deep voice reminiscent of James Earl Jones. With the passage of time and disease,  Mr B’s waning mobility made it impossible for him to climb the stairs to my office.  So for the past 4 years he has been getting home visits from me. His regular check-ups happen about every 6 months, and his caregiver calls me in between if he has any other issues.  The visit this week was one for “other issues”. His caregiver reported that he had not been sleeping for the past 4 days.

For the past 2 years or so, Mr B has been basically bed-bound, his large frame folded up into a low double bed, where he spends most of his days. Hanging on the wall at the entrance to his bedroom is  a framed photograph of Mr B in younger days, dressed in military uniform complete with a beret. It is a striking contrast to the gnarled, wrinkled gentleman, dressed in crushed shorts and a faded old shirt, lying on the bed. As with prior visits, I found my patient curled up on his side, with his long legs no longer able to fully straighten, and the ever-present transistor radio on the pillow beside his head (likely in the space occupied by his wife many years ago), tuned to some local station playing oldies music.

“Good afternoon Mr B, how you doing today?” I greeted him, as I entered. He opened his eyes, recognised me immediately, and gave a big sigh.

“Not so good Doc,” he said in his still deep rich voice.

“Why, what’s the matter Mr B” I asked him, as I sat down beside him.

“Well, every time I close my eyes I keep having this terrible dream, and so I can’t sleep” responded Mr B.

“Tell me about the dream, Mr B” I said.

He responded with this: “I dream that I am in a car that is moving by itself with nobody driving it. I can’t control it, and it is heading towards a steep precipice. I see people along the way, and I shout asking for help. Nobody can help me. The car gets to the precipice and starts going down, and I am very afraid. But the car is actually on a road going down into the precipice. The road is bad at first but it gets better the further I go, but I am scared because I am going deeper and deeper into the precipice, and I don’t know how to get back out. Eventually the car stops and I am okay but I don’t know how to get back. This dream keeps happening over and over, and I can’t sleep because it is terrible to be in the car and not able to stop it.”

As I sat and listened to his story, in his dimly lit bedroom, with the humming static  from his transistor radio in the background, I was struck by the symbolism of the dream. To me it was a dream about dying: a journey that cannot be stopped, and is a one way trip, with no return. The fear he felt in the dream was perhaps the fear of the unknown : what comes after we leave this world. It also seemed to me that in some way Mr B realised subconsciously or otherwise that the path he was travelling would become easier, just as the road in his dream got better as he descended into the “precipice”. Most telling of all was that when the car eventually stopped, he was unhurt, even though he was afraid. Though he was consciously afraid of the unknown of the hereafter, some deeper subconscious part of Mr B was trying to reassure him that he would be okay. That was my personal interpretation the  patient’s dream.

So I pointed out to Mr B the aspects of his dream that should reassure him that things were not as bad as he might fear. The road got better and he reached the bottom of the precipice in one piece in his dream. He murmured his acknowledgement that I had a point, but grumbled that it was a distressing to be unable to sleep peacefully. I agreed, and reassured him that I would prescribe something to help him sleep, but I could not guarantee that the dream would not recur. So I encouraged him to try to focus on the part of the dream where he is okay at the end of the car ride down the precipice. He said he would try and do that. I checked his blood pressure, and sugar which were fine. His caregiver confirmed that he was otherwise okay. I  wrapped up the visit by writing a prescription for a few days of a sleep aid that had worked for him in the past, and promised to check in on him in the following week.

I have no doubt that Mr B’s spirit is preparing him for the final and perhaps most important journey of his life. It is the first time as a doctor that I have heard a patient’s first hand account  of such a vivid dream.  Before becoming confined to bed, Mr B had a stroke for which his relatives took him to the hospital where he spent a few days. After that episode Mr B declared a distinct aversion to further hospital encounters. I had a discussion with his relatives around the same time, about where Mr B would draw his last breath when the time came. A decision was made then that there would be no more hospitals. Right now, Mr B is in his own bed, pain-free, and well looked after by his caregiver. His physical needs are well taken care of. After my visit, I called his nephew and suggested he inform anyone who wanted to see Mr B that this would be a good time. For now, we help him to get a little sleep at night, and we wait.

I hope when the time comes, Mr B’s car takes him without incident to the end of the road. I am grateful to him for showing me that there are times when doing my work  is less about my prowess with a stethoscope and prescription pad, and more about my willingness and ability to listen with my ears and heart to what my patients are trying to tell me.

 

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