03(04): Vivid and bizarre dream which interrupted my sleep

Nicholas Loh Avatar

I had been sleeping and just woke up (1:23 am) from a vivid and bizarre dream. I’m going to document/type what I can remember before the details are quickly forgotten.

In the dream, I was with five other medical students (donning our white coats) working as assistants for a cardiologist (this person is someone who is an actual MBBS-PhD clinician-scientist who works in Adelaide; I know him personally) who was the lead investigator of multiple projects in a seven-storey research facility. Overall, the research facility was well-lit. Everything was running quite good. There were many doctors employed and working in the research facility.

In addition to the doctors and students, there were some other supporting staff. For some reason, there were prison inmates in the building too. I don’t even know what they were doing in the building. Were we conducting unethical experiments on prison inmates? I don’t know. I can’t remember. Maybe they were just there to help out as a cheap/free source of labour.

But one afternoon, just after lunch, the building-wide alarm bell was rung, and all of us (medical students + the lead investigator) rushed to the seventh-floor cafeteria, and we found many chairs and tables overturned. The place was in a mess. The person (the manager) responsible for the tidiness of this particular place was quite furious. We saw one of the prison inmates (who was decked in full orange) running away. The manager told us medical students that we needed to catch up to the guy. So we ran after him. We managed to catch a glimpse of his face initially. I asked the lead investigator, “I saw his face, but do not know about him. What about you, Doctor? Do you know his name?” “No”, he replied.

The lead investigator was visibly disgruntled by the entire nuisance. Based on past events, he was going to have to submit some kind of incident report. I offered to help draft a paragraph or two of the report that he needed to submit. He then replied saying that he would really appreciate such a gesture.

Eventually, we did catch up to the person who ran away. And here’s the part I don’t get. Due to what had happened, he was condemned by the building management, and was made to die. If he wasn’t proactive and simply acted very passively, then he would be put to death by a lethal injection of a fatal amount of IV KCl, WITHOUT first sedating him! Some of the doctors working there would put ECG leads on the inmates who were strapped down for the lethal injection, and used the opportunity (opportunity for students to witness the characteristic ECG patterns live, along with the obvious real-time clinical correlation) to teach medical students (obviously unethical on so many levels) about death by unstable hyperkalaemia which induces a fatal arrhythmia (characterised by certain morphological changes on ECG (listed in order of onset of appearance with increasing concentration of serum potassium: peaked T waves, flattening of P waves, PRI prolongation, increased QRS duration, and eventually sine wave appearances, and asystole).

ECG morphological changes that are characteristic of unstable hyperkalaemia

The inmate had heard stories about this terrifying experience, and so, he decided to be more active to avoid this fate. He decided to commit suicide by hanging, which was permitted within the facility as an alternative to the lethal KCl injection. He opted for ‘the red room’ at the corner of one of the floors in the facility (I only remember that it wasn’t the seventh floor). This is the part of the dream that was most vivid. A guard and I accompanied him to the location. When he reached the final door, he unlocked a metallic mechanism at the top of the door, which effectively unlocked the door. He then opened the door.

He pressed a red button, and a buzzing sound was audible while a square-shaped opening formed at the top of the ceiling and a noose was lowered gradually while suspended from the ceiling. The loop also somehow got larger as it was lowered down (so that the inmate decked in orange could put his neck within the loop easily from a normal standing position). The noose was not of the typical beige rope-like material. Instead, the noose was a black loop created by material similar to that of bicycle chain locks: the ones which are virtually impossible to cut if one doesn’t have the relevant professional cutting tools.

Once his neck was in place, he pressed the red button again. Alas, his fate was sealed. The noose loop then became smaller by a certain percentage (such that his neck could no longer spontaneously fall out). The noose was also then raised, which caused the inmate to be lifted off the ground. He was quite calm about it, and decided to position his arms such that his upper arms were flexed to 90 degrees bilaterally, and that his forearms were then also flexed 90 degrees bilaterally about the elbow joints, but with hands pronated bilaterally.

In the initial phase of the asphyxiation, I saw him starting to struggle. His hands started becoming more tense and then it looked like he was shivering. I then saw spontaneous mallet-finger formation on his ring fingers bilaterally. He looked uncomfortable. So, when he was first being smothered, he struggled and I could hear attempted gasps that were weak. However, it got to the point where you could see his body starting to physically resign and accept its fate. The intensity of the struggle lessened, and his hands could no longer maintain the position he initially adopted. What I noticed first was how the flexion of his upper arm bilaterally was lessened, followed by the more rapid homeostatic extension of his forearms bilaterally. Simply put, he could not sustain the position of his arms as doing so required active effort.

I didn’t get to the point of his death because it was at this moment during the hanging process that I awakened. I noted palmar tingling on my hands bilaterally, and immediately checked what the time was on my iPhone. I was hoping it would be around 4+ am, but it was only 1:23 am… I’m about to finish typing this account, and as I’m finalising this blog post, it’s 3 am. I’m not sure what to make of that dream, but I’m glad that it’s a Saturday morning. And I think I’ll just consider this a rather early start to my Saturday.

20 November 2021

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