Expert: Ronald Levy, M.D. - 5/26/2008

Question
I hope you don't mind if I ask you another q.  I had breast cancer surgery last year, and about a week later I had two disturbing dreams that I know were about the surgery.  I dreamed of hearing muffled voices through water, unable to move, on my back under the water, with a shark biting me.  I could not tell the people whose voices I heard that I was being attacked.  I have since read that there are earplugs in your ears during surgery.  I think that could explain the muffled voices in my dream.  The water was obviously the anesthesia.  The shark attack, I think, was how my subconscious interpreted the surgery cuts that were going on.  Also, I dreamed about baby bunnies lying in a pile.  I tried to pet them and they bit my hands and the bites were like staples.  I couldn't shake them off.  I woke up in a panic.  Later I learned that hemoclips were used to stop bleeding when they took the nodes.  I can only guess somehow my mind felt the pain and attributed it to the palms of my hands.  I am just guessing on these things, but was wondering--do they usually put earplugs in your ears?  And, I have read that there is a part of surgery where they have to ID a nerve before they take nodes, so the patient is not paralyzed at that time.  Does this leave you less "out" during node dissection?  I tell you, those dreams were so real, and I could not sleep well for about a week after surgery, until I'd had those dreams and gotten past them.  I think I was, on some level, aware of some parts of surgery.

Answer
It is NOT commmon to put ear plugs and I don't know of anyone that does. I also can't tell you if what you experienced was awareness or not. It is easy to intrpret dreams in many ways and this could just be your way of rationalizing what happened. I strongly doubt that you felt the hemoclips being put on (even if you were completely awake) because they are placed on small blood vessels that have to pain or sensory fibers.  You are correct that these procedures are done without paralytics becuase the surgeon needs to identify 2 nerves before removing the lymph nodes (the long thoracic nerve and the thoracodorsal nerve). Because of this, you actually have MORE anesthesia during this time to make sure that you don't move. The fact that these dreams didn't start until a week later suggests to me that this is not awareness as this is usually present immediately after surgery. I am sorry about the nightmares but hopefully thety have gone away.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston