I had a nightmare last Christmas. I thrashed in bed for at least an hour before slipping into a seat at the start of a medical lecture. Some of my classmates were present, and while standing next to a friend’s desk, he said, “Wow, your knee is red and throbbing, did you know?” Before acknowledging his comment, I became aware that the lateral side of my right knee was red, with a tiny indurated spot at the center. It didn’t hurt, but it throbbed as though my heart were inside my knee. I told my classmate it was fine, although I recognized that it was because of a bee sting that I hadn’t notice happened. No sooner than I returned to my desk, the indurated area burst, like pressure applied to a blackhead. The expulsion left a deep hole in my flesh at the joint, which somehow had relocated to be on the medial aspect of my right knee. I also saw a dark, bloodied, fleshy “doorknob” that fell out of my knee, which looked like the head of a femur that has undergone severe avascular necrosis. Fully acknowledging that the true anatomy of the knee is inconsistent with what I saw and felt in my dream, I knew what fell out was “the head of my knee bone.” Additionally, out of the hole in my leg stuck a long bone, perfectly perpendicular to the limb. I could manually “push it back in,” but I had to keep my hand over it to prevent it from popping out again. The professor, suddenly seated beside me, said, “You have osteomyelitis, which has become necrosed now.” Despite the lack of pain, I began to feel a sense of dread. I was sweating and hyperventilating, and I asked the professor to take me to the hospital. On the way, I realized that four teeth on the lower left side of my mouth, which had become loose some days prior, were literally “hanging by a thread” of gingival tissue. I also realized that earlier, other teeth had come loose and fallen out, but I hadn’t thought anything of it. I held onto my knee joint tight to keep the bone in the whole way to the hospital. When we arrived, it was decided that I needed a full-body MRI, and I was in the line of sight and hearing as my team discussed the results. They said that my legs were riddled with metastases in the muscle tissue, and there was cancer on the back of my tongue. “It hasn’t quite reached the back of the throat and structures there, so that’s good,” they said. But as they kept looking, they saw that my pituitary gland and stalk had been consumed and consolidated into one huge tumor, and I saw brain metastases riddled throughout. Throughout the discussion, they muttered a host of comments pertaining to how screwed I was. I laid flat on the narrow table and cried, feeling the weight of mortality. And then I woke up flat on my face in the dark. I was initially paralyzed, which added to my panic upon awakening, though eventually, I was able to wiggle my right leg in the bed, and I felt no hole, nor shifting or sliding of bones. I was sweating and very hot, much like I had been in the dream. I looked at the clock: 6:20 a.m. Laying there wide awake, I pondered how every individual in the dream, from my classmates to the health care workers, were either visions of real people, or were based on a combination of real people that I’ve known. The personalities of those in my dream were complex, but the negative qualities were those that I had perceived from individuals that I had worked with in the past. For example, one resident who helped interpret my dream MRI had the dismissive quality of a surgical resident I had interacted with, whom it was clear did not want to interact with me because he was busy, but had to because it was his job. I wondered what it meant, if anything, though acknowledging that it may have been a conglomeration of completely random visions – the product of neurological crosstalk as my brain underwent synaptic remodeling and memory formation. However, what I came away with was that it was an allegory of subconscious experiences I’ve had in medicine. The rotting of flesh and bone began with subtle findings – a tiny hard spot from a painless bee sting which was found to be connected with teeth falling out, and later manifested as fulminant osteonecrosis and disseminated cancer. Like some insidious conditions, feelings can fester. They can spread like cancer, and sap the spirit of nourishment until it starts to die, riddled with doubt and sensations of inadequacy. They can degrade the soul, as though it were suffering from a systemic inflammatory disease. But this progression, like many conditions of the flesh, is treatable. With early detection, the process can be arrested and cured. Talking about feelings, journaling, praying, or finding an outlet in wellness activities that channel joy is as essential to academically thriving as studying, practicing, and pushing to meet the demands of a health care provider. Academic “tasks” can end up taking precedence over mental and emotional health, but can result in losing a sense of mindfulness. This is equivalent to becoming numb to the bee sting, comparable to diabetic neuropathy that leads to a painless foot ulcer that festers, and eventually requires limb amputation. But no one, including we who find our calling in caring for others, are born as dead or dying souls. We cannot allow complacency to creep in and find ourselves living robotically, even if only transiently. We must take care to give ourselves grace and acknowledge our feelings to remove bee stingers. Joy is our antibiotic – we apply it when we remain mindful to keep it as our baseline. Let not your stings fester. Source
