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Fantasies

Fantasies

There seems to be an unlimited number of opportunities for all of us to be thankful. Many times we lose our perspective of what to be thankful for. One thing I am thankful for: Dreaming.

Dreams are classically described as successions of images,  thoughts,  feelings, and  awarenesses that usually occur in the unconscious mind during certain stages of sleep. Dreams are mysterious at best. Why do we dream? No one knows, but everyone has an opinion about dreams and their impacts on our lives. Some believe that dreams are manifestations of one's deepest wishes and anxieties, often relating to repressed childhood memories or obsessions. Others contend they are mere imaginary experiences that result from our neuro-associative areas connecting while our frontal and pre-frontal cortexes are off line while we are asleep. Without executive functions, we do not have the ability to challenge the reality anything or anyone. We have no discrimination what-so-ever. Therefore we believe we can glide with the wind or swim underwater indefinitely.

Regardless of their origins, we dream. Most of us dream in black and white. A few of our dreams are in color. Some are recurrent and seem like a never ending story. Some are short and unconnected. Some are violent and evil. Some are filled with charity and beauty. And some people never dream at all, at least they do not remember their dreams.

Why am I thankful of dreaming? Because I believe we should follow our dreams. Although some dreams come to us in our sleep, the best dreams are the ones we construct while we are awake. I like to think of these dreams as fantasies. Recognizing a fantasy that belongs to us can be difficult, but once done, it is relatively easy to own it. I suggest everyone should live by their fantasies.

I seldom ask patients if they have fantasies, much less ask them if they live by them. Many patients are so ill that their fantasies are typically related to participating in normal life events without pain or agony. One particular patient comes to mind.

Susan was a twenty-seven year old female who had her entire stomach surgically removed. Why? She developed shortness of breath in her mid-twenties while attending a work conference. She was misdiagnosed with asthma by an emergency room physician in Mississippi. Over a few months, she had a worsening of her shortness of breath which lead her to Jewish Hospital in Denver, Colorado. She was prescribed corticosteroid therapy prior to her evaluation at the Jewish Hospital. The physicians at Jewish Hospital diagnosed her asthma as secondary to gastrointestinal reflux disease although her pulmonary function tests were normal and she did not have wheezing.

Ultimately, her alleged reflux disease was resolved with surgical removal of her stomach in two stages. After surgery, she became wheelchair bound, weak, fatigued and her physicians prescribed twenty-seven medications as well as intravenous iron infusions to help her keep an appropriate amount of iron in her body. She was as disabled as anyone I had seen in my medical career. She still had shortness of breath frequently without any wheezing or clinical evidence of asthma.

Her mother brought her to my office stating that she had heard I did miracles with deathly ill patients. I remember asking Susan if she played sports in college. She did. She played soccer. I asked her if she would play on my coed soccer team if she could run again. Her mother started to wheel her out of my office saying, "He's a quack Susan." I stopped her, "Hey. She has to have something to look forward to. A fantasy to live for. Give me a chance to help her." Her mother replied, "All I want is for Susan to get up once and awhile and fix herself something to eat. That's it. She's never gonna have a family. She's a mess." I responded, "What do you have to lose?" Her mother said, "Nothing." Susan said, “I want to meet a man who loves me. I'll do anything to be normal so I can be in love."

To make a long story short, Susan started playing soccer on my coed team nine months later. She started absorbing iron from her food and her medications were reduced to three. I discovered she was having panic attacks that made her short of breath, not asthma. Her physicians abandoned her when she revealed her true diagnosis. I was the only physician to continue her care. Several articles were written about her miraculous healing in both newspapers and medical journals. I was never identified as the miracle worker who restored her back to health. I was proud of her for working hard to recover from her extreme state of disability.

She ultimately played soccer on a higher level, participating on several teams. At one of the soccer fields, she met a man who she fell in love with. He was not a good man. He convinced her to alter her prescriptions and give him the excess so he could sell them. A pharmacist caught her changing her prescriptions. Once I was notified, I had no choice but to discharge her from my practice. It was a sad day. She moved to Texas to be with her boyfriend. I haven't heard from her since.

Her mother sent me a very nice letter thanking me for believing in her daughter and taking good care of her. Her mother stated she understood my decision to discharge Susan from my practice. She felt her daughter was influenced profoundly by her boyfriend in all the wrong ways.

Susan constructed fantasies about her life once her health was taken away from her. These fantasies got her through hard times, gave her reasons for living and working hard to recover from a devastating illness that was purely iatrogenic. Unfortunately, I think her desires became distorted because she never recovered her self-esteem. Illness can rob everyone of their self-esteem.

Create your fantasy out of the pieces of your authentic self and live each day under its spell. You will live an interesting and fulfilling life. Just one word of advice: stay on the right side of the law when striving to live your fantasies.

Doc  

Posted by Amanda Sanders at 11:28 AM
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