Dreams of Exam Room Grace – John Spangler

Dreams of Exam Room Grace

John Spangler, MD, MPH

Winston-Salem, NC

Have you ever had a dream come true?

I was a sophomore in college facing one of my biggest organic chemistry tests of the semester. I was already failing the course, because I had not attended class since the first week.

Class would begin in 5 or 10 minutes, but I could not find my calculator, nor could I find my shoes.

Frantically, I searched my dorm room, realizing that this might be the end of my dream of attending medical school.

Visions of my parents’ and friends’ disappointed faces appeared in rapid succession.

I felt my heart pound faster. Fear coursed through my veins. I broke out in a cold sweat.

Then, suddenly, I woke up — from a terrifying, recurrent dream.

This dream always plays out in the same fashion if not in the same setting.

I am enclosed in my dorm room, bedroom or class room. Panicked, I unexpectedly realize that I have a test in 5 or 10 minutes. Sometimes I am in high school, sometimes in college.

Invariably, I am unprepared, but often, even while dreaming, I will realize: “I already graduated from high school (or college), so I don’t have to worry about this test.”

I never have dreams about failing medical school exams. Once I matriculated, I was much more relaxed about tests, which were pass/fail. Learning became a joy, because, mostly, what I was learning seemed relevant to patient care.

Among my patients, dreams reveal a lot about “tests” in their own lives — trauma and trials and tribulations. Sometimes their dreams correlate tightly with psychopathology.

PTSD. Depression. Anxiety.


If you develop trust with patients, they often will tell you their dreams.

Lisa, in my opioid addiction clinic, tells me her recurrent dream:

“I am at a friend’s house. He’s a user. He offers me pills and I take them from his outstretched hand. I actually feel — literally feel — the euphoria I used to get when I first started taking oxycodone. It courses through my body while I am asleep. Then I wake up, craving and sweaty, with stomach cramps.

“At times like that,” she says tearfully, “I come very close to relapsing.”

Kent described his recurrent dream.

“When I was in Vietnam, I saw my platoon wiped out by mortar fire. Blood and body parts were everywhere. The explosions were so loud, my ears rang for weeks. I still have not recovered my hearing.

“A few buddies remained alive for a couple of minutes, writhing in pain, screaming for help.

“There was nothing I could do. That’s when I started shooting up heroin. It was pure escape.

“Dr. Spangler, can you do anything to stop these dreams?”

Richard, 82 years old, tells of June 6, 1944.

“I survived D-Day. I can’t describe how horrible that day was. My best friend right next to me died instantly from German machine gun fire. The water was pure red.

“That’s what I see in my dreams. Red water.”

Marie’s dreams are about her abusive father beating her.

Katherine’s are about her father doing “unthinkable things to me.”

Myra’s dream was about living longer. At age 43, she had metastatic breast cancer. She had four children — 16, 14, 12 and 8 years old.

“Will they marry, Dr. Spangler? Will they have children? Who will ask Kate to the prom this spring? Who will help her buy her dress or fix her hair?”

Ruth, age 65, died from an enlarging meningioma, a benign brain tumor that can be treated early. She had presented to her previous physician 4 or 5 years ago with new onset headaches.

“The doctor never did any kind of investigation,” Joe, her husband, told me. “Just pills, pills, pills. All I dream about now is begging the doctor to order a CAT scan for Ruth.”

That case is headed towards litigation, which probably will never eradicate Joe’s dreams, nor compensate for his loss.

My favorite poet, Mary Oliver, writes about dreaming.

Her heroes like Shelley, Emerson and Thoreau

were dreamers [who] lived looking and looking, seeing the apparent beyond the apparent, wondering, allowing for uncertainty, [but] also grace, easygoing here, ferociously unmovable there…1

Often, all I have to offer my grieving, dreaming patients is grace, and allowing for the uncertainty which they face.

Grace at the bedside listens and tries to understand.

Grace in the exam room “see[s] the apparent beyond the apparent,” intuiting the patient’s unformed fears lurking behind the clearly recognizable brain tumor on the MRI.

A physician’s grace attempts to comprehend the yawning anxiety that is mixed with the blood-red water, the fistful of pills, the scattered body parts in patients’ dreams.

I actually did well in college organic chemistry, my panicked dreams notwithstanding. And, compared to what my patients face in dreams of real events, my fear is but a speck. I always awake to the grace of my easygoing life.

One night, I want to dream of myself enclosed in exam room 4 in Module D at my family medicine clinic.

It is deafeningly quiet in that room. The walls are inexplicably white, the computer screen pitch black. I lean towards Lisa or Kent or Richard or Myra and gently touch their trembling hand, offering exam room grace.

“I will be here,” I say. “I will be ferociously unmovable. I will stay right here.”

Perhaps the next time I see them that dream will come true.


1. Oliver, Mary. Winter Hours: Prose, Prose Poems, and Poems. New York, New York: Houghton Mifflin Harcourt, 1999.

Author’s note: All patients’ names have been changed to avoid personal identification.

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