Do You Dream of Radiology?

I like eating raw fish.

Of course, it sounds a lot less couth when you don’t call it sushi/sashimi. You might envision Danny DeVito ripping into a hunk of bluefish during his 1992 big-screen rendition of the Penguin rather than a dainty affair with chopsticks and lightly vinegared rice.

I have spent enough time (and certainly money) on such enjoyable repasts that it was a no-brainer for me to click on a 2011 documentary I somehow only just stumbled across this month: Jiro Dreams of Sushi. The titular character, then a youthful 85 (now 99, bless him) operated a highly regarded Michelin 3-star restaurant. The piece showcases not only his mastery of his craft but his love of it as well. He also discusses how he literally dreams of his work.

If the title hadn’t gotten my attention, that sure would have. Folks with superb memories might recall my writing a blog back in 2012 about how I dream of radiology. The dreams aren’t typical work-related vignettes, like discovering you have to go back and redo your residency, or suddenly realizing you are stark naked in the reading room. Mine are literally images and nothing more. My mind’s eye becomes a PACS, and my brain invents cases to display on it.

They are rarely if ever, simple affairs. At least, I can thank my noggin for giving me something interesting rather than a parade of ICU chest X-rays. Usually, there are either a gazillion abnormalities, or things are bizarrely complex. They are the sort of cases that would take me a good, long while if I could even figure it all out.

That is fitting because the case sticks with me for longer than most other dreams. I have gotten up to use the lavvy and gone back to sleep, only to find myself dreaming of the same darned imaginary study. Not uncommonly, I will wake from one of these sessions to realize my “inner voice” is dictating about what it has been looking at.

Jiro’s experience differs from mine: He described getting valuable inspirations and other ideas from his dreams, stuff he would subsequently incorporate into his work. For him, it was an enjoyable, enthusiasm-generating affair.

I don’t exactly hate my version and certainly don’t dislike my work (more about that in a bit). I did, for a long time, rather resent whatever part of my brain was in charge of making storylines for my dreams because these seemed sort of “mailed in.” They have no plot. If a normal dream is akin to watching a TV show, these dreams are more like staring at a painting or framed photo on the wall. Also, a night of these episodes, rather than regular dreams, leaves me feeling decidedly less rested.

At some point, I started considering them a little differently. What if my brain was training me to be a slightly better radiologist? If practice makes perfect and every case we see incrementally improves our skills, might these dreams be adding to however many hours I spend at a workstation during my waking life?

That would be giving a lot of credit to my unconscious mind. For it to be true, the dream cases would have to be sufficiently detailed, anatomically accurate, and “true to life.” If, on the other hand, it was all made up, I would effectively be practicing on defective models and making myself less capable.

Going with the original thought — that these cases are somehow making me better at what I do — I am a bit more in sync with Jiro. Part of the appeal of the documentary is that he makes no mystery of why he thinks he has done as well as he has. He explained one of his basic tenets as follows:

“I do the same thing over and over, improving bit by bit. There’s always a yearning to achieve more. I’ll continue to climb, trying to reach the top, but no one knows where the top is.”

Remember, the guy said this at the age of 85. He only stepped away from day-to-day management of his restaurant in 2023.

Still going strong in my chosen profession at that age sounds great to me. I don’t think I ever had the idea of retiring at age X, and I can’t remember the last time I looked forward to retiring at all. Jiro’s tenets include “You have to fall in love with your work.” I probably wouldn’t go that far but I certainly like it a lot. You could throw a winning lottery ticket at me, and I would still be wearing my dictation headset on a regular basis.