July 1, 2026 Salus Health Care Forum

Gay

She’s that patient.

Jeremy

Maybe the one who’s totally stable. Yeah, that’s fascinating.  Okay, so you can quantify deregulation to some degree.

Gay

Yeah.

Mark

I just have a quick comment. I think it was Perry that listed fear. Was that you, Perry?

Perry

Yeah.

Mark

One of the things that I did was often playing music. It should be more uniform. And I had their family bring pictures of the patient. I used ketamine long before Elon Musk did. Ample tranquilizer, actually, initially. But I knew that it was a congener of PCP and it could cause dissociative symptoms. So I used very small doses in combination with a regional anesthetic, the music of their choice, lighting that was dimmed but didn’t inhibit the surgeon.

This was discussed with the patient and the surgeon ahead of time. I had remarkable results with that. So, to allay the fear, bring in pictures and music. With the advent of the iPod, it really made my life easier to bring in music. It’s amazing.

Bill B

To go back to Perry’s statement about fear. There is a psychoanalytically oriented researcher named George Klein, who studied something called peremptory ideations. It’s as if we have an ideational train running through our psyche under conditions of stress that picks up memories, fears and other matters while moving unconsciously through our mind. I was involved many years ago in a major study about dreams. We studied the dreams of patients three days before and three days after they went into surgery in a hospital in Portland, Oregon. What’s extraordinary in many ways relates back to what Perry said. Fear of the upcoming surgery pulls in all sorts of material. There appears to be a trigger that starts the ideational train. And then as it’s moving along, it’s picking up memories from all sorts of past events. If you will, the images of those past traumas are hopping on the train. The train gets increasingly full. So, the dreams that people had the nights before the surgery were filled with a lot of memories and ideations that’s been drawn in from other experiences. It was really quite intriguing and a bit disturbing to actually gather the dreams at night using the EEG.

So, Mark, the idea of blocking the train just before the start of the surgery with pictures, music and all, or at least slow it down may be really critical.