 Dr
Doug Farrago wasn't having a very good day. One of his
long-time patients, whose family he knew well, was diagnosed
with a severe case of lung cancer and it looked terminal.
On top of that, he just heard that another patient was
accidentally hit by a car while selling blueberries at
a roadside stand.
Dr Farrago needed a break. So he
turned to one of his partners at his family practice
in Auburn, ME. "I told him the stories and how I was
feeling," he says. "I was looking to him for support."
His partner stared off into space
thoughtfully as he listened to what Dr Farrago told
him. He nodded his head; "I love blueberries�," he mused.
It was a dark joke. "You're always
going to have patients who live and die," Dr Farrago's
partner reminded him, "You have to learn how to let
it roll off your back." His partner's therapy of choice?
Comedy.
LOOK
ON THE DARK SIDE OF LIFE
Physicians see bad things happen to good people everyday.
Grief can wear them down if they have no method of relief.
Gallows or black humour tackles serious, morbid or frightening
subjects in a light and off-handed way. It's a technique
medical staff have used for centuries to relieve tensions
created by embarrassment, fear and loss.
Black humour is ingrained in the
medical community, and shared by others who deal with
pain and death daily -like firemen and morticians. Nurses,
paramedics and physicians have all swapped stories about
which patient got what stuck where and how. And it's
not uncommon for those working in an OR or ICU to resort
to jokes that a civilian might find disgusting or inappropriate.
Comedy can help physicians cope
in even the most extreme circumstances. Major Sandra
West, who for six months headed the hospital at the
Kandahar airfield in Afghanistan, says dark humour was
ever-present at the base hospital. "There was a fair
bit of bantering and insults flying back and forth in
the heat of the moment in the trauma bay," she recalls.
NOT
FOR EVERYONE
Although dark or perverse humour brings together physicians
and other healthcare workers, some worry that family
members might over hear staff joking in an emergency
room or hospital setting.
Dr Kristi A Dyer, a physician and
former EMT from Sacramento, CA, says that physicians
should keep humour to a shared laugh or joke, rather
than something that is 'funny' at the expense of another
person. She says that since shifting her interests to
end of life care, her use of black humour has all but
disappeared, except if she falls back into it as a coping
strategy during times of sudden, unexpected stress.
And Dr Dyer is right to warn —
the public's emotions can run high. Recently a brawl
broke out on one of the BBC's blogs when it came to
light that British physicians charge what they call
"ash cash" to certify a person is dead before cremation.
Dr John Crippen, the British GP behind NHS Blog Doctor
defended the term specifically and medical gallows humour
in general on his site. "We used to crack jokes about
death, and cancer, and fetal abnormality, and children
with deformities too - ever seen the acronymn 'FLK'
in a child's notes? It means 'funny looking kid.'"
Still, the best way to avoid getting
into hot water over any dark jokes is to keep them in
closed areas like the OR or staff room, or to put them
down in coded print. Maj West says when notes that when
a documentary team filming her and her colleagues in
February for CBC's The Fifth Estate caught a
few of the team's jokes on tape, the footage was edited
out of the final version when it aired in March. "Taken
out of context the jokes could give people the wrong
impression, and it's something you wouldn't want those
on the outside to hear," says Maj West. "It's just one
of the things we do to cope."
THE
CUT THAT CURES
Dr Farrago took the advice his partner gave him to heart.
"If you don't do anything to let out those feelings,
you're going to get depressed and then you quit," he
says. So to help him keep his sanity he started the
Placebo Journal, a bimonthly collection of "idiopathic
wit & wisdom" which brings together medical humour
of all stripes so doctors can share their laughter.
The journal publishes true stories
of medicine sent in by physicians, which often tend
toward the morose. As an example, take the story of
a woman who shows off the contents of her impacted bowel
to family members after a doctor successfully assists
her to dislodge a two pound stool; or the mysterious
tale of a nurse and a preacher who seem to curse every
elderly patient who crosses their path.
THE
BEST MEDICINE
A recent study published in the Journal of Clinical
Nursing demonstrates how humour is often the best
medicine for healthcare staffers who need to reduce
tension and express frustration.
One of the study's main points
is that humour helps healthcare professionals connect
with one another, which then provides them with a mutual
support system. "If you have those fun moments and that
connectedness even the worst hell can happen," said
one nurse who works with terminally ill patients. "You
sail through it as opposed to walking out really wounded."
And the numbers back her up. One
of the study's authors, Dr Ruth Anne Dean, says the
research suggests that nurses and other healthcare professionals
shouldn't try to suppress humour. "They should trust
their instincts about when it is appropriate," she says.
"Humour offers a humanizing dimension in healthcare
that is too valuable to be over looked."
"There's a reason behind high suicide
rates and alcohol abuse amongst doctors," says Dr Farrago.
"I know so many robo-docs who just keep everything inside.
You're dealing with peoples lives and there has to be
a way for docs to get together and share."
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PHYSICIAN LIFE
