| The Funny Bone |
Sick Humor These are the kinds of unfunny things I find funny. I’ve been writing about medicine ever since I entered medical school, and I’m afraid I’ve often succumbed to the easy temptation of presenting myself in print as rather noxiously sensitive. But every so often I catch myself in some unduly smug and self-congratulatory locution, and I pause, as an imaginary conga line of pediatric residents comes snaking across my brain. And what’s that lyric they’re singing? Could it be, perhaps, my own catchy ditty: “He was too young to come out of his mother/He should have stayed on inside and been fine/He was too young to come out of his mother/He got a tube and a vent and a line/It was an itsy bitsy teenie weenie hypercarbic seizing preemie.” You get the idea. As a resident, I probably laughed harder over our hospital housestaff shows—writing, rehearsing, performing, and watching them—than I have ever laughed over anything. I still giggle when I think of some of our finer moments—although, out of a strict HIPAA–inspired sense of confidentiality, I shall not reveal so much as a single lyric, line of dialogue, or even sight gag that was not my own, thereby sparing my residency colleagues—all no doubt highly distinguished leaders in their fields today—much embarrassment. I know, of course, why I laughed so hard. It was because I desperately needed to laugh, because I was so deeply engaged in learning how to be a pediatrician, and because I was so anxious and scared and charged up and sleep-deprived. It was because I was living close to the edge of other people’s tragedies and laughing in the face of a new and profound understanding of the vulnerability of human life. Humor thrives on tension and anxiety—and sometimes, let’s be honest, on hostility. One of my fellow residents told me that two particular lines from one of my songs in our holiday show—sung to the tune of “Comedy Tonight”—gave him his happiest residency moment. Like all of us, he had spent many complicated nights in the newborn intensive care unit and many agonizing mornings second-guessing the ethical implications of the decisions he had made. It felt so good, he said, to stand on stage, face the whole gang of our teachers, and belt out, after a chorus of “Old malformations, new complications,” these lines: “We save their lives, we are so clever! / And then their parents get them forever!” And yes, it was just a little bit hostile—toward our mentors, toward the mingled expertise and helplessness of our profession, and perhaps even toward the tragic complexities of life and death. Maybe I’ve always had a warped sense of humor. Maybe we all do—a particular is-nothing-sacred kick often distinguishes successful humor, and there is always relief in laughing at the things that scare you, rile you, worry you, or haunt you. But as I became a doctor—as medical material became the very stuff of my life—I stopped noticing that there was anything twisted about medical humor. Every workplace features its unique brand of humor, I suppose, just as every workplace has its own rules, traditions, and jargon. Air traffic controllers (talk about tension and anxiety) probably make bad pilot jokes, and we’re just as glad not to hear them. For all I know, there are strong traditions of florist humor, gas station attendant humor, even mortician humor. But medical humor has an especially grand—or especially tawdry—pedigree. After all, we are a profession with a tradition of hierarchy and even pomposity, which always fuels rich opportunities for humor at the expense of those in the upper echelons—just ask anyone who has ever served in the military. We also deal with bodily functions, and as the mother of a fourth-grade boy, I can attest to the profound and—if you will pardon the expression—gut-level appeal of any humor based on the noises, aromas, and substances produced by the human body. We all know that, despite their limited understanding of pathophysiology and biochemistry, my son and his ten-year-old friends could appreciate many of the jokes in your standard medical school show; orifices are just enduringly funny. Our training involves a deliberate attempt to help us discuss all these bodily functions without any sense of embarrassment—in other words, all the good work I am doing with my fourth-grade son about what is not funny, especially at the dinner table, will go right out the window should he ever find himself in a medical training program. Doctors have to cope with life and death—or with the idea of life and death—and with the frailties of the flesh. This engenders a certain kind of tension, brought about, no doubt, by our enforced confrontation with certain bleak realities that others might prefer to escape by denial. And this tension, in turn, cries out to be broken, and to be broken with humor, the blacker the better. I grew up watching famous doctor faces on television—not only Marcus Welby’s furrowed brow, but also Hawkeye Pierce’s sloppy grin on M*A*S*H. So it was with zeal that, a few years ago, I tried writing a sitcom about medical school. I was working with my brother, a screenwriter by profession, and together we assembled a fictitious group of medical students and then enjoyed ourselves at their expense. I tried to write about the academic tension gripping our characters as they began their first year—and then to show them kicking back, acting silly at a party, and ending up in dubious romantic entanglements. I exploited their propensity toward self-diagnosis in the virginal supernerd who became convinced that he had mysteriously acquired a sexually transmitted disease and kept coming up with unlikely diagnoses (“Oh, no, I have mucocutaneous leishmaniasis!”). But whatever hijinks we came up with weren’t edgy enough for the TV people; they kept asking us to “ratchet it up.” Thus, my poor medical students ended up playing pin-the-penis-on-the-cadaver at their party—did I miss this in medical school? was I just not invited to the right parties?—and my poor virginal super-nerd had a run-in with a singularly well-equipped yet vindictive young woman who superglued kitty litter to his groin (“Oh, no, I have leprosy!”). And, even after all that, the network mysteriously turned its back on our biting medical satire. But now I’m a grownup doctor, right? Those silly madcap medical school and residency days are far behind me. I may suppress a giggle at the memory of certain tasteless lyrics I once had something to do with authoring, but those were my pressured, sleep-deprived training days. Now, I am pleased to report, I have become a matriarch, an authority figure—oh, hell, let’s admit it, I have become that common residency figure of fun—the LMD, the pain-in-the-neck local doc. Now it’s me on the other end of the phone late at night trying to convince the Emergency Department resident that, despite the results of his review of the literature, I sent the kid in for a head CT and that’s what I want, damn it. And yes, I can just imagine the faces that resident is making as he listens to my diatribe—and yes, I can imagine his choice of words—and I’m sure they are choice—when he finally gets to hang up on me and report back to his colleagues. But these days I don’t have time in my busy schedule to engage in coarse, insensitive, tasteless jokes at the expense of other doctors—I’m too busy telling stories on my patients and their families. Oh, I have my standing jokes at the community health center where I work, such as the taxi-voucher family and the lady obsessed with getting her child door-to-door transportation from the public school system, even though the child seems perfectly healthy. And yes, of course, I know there are serious issues here—as I talk to the social worker of the family who can’t keep their children’s primary care appointments without constant taxi vouchers to transport them hither and yon, or as I consider the possibilities of Munchhausen’s by proxy in a mother who seems determined to pin some drastic diagnosis on a healthy child. But it also makes for a funny story, a wait’ll-you-hear-this-one moment, when I hang up the phone and turn to my colleagues, who have been listening with interest to my side of the conversation (“Well, the public schools have gotten pretty strict these days—I don’t think they’ll agree that he needs door-to-door transportation just because his fingers get cold—have you thought about buying him warmer gloves?”). And I can’t help it, there’s also a laugh to be had when that teenager comes in for something to make her mosquito bite stop itching and then casually mentions, as she’s leaving with her prescription for hydrocortisone cream, that she hasn’t had her period in six weeks, and no, she hasn’t been really careful about using condoms every time, and also, she’s been having this discharge. If you have ever practiced adolescent primary care, you should be laughing by now. So you laugh in recognition, and sometimes in appreciation—for all my medical authority and privileged social status, I am easily intimidated, and some part of me can’t help cheering for even the most difficult patients who have the sheer gall to stand up to doctors, the hospital, or the medical system, even if it’s just to try to weasel more taxi vouchers. And you laugh at yourself, of course—if you don’t have some good stories about diagnoses you failed to make or patient relationships you mishandled, if you aren’t the butt of a good many of your own funny stories, then you’re in danger of entering the twilight world of the terminally self-righteous. So medical humor is still my way of acknowledging the unpredictability of reality, even when the weight of all evidence-based medical knowledge is brought to bear. As it said on a sign I used to see hanging on office doors back when I was a graduate student in biology, “Under the most rigorously controlled conditions of pressure, temperature, humidity, and other variables, the organism will do as it damn well pleases.” Pathogens don’t always do what they’re supposed to do. Patients and their families don’t always do what they’re supposed to do. Hospitals don’t always do what they’re supposed to do. Insurers never do what they’re supposed to do. And most of all, of course, doctors don’t always do what we’re supposed to do. Could it be that humor, even terrible humor, is something of a saving grace? Perri Klass ’86 is an associate professor of pediatrics at Boston University School of Medicine, a pediatrician at Dorchester House Health Center, and the medical director of Reach Out and Read. Among her recent books are The Mystery of Breathing, a novel, and, with Eileen Costello, MD, Quirky Kids: Understanding and Helping Your Child Who Doesn’t Fit In. This article appeared in the Autumn 2004 issue of the Harvard Medical Alumni Bulletin. Photo: Image Source/Punchstock |
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