Medicine has a long and somewhat secretive tradition of a dark and, at times, adolescent brand of gallos humor. Tragedy seen ever day in doctor's offices, ERs, and operating rooms can become the punchline to a joke or the butt of an anecdote. Doctors won't talk about this with patients, but get a group of a few doctors together and something is bound to come out.
Perhaps this is no where better epitomized than in Samuel Shem's classic 70's work titled
House of God. The book tells the true story of one young doctor's experience being an intern and the tragedy that he learns to laugh at. Patients become gomers (
g et
o ut of
m y
ER ). Battles between residents "turfing" patients to other residents, so they don't have to take care of them. Included is a set of rules which include, "The patient is the one with the disease," and, "don't take a temperature if you don't want to find a fever." The book also has a fair amount of sex in it, or at least far more than I ever saw an intern have. I guess it was the 1970's. I know of someone who read this his first year of medical school, and at least in part due to this book, dropped out of school. We kept a copy of this bible of sorts in the call room and I read it during my first year of residency. I have to admit that I took solace in knowing that there was this tradition of laughter in medicine and also that I never became as bitter and cynical as the young doctors in the book.
A more modern, yet at times equally raunchy, version of this is the
Placebo Journal (
www.placebojournal.com ). Edited by family physician Douglas Farrago, this publication is dedicated to keeping it's "finger on the prostate of medicine." The latest edition pokes fun at a range of topics from childhood obesity, to the pharmaceutical industry, to the care of nursing home patients.
When I was a resident physician, and even now, I certainly have to admit my own participation in gallos humor. My first year of residency, in the days of giants before 80 hour work week limits and when we worked 36 hours at a time, one of my classmates prescribed a pain medication patch for a clinic patient with tuberculosis. The patch contained enough medicine to last a full three days. This patient picked up his prescription at the hospital's pharmacy and went to the bathroom next door. There he promptly took a needle and syringe to extract all of the medication out of the patch and inject it into his vein. The patient shortly thereafter collapsed and had a full respiratory arrest from this overdose. A code was called and we wound up intubating him to help him breath until the medication wore off. While tragic, I have never heard such laughter at the morning report the next day when this tale was told.
So why do we do this? Isn't our profession supposed to be one of caring and compassion?
Katie Watson, medical ethicist from Northwestern University's Feinberg School of Medicine, recently had a commentary on National Public Radio's segment, "All Things Considered" (6/14/06). While one would think an ethicist would have strong disapproval for this type of behavior, Watson took a far different approach. She describes this type of humor as a "psychic survival instinct." Apparently Freud wrote a book on laughter and humor and likened them to dreams. Humor is a way to channel and try to make sense of shame, repression, and fear. She goes on to say that, "Gallos humor is respect for the work that lies ahead," and is, "an admission of loss and the promise to fight again." While she admits that she would be horrified to be the mother of a patient whose tragedy was turned into laughter, if she was that next patient to be seen, she would want the doctor to use humor as a means to move through the tragedy, so he or she could focus on her, the next patient.
So be forewarned, if in reading this blog I occasionally go over the line with what is generally considered tasteful and poke fun at patients from time to time, I do it because I appreciate that there is suffering in illness. I do it so I can care for my patients not for just the next few hours or days, but so I share in their tragedies and suffering great and small every day for the next thirty years.
The Country Doctor
Perhaps this is no where better epitomized than in Samuel Shem's classic 70's work titled House of God. The book tells the true story of one young doctor's experience being an intern and the tragedy that he learns to laugh at. Patients become gomers ( g et o ut of m y ER ). Battles between residents "turfing" patients to other residents, so they don't have to take care of them. Included is a set of rules which include, "The patient is the one with the disease," and, "don't take a temperature if you don't want to find a fever." The book also has a fair amount of sex in it, or at least far more than I ever saw an intern have. I guess it was the 1970's. I know of someone who read this his first year of medical school, and at least in part due to this book, dropped out of school. We kept a copy of this bible of sorts in the call room and I read it during my first year of residency. I have to admit that I took solace in knowing that there was this tradition of laughter in medicine and also that I never became as bitter and cynical as the young doctors in the book.
A more modern, yet at times equally raunchy, version of this is the Placebo Journal ( www.placebojournal.com ). Edited by family physician Douglas Farrago, this publication is dedicated to keeping it's "finger on the prostate of medicine." The latest edition pokes fun at a range of topics from childhood obesity, to the pharmaceutical industry, to the care of nursing home patients.
When I was a resident physician, and even now, I certainly have to admit my own participation in gallos humor. My first year of residency, in the days of giants before 80 hour work week limits and when we worked 36 hours at a time, one of my classmates prescribed a pain medication patch for a clinic patient with tuberculosis. The patch contained enough medicine to last a full three days. This patient picked up his prescription at the hospital's pharmacy and went to the bathroom next door. There he promptly took a needle and syringe to extract all of the medication out of the patch and inject it into his vein. The patient shortly thereafter collapsed and had a full respiratory arrest from this overdose. A code was called and we wound up intubating him to help him breath until the medication wore off. While tragic, I have never heard such laughter at the morning report the next day when this tale was told.
So why do we do this? Isn't our profession supposed to be one of caring and compassion?
Katie Watson, medical ethicist from Northwestern University's Feinberg School of Medicine, recently had a commentary on National Public Radio's segment, "All Things Considered" (6/14/06). While one would think an ethicist would have strong disapproval for this type of behavior, Watson took a far different approach. She describes this type of humor as a "psychic survival instinct." Apparently Freud wrote a book on laughter and humor and likened them to dreams. Humor is a way to channel and try to make sense of shame, repression, and fear. She goes on to say that, "Gallos humor is respect for the work that lies ahead," and is, "an admission of loss and the promise to fight again." While she admits that she would be horrified to be the mother of a patient whose tragedy was turned into laughter, if she was that next patient to be seen, she would want the doctor to use humor as a means to move through the tragedy, so he or she could focus on her, the next patient.
So be forewarned, if in reading this blog I occasionally go over the line with what is generally considered tasteful and poke fun at patients from time to time, I do it because I appreciate that there is suffering in illness. I do it so I can care for my patients not for just the next few hours or days, but so I share in their tragedies and suffering great and small every day for the next thirty years.
The Country Doctor