Katie Watson: Gallows Humor in Medicine
Selected Excerpt
It was 3:00 AM and three tired emergency room residents were wondering why the pizza they'd ordered hadn't come yet. A nurse interrupted their pizza complaints with a shout: "GSW Trauma One - no pulse, no blood pressure.”
The residents rushed to meet the gurney and immediately recognized the unconscious shooting victim: he was the teenage delivery boy from their favorite all-night restaurant, and he'd been mugged bringing their dinner.
That made them work even harder. A surgeon cracked the kid’s rib cage and exposed his heart, but the bullet had torn it open and they couldn't even stabilize him for the OR. After forty minutes of resuscitation they called it: time of death, 4:00 a.m.
The young doctors shuffled into the temporarily empty waiting area. They sat in silence. Then David said what all three were thinking.
"What happened to our pizza?"
Joe found their pizza box where the delivery boy dropped it before he ran from his attackers. It was face up, a few steps away from the ER's sliding doors. Joe set it on the table. They stared at it. Then one of the residents made a joke.
"How much you think we ought to tip him?"
The residents laughed. Then they ate the pizza.
David told me this story fifteen years after he finished his residency, but the urgency with which he told it made it seem like it happened last night. "You're the ethicist," he said. "Was it wrong to make a joke?"
Discussion Questions
Professor Watson describes how standards of humor have changed for the better in medicine, using House of God as an example. Have you read House of God? What do you think of it, and have your opinions changed over time?
Have you ever told a “gallows humor” joke that made you wonder, “Was that ok?” Please share your reflections, and if you feel comfortable sharing the joke, please share that as well.
Professor Watson makes a case for back-stage humor to allow clinicians to say what standards of professionalism would generally proscribe. Do you agree with her sentiment? Are ways in which this could be problematic?
How have you found gallows humor useful in your life? Moving forward, are there lessons from this text that you can see yourself using when you’re joking with others? Do these lessons feel applicable to the situation with COVID19?
Reflections from #MedHumChat
“Yes, I have, um...numerous examples. I’ve found that you can joke about almost any situation, no matter how sensitive, but you need to punch up or at yourself to not come off as an asshole, this is especially true with gallows humor in medicine where power dynamics are everywhere.” —@DGlaucomflecken
In response to @DGlaucomflecken, “Punching up should be the number 1 rule. Jokes aimed at those in power can point out absurdities, inconsistencies, injustice. This way, it’s cathartic, productive. Humor can also help set the power dynamic, reinforcing or subverting the status quo.” —@JCarlo_Pasco
“I think humor can be a form of camaraderie & a way to express mutual understanding. Something like, "Hey, we've all been there before". There will always be a range in peoples' tolerance for gallows humor, so sensitivity to the subject & audience is key.” —@Allison_tandem
“Rereading the Watson essay has convinced me that forgiving myself for some unfortunate gallows humor borne of awful experiences is a worthwhile enterprise. And that there's a time and a place for it. And that the joke has to actually be funny.” —@alessacolaMD
About this #MedHumChat
“Gallows Humor in Medicine” was paired with an excerpt from The House of God by Samuel Shem for a #MedHumChat discussion on April 1, 2020 exploring Gallows Humor in Medicine.
The pieces for this chat as well as the accompanying discussion questions were curated by Drs. Margot Hedlin and Colleen Farrell.
We were joined by special guest Dr. Margot Hedlin (@MargotHedlin), NYU Internal Medicine resident and one of the executive producers of Core IM Podcast (@COREIMpodcast). Dr. Hedlin recently released a podcast exploring gallows humor in which she interviewed Samuel Shem and Katie Watson.
About the Author
Professor Katie Watson, JD, is a lawyer, bioethicist, and Associate Professor at Northwestern University Feinberg School of Medicine.