When is it okay to laugh in medicine? Which topics are fair game for humor and which are off limits? How can humor help clinicians and patients cope with suffering and tragedy?
We’ll explore these questions through Katie Watson’s seminal bioethics paper Gallows Humor in Medicine and an excerpt from Samuel Shem’s The House of God, arguably the best-known work of gallows humor in medicine.
We will be joined by NYU internal medicine resident Dr. Margot Hedlin. Dr. Hedlin recently released a Core IM podcast episode exploring gallows humor, featuring interviews with Watson and Shem. We definitely recommend you listen to the podcast episode in advance of the chat!
Gallows Humor in Medicine by Katie Watson
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?"
“The Laws of the House of God“
excerpted from The House of God by Samuel Shem
I. Gomers don't die.
II. Gomers go to ground.
III. At a cardiac arrest, the first procedure is to take your own pulse.
IV. The patient is the one with the disease.
V. Placement comes first.
VI. There is no body cavity that cannot be reached with #14 needle and a good strong arm.
VII. Age + BUN = Lasix dose.
VIII. They can always hurt you more.
IX. The only good admission is a dead admission.
X. If you don't take a temperature, you can't find a fever.
XI. Show me a BMS who only triples my work and I will kiss his feet.
XII. If the radiology resident and the BMS both see a lesion on the chest x-ray, there can be no lesion there.
XIII. The delivery of medical care is to do as much nothing as possible.
Glossary
Admission: a patient entering the House of God; two types: emergency, through the emergency room; elective, scheduled.
BMS: Best Medical School (in the world); a BMS student.
BUN: Blood Urea Nitrogen; indirect measure of heart failure.
Gomer: Get Out Of My Emergency Room; “a human being who has lost—often through age—what goes into being a human being” (the Fat Man).
Lasix: a drug; diuretic often used to treat congestive heart failure.
Placement: process of finding a home for a gomer or gomere, especially, finding a nursing home; a possible TURF.
Turf: get rid of, as TURF a gomer to Urology; often preceded by a BUFF, as in BUFF and TURF; occasionally followed by a BOUNCE, as “I TURFED my gomere to Urology, but she BOUNCED back to me”; to BUFF and TURF, according to the Fat Man, is the essence of delivery of medical care, the concept of the “revolving door.”