Monday 20 July 2015

Pain and humour

The amount of knowledge medical students are forced to acquire in a limited amount of time is simply staggering.  Most of the basic science courses in medical school are vitally important to the practice of medicine: pathology, anatomy, pharmacology, and physiology.  Some others are seldom useful once we are in practice, such as genetics.  And some have little (if anything) to do with the practice of medicine, like biochemistry.   We learn about how the various systems of the body work: circulatory, pulmonary, gastrointestinal, renal, endocrine, and immune.  Most medical schools are now even teaching students how to talk to patients and deliver news, both good and bad.

But one thing we are not taught in medical school is humour.  I've met far too many straitlaced doctors who wouldn't know funny if it walked right up to them and slapped them in the face with a fish.  But in my experience, patients appreciate a well-placed joke, even if it's at their expense.  "Is there any chance you could be pregnant?" is my standard bit when performing a trauma ultrasound on a man.  A few of them have looked at me like I have two heads and a pair of antennae, but most of them laugh even as they try to ignore the pain of their fractured leg.  It's a small token of humour, but even that is often enough to break tension and calm people significantly.

But several years ago John (not his real name™) taught me that humour in medicine is not just for the doctors, among other things.

John was in his late 70s when he was referred to me with a colon mass that had been found on colonoscopy after he had noticed blood in his stool.  He walked into my office with a big smile on his face, something I found unusual and concerning for someone meeting the guy who would ultimately be whacking out half his colon.  However, as soon as he began speaking, any concern I had evaporated rapidly.

"Hiya, Doc!" he greeted me with a very firm, warm, friendly handshake, the type normally reserved for your favourite uncle or your company's CEO.  "So you're the one who's going to be cutting me open and saving my life, eh?  I have five grandkids, so I need to be around to spoil them, you know."

I liked him instantly.  This is my kind of guy.

After going through his medical history and biopsy results, I explained the procedure to him in great detail, including all the potential risks: bleeding, infection, anastomotic leak, anaesthesia, reoperation, death.  He nodded along, listening intently.

"So if you take out half my colon, would that make it a semicolon?" he said with a perfectly straight face, followed immediately by a crooked grin and then a solid guffaw.

I couldn't help but laugh with him, and we traded jokes for the next 10 minutes before saying goodbye.

John's surgery soon thereafter was uncomplicated, and when I went to see him in hospital the following day, his sense of humour hadn't faded one bit despite his postoperative pain.  I took off his bandage to look at his incision (which I had closed with surgical staples), and he winced slightly as he chuckled through his pain.

"You know I've always wanted a belly button ring.  This isn't exactly what I had in mind, though.  Maybe I can hang a charm from the staples like a bracelet!"

I laughed and palpated his abdomen gently, and he winced again.  I apologised for hurting him, as I explained that I wasn't trying to hurt him, I was merely performing my routine postoperative examination.

John apparently had a visceral reaction to my word "hurt".  He suddenly got serious for the first time since I met him.  He then held up his forearm and showed me a rather faded tattoo.  As faded as it was, the string of numbers was still legible even after the passage of so many decades since the Nazis had put it there.  "Son," he almost whispered, "I've already been through more pain than you could possibly imagine," he said, his kind smile returning rapidly depite his wet eyes.  "Nothing you can do will ever hurt me."

A few days (and many jokes) later, John went home to finish recuperating, which he did.  His daughter and I kept in touch over the next few years.

I found out several years later that John died of old age, peacefully in his sleep, at home, surrounded by his family.  His daughter told me that his jokes never stopped, even after he lost his wife, and up through the very end.

There were few people left on Earth who had as much reason as John to be bitter and angry.  If he had been the biggest curmudgeon I'd ever met, I could not have faulted him one bit.  However, John instead chose to use humour instead of melancholy, puns instead of pain.  

And in doing that, he became one of my favourite patients, indeed one of my favourite people, I have ever had the good fortune of meeting.


  1. Wow. I've always thought humor was vital and lifesaving, and John proves it.

  2. I . . . I have never cried reading your blog before. But tonight, I did. It brought back so many memories of the people I was fortunate enough to grow up next door to. It must have been the summer I was either going into 3rd or 4th grade when I asked her why she always wore long sleeves. She told me that she had an old tattoo that she didn't like, so she covered it up. Having several uncles with tattoo's this didn't seem odd to me. It wasn't until I was older that I put it all together. Polish. Jewish. WWII. Tattoo. Ended up in Switzerland after the war. Then it all made sense.

    Thank you Doc. Thank you for sharing John with us. Thank you for bringing back the memories of Gina & Gerson (their REAL names, because they deserve to be known).

  3. Rest in peace John

  4. Right in the feels. He sounded like a good man. RIP

  5. Reminds me of my hubby's granddad. He didn't have "the tattoo", but he had been displaced for work and ended up somewhere in Russia where he was able to flee and he made his way back to Austria over the course of years, by foot, at night, off the roads. When the war was over, he was 32, severely underweight, had a permanently injured foot, and his hair had turned entirely white.

    When I first met him, he was well into his nineties. He had the most positive outlook on life I've ever seen in a person. He was always friendly, smiling, happy, concerned for others and very humble. Even shortly before he died from cancer at almost 100 years of age, he would smile and be happy whenever we visited him in the hospital. No matter what life threw at him, he would focus on what he had and be content with it. My hubby once told me, the only time he had ever seen his granddad sad, ever, was when his wife died.

    I have the utmost respect for people like that, who experience humanity at it's gruesomely worst and still manage to look people in the eyes and smile with true joy.

  6. Love this blog. Have never commented before. Thanks for sharing so that this man's love of life can remind and inspire us to choose happiness in the face of adversity.

  7. I've spent too much time feeling sorry for myself lately. Thank you for the reality check.

  8. Amazing story. Thanks so much for sharing. What a wonderful soul. I agree with last comment. Thanks for the reality check.

    One observation you might want to be careful with that ultrasound pregnancy joke because these days with all the trans people etc you might actually get some guy who might be pregnant. Haha

    Also second to last sentence has a bit of a typo. "However, John instead chose to use humour instead of melancholy, puns instead of pain."

  9. I've been reading this blog for close to a year now, and not once have I commented on anything...
    This is your best story doc. The world needs more people like this guy!
    Thank you for sharing this.

  10. Great pick me up story...laughter can be the best medicine

  11. Had a youngish man recently with metastatic lung cancer, sounds a lot like your patient. He was always dropping jokes with a straight face. Things were not looking too good and he was in hospital. He went down for a chest x-ray (as you do). The technician explained the procedure to him, and asked if he had any questions.
    Nope, he said, I can't do it. X-rays might give you cancer! (He reported to me later with glee that the tech was gobsmacked and totally didn't get the joke at all!)

  12. since nobody else has said it out loud:

    "Better a semicolon than a full stop"

  13. Doc, thanks for sharing this wonderful story. I too have had the privilege of being able to know and serve survivors....not just one, but several, when I worked as a property manager at several developments that provided housing for the senior citizens in my city. Getting to know these individuals, and being constantly amazed and amused by the profound sense of joy, enthusiasm. love, and humor with which they faced every single day of their "new" lives, was truly one of the most humbling and enlightening experiences I've had in my life. It sure puts whatever *we* consider to be the trials and tribulations of *our* own lives in perspective!

    As time has passed, the dear bubbies and zaides who "adopted" me as members of their extended family have made their transitions, but they remain always in my thoughts, and I am forever grateful for having been a part of their lives for just a few precious years.

    1. especially if you are contrasting them with the sort of people for whom a stubbed toe is a severe trauma and a blood pressure cuff is deliberate torture.

      (though I've seen a few wiseguys play that up for a joke.)

  14. John would have fit in with my family because the worse the situation, the faster the jokes and quips are delivered. I'm so glad he crossed your path. I bet he made many lives a little (or a lot) better during his lifetime.

  15. I feel like you mentioned this guy before, or maybe it was someone like him?

    1. I may have, though I can't find it if I did. Something reminded me of John a few days ago, so I wrote this about him.

  16. I have ehlers-danlos syndrome, had to have a shoulder fusion and one of the screws broke.... I had a loose screw... I was in the er and told a doc that and he sat and chuckled the entire time he was trying to relocate my other shoulder

  17. I have ehlers-danlos syndrome, had to have a shoulder fusion and one of the screws broke.... I had a loose screw... I was in the er and told a doc that and he sat and chuckled the entire time he was trying to relocate my other shoulder

  18. A new comment on one of your older posts, as I just found your blog a day or two ago: Humor can indeed be a lovely way of calming someone in need, or simply connecting with someone you are trying to help (or they trying to help you). Humor is a large part of my family's daily life - so much easier to face adversity, big or small, if you can find a little humor in it.

    Your story of John (not his real name) reminded me of the one patient I knew with a similar tattoo. She was from the Ukraine and had received hers around the age of twelve or thirteen. She was the sweetest lady, always cheerful, and her daughter, who always came in with her, told me she was like that all the time. I was always happy to see her. She sometimes spoke about that time, but she only ever told one or two sort of light, cheerful tidbits. (I would think, "How could anything about that time and those experiences ever be even the slightest bit light or cheerful?") She told those very short stories from a young girl's perspective, for instance, a tale about walking past young soldiers - probably only late teens or early twenties themselves - with a friend and flirting harmlessly with them as they passed. I used to wonder how she could find anything at all light about any of that, but I think she really chose to only remember whatever tiny glimmers of light (or humanity) she encountered. I have no idea how good or bad her experience was, but she had the tattoo so to my mind, it couldn't have been good. Here was a person who definitely saw her glass as half full, and I really liked her for that.

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  21. If I'm able, I usually try to lighten the day of my treating staff as much as I can.

    Last year I was sent off for a colonoscopy (never again do I want to do that prep... fake lemon has been ruined for the rest of my life!!) I turned up for my pre-op preparation (48 hours, no food... I was absolutely ravenous, a bit cranky due to lack of sleep, and nervous about the procedure) and asked if I could use the bathroom (as the prep was still coming out... ugh!)

    A nurse raced in as I went through the door, and said "wait! we need a urine sample!" Having used the bathroom less than 30 minutes previously and with nil by mouth for the past 10 hours due to sleep and directions, I said that it was unlikely I'd be able to produce anything. She insisted they needed "just a drop" to test for pregnancy, and I told them that there was absolutely no possible chance I was. She insisted, so I managed to produce about a teaspoon, and handed it over.

    As I handed it to the nurse, I said "I have one request... if it comes back positive, let me know so I can contact the Catholic Church". The entire staff room burst into laughter. I think there were a few who ended up struggling to breathe, and were wiping tears out of their eyes. (un)fortunately? The test came back negative (I did basic biology! Certain activities are required for pregnancy!) and so I wasn't going to get a massive payout from the Catholic Church... Maybe next time!

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      The most inconvenient thing I have found, is allergies to antibiotics. Penicillin, Erythromycin and now Keflex. Now when I get an infection, the doctors stare at me and are like "So... what -can- I give you?" I think I need to start carrying a list of antibiotics I -have- had without a reaction to...

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