There's Lots of Humor in Medicine

We're just afraid we'll be cancelled if we say it out loud.

Life in Emergistan

If Only Emergency Medicine Could Be Funny Again

I saw a patient a while back who was living with his mother and her boyfriend. “Last night, Mama's boyfriend had a cardiac arrest,” he told me, “and he rolled out of bed and crushed the Pomeranian!” (It's better with a Southern accent.)

Now that's good material unless you have a heart of stone, but I haven't used it until now. (Well, OK, once before on Substack but that was well after I wrote this column.) Why? My ability to write humor has been blunted in recent years.

I used to be much funnier as a writer. (Well, I always thought I was funny.) My early years as a columnist were often spent writing satire, telling stories that highlighted not only the pathos of our jobs but the bizarre humor of the weird professional world we inhabit. Jokes, stories, and comical lists all served to lift up my colleagues, to offer a little daylight in the darkness of our work. It also got my column posted in break rooms across the land. You can't buy that kind of publicity!

A couple of things happened over time, however. I grew older and found myself more broken by what I saw. I see people every day whose lives are tragedies long before they ever arrive at the ED. I feel a need to write about that. I see more and more that deep personal and social wounds are behind many vague physical issues. I also see them as profoundly spiritual issues; I like to think this is a result of the development of my faith and my profession.

The other thing that happened was that physicians, at least some of the loudest ones, stopped being funny, quit liking humor, and started being cruel.

Hopelessly Divided

I learned this several years ago when one of my columns was posted on Twitter. It was a satirical piece but resulted in a dogpile with comments and assertions about me that were cruel, accusatory, faintly threatening, and almost hilarious. I left Twitter not long after that because that platform was, as it is now, largely a dumpster fire of the same sort of behavior. I have since come back to test the waters, but I really don't care how it goes. I'm unlikely to put much effort into it because I just don't have the heart.

That event shook some of the funny out of me but for reasons even worse than people saying mean things. I realized that far too many physicians who were part of my audience had become self-appointed hall monitors, lurking everywhere, looking for excuses to accuse others of dark motives, every bit of wrong-think possible. They post comments like “You shouldn't be seeing patients.” They hint at contacting state medical boards.

Then they scurry off to ruin careers. They accuse their colleagues of all manners of things, sometimes resulting in physicians actually being fired, losing friends, and falling into depression or anxiety. The accusers walk away smugly satisfied at having made the world a better place.

I think this has to do with living and being educated in a charged time in politics and culture. Everyone is on edge, and we are increasingly divided by ideology into distinct tribes. This, of course, became much, much worse during COVID, but it hasn't improved now that the pandemic has eased.

I also think that it is related to the medical education process. My wife, a counselor by training, and I were talking about how medical education can delay maturity. Sure, it takes a certain level of maturity to navigate medical school and residency. But the system forces us into toxic competition, unhealthy and often negative self-assessments, and endless struggles with other physicians during this time. The official vetting process also never ends, leaving us feeling ever vulnerable.

We are divided after training into specialties but still somehow feel a need to compete with and belittle one another. It seems likely that this same instinct bleeds into our discussions of topics outside politics, culture, and religion.

Lightening Up

All of this makes it much harder to try to be funny. It makes me as a writer frame every sentence with trepidation, operating with an internal alarm system that beeped only a little at this story about one of my patients: He swallowed four grams of meth and then felt a need to chase it with a Red Bull. I'm sympathetic to those with substance use disorder, but I still wonder why he did that. Did he want to make sure he would stay awake just in case the meth was poor quality? Wait, it was for the B vitamins!

The odd thing is that even the most self-aggrandizing thought-police in medicine recognize that burnout and moral injury are everywhere. They are surely aware that suicide, depression, and substance use among physicians (and nurses and all of us in the field) are huge problems, but they still attack and accuse with reckless abandon.

I hope we can start being funny again and stop being so cruel and threatening, stop seeing every comment or post as a threat to progress, freedom, and equality. The job isn't getting easier for anyone in any specialty, and we all need a laugh now and then.

Like this: EMS brought in an unresponsive, intubated patient, and said, “There was a chicken on his couch.”

My nurse asked, “Cooked or live?”

It was a great question, and it took the edge off a stressful situation. We need more of that, not less.

This was originally printed in Emergency Medicine News.

https://journals.lww.com/em-news/fulltext/2022/10000/life_in_emergistan__if_only_em_could_be_funny.11.aspx