Dr. Rob: Good humor

The following is a reader take by Dr. Rob.

I don’t remember why he came to see me on that day. He was anxious on most of his office visits, so I had to spend most of my time dealing with his surplus of symptoms. As I walked in to see him on this day, he started rapidly hitting two fingers of against the top of his opposite wrist. As he continued to smack his wrist he said to me in his thickly accented and very anxious voice, “Doctor, doctor, it hurts when I do this.”

It was familiar; it is an old Groucho Marx joke. So was he kidding me? It didn’t seem so. I paused, looked around for the hidden camera, and slowly responded (while he continued the onslaught on his wrist), “uh”¦.well”¦.maybe you just need to stop doing that.”

He stopped and the visit went on. I was right; his pain did go away when he stopped beating himself. I must be a genius.

While this story still makes me chuckle, it is very likely that later that day I also dealt with someone fighting depression, losing a spouse to death or divorce, or struggling in the grips of terrible pain. My days alternate between tragedy and silliness. So how do I ride this emotional Tilt-a-Whirl without going nuts?

I laugh.

Silly things are everywhere. When there isn’t humor, I introduce some; either by writing about mutant goats on my blog or finding peanut butter in a child’s ear. A belly laugh is never far away. Children are often terrified of the doctor’s office, but they also are the easiest to get laughing. When they tell their mother that they like their doctor, I have won.

Is it callus or inappropriate to laugh with so much tragedy? No. I have learned that sadness and happiness are not mutually exclusive. There is always some of each in our lives. Despite incredible pain, people can often still find humor and things to smile about. It is often in the hard realities that we see the irony and absurdity of life most clearly. We laugh harder when we are struck with the contrast between darkness and the light.

To me, humor is life’s frosting (fat free, no less). More than that, it is the blood that runs through my veins. If we did not have things to smile about and laugh at, how many of us could stand life? Sadness alone is intolerable; happiness does not just balance the sadness, it redeems it.

Another man left this message on my nurse’s voicemail: “I have an appointment on December the 5th at 10:15 AM to see Dr. Rob. Can you send me an appointment reminder card so I can put it on my schedule?”

I still haven’t figured that one out.

Most adults hate to go to the doctor as well (I fear the ones who don’t). My mom never went because she didn’t like to get weighed ““ and she is thin. At the doctor’s, people are self-conscious that the camera is now turned on them. I am at work and in my element, and they are out of theirs. Humor relieves the tension; it puts them at ease.

“Wow, that was quick!” a patient says as I walk in the room earlier than expected.

“Sorry. I’ll come back later.” I say, turning around and walking back out. They laugh, the ice is broken, and now we can talk.

There is a time to not joke, of course. There is a time to weep, a time to keep quiet, and a time to just listen. The visit is never about me. But humor draws us closer as we laugh together. They don’t see me as this cold, uncaring person staring over the clipboard at them, they see a trusted friend (albeit a goofy one). The distance is less, so it is easier to cry in front of me. And they do.

We live our lives between happiness and sadness ““ with a different balance of both at any given time. One is not more human than the other. Neither is ever very far away. But to you serious (read: boring) doctors and nurses out there I say: lighten up. Laugh a little. Even in the most serious moments, it is OK to find hidden joys.

Oh yes, and watch for that whoopee cushion I put on your chair.

Dr. Rob is a primary care physician and blogs at Musings of a Distractible Mind.

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  • Dr. Val

    Great take. The NYT just ran an article about whether or not it’s appropriate to cry with a patient. Laugh or cry, I think patients appreciate a doctor who is human. The whoopee cushion on the exam table? What would the Times say?! ;p

  • doug

    Nicely done Dr. Rob. Humor is also forged in the fire of medidal burnout. Unfortunately, so is depression, polysubstance abuse and suicide. We have a choice.

    By the way, I believe that was a Henny Youngman joke. “Doc, it hurts when I …”

    If you have any great stories you want to share then please send them to me at the Placebo Journal!

  • inthisstorm

    From a patient’s perspective, I *so* appreciate this.

    I would really appreciate a whoopee cushion in the office of any one of the too many doctors I have been seeing lately!

  • DDx:dx

    So is the bile or the phlegm the “good” humor? Ah, the balance…
    I have to say, the joy and intimacy, sorrow and challenge I experienced in Family medicine made me feel guilty for charging our fees. I can’t think of a better job. And it made the process of self worth difficult for me, for why should I charge someone for doing what I consider “fun”….Kinda a catch 22, I know. It’s only valuable if it makes you miserable…
    But this is my conflict to deal with. I need to stop hitting myself on the wrist..

  • Rob

    Thanks for the encouragement all. You do feel a little funny putting yourself out there with the high exposure.
    Doug: e-mail me and let me know what kind of stories you are talking about. My blog is filled with oddities, but as far as patient stories are concerned, I do have my share.
    Inthisstorm: I noticed your post on your blog. Thanks. I don’t really do the whoopie cushions, although I do a good Scoobie Doo impersonation.
    ddx:dx (I had trouble typing that). Yes, the title was meant to be a bit of a pun. I too enjoy my job, but I think my joy for it makes my patients happier to pay me. I don’t know if I would want to go to someone who did it out of duty. The passion is very important. I get sick of hearing docs complaining all the time. There is good about being a doc.

    By the way, I clicked your link and will try to read your blog now. Interesting.

  • Paul

    Ah shoot!

    When a patient says “That was fast!” as I enter the room 1 minute after they did, and I say “Well, I can come back in an hour if you want..” and they laugh….

    I was about to copyright that. Didn’t know others did it too!

    Great post!

    I agree!

  • Supremacy Claus

    Some supercilious doctor authorities say, it is inappropriate to laugh at a patient. They label doctors who do as “disruptive.”

    I think, it is appalling rudeness to just stare after a patient makes an attempt at humor. If patients like being made to laugh by a doctor, they like making their doctor laugh even more.

    These officious doctors on licensing and ethics boards are the most disruptive doctors of all, by their wrongheaded interference with clinical care, their horrid political correctness, and by their left wing tyranny.

  • TBTAM

    Great post, Dr Rob. I love your blog, and I’ll bet your patients love you, too.