When the father went into the hallway to call the police himself, Molly turned to the girl. “If you really were raped, we will do everything we can to help you,” she said. “If it’s not true, we have a big problem: Someone will get arrested, go to jail, and possibly serve time just so you can get out of trouble for drinking. Now tell me, what’s worse: being grounded for something you did or someone going to jail for something he didn’t do?”
The girl looked down. When her parents came back into the room, she muttered, “Maybe that didn’t happen. I don’t remember.”
On another occasion, the daughter of a local VIP got drunk at a school dance and passed out. A friend’s parents brought her to the ER. When the girl’s father arrived, he yelled so loudly that Molly closed the door to the patient’s room for a while. Soon after Molly opened the door again, the girl had an epiphany.
“Daddy, Daddy! Jesus is talking to me!” she shouted. “He’s showing me what I did wrong! Daddy! Kneel beside the bed with me and let’s pray! Dear God! Thank you for giving us your son to take away our sins! Thank you for showing me what I did today was wrong!”
The father fell for it. He knelt next to the bed with his daughter. “Praise God! Praise Jesus!”
“Daddy! We need to go to church when we leave here and let everyone know that alcohol isn’t the way. Jesus is the only way!”
Her father shook his head, feeling it. “Amen! Praise Jesus!”
“Daddy! I want to speak in front of the congregation and let them know that Jesus is good! Alcohol is not good! Daddy, this will never happen again!”
“Amen, baby. I love you.”
And the yelling was done. The Academy ER had a sticker sheet of glittery Oscar statues that were reserved for patients who put on Oscar-worthy acts. The nurses would stick one on a patient’s chart so that everyone who treated the patient knew what to expect. Some staffers didn’t like Oscar because it gave the practitioners preconceived notions. But Molly thought it was funny and a stress reliever.
Molly had to give credit to this resourceful teen. As a nod to her performance, Molly stuck Oscar onto the girl’s chart.
Citycenter Medical
One afternoon, medics brought in a woman who had attempted suicide by turning on a barbecue grill in her bedroom and inhaling the gas. It looked like she would survive. As Molly documented at the nurses station, a pregnant nurse walked by and sniffed. “Ta’quisha, you get grilled hot dogs for lunch?” she asked loudly. Ta’quisha, a tech, told the nurse about the attempted suicide; she was smelling the fumes off the patient.
“Now I’m hungry!” the nurse said.
At the end of the day, an ambulance brought in a 60-year-old man who had been found slumped over at his desk at work. The man twitched and his eyes rolled toward the back of his head. The staff at the nurses station was busy watching the attending doctor question the EMT to determine whether the patient had suffered from a stroke or a seizure.
“Is anyone watching him?” Molly asked, jumping up to help. “Does he have a line?”
After the patient was intubated and sedated, Molly brought him into radiology for a CT scan. The neurology team crowded into the viewing room, excited to see what had gone wrong in the man’s brain. As the scan materialized on the monitor, a voice behind Molly shouted, “I win!” She turned to see the neurology resident making the victory sign. “It’s not a stroke, it’s a seizure!” he said happily. “Who else had seizure?”
Many hospital staff members got through the day by relying on a morbid sense of humor. Molly had come to know the funnier doctors well enough that they joked with her frequently. It was impossible not to laugh at some of the patients, too, like the guy who came in with his penis stuck in a metal washer (it was a large washer). Or the middle-aged man who decided to experiment with his garden bounty one night when his wife was out of town. Unfortunately, he couldn’t then remove the cucumber from his anus. In the hospital, he was moved from the ER to the OR because, the small-fingered doctor told her nurses, “I wasn’t able to get it and it’s sideways now.” Molly noted, “There’s a multibillion dollar sex toy industry that’s discreet and online. Why do people use common household produce?”
Staff played games to make the day more fun, including Guess the Blood Alcohol Level pools. Some of the nurses kept a running list of the most amusing patient names to come into the ER. One doctor tried to crack up his nurses by writing ridiculous discharge papers, such as: “Dear Homeless Guy, I am disappointed that you are both drunk and smelly. That won’t get you any pussy.” This doctor also liked to joke with Molly about how to break fatality news to family members: “Raise your hand if your loved one is still alive. . . . Not so fast, you two!”
Making Fun of Patients: The Truth Behind Dark Humor, Double Entendres, and the Butt Box
Humor and pranks might seem crass in an emotional environment where people are coping with or fighting illness, trauma, tragedies, or death. But that’s exactly why nurses depend on them.
Researchers have found, historically, that healthcare professionals use humor with their patients and each other in all but three circumstances: around uncooperative patients, with patients who are upset, and when interacting with dying patients’ loved ones. Plenty of studies have shown that humor can help patients; in addition to spontaneous banter, many doctors (such as oncologists) use prepared jokes about their treatments. Studies also reveal that nurses use humor with patients more frequently than doctors do.
What’s less well known is that behind the scenes, doctors’ and nurses’ humor among colleagues is different—and darker than might seem appropriate to an outsider.
At the milder end of the spectrum, nurses try to lighten the mood by staging pranks on each other or unsuspecting doctors. Some nurses like to crouch in an empty room, turn on the call light, and when the summoned nurse enters, jump out to scare the bejeezus out of her. In one hospital, a nurse hid under a sheet on a gurney that two nurses were told to transport to the morgue. On the way, the hidden nurse groaned and then began to sit up, sending her coworkers shrieking down the hallway.
A California nurse has sprayed Mucomyst (an inhaled substance that treats breathing problems) into the top gloves in the supply box so that the next taker would have sticky, smelly hands. Nurses have awakened night shift colleagues with a sternal rub, an uncomfortable method to test for unconsciousness by firmly fist-rubbing midsternum. An Illinois nurse remarked, “I am not the only nurse I know who has farted in a sedated patient’s room and blamed it on the patient when someone walked in.” Nurses are not above leaving fake poop in bedpans for unsuspecting staffers (including on the front seat of an ambulance). A unit in Oklahoma has a pranking tradition that sends new nurses on a scavenger hunt for a “window that opens” on a floor where no such window exists.
When a young Southern nurse asked an older nurse how to warm a bag of blood before administering it to a patient, the older nurse joked that she should microwave it. The gullible nurse’s resulting explosion resembled a crime scene.
During a Virginia nurse’s first week in the ER, a physician exited a patient room holding up a large splotch of brown mush on a gloved finger. The doctor asked the nurse, “Hey, do you think this looks like it has blood in it? I can’t decide.” The nurse recalled, “Horrified that he’s walking over to the nurses station with shit on his finger, I stutter and tell him I don’t see anything. He looks perplexed. He then proceeds to lick the sample off his finger. ‘It doesn’t taste bloody,’ he says. It was chocolate pudding. I’d been punk’d.” Juvenile, yes, but a common hospital prank.
A doctor at Pines Memorial set up new students by teaming with a nurse like Molly to hand him a urine specimen cup full of apple juice. When teaching the med students how to diagnose, he’d drink the juice and say, “It tastes infected.” Molly joked that someday she was going to hand him a cup of urine without telling him.
Nurses say t
hat urologists tend to have a lewd sense of humor and a strong affinity for penis jokes (“Urology department—can you hold?”). Operating room nurses proudly boast that their unit has the bawdiest sense of humor in the hospital. “We get very naughty; we blame it on the fact that we wear what look like pajamas all the time. Just about everything that comes out of our mouths is a double entendre that probably borders on harassment, but that’s how we get through the days,” said a Pennsylvania OR nurse.
When the Pennsylvania nurse pokes her head beneath surgical drapes to check a patient or flush a catheter, her male colleagues make slurping blow-job sounds. If the surgeons turn the lights off to better view the monitor, they announce they do their “best work in the dark.” As the nurses help them fasten their surgical gowns, the doctors quip, “Tie me up like you mean it.”
Much of the time, hospital humor is harmless because nobody is offended. But when the patient isn’t unconscious or family members are within earshot, doctors’ and nurses’ jokes can be misinterpreted. A Texas nurse remembered a case when a patient stopped breathing; staff hustled his brother from the room so that they could work the code. The patient died. Afterward, the brother furiously reported the nurses and doctors to hospital administrators because he saw them joking with each other as they tried to save his sibling’s life.
What were they thinking? And what could have been so funny during such a traumatic time? Few outsiders are aware of doctors’ and nurses’ reliance on “gallows humor,” a phrase popularized by Sigmund Freud in reference to a story about a man joking as he goes to the gallows to die. Also known as dark humor or black humor, gallows humor is a morbid way to joke about, or in the face of, tragedy or death. Gallows humor describes, for example, when a doctor calls out a patient’s long list of extensive injuries to a nurse and then adds, “and he’s got a stubbed toe, too.” Or when nurses call a coworker “Grim Reaper” because, through no fault of his own, three of his ER patients die in one night.
When patients are dying, some doctors and nurses say they are “circling the drain,” “headed to the ECU (the Eternal Care Unit),” or “approaching room temperature.” A nurse team calls motorcyclists who don’t wear helmets “donor-cycles.” Some staff refer to the geriatric ward as “the departure lounge.” Gunshot wound? “Acute lead poisoning.” Patient death? “Celestial transfer.” That’s gallows humor.
One of the best true-life examples of gallows humor occurred a few decades ago. In the middle of the night at a hospital in an unsafe neighborhood, three ER residents were waiting for their pizza delivery when a gunshot victim was rushed inside: It was the delivery boy, who had been walking toward the building when a mugger shot him.
The doctors tried to save the victim, but had to call his time of death after forty minutes of resuscitation efforts. “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?’ ” recounted bioethicist Katie Watson in a 2011 Hastings Center Report. “Joe found their pizza box where the delivery boy dropped it before he ran from his attackers [and] set it on the table.” The hungry doctors stared at the box. Then one of them asked, “How much you think we ought to tip him?”
Many nurses told me that gallows humor is common and necessary. A survey of New England paramedics found that nearly 90 percent used it; in fact, gallows humor was by far the respondents’ most frequent coping mechanism, much more so than talking with coworkers (37 percent), spending time with family and friends (35 percent), and exercising (30 percent).
Gallows humor is not the same as derogatory humor, in which doctors and nurses appear to make fun of specific patients. But many healthcare providers use that, too, to similar effect. In 2014, a Virginia patient who left his cell phone audio-recording during a colonoscopy allegedly recorded his doctors making fun of him while he was under anesthesia. The doctors reportedly said a teaching physician “would eat [the patient] for lunch” and joked about a hypothetical situation regarding firing a gun up a rectum. The patient sued the doctors for defamation and sought more than $5 million in damages.
Despite its propensity to be juvenile or offensive, derogatory humor is a coping mechanism. Staff members at hospitals across the country make fun of patients’ names; a Virginia doctor tapes his favorites to his locker. In a Maryland ER, a travel nurse said that “Status Dramaticus” is nurse code for patients with low acuity but high drama, and a “Positive Suitcase Sign” is “when a patient expects to be admitted for a bullshit complaint and brings along a giant suitcase like they’re checking into the Hilton.” In North Carolina, whenever a psychiatric patient who often hit people emerged from his room, techs hummed the Jaws theme. A study of humor in a psychiatric unit quoted a doctor announcing at the beginning of a meeting, “Let’s run an efficient meeting today; only one joke per patient.”
Certain groups of patients are targeted more than others, including obese people, particularly in the OR and obstetrics–gynecology departments. In a gynecological surgery case, for example, doctors and nurses played “the pannus game,” in which they wagered on the weight of the pannus (the flap of fat on the lower stomach) they were removing. Many healthcare workers trade anecdotes about the items they find or expect to find stuck in the folds of patients’ fat. A medical student told researchers, “There’s lots of stories about larger older women who when you lift up their fat, you see Oreo cookies, a remote . . . [all] hospital urban legends.”
The patients whom hospital workers are most likely to make fun of are people “whose illnesses and health problems were perceived to be ‘brought on’ by their own behaviors, which ‘inhibited’ doctors’ abilities to take care of them,” Northeast Ohio Medical University researchers said, such as excessive smokers, drinkers, or drug users; people who engage in criminal behavior; reckless or drunk drivers; and people who practice unsafe sex.
Other categories include “difficult” patients (who are demanding, aggressive, etc.) and patients who are sexually attractive. A medical student told the Ohio researchers about cases “when the patient is out and people will come in and remark about her knockers being fabulous.” Another student assisted doctors who rated the penis size of their patients, and said, “‘Don’t look at this guy’ or ‘Look at this guy because he will make us all look good.’ ” However inappropriate it is to comment on an anesthetized patient’s genitalia, the doctors were more likely doing it to lighten the mood for the staff than to pick on that specific patient.
Healthcare professionals are careful to say that they usually make fun of situations and symptoms, not the patients themselves. A medical student explained to the researchers, “There’s nothing potentially funny about a sinus infection or earache. They’re not amusing. But . . . if somebody comes in with an object lodged in their anus, that’s entertaining.”
It’s so entertaining that some ERs keep an orifice box (also known as “the butt box”) into which nurses can plunk the objects that enter the hospital in patients’ orifices. Some of the items that patients have stuck into their rectums include: glass perfume bottles, a steak knife (inserted point-first), a six-inch bolt, soda-can tabs, bugs, animals, a broken candle jar, and an entire apple. After Indiana nurses pulled a G.I. Joe out of a man’s rectum, they hung the real unfortunate hero by his neck in the nurses station as a prank. When a California patient said he had swallowed “something,” nurses played a game of “name that object”; the “something” turned out to be a pipe, a padlock with a key, a screw, two bobby pins, and an unidentifiable object that may have been a battery. Nurses in a Virginia ER had a hard time keeping straight faces when a patient arrived with a vibrator buzzing loudly so far up his rectum that surgery was required to remove it. In hospitals that don’t keep a butt box, some nurses surreptitiously take cell phone pictures of amusing X-rays.
Doctors, medical students, nurses, and techs who participate in derogatory humor generally do so in
meetings, in the hall, or in group or private conversations. The nurses I interviewed said that gallows humor is more common than derogatory humor, which one doctor has distinguished as “the difference between whistling as you go through the graveyard and kicking over the gravestones.”
Why participate in either? Experts say that humor helps medical professionals distance themselves from the anger, grief, stress, and frustration that are inevitable in their jobs. Nurses depend on gallows humor so that they are not overwhelmed by anxiety and sadness. “Sometimes when something happens that is so awful that you want to cry, instead you use black humor to keep from crying,” said a Texas nurse practitioner. “They’re not really ‘jokes.’ Mostly it’s just trying to relieve the tension.”
A Mid-Atlantic travel nurse uses gallows humor to “find the bright side” in tough circumstances. “In a massive trauma, I’ll take note of the cheery toenail polish color of a patient, or remark that they picked a great day to wear clean underwear for the car accident,” she said. A Canadian nurse remembered a recent code during which the doctor in charge did an impression of another doctor “who was known to freak out during codes. He said, ‘Oh my God, somebody help this man!’ It brought some levity to the code, had all the nurses laughing, and got everyone relaxed a bit during a very stressful event. The patient survived and the code was not affected at all by the joke.”
Gallows humor is a way both to disconnect from a horrific situation and to connect with the other health team members who are together facing that situation. Humor has been shown to improve doctors’ and nurses’ morale and working relationships. It allows them to express their feelings more easily and to say things that otherwise could be difficult to say. It’s also a bonding tool; as researchers have observed, “having a common sense of humor is like sharing a secret code.”
The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital Page 23