Humor, Serious Illness, and End of Life

“f I had no sense of humor, I would long ago have committed suicide. — Mahatma Gandhi

Please tell me you’re Republicans. — Ronald Reagan’s quip to the surgical team as he entered the operating theater before anesthesia after he was shot in an assassination attempt.

Source: cottonbro/Pexels

One of the ways people cope with the onslaught of helplessness, sadness, trepidation, and angst one feels when confronted with a dire circumstance is with humor.

During my decades of medical work, I have observed in people the need to feel whole. The “wholeness” I refer to is the internal conscious narrative of who we are moment to moment. It is the "I" that wakes up in the morning, goes to work, socializes with friends, spends time with family, and goes to sleep at the end of the day. None of that requires a serious look at the unconscious mind.

The Absurdity of Serious Illness

Illness, especially serious illness, tampers with our sense of self. It affects the “I” in profound ways. It challenges our identity and strips us greatly of our sense of control that we desperately need to function as a whole “I.” One can say that a serious illness deconstructs the “self” faster than years of talk therapy. However, the evil twist is that it’s ruthless and cares little for how prepared you are to engage with its “therapy.”

And what is a life-limiting illness, if not an absurdity? The sentiment is one of ridiculousness. Rick Jobus, who was diagnosed with ALS, wrote this in his blog:

• “The initial pronouncement was maddeningly surreal. The imagery of what lay ahead of me was mortifyingly disgusting. That revulsion quickly became anger as the predicted symptoms began to manifest themselves. The rage within me only intensified with each stage of my body’s devolution. From limping unaided to stumbling with assistive devices to struggling in transferring myself to a wheelchair to becoming fully immobile, my irritation redoubled. As my speech made its way from occasional slurring to labored, guttural utterances, my rancor boiled. But by far, the greatest accelerant of my fury was the unanswerable questions. Why ALS? Why me? Why now? The vacuum created by seemingly having no meaning or purpose was absurdly overwhelming.”

Typically, there are no good answers. Sometimes the answers are quite negative and make the situation even worse. One may think that it’s justice or retribution for past deeds. Perhaps it’s just random bad luck, a genetic game of chance that caused this disease that could have happened to anyone, but unfortunately, it happened to me.

If one cannot adjust/adapt and handle that perspective, a nihilistic attitude can develop. Absurdist or surreal humor can both reveal an odd similarity to the person’s existential predicament and at the same time evoke a bit of catharsis so needed when one is solely preoccupied with their struggle.

Why do I try to create levity and lightheartedness? Think back to Patch Adams with his red clown nose in a hospital room next to a sick person. What is it about that dynamic that works? There are different types of humor. The humor that I try to create unites us both in an absurdly difficult situation that we both happen to be in.

So, take for example a person who has metastatic colon cancer with a bowel obstruction. Unless that person can pass some stool and have a successful bowel movement, she will have a really tough time with nausea/vomiting and abdominal pain. She will suffer immensely. So, when she tells me with a grin, “Doc, I’ve just had the biggest shit of my life!” with that smile, she is telling me through her humor that she is still alive and well in his world and still has the resilience to go on and persevere in her struggle with all of her humanity preserved without becoming despondent and hopeless.

Some of our greatest joys that we can remember are when we "pissed in our pants" laughing at something. Just that description puts us in a happy state of mind that can't be repressed. We know the feeling, the emotion. We can relive that state and smile in our minds' eye. That joy is ineffable and to be able to allow one to experience something even close to that state is worth the effort.

Connection via Humor

How about this one?: "Amid your discomfort, let me share this stupid story with you…” Taking that at face value and telling something like that to a person who is in no mood for jokes will not go well. But, at the right time and to the right person, that way of communicating allows humor to work its magic.

Remember, when we are suffering, our worldview shrinks tremendously. It shrinks into the black hole of suffering with a mass of a thousand suns. Hope, joy, pleasantries, goodwill, connection with others, meaning in life just disappear. We become less than human. We are taken over by the suffering. What humor allows is the reconnection of one’s suffering with their humanity and brings just a bit of temporary joy back into view.It’s not a panacea, but it makes its mark. It’s a therapy that only we humans can share with other humans without needing any technology, pills, or procedures. All that is required is lived experience, a bit of tact, and a sense of humor.

Humor Essential Reads

A Skill that Strong Couples Possess: Irony

The Joke’s on Us: Comedy Is Conflict in Disguise

In palliative care, our work is not focused on curing. We work alongside people who receive care for their medical illnesses. For those on hospice, we can sometimes be the main clinician who both provides and supervises their care. Perhaps the one main ingredient that we bring to the table is connection.

If one looks at today’s medicine as transactional, i.e., monies exchanged for medical care, what is missing is connection. For decades, we got used to this type of medical care, but we don’t like it. Why? Because it is bereft of humanity. Technology, expertise, and skill devoid of humanity is not fulfilling care.

That is why we describe a doctor who sees us on time and is competent as a “good doctor” but a doctor who sees us on time is competent and has a great bedside manner a “great doctor.” It has “street cred,” especially when people are struggling, and things are not going well. Perhaps when a young patient comes to a clinician with bronchitis and requests therapy, a deep human connection is not vital but when you are faced with a grave illness when things are not going as you had expected and chemotherapy is fraught with side effects or the chance of cure is small or no matter what you do, the chance of survival is low, then connection matters.

That’s why in palliative and hospice care we have nurses, social workers, spiritual care counselors, chaplains, and volunteers from so many fields who focus on building and restoring human relationships in our patients’ lives. The focus is on human connection. Is that worth something? Well, perhaps not in the financial sphere but in the emotional, psychological, and spiritual spheres it certainly is.

So why use humor? To build rapport, to form a connection, to create a less threatening space where psychological suffering can take a back seat (even temporarily) to a more positive frame of reference, to achieve catharsis with a release of negative emotion/energy, to foster resilience in a very challenging situation, to allow one to think more broadly about their predicament and get unstuck from their all-absorbing suffering and negative affect.

Laughter is the closest distance between two people.