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 that 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?”