“What do you think?” my nurse, Laura, had asked as we discussed her call from Ms. Lyons*. Ms. Lyons, an ovarian cancer survivor whom I have known for years, had called Laura after she had developed a discoloration on her abdominal wall and vague abdominal pain. She thought it might have something to do with her anticoagulation injections, but she also thought she had felt “something” in her belly.
“It sure sounds like a hematoma,” Laura had said to me. After some discussion between us, we decided to bring her in. When Laura asked her to come in, Ms. Lyons demurred; she did not live near us, felt otherwise well, and wondered if that was truly necessary. In order to investigate further, we asked her to take a picture. We had wanted to see what the abdominal area looked like.
Moments later, Laura broke out laughing. I came in to her office wondering what was so funny and on her screen was the smiling, radiant face of Ms. Lyons. Apparently, we had not been specific enough in our request; instead of taking a picture of her abdomen, she had sent a mobile self-portrait.
We called her, told her she looked lovely, and then re-stated our request for a picture of her abdomen. In response, she laughed hysterically, and we did with her. After seeing her abdominal photograph, it was clearer that it was a hematoma. She did not need to come in urgently, but at her next visit, I asked her if she would autograph her picture if I printed it. We laughed again, shared a hug (and a couple of tissues from laughing so hard) and went on with our business.
I remembered this vividly as I read an article by Stephen Rose and colleagues in the International Journal of Gynecologic Cancer. They sought to evaluate the role of humor in the treatment of women with recurrent ovarian cancer by interviewing 17 women. They reported that over 80% used humor to cope with cancer, and 76% found humor helpful to alleviate anxiety. All patients reported that the use of humor by their clinicians was helpful and did not trivialize their illness, even in the context of a hospitalization or during treatment. Among the main themes they identify, one struck a particular chord with me—to involve humor with a patient, one should have an established relationship with them.
In general, laughter and humor do not come to mind when one talks about cancer. Oncology is a serious endeavor aimed at treating a life-threatening condition. Our profession and our patients compel us to stay abreast of new findings and new treatments, to engage in a conscious and thoughtful discussion about next steps, and to always be honest. Indeed, as I look back, nowhere in my training or practice has anyone ever said, “But remember to laugh.”
In reality, patients want to be treated as people, not a condition, and part of the way we can do that is to engage them beyond the realm of cancer. We do it already when we ask about how a spouse or a child is doing, what plans are in place for a weekend, or just a simple “how are you?” But we can do more, especially for patients we have known for a long time. Sharing a joke, an anecdote, and a laugh are as human as holding one’s hand. In addition, as this small paper reminded me, at times, laughter can also be the best medicine.
*Name changed to protect privacy