“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
May, 15 2013 12:58 PM
...And of course, it's very therapeutic for patients to laugh at their oncologists, too. Poking gentle fun of my doctor makes me feel like I am taking back some control. Humor is also a big part of who I am. When I found myself able to make jokes with and about my doctors it made me feel as thought things were calming down, which thanks goodness they were...
Top 10 Things I Would Like to Say My Oncologist…
I made this Top 10 List shortly after I was diagnosed with metastatic breast cancer in 2009. Over the ensuing months, I have actually said most of these things to my doctor. Time for a new list!
10. Instead of putting my arms behind my head for this exam, how about if throw my hands up in the air like I just don’t care?
9. Do you mind if I conduct a “Pampered Chef” party in your reception area?
8. See that? Do you think I’m getting stigmata?
7. Where do I sign up for the “Look Good, Feel Crappy” class?
6. There must be some mistake. I’m looking for the Rotary luncheon.
5. Do you validate?
4. I was told MRIs are “Buy One, Get One Free” this week. Is that true?
3. On the bright side, my prostate has never been healthier.
2. How do you get your coat so white?
1. Screw the gown. I’m going commando!
Don S. Dizon, MD, FACP
May, 16 2013 8:00 PM
I am so happy you posted your list. It is both funny and direct. I am sure the witty repartee you enjoy with your physicians is a mutually benefical experience. I know some of my best clinical days are the ones where I've shared a smile or a laugh with a patient, particularly one that I have had the privilege to know for a long time. It helps to remind me that life does indeed go on, beyond the walls of an oncology clinic, an infusion unit, and a cancer center.
Hope you are well, and thank you for posting!
May, 18 2013 12:09 AM
Thanks Dr. Dizon. In 2011, I considered my physician's perspective. She always asks me about my energy level, any unexpected weight loss and any new bone pain.
While she does her exam, she often makes small talk. I never know if this is to distract me or just to make things more interesting for her. I’ve already covered the Top 10 Things I’d Like to Say to My Oncologist. So it’s only fair to consider the doctor’s side of things:
10 Things My Oncologist Will Never Say
10. Frankly, I’m stumped. With your permission, I’d like to call in that noted cancer specialist Suzanne Somers.
9. Sorry to keep you waiting. I was updating my Facebook page.
8. Just as you have long suspected, there is actually no pharmacy or pharmacist on site at this hospital. The reason it takes so long is that we actually go to Canada to buy your drugs.
7. Sucks to be you!
6. When we’re finished here, my fellow and I are going to play H-O-R-S-E behind the parking garage. Care to join us?
5. Radiology and Pathology sent over these flowers and an apology. You don’t actually have cancer. So today’s visit is on the house.
4. Ringo is my favorite Beatle.
3. Hey, perfect checkup! Stop by the receptionist’s desk and she’ll give you a coupon for a free ice cream cone.
2. I’m just temping here until I can get a full-time hostess position at The Olive Garden.
1. Turn your head and cough.
May, 27 2013 3:21 PM
Love love love this article and comments by Katherine!! I've always believed that humor puts everything into perspective. When we are treated as just a cancer patient, sometimes that's all that we identify with and it's depressing! The doctors, nurses and other health professionals who treat us as people who have lives outside of cancerland are truly caring, real people. And it's easy to forget that doctors are just human when they come across only as a clinician. When a doctor truly engages with a patient, it shows their humanity and willingness to put themselves out there. The downside, of course, is that they also open themselves up to strong emotions when they lose a patient. To me, those doctors are true healers and real heroes.
Don S. Dizon, MD, FACP
May, 29 2013 1:23 PM
Dear Robin, Thank you for your comments and I am really happy you enjoyed the post and Katherine's amazing commentary (and lists!) Hope to hear from you again and I also hope your words reach my colleagues. Cancer care is a partnership, and as such- it's nice to hear from our patients, as much as it is to hear from our fellow clinicians. Welcome to ASCO!