Using Humor to Cope with Cancer
The first Sunday of every June is National Cancer Survivors Day. At a Survivors Day program I did in Utah several years ago, I came across a woman who had had a double mastectomy because of breast cancer. Several weeks after her surgery, she went out to her front porch early one morning to get her newspaper. As she bent over to pick it up, one of her new prosthetic breasts popped out. The family dog, thinking this was just a new toy, grabbed it and started running around the yard with it. She ran after it, shouting "You come back here with my breast! You bring my breast back!"
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When she realized what she was saying, she stopped and looked around to see if anyone had heard her. To her great relief, no one else was up that early. But as she reflected upon about what the neighbors would have thought had they heard her, she started laughing, and couldn't stop. She was soon laughing so hard that tears were coming out of her eyes.
When she finally stopped laughing, she realized that this was what had been missing from her life - not just since her surgery, but since she heard those three words that none of us want to hear: "You have cancer." She could not remember laughing since her diagnosis of cancer. And she was determined to never let another day go by without having some laughter in her life. She realized that she needed to laugh, even when she didn't feel like laughing. The laughter itself boosted her spirits and made it easier to face the tough days.
I now tell this story to all the cancer groups I speak to, because I think her experience applies to everyone learning to live with cancer - or any other serious illness. You need to be sure that you have some joy in your life every day, and humor and laughter provide you with a powerful means of creating joy. If you can't find anything to laugh at, laugh on credit! The resulting impact on your mood will help you find things that are honestly funny to you. Your patients will also welcome the resulting positive mood you bring to them.
Consistent with this specific patient's experience, women who used humor to cope with their ordeals with breast cancer were found to be experiencing less emotional distress the day before their cancer surgery, three days after the surgery and also three months following surgery.74 Other evidence similarly points to humor as a valuable ally in helping breast cancer patients cope.75 When the role of racial/ethnic factors in the use of humor to cope among breast cancer patients was studied, however, it was found that active use of humor as a coping strategy was common only among white non-Hispanic women. Among African-American and Hispanic women, religion-based coping was much stronger than humor-based coping.76 And coping via humor is just as important for family members as for patients. There is evidence that both breast cancer patients and their family caregivers who actively use humor to cope have a higher quality of life.77
Most cancer patients tell me they know that it's important to keep a positive attitude, and to try to keep some humor and laughter in their life. But they simply can't generate a mood or frame of mind that allows them to find anything to laugh at. Their sense of humor abandons them right when they need it the most!
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The fact that people like Gilda Radner, of Saturday Night Live fame, die from cancer shows that while your sense of humor strengthens your immune system (see Humor and Nursing I), it's not a magic bullet guaranteed to cure your cancer. What it does do is strengthen some of the body's basic health and healing mechanisms. Humor and laughter help assure that your mind and emotions are working in favor of good health, and not interfering with it.
While humor did not save Gilda's life, she made it very clear that it helped her cope with the disease and improved the quality of her life as she fought the battle. She knew she was winning the battle to cope with her illness, even as her body was losing its battle. In her book, It's Always Something, she says, "The important thing is that the days you've had, you will have lived. What I can control is whether I'm going to live a day in depression and panic, or whether I'm going to attack the day and make it as wonderful a day as I can." Gilda knew that when you're living with cancer, there'll always be something to deal with every day. But she also knew that her sense of humor was her strongest ally in living her days fully. It can also be yours - and your patients'!
Humor in Emergency and Disaster Situations
Further evidence of the power of humor in helping you cope comes from other types of employment that involve frequent contact with death, illness, injury or suffering. Employees in these areas consistently show the same pattern of joking and humor we have found to occur among hospital staff. Paramedics and emergency medical technicians (EMTs), for example, are constantly being exposed to serious injury/illness (and occasional deaths) - often under physically and emotionally trying conditions. Humor has been shown to be one of the main tools they use to cope with their own emotional reactions to these situations.78
_____________________________________________________________ "Life does not cease to be funny when people die any more than it ceases to be serious when people laugh." George Bernard Shaw
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Police officers also must learn to deal with frequent exposure to sudden death in traffic accidents, suicides, homicides, and the taking of lives themselves. They, too, commonly use humor as a means of coping with stress and relieving tension.79 All three of these emergency response professionals laugh at things most of us would consider to be in bad taste. But they have all learned that they need to laugh, because it helps them adapt to the terrible things they are exposed to. They need the release that humor and laughter provide. The laughter is emotionally cleansing, and helps them counter the psychological gravity they experience every day on their jobs.
Firemen, EMS workers, ambulance drivers, and policemen often talk about "crispy critters" after fires, or "road pizza" after traffic accidents. Following major disasters, such as hurricane Katrina, floods and earthquakes - and even the tragedy of 9/11 - there is always a critique among the emergency response team concerning how well they handled the situation. There's often a great deal of humor in these discussions, as emergency workers let go of the incredible tension and strain that builds up throughout the response to the disaster. (The one possible exception is 9/11, where the sheer enormity of the disaster made any kind of humor impossible and inappropriate.)
I have done numerous keynote addresses for FEMA (Federal Emergency Management Agency), state emergency response conferences, and police conferences, and they consistently tell me "If we didn't learn to laugh at some of the things that happen, we'd never survive on this job." They learn not to share their humor with others who do not do their kind of work, because it's seen as inappropriate and insensitive, but they know that it's one of their most important tools for getting through some of the difficult days.
The following examples will give you a taste of their sense of humor.
• After responding to a call in which a man had committed suicide by jumping in front of a train, a member of the response team said to his buddy, "Hey, give me a hand, will ya?" (The body was dismembered.)
• After a plane crash, in which the emergency response team spent the morning putting bodies in bags, someone said "The bag lunches are here."
• Delta Airlines suffered three crashes within a 2-3 year period in the 1980's. Firemen and police could be heard following the last crash sharing some of the following jokes:
• At Delta, we now offer three classes of service: smoking, non-smoking and burned beyond recognition.
• Delta now offers you free drinks if you present your dental records when purchasing your ticket.
These jokes generally seem insensitive to people not in the field of emergency response, but they are crucial in helping emergency response professionals sustain the frame of mind they need to save lives. Just as this humor helps them cope with the tragedies of others' lives, it can help your patients manage the tragedies that arise in their own life. The same statement, of course, applies to you.
While emergency response professionals know from experience that humor helps them remain effective on their job, they sometimes feel a twinge of guilt about laughing at such things. This is especially the case for newcomers, who still feel that it's somehow inappropriate to laugh in the midst of others' misfortune.
The key thing to remember if your own humor takes this direction is that you are not really laughing at others and their misfortunes; you are laughing at the situations and unpredictable events that arise in the midst of those misfortunes. You are seizing the opportunity (and sometimes creating it) to let go of the difficult emotions that inevitably accumulate in your work.
In addition to helping you let go of already accumulated anger, frustration or tension, humor initiated in the midst of a disaster can also help prevent these negative emotions from building up inside you to begin with. As one EMS employee told me, "Humor is an emotional condom." It helps keep negative emotions that might interfere with the quality of emergency response from accumulating to the point that they do interfere.
Emergency workers' humor generally shows up after the emergency situation has been handled. One ambulance driver explained to me that a woman he was about to take to the hospital kept saying that she had "brain farts." She repeated it over and over, as if she thought it were really important. He restrained his laughter until she was safely delivered to the hospital, and then let his laughter loose as he shared the story with his buddies, realizing all the while that she must have meant to say that she had brain "infarcts" (dead brain tissue).
During the long-lasting flood of the Mississippi river in 1993, there were endless jokes among emergency workers about the flood. One joke circulating at the time was that Des Moines, Iowa had changed its zip code to 50H20.
Again, the purpose of reviewing all of these examples of humor in emergency situations is to remind you that humor can also help you in coping with your own personal and professional crises - helping you provide a higher quality of care in the process.
