Hospitals are often tense, even grim, places. Doctors' offices aren't much better. Nursing homes are worse.
Humor, which can usually help, is often conspicuously absent.
"Humor is a drug, one of the best you can give your patients," a nurse -- Marion Dolan, executive director of Heritage Home Health in Bristol, N.H. -- wrote in the nurses' magazine, RN.
"It's a pity we don't dispense it more freely.
"Maybe we just don't know how."
How indeed? After I wrote last week's report on humor and laughter, I searched for articles that might help tell doctors, nurses and other health workers "how." The best ones I found were by nurses and a nursing home director.
Humor, they agree, is not mainly a matter of telling jokes. It is an attitude, one that takes life seriously but not too seriously. It is a matter of smiles, of laughter at times and -- crucially -- one of eye contact, a sincere reaching from person to person.
Even about an enema.
Dolan tells of "Mr. Chu," admitted to the hospital for an emergency appendectomy. A sailor off a Chinese ship, he spoke no English. When Nurse Dolan approached with the apparatus for an enema "and gestured to explain" what would happen, "a look of horror came into his eyes, and he curled up in a fetal position in the farthest corner of the bed."
"All of a sudden I could see the headlines," Dolan writes. " 'World War III Erupts Over Enema in New Jersey Hospital.' The more I thought of the headlines, the more I laughed. I looked into Mr. Chu's eyes, and he started laughing, too. Our laughter leaped the language barrier," and the vital task was accomplished.
"When it comes to using humor as a therapeutic tool, more opportunities exist than we realize," Dolan maintained.
Kaye Herth, a family nurse practitioner at the Harwin Clinic in Houston, wrote in Nursing Times of an elderly woman with advanced ovarian cancer, who was "anxious and fearful."
Her family said she loved to tell jokes, so, Herth wrote, "I decided to use her talent in a way that would build her self-esteem and use her sense of humor. I told her I needed a tape of funny stories to share with others, and asked her if she would help . . . She hesitated but took the tape recorder home, promising to think about it.
"A few weeks later, her family called about the remarkable change in their mom. She was spending hours working on the tapes. They said it was the first time they had seen her relax and laugh since she learned she had cancer."
She died four months later -- humor is no panacea -- but those months were a happier time for her and her family.
Another patient, Herth reported, brought her 6-month-old twins to the clinic for checkups. "She wept, saying she was so overwhelmed she felt 'on the verge of child abuse.' "
Herth suggested: "See that the twins are safe. Then shut yourself in the bathroom, turn on the radio and read a funny book, such as Erma Bombeck's satirical jabs at homemaking and motherhood."
The young mother tried it and said it made "an enormous difference."
Practitioners like Dolan and Herth say even a little humor -- just a light remark, not necessarily something very clever, not necessarily a big laugh -- can often relieve a patient's anxiety and open the way to a true "therapeutic relationship."
Herth asked another patient, a young woman getting extensive radiation for Hodgkin's disease, how things were going. She answered, "Fine," but obviously didn't mean it. "I ventured, 'I bet you feel like a Crispy Critter.' She laughed, but then began to express her fears and concerns." ::
A nursing home may ordinarily be the least humorous place of all. Yet Steve Goodwin, then administrator of a Lancashire home for the elderly mentally impaired, wrote in the British magazine Nursing Times: "For those in longterm care, what ingredients flavor life and make moments memorable? Humor adds spice to the insipid recipe of time."
Humor, he said, "is a language that reaches old and young, nurses and patients . . . It opens doors to hidden darknesses in moods, creates conversation and often earns respect . . . It can even bring a response from those in deep despondency."
He advises medical directors and administrators: Take advantage of the invaluable humorists, be they nurses, patients or others. Many of the old, he said, are gray and lifeless "and many have great cause to be so." But there are also "the many others who are witty and chirpy . . . I remember a man in his late 90s telling a group of 4-year-olds from a visiting play group that the reason he had so many wrinkles was because he had smiled so much all his life."
Dolan told of another patient, "Mrs. Carlson." "Withdrawn and depressed, she agreed to join in the unit's holiday celebration only after much coaxing . . . The program featured a clown cheerfully made up in red, green and yellow. He came over to where she sat slouched forward, head down, eyes averted. He knelt down and looked up at her. Mrs. Carlson stared for a moment, then started to laugh."
"When you see a withdrawn patient open up like this in response to a comic situation, that's your chance to open a channel of communication. Jump at the opportunity," Dolan advised fellow health workers.
Let humor breed, said Goodwin, and "other expressions are more likely to follow, ideas are more rapidly expressed, thoughts exchanged . . . If humor breeds . . . many other therapeutic aspects are likely to be growing alongside."
Johns Hopkins Hospital, in 1910 as today, was a famed place of healing, and the home of one of the world's great doctors, William Osler. In an article titled "The Faith That Heals," he wrote in that year that: "Our results at the Johns Hopkins Hospital were most gratifying. Faith in 'Saint Johns Hopkins' . . . an atmosphere of optimism and cheerful nurses worked just the same sort of cures as did Aesculapius at Epidaurus."
Next Week: When doctors are sick -- what patients can learn.