the opposite of open

i am fascinated by gallows humor, that dark derogatory humor that many a resident has taken up as a shield in the face of overwhelming stress.  is it good?  is it bad?  i really don't know, but my thoughts are this - at the time, it helps.  why else would it exist?  i am thinking of internship and residency, typically the most intense years of any physician's young life.  the pressures are tremendous.  you spend your days in a state of mental and physical exhaustion, your responsibilities always falling just beyond where you think you can reach.  as soon as you become comfortable in one setting, you are advanced to something else.  there is no moment for complacency.  each month is like starting a new job over and over again, each ward with new people to integrate yourself with, new knowledge and skills to master.  and all the while you are caring for some of the sickest people in the world.

so under that tremendous pressure, you bond with your fellow residents by making terrible, inappropriate, dehumanizing jokes.  typically at the expense of your patients, but also your superiors and even each other.  you are too vulnerable and fragile to make fun of yourself.   the more stressed you are the more cynical and dark your humor.  but when i think about that humor now, the least biting of it still makes me laugh. a mild example is the diagnosis we gave to patients who refused to leave the hospital - adherent mattressitis.  saying it still makes me smile.  but shall i admit now that we referred to an older man in our medical ICU as the roach?  he resided there for months, one complication after another, yet still he lived, unkillable.  i hope you are aghast.  even i cringe as i see those words written on the page.  it seems unthinkable.  if a patient were to be a fly on the wall of the resident's lounge, the only feeling we could have would be shame.  but that is not the case.  the patient is not in that room. (in the presence of our patients we were different, we were professional and careful and caring, and all the things we knew were right.)    at the time, that dark humor lightened our mental loads.  it was the levity that served as a much needed counterbalance to the gravity of what we were doing.  for the worst of it, we can only forgive ourselves.

now i look back and see that dark humor as coming from a closed posture, a posture that removes you and limits you in some way, the opposite of open.  thankfully i no longer have much of a need for that type of humor in my life.  i would much rather seek out the humor that draws people in, that humanizes and opens us to each other.  it is one of the reasons i started this blog, to explore the possibilities of my own evolving sense of humor and its place in medicine and in my life. i am still exploring and i thank each of you for reading or commenting.