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A Doctor’s Dilemma: How do We Keep Our Humanity?
May 22, 2012 (published)

There is a measure of gallows humor you need to get through a rough day at work, no matter what that work may be. But when your work involves the dying and those who grieve for them ‒ regardless of whether they have two legs or four ‒ that skill becomes vitally important.

We do this all the time in the ER, and if the general public could see it they would be horrified. We would look like insensitive ghouls who feast on pain.

I am sure that, to some degree, this goes on anywhere that human pain is rarefied and distilled down – human hospitals, mortuaries, crisis centers. It is a simple defense mechanism.

It can be explained as, “I’m laughing to keep from crying.” It helps keep you somewhat whole and functional, and allows you to carry on and do your job – questionable in terms of taste and professionalism, but necessary and actually helpful on the whole. If you were a blubbering wreck because you just had to euthanize a kitten, you would be less able to help the next patient in line. The purpose of gallows humor, which could easily be labeled as “sick” to an outside viewer, is to temporarily offset the sometimes debilitating despair and allow you to return to function.

One curious variant of this came into play today. I was chatting with one of the doctors here, and she was describing a large mass found in a dog’s abdomen on ultrasound.  The mass was extensive and highly likely to be malignant; impossible to tell without a biopsy, but this was the radiologist’s assessment. The mass will probably be the dog’s undoing.

The doctor is someone I trust, and one who shows a great deal of compassion for her patients and owners. She is not immature, she is not shallow and she is not a ghoul by any means.

But as she was describing the encounter with the ultrasound and the nature of the mass, she grew animated and excited. The sheer size and extent of the mass, I think, coupled with the fact that we had found out what made the dog ill, had conspired to put her in a highly excited state. She described the mass as “really cool.”

Remember, she was not wishing ill on the patient or owners. She didn’t want the dog to be in pain or die. She was just describing her visceral reaction to a giant tumor. From a medical perspective, when we are faced with much sameness and boring everyday conditions, something this unusual and dramatic is, well … really cool.

To the patient, however, it is anything but: A death sentence at worst, and in most cases an involved and painful surgery, and very possibly weeks of medications and uncertainty.

I remember one of our instructors in veterinary school, a pathologist, relaying a story about one of his dogs.  He had taken a small sample of a mass he found on his own dog’s skin, and asked a colleague to look at it under the microscope. (We veterinarians rarely work on our own pets.)

Not wanting to bias his friend, he did not mention that it was from his own dog.  His colleague took a look under the microscope and said “Wow. That’s really cool! That is the most aggressive cancer I have ever seen!” My instructor said he wanted to punch the guy.

I don’t have the answer on how to maintain compassion and humanity in the face of such suffering or on what role humor plays in allowing us to deal with mortality.

I do know, however, that even though to an outside observer it may seem like gallows humor is a sign that we have lost our compassion and descended into soullessness, it is actually quite the opposite – it is how we maintain our humanity and can find a way to care, day after day.



3 Comments

Dr. Adrian
September 21,2012
I agree with Dr Di - these are super helpful and interesting. I find myself perusing them to glean some of the 'normal' aspects of animal health, as well as to remind myself how non-medical people might be thinking or viewing something. And I laugh at the perfect descriptions frequently. :)
Dr. Tony Johnson
May 26, 2012
Thanks so much, Dr. Di. I appreciate the feedback and I love being able to connect with veterinarians and their clients through ANIMALicious.
Dr. Di
May 26, 2012
Dr. Johnson, you have a great way of writing about what we as veterinarians feel. I truly enjoy your articles.

 
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