Commentary — May 2015
By Skye Clarke, DO
Now in my last year of residency, I feel confident in my identity as a "real doctor," and not just a scared, nerdy kid in a scratchy, white coat. However, I still struggle with maintaining that particular type of composure traditionally expected from physicians. I am a laugher. The world is hilarious to me.
Every time a code grey (combative patient alert) is announced, I suppress laughter at the thought of myself and like-bodied coworkers (imagine scrawny, myopic doctors, muscles wasted from years inside studying) breaking into a choreographed ninja routine in matching spandex to subdue the aggressor.
When a patient, convinced she has a family history of blindness from "aunt's eye-ities" actually has a personal history of "anxiety," I am delighted at such grammatical blunders.
This does not mean I don't take my patients' problems seriously or that I constantly mock people in my head. I simply find enjoyment in observing unique mannerisms. This is one reason I love being a doctor. My patients are the most interesting people in the world, and I truly delight in them. I often explain to friends, "I'm not laughing at you, I'm enjoying you!"
As one can imagine, constant laughter is not necessarily a good thing in medicine, and that is something I have worked hard to control. However, the occasional patient breaks through my hard-won barriers and leaves me pondering my ethical conundrum: As a doctor, when is it okay to laugh? We want our patients to know we are human (and to laugh is human), but laughter can also be interpreted as mockery, callousness, or judgment.
My greatest challenge in this battle against hilarity was a recent patient named "Poe," who came to see me for hypertension. I walked into the exam room and found a 45-year-old man with a purple clown wig and a pacifier. I kept my composure.
Then Poe said, in a falsetto baby's voice, "Hi, Doctah, I'm a widdle baby." I opened my eyes wide, bit the insides of my cheeks, and did everything I could not to laugh. I stared at the ground when asking questions. I coughed when I felt a laugh rise up. I tried! But as we continued, his baby coos began to work at my defenses; and then to completely disarm me, he did a funny little dance while singing Bette Midler's 1988 smash hit, "Wind Beneath My Wings." My steely reserve broke, and large billowing laughter exploded out of me.
Was I a horrible doctor? Would he think I was mocking him? I hoped not, but I couldn't stop laughing. Finally, I turned to him; he was laughing, too. And he said in his high-pitched baby voice, "The world is just funny, I think," and it was awesome. We only stopped laughing when the nurse checked on us because she thought she heard crying. He has been my regular patient ever since, and we find a way to laugh together on every visit.
I do not pretend that this is the ideal patient interaction or that I won't continue to work on controlling my own laughter, or that Poe may not have serious mental health issues that we will tackle together. As a doctor, it is my job and duty to be a healing force for my patients, to earn their trust, and to always hold their best interests as my top priority. I truly believe I live up to these expectations. However, I have decided that sometimes, when the intention is not malicious, it is okay to enjoy our patients, take joy in their oddities, and find a way to laugh with them.
Skye Clarke, DO, is a resident in the Family Medicine Residency Program at The University of Texas at Austin Dell Medical School.
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