You probably don't want to know how your nurses talk about you

Some recent events on the personal front have reminded me once again of a bit of friction which occasionally takes place in hospitals between the staff and patients. It’s not limited to medical situations by any means, but it seems to be the most raw in cases such as that. There are occasions where visitors – or even the patients themselves – will inadvertently catch wind of some of the comments and jokes that the nurses and doctors make at times and they likely won’t much care for them. Along with other, high stress positions, medical professionals can have a tendency towards some particularly gruesome gallows humor at times.

I was reminded of this back in April when Alexandra Robbins published an article entitled, Nurses Make Fun of their Dying Patients. That’s okay. The title alone is a little rough on the reader right out of the gate, but the meat of the essay isn’t nearly as dire or insulting as it sounds.

Although patients typically don’t overhear it, a surprising amount of backstage joking goes on in hospitals — and the humor can be dark. Doctors and nurses may refer to dying patients as “circling the drain,” “heading to the ECU” (the eternal care unit) or “approaching room temperature.” Some staff members call the geriatric ward “the departure lounge.” Gunshot wound? “Acute lead poisoning.” Patient death? “Celestial transfer.”

“Laypeople would think I’m the most awful human being in the world if they could hear my mouth during a Code Blue,” Lauren told me when I was reporting my new book on nursing. (I agreed to use only her first name, so she could speak freely about behind-the-scenes hospital life.)

Indeed, while people may readily excuse gallows humor among, say, soldiers at war, they may have a lower tolerance for it among health-care professionals. “Derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves,” Johns Hopkins University professor emeritus Ronald Berk contended in the journal Medical Education. “Those individuals who are the most vulnerable and powerless in the clinical environment … have become the targets of the abuse.”

I strongly disagree. The primary objections to gallows and derogatory humor in hospitals are that it indicates a lack of caring, represents an abuse of power and trust, and may compromise medical care. But in my reporting, I found that nurses who use this humor care deeply about their patients and aren’t interested in abusing their power. Their humor serves to rejuvenate them and bond them to their teams, while helping to produce high-quality work.

I understand what the author is getting at, and possibly a bit more than some of the readers who argued with her ferociously after the piece was published. That’s likely because I grew up with an older sister who worked her entire life as a nurse and was full of stories, jokes and horrendous tales of the ER and – far worse – life in a preemie nursery in the seventies when the mortality rate for the infants was still terribly high.

I’m not dismissing the hurt feelings, complaints or even shock of patients who overhear such things as described in the article above. Some of what commonly passes for humor in the nurses’ lounge would put the most cynical listener off their feed. And the patients and families under their care are frequently there during one of the worst periods of their life, with anxiety, stress and the pressure of potentially dealing with imminent mortality hanging over their heads. When the staff lets go with some of these patently callous sounding comments where there’s any chance of a patient hearing them, something has gone wrong.

But I can still excuse them. Military men, relief workers, cops and firemen all face similar professional challenges to varying degrees and they mostly tend to develop a penchant for such gallows humor. It’s rather hard to avoid. Returning to my personal experience on that, I recall my sister going through an extended period where she was depressed and could barely leave the house at times. She was dealing with tiny, premature babies dying on a weekly, if not daily basis. That would have to get to anyone after a while. But she eventually adjusted and, yes, she began to take on some of that off putting humor which her profession exhibits on a regular basis.

The bottom line is you’ll find this with cops (we have several in our family) as well as other first responders and pretty much anyone who has to deal with tragedy on a regular basis. It may sound cold and heartless, but I think we owe it to them to cut them some slack and understand a bit of their world. (Though, again, they should certainly keep it away from the patients.) Sometimes awful humor is the only way to cut through the fog of horrible things which they are faced with on a daily basis.

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