My dying patient taught me that laughter can sometimes normalize difficult situations. Finding humor in the problem lightened the mood and allowed us to devise a care plan that preserved her dignity.
My patient looked at me and smiled as I walked into her warmly decorated inpatient hospice room. Mrs. P was a 60-year-old woman recently diagnosed with metastatic pancreatic adenocarcinoma. She had bulky metastasis to her liver leaving her with a belly growing with tumor burden and ascitic fluid. A few months prior, she was struggling with a worsening rectal prolapse and had planned to have surgery. Her diagnosis of cancer changed her plans.
She’d been in hospice for about two weeks. With her doses of opioids to alleviate pain, constipation began to add to her many abdominal issues. She was now spending over two hours a day in the bathroom, of which a significant amount of time was spent reducing her own prolapsed rectum. She told me how difficult it was to know she was losing control of her body but wasn’t at the point where she was willing to accept help with a task she felt was embarrassing.
Every day we would tweak Mrs. P’s bowel regimen, and each day she and her family became more comfortable talking openly about things that are typically kept private. After we had exhausted our medical options, I was reminded of an old trick: table sugar. Sprinkling one or two packets of table sugar onto a prolapse can help draw the water out of the rectum and reduce it. I could see the shock and mortification in Mrs. P’s face. Slowly, her face softened and eventually turned into a smile.
“Do I do this before or after I put the sugar in my coffee?”
Mrs. P taught me the power of humor as a tool in the right context to normalize difficult situations and find absurdity in the discomfort. Laughing together has the power to align clinicians with their patients on the same side of the battle. Bringing humor to a seemingly humorless situation guided me, her family, and her caregivers in how to help care for her in a way that preserved her dignity and maintained her humanity.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.