Caregiver Humor
by Allen Klein

Sometimes a laugh is the only weapon we have.
Roger Rabbit

Several years ago my father-in-law was very ill. One time, when he came home from the hospital, it was his and my mother-in-law’s wedding anniversary. I suggested that they invite a few friends over for dinner and I would do the cooking.

Jimmy managed to get out of bed to join us. He enjoyed the meal but the strain of feeding himself and the conversation among the guests were obviously tiring him. Noticing this, and knowing that he could not hear very well, my mother-in-law wrote a note and passed it to me to give to him. I read the note and got hysterical with laughter. She remembered what she wrote and laughed out loud too.

The note said, ”Happy Anniversary dear. Do you want to go to bed?” Jimmy read what his wife had written, looked up across the table, and with a twinkle in his eye and a smile on his face said to her, ”I would love to dear, but we have company.”

Looking back, I realized that it was only a brief moment of levity in his difficult last months but it was moment that was retold at his memorial service and long remembered after he was gone.

Looking for humor in the not-so-funny world of serious illness may, at first glance and to outsiders, seem disrespectful to those who are suffering. However, situational humor, which inevitably arises during such stressful times, is very appropriate. Because of humor’s ability to provide a new perspective to any situation, it is an important coping tool for everyone involved, including the patient, the family, and the caregiver. A good laugh, for example, shared between the home care worker and the patient, or their loved one, can momentarily transcend stressful times and join the two together.

Laughter is a powerful tool in dealing with powerless situations. It can give both hope and an upper hand to patients, who are experiencing both physical and mental loss, as well as to caregivers, who cannot change that loss.

The safest way for a health care worker to find that laughter is to first establish a rapport with the patient. Then look for humor by listening to what the patient jokes about. (One warning here, however—sometimes patients joke about what concerns them the most. Caregivers need to listen carefully and then tread lightly.)

Above all, do not go into a patient’s room with a battery of jokes. First, jokes can be offensive, and second, when you first enter a patient’s room, you have no knowledge whether they will be receptive to your kidding around. Keep in mind that humor is a wonderful bonding tool but it can also backfire and create alienation.

Finding Something to Laugh About

I believe that, as long as we are not in a state of shock, there is always something to laugh about. What happens in what we label as a “serious situation,” however, is that we turn off our humor antenna. The humor is there but we don't see it. And even if we do find the humor, we often label it as inappropriate. Yes, laughing at someone else's troubles is inappropriate. But sharing a laugh about some aspect of that trouble is not. So how do we determine what is appropriate and what is not?

Humor is appropriate if it comes from an open heart. I've always believed that is true but I heard another term recently, which can also guide us toward appropriate humor. One minister said, “if you use humor with a sensitive spirit then it will turn out okay.“

Using humor to poke fun at life-challenging illness is in bad taste if it puts down someone who is suffering. But appropriate humor, that which naturally comes out of adversity, is not.

Appropriate humor can help people cope. It empowers them. It is defiant, triumphant and life-affirming. It provides perspective and balance. And it diverts attention, provides comic relief, and liberates patients, families and caregivers from their loss.

Humor can provide enormous benefits in tumultuous times. The problem is how to find it .
Some suggestions follow:

Give people permission to laugh

”A lot of times, I'll ask a patient, ‘Well, tell me, do you laugh?’ Most of the time I get the answer, 'No way. I've got cancer, I don't laugh.'” So Lynn Erdman, RN, Director of Presbyterian Hospital's Cancer Center in Charlotte, North Carolina, then asks the patient, ”Well, did you used to laugh?” Often the answer she gets this time is, ”Oh, yes.” Erdman then pops the sixty-four-thousand-dollar question. ”Do you want it to stay the way it is now or do you want it the way it used to be?” Ninety-five percent of the time, patients want more laughter in their life.

What Erdman does, in a very simple and effective manner, is give both the patient and the family, who may feel guilty or uneasy about laughing when their loved one is dying, permission to laugh together again.

One of Erdman's favorite humorous hospital-related stories concerned a woman who was dying “a slow but not painful death.” The woman's daughters were vigilantly sitting by the patient's bed day and night. They were waiting for “Mom” to die. After several days, one of the sister's poked the other one and said, “How much longer do you think this is going to take?” At that point Mom opened her eyes, looked at the foot of the bed, where her two daughters were seated, and proclaimed, “A watched pot never boils.”

The death-watch environment immediately changed as the woman and her two daughters had a good belly laugh. Mom died twenty minutes later.

Know the Person

When my friend's sister had nose cancer, I sent her get-well wishes along with a red clown nose to cover her own damaged one. My friend was upset. He thought I should not have done that. I, on the other hand, knew his sister and knew she would probably like it. I knew she had a leaning toward the outrageous because several times she really appreciated the funny and sometimes off-the-wall children's books I gave her in the past.

Nonetheless, because of my friend's comment, I thought that maybe I had indeed offended her. So I called to apologize. She was surprised at my call because she had been delighted to receive the gift and the laughter it produced.

Several health care workers I spoke with talked of the importance of establishing a sense of trust before humorous encounters could begin. They stressed the importance of being aware of a patient’s feelings and listening carefully to what a patient is saying. Humor can help, they noted, as long as the patient knows that they are being heard. Humor used to negate the patient’s wishes can be detrimental.

Look for the ludicrous

Harry Kondoleon, author of Diary of a Lost Boy, a funny novel about a dying young gay man and his straight friends, once said, “Dying, you see some things as quite beautiful and others as ludicrous.” It’s the ludicrous part, as Kondoleon points out, that makes moments in the dying process laughable.

For example, in a letter to Ladies Home Journal, cancer patient Carol Willis wrote about the bittersweet but inane advantages of dying:
I must be truthful and say there are a few advantages in living only half a lifetime. Besides the end of good, death also means the end of tribulations, no more holding in the stomach, no more P. T. A., no more putting up the hair in pincurls, no more cub scouts, no more growing old.

And, in Reader's Digest, one person wrote about an absurd incident that happened the day after a friend's mother had died: “The local library called to say that the book her mother had requested was now available. When my friend explained that her mother had died the previous day, the librarian said, ‘Oh, would you like me to hold the book for three more days?'”

Can't laugh? Try smiling.

When I was a hospice volunteer and a home health care aide assigned to a new patient, I would sit in my car for five minutes before I entered their home. There, I would do a smiling meditation. I would sit silently and center myself by focusing on smiling. I had read the patient's chart and knew a lot about the person I was going to visit but I never really knew what it would be like when I'd enter their home. So I did whatever I could to bring whatever lightness I could into the situation.

A smile is a way of connecting non-verbally with a person. As someone once remarked, “A smile is a light on your face to let someone know that you are at home.”


Copyright 2011, Allen Klein