Doc, I'm breathing funny!
Funny peculiar, or funny ha-ha?

In this week's New England Journal, Rachel Sobel, a medical writer and fourth-year medical student at UCSF, has a thought-provoking piece about humor in the medical workplace. When young doctors loosen up in private, patients are often the butt of their jokes. This helps to shore up doctors' sanity in a stressful environment, but corrodes the dignity of the sick and the doctor-patient relationship.

The medical teams convened for a ritual snack break at 10:45 on a recent call night. We ate our ice cream in the far corner of the Moffiteria — as we affectionately call the cafeteria at UCSF's Moffit–Long Hospital — fueling up before the onslaught of admissions. The evening's theme: funniest beeper pages in the middle of the night.

"I once got this page from a nurse," said an intern. "`Doctor, your patient is covered in ants.'" The table erupted in laughter. Apparently, the patient had come in off the streets and brought the ants with him. They crawled out from their hiding spots after the doctor had done the initial workup. Another hilarious page: "Doctor, your patient is on fire." The man in question was psychiatrically unstable and had ignited himself. We were howling in between spoonfuls of ice cream.

[. . .]

In retrospect, I realized that during that night in the Moffiteria, I had, strictly speaking, violated a central tenet of the professionalism contract, which states: "I will treat patients and their families with respect and dignity, both in their presence and in discussions with other members of the health care team." We had been laughing at the patients and their misfortune. They were the butt of the joke, their dignity violated. But they were also the ultimate reason why I had endured the rigors of training thus far — and why staying up late studying had been a labor of love. In hindsight, laughing seemed a bit like betrayal.

Why, then, in those few seconds of juvenile hilarity, did I not feel an ounce of guilt? Perhaps it was simply that being with a group of other medical "professionals" made it seem okay. Or maybe it was justified because laughing brought us together as a team in an important bonding moment, which would ultimately benefit our patients. Or perhaps laughing was less about making fun of patients and more about coping, finding humor in a day filled with suffering. We were witnessing more darkness in our 20s than many other people see in a lifetime.