First appeared in slightly different form in the American Journal of Nursing, August 1985.


                        by Wayne Johnston, CRNA

You saw me laugh after your father died.

I was splashing water on my face at a sink midway between the emergency room lobby where you stood and the far green room where his body lay.  Someone told a feeble joke and I brayed laughter like a jackass, decorum forgotten until I met your glance over the doctor's grey flannel shoulder--your eyes streaming tears.

To you I must have appeared a callous buffoon in green pajamas, a personification of all that is cold and impersonal about hospitals.  In silence, I dried my face on paper towels rough as sackcloth, and retreated to the operating room.

My laugh was innappropriate, and for that I apologize.  But it was, nonetheless, a necessity.

I laughed, nominally, at a corny joke.  It's no secret that hospital people seem to enjoy warped humor, not always the lovable variety Richard Hooker dramatized in M*A*S*H.  We're too often morbid: burned patients become Crispy Critters; Vietnam casualites were Jungle-Burgers.  It can be ugly.  So can hospital work, at times.

From training and experience we learn to erect emotional defenses.  We are taught to avoid excessive involvement with patients, to employ 'professional detachment.'  All too often, the result is that the patient is depersonalized, becoming "the gallbladder in 308," or worse.

While we may appear emotionless behind our various masks, please understand: much of the stress that health care workers suffer comes about because we DO care, perhaps too much.  We cared about your father.  Though he was an unidentifed John Doe when the ambulance rolled in, we didn't need his name in order to care for him.

None of us in that room took our assignments lightly.  When I was starting a second IV line, with the Code Blue in full swing, I noticed that your father wore a signet ring just like my late father's.  All of us worked damn hard.  We intubated, oxygenated, monitored, massaged, shocked, injected.  And, in our various ways, prayed.  It did no good.  After forty minutes the doctor said ... stop.  We stood back, uneasily, avoiding each other's eyes.  We began to remove our puny and now futile tubes and wires, slowly, in awe of death, as always.  In silent sorrow.

A very wise man, Joseph Campbell, said in his book MYTHS TO LIVE BY that in order to really help this world of ours an individual must "live in it in the joyful sorrow and the sorrowful joy of the knowledge of life as it is."  Maybe someday, if I live to be 70 or 80, I'll gain a deep understanding of Campbell's wisdom.  At present I can at least see that we need joy in our lives to balance against the sorrow, and it seems a juggling act of apples and axes.

As a nurse anesthetist, I practice a similar juggling act every day, balancing painkillers against pain, matching dosages to severity over the course of time.  Anesthesia care is an Art and a Science, but no more perfect than any other human enterprise involving dynamic balance.  Every human fears, at times, that the axes outnumber the apples.

To be complete, our "knowledge of life as it is" must encompass death.  Confronting death as frequently as we do in hospitals weights our scales with sorrow.  We are left to search out our own sources of a counterbalancing joy.  Some find it in religion, in their families, in love; others, in poetry, music, art, sex, drugs, or food.  And then, thankfully, there is humor.

The most universal, inexpensive, egalitarian, legal and portable source of joy is humor.  Plain old everyday laughter.

Being human, and consequently clumsy jugglers on occasion, we all some time or other laugh at the wrong moment.  I hope that your father would understand that my laugh intended no disrespect.  It was merely a grab at balance, a knee-jerk reaction of the emotions, akin to what physiologists call a righting reflex -- what happens when a cat is tossed into the air.

That day you saw me laugh, I knew that another patient was awaiting me, another patient who would need my full undistracted attention in surgery.  As I stood at the sink and washed sweat and vomitus from my face and arms that day, my laugh was no less cleansing for me than your tears were for you.

Mea culpa.

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           © 1985 by AJN, 2000 by Wayne A. Johnston, CRNA

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