FiftyFourandAHalf

Judy was shocked when I came back through the swinging doors from the Blue Colony Diner’s bathroom laughing uncontrollably and sat back down at our booth.

“Ummm, Lease?  Weren’t you crying when you went back to the bathroom?”

I nodded, unable to speak or even breathe.  Unable to stop laughing long enough to explain.

My sister was clearly afraid that I had gone over the edge.  And of course she had good reason to worry.  You see, I had met her at the Diner hours earlier than planned, straight from a pre-surgical appointment with my doctor – my surgeon — in Baltimore.

He had, well, upset me.  I cried for the three hours it took me to drive the normal four-plus hour trip.

At the Diner, I told Judy that the surgery I was facing with abject terror in just over a month was going to be two operations, instead of the one I knew about.   Nobody, not one person among all the medical folks I met with, in all the months we’d been discussing my options, had thought to mention that, ummm, minor detail.

I was terrified.

I was pissed.

I was wallowing in self-pity.

So of course I was rather emotional as Judy and I sat in that booth at the Diner.  There, over tears and coffee, I explained the two procedures.  And then, because the reason for the surgery was bowel disease, naturally, I had to go.

The Blue Colony Diner’s bathroom is small with two stalls.  I had gone into the stall next to the wall with the window at the top, made myself comfortable on the pot, and got down to business, when it happened.

I heard a bang above me and looked up to see a ladder appear, neatly centered in the window.  And then I saw a large, work-gloved-hand on the lowest visible rung.  And then a second gloved hand appeared.  And then the first one moved up a rung. The top of a painter’s cap popped into view.

Shit!!!  Someone was coming and I was in no position for visitors. 

I was also in no position to leave quickly because, well, I was having bowel problems.  There was nowhere to hide — by then, somebody was in the next stall.  All I could do was sit there, waiting, watching and laughing.  The fact that the man climbing the ladder would soon look down at me shaking with laughter only made it worse.  I couldn’t stop pooping, I couldn’t stop laughing, I couldn’t finish up and leave.  I couldn’t do anything but wait for the inevitable while watching one hand after another go up the ladder rungs.

Back at the table, I was eventually able to tell Judy what had happened, wiping my tears away.

“This could only happen to me,” I said.  Then I sighed and looked at my sister. “Shit.  I guess I have to have the god damn operations.  Both of them.”

“Yeah,” said Judy taking my hand, “I guess you have to.”

Laughing at the bizarre appearance of a man in the window of the bathroom had let me laugh instead of cry.  It helped me calm down and accept the inevitable.  Let me come to terms with what I knew I had to do.  That yeah, it was two operations.  And yeah, I had to have them or continue to be sick.  Really sick.  The “sighting” let me release my anger and most of my self-pity.  The terror hung around a while longer.

“You know,” I said to Judy as we left, “I don’t know what I’d do if I had a disease that wasn’t funny.  Imagine how hard it is,” I said, “to have heart disease!”

I couldn’t have been more right.  Being able to laugh at my poop problem made it stink a little bit less for me and for the folks who went through it with me.  My family, friends, and co-workers.  Not so much my doctors.  Frankly, they just didn’t get the humor or my need for it.

So when I read an article in the New York Times about an oncologist who jokes around with his patients, I was delighted. I wanted to cheer.  I wanted to shout “It’s about time one of you guys figured this out!”  I wanted to pat the author on the back.

I also wanted to say “DUH!”

You know that I am a fake medical professional.  I am, however, an actual expert patient.  I’ve been going to one specialist after another for 40 years; I’ve had loads of practice.  Still, I swear I can count on one hand the chuckles I’ve had with doctors in a professional setting.  Seriously!  And that doesn’t make facing your illness (and your own mortality) any easier.

Most doctors — especially specialists — seem like they are preparing you for the afterlife rather than helping you be healthy in this one.  Funeral directors act less like funeral directors than do most doctors.  Yup, the Docs are often about as comforting as Charon, rowing you across to Hades.

Take my doctors (yup, I’m tempted to add “please”).  They are wonderful doctors, but it’s been hard to find one with a personality until fairly recently.

Dr. C., the gastroenterologist I was seeing when I was really sick in the 1980s, was a terrific doctor.  He took great care of me.  He was knowledgeable about the latest treatments and it was he who recommended me for what was then a new, fairly radical surgical procedure that gave me my life back. I will always be deeply thankful to him.

But he had no sense of humor at all.  He would look at me with deadly seriousness throughout my office visits and procedures.  I was always joking with him; that’s how I act with everybody.  He didn’t seem to get it though.  He didn’t seem to understand that I am funny and that that’s how funny people act.  Or that I might be afraid.  Or perhaps nervous.  Or that I felt completely alone.  Did I mention that I was terrified?

Early on in my treatment, Dr. C. once actually said to me, “Elyse, I don’t think you are taking your disease seriously enough.”

“Is there something you’ve told me to do that I’m not doing?” I asked.  “Am I ignoring any of your advice?  Any instructions?  Any helpful hints?”

“Well, no.  But you are treating your illness too lightly.  You joke about it all the time.  You have a serious illness, Elyse.  You need to take it seriously.  You need to act serious.”

“Oh, you mean it’s not normal to poop every time you take a breath?”  I asked.

He gave me a stern look.

“Dr. C., the only way I can deal with this disease is with humor.  The only way.  Besides, poop is funny.  Not so funny that I want to do it quite so often, but still.  It’s funny.”

From then on for the two years he took care of me, I was on a mission to make him laugh.  It made those serious sessions more bearable.  And when I finally succeeded? Oh it was sweet!

[Dr. C was trying to untie one of those crummy ties on my paper gown so he could examine me.  Instead, he knotted it and couldn’t get it open.

As he fumbled with it, I deadpanned “Good thing you’re not a surgeon.”

His eyes widened and then it happened.  He laughed. ]

Gastroenterologists are a particularly somber bunch, and that, well, that I just don’t get.  How can that be?  I mean, they have their hands and their noses in people’s butts all day, every day.  You would think they’d need a good laugh.

[Only once did one crack a joke.  He finished my rectal exam, and taking off his rubber glove, said:  “My children don’t understand why I enjoy doing that.”  I could have kissed him, but he smelled like poop, so I didn’t.]

Now back to the article.  It’s called “Poking Fun at My Patients.”  Dr. Mikkael Sekeres wrote about how he jokes around with his cancer patients, just as if they might need a chuckle.  Just as if they are normal folks.  As if they might just need the reassurance of normal personal interaction.

Wow.

Seriously.  It may be a medical milestone.  I’m pretty sure that this realization will come as a shock to many doctors.  It’s really too bad they already awarded the Nobel Prize for Medicine this year.

Dr. Sekeres has normal joking interaction with patients.  Give and take, a little bit silly.  And it makes them more relaxed, more comfortable.  It helps them to feel that they are people to him, not just a disease in some sort of organic frame.

Here is more of what Dr. Sekeres wrote:

Certain aspects of medical school, like learning the basics of normal and abnormal organ function, or rotating onto specialty services as mini-apprenticeships to recognize disease and treat it, haven’t changed much in 100 years of medical education.

What has changed is the emphasis on communicating with patients, which includes understanding how social and cultural factors and life circumstances can influence everything from disease occurrence to medication compliance. This is a good thing.

 […]

I need to have insight into their lives outside my stark exam room to appreciate how their environments will affect the care plans we develop.

We also learn how patients react to illness, and how a diagnosis like cancer can dramatically alter a family’s landscape, or how a person defines herself.

Serious illness can be physically and financially devastating.  It can also be incredibly isolating because you sometimes feel like the only person with such bad luck, or like you might have done something differently that would have prevented the disease, or that your life sucks and then you’re gonna die. And it’s gonna happen to you sooner rather than later.  Often it’s all of the above in some random pattern you never quite figure out.  It can engulf you.

The emotional burden of illness, though, can be eased a bit if more doctors act like Dr. Sekeres.  Being treated with a smile and a little bit of humor, well, it can make all the difference.

So next time you go to your doctor, especially a specialist you’re scared to see, tell him/her something from me and Dr. Sekeres:

Hey Doc?  Lighten UP!

*     *     *

Oops.  I apparently didn’t make it clear that this adventure, and those surgeries, happened 30 years ago.  I survived.