During a long day shift, which included, by-the-by, a multiple system trauma sent downtown and a VSA, a few of us, the doc and a couple of RNs, are by the Treatment Rooms desk, when Triage brings us a couple of charts. The first is a 24 year-old woman presenting as “Difficulty Swallowing” and the second, has the very unfortunate chief complaint of “Salty Taste in Mouth.” Some things you cannot make up.
Much mirth, all in completely adolescent bad taste, ensues. Is there any other in the Emergency? A patient or family member, clad in Middle Class Canadian Suburban Winter Attire, overhears us a little and waxes indignant. She marches up the to the nursing station, and announces, “You are being. . .”
A pause while she searches anxiously for that particular damning word
“. . .unappropriate!”
Which provokes more unappropriate laughter after she haughtily stomps off. Of course, we’re being unappropriate. No doubt about it. It’s a truism emergency staff, nurses and physicians alike, have a wicked black sense of humour, explained away by the uncontrollable stress we face. Regular readers have seen numerous examples of it on this very weblog. But like any truism, it needs some examination. It’s true emergency staff use humour to blow off steam. Some of the funniest one-liners I have heard have been uttered while body-bagging the particularly difficult, tragic, and ultimately unsuccessful code. It’s a coping mechanism. We have to laugh, lest the awful meaninglessness of it all overwhelms us.
But there are other reasons. You have to see any emergency department as a kind of pressure cooker, where egos as toothsome as sharks swim the corridors, with its own peculiar culture, jargon, ritual, etiquette and notions. Those new to the emergency are sometimes overwhelmed by the intensity. Humour allows newcomers to be socialized to emergency department esoteria, to share in its particular mores. It helps them to become one of us. And among the veterans, it sustains a sense of cohesion when times are tough, tempers flare, and tension runs high. In short, humour keeps us from feeding on each other.
All humour requires a theme and stock characters. The general theme — with variations — in emergency department humour is Our Unending War with Human Stupidity, the narrative features our own cleverness in dealing with the stupid, the stock characters typical: the Drug Seeking Individual, the Foreign Body in Unlikely Places, the Muffin in Distress, the Drama Queen, the Nursing Home Dump, the Too Stupid to Live, the HBD and Went Boom. But there is danger in creating the Us-and-Them mentality implied in warfare, because it also implies treatment and care according to our subjective whims. Labels and caricatures deceive and misrepresent, when what is needed is accurate assessment. The Muffin in Distress, after all, might be a septic gallbag; the Drama Queen, an ST Eelevation MI; the HBD, a cerebral bleed. Most of us, it’s true, work beyond the labels, and treat the patient, not the caricature. But we have all seen cases where the opposite was true.
Yet unlike hospital administrators or professional regulatory bodies or other bloodless types, I cannot pass judgement. I use humour myself. I am, at times, irredeemably unappropriate. But sometimes, life in the emergency department sucks, and in ways unimaginable to most people. To use a catchphrase, embracing the suck allows us to do our jobs.