When laughter causes pain #WILTW

This is the 144th #WILTW

It’s 11.30pm and there are still 30 patients to be seen. It is a busy winter evening with long waits, some very ill patients and a noise level in the Emergency Department that makes it difficult to think. Having spent the majority of the evening in the Resus room with no break for at least 6 hours David wonders over to Sarah, the other senior on shift.

“You ok?”

“Yeah. It’s bedlam isn’t. Our inflow isn’t stopping. Feel sorry for some of these families. They’ve been waiting for hours. “

“Have you had a break?”

“No. lets just get these last few priorities sorted. Worried we are going to miss something given the length of time to assessment at the moment. Well done on the metabolic case by the way. Good call. “

“Was nothing special. Here have a quick a look at this. It’ll keep your spirits up.”

He shows her a picture on his phone. They both laugh out loud, exchange a few more words, and then continue seeing patients into the early hours of the morning. 

A week later David meets the head of the department. A complaint letter from someone who had waited 3 hours to be seen cites a person matching his description laughing at the nursing station. They want to know why doctors are employed if they aren’t going to be professional?

Doing the right thing in healthcare is a balance. There is no black and white. While values based leadership works, it only does so when values are agreed. A decision to close a hospital may save a life by improving the skill mix on an emergency rota; only to take another by increasing the distance needed to receive that skill. You cancel elective cancer surgery to free up beds for an emergency trauma list. Who judges whether that is the correct decision?

The more emotional the context of the situation the more an individual decision can be dichotomously vilified or applauded. How does a professional’s self care (sometimes in the form of humour) balance with a patient’s need for steadfast professionalism? What actions that are helpful to one person turn out to be offensive to another?

This week Archives of Disease of Childhood published a paper examining the role of clowns on Paediatric Intensive care Units. The authors acknowledged that while ward based professional clowns are well accepted, there use in the critical care environment seems counterintuitive. However they put forward a powerful argument, using their extensive experience, that this is not the case and describe how to approach this challenging situation to benefit children..

Also set on an intensive care unit and published this week, a different study demonstrated a letter of condolence sent by staff to bereaved families had no effect on grief reactions and may in fact have worsened depressive symptoms.

Interpreting how we are perceived by others is an almost impossible task.  As the ‘spirit’ of some communication is so spontaneous simply being aware our actions maybe mis-construed is the most pragmatic path forward.

It is the spirit which provides energy through a simple knowing look when the queue of patients to be triaged doubles. It is the spirit that provides resolve when a doctor and nurse go together to break bad news. It is the spirit that acknowledges gallows humour, not as demeaning to patients, but as a way to deal with the shared pain of some of life’s tragedies. It is a spirit that says, “I’ve got your back, because you’ve got mine.” – How the NHS Spirit pulls through 

What have you learnt this week? #WILTW

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2 thoughts on “When laughter causes pain #WILTW”

  1. Thanks Damian – I love reading your posts and reflecting on my own experiences.

    Patients and relatives perceptions is one of the reasons I encourage juniors to go to the tea room to eat rather than eat a sandwich at the desk. Out of sight is out of mind to the onlookers. I’ve had relatives complain that a doctor was taunting a NBM patient by eating in front of them, little realizing it was their first chance to eat something in six hours. Just like the queen, doctors need to eat, drink coffee and go to the toilet. We are human beings after all.

  2. Thanks Andy – In hindsight didn’t delineate the many subtexts this discussion could prompt (I didn’t touch on the consternation and disagreement about whether you can wear antlers at xmas causes!)

    Understand the need to eat lunch/drink coffee out of site and your example about NBM a really good way of getting staff on board with this. Must admit slightly more open minded about sweets – but suppose the same problems may arise and there is always the public health message as well!

    Always appreciate comments on #WILTW – so thank you again!

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