Humour and laughter are present in most of human interaction. Interactions inhealth care settings are no exception. Palliative care practitioners know from experiencethat humour and laughter are common in palliative care despite the seriousness of the carecontext. Research establishing the significance of humor in care of the dying is limited

This is Part 3 – The Research – Part 2

Research Findings

Humour and laughter were pervasive and persistent in the palliative care setting. Ranging in intensity from warm subtleties to uproarious hilarity, they varied in expression from gentle remarks, witty expressions of incongruity, playfulness, dark humour, and the sharp edge of humour with a bite. In each circumstance, humour generated an outcome, ranging from a momentary flicker of a smile, to a small chuckle, or to uproarious laughter that energized and lightened the atmosphere. Humour served myriad functions. Among these multiple functions, three primary categories emerged: building relationships, contending with circumstances, and expressing sensibility.

Contending with Circumstances

Humour and laughter were significant for both patients and staff as a means of contending with the circumstances of tension and sadness that often emerged in the setting. Humour could not change the facts of the situation. All of the patients ultimately died, regardless of the quality of care they received or the devotion of the family. Although the realities of terminal illness could not be altered, the experience of the final days and weeks was profoundly influenced by the use of humour.

Humour as Respite: Transforming the Moment

When something is transformed, there is a change in form, expression, or character. Humour often pro- vided a respite that changed the expression or character of the situation. For patients and fami- lies, laughter offered a moment ’s pause f rom the burden of illness, suffering, or grief. For staff, it offered a break in the intensity of caregiving and the pressures of demanding situations and work- place pressures.
Not only was there a discernible change in the atmosphere, the transformation was often visible. There would be a physical change in the counte- nance of the participants. Eyes would twinkle, and furrowed brows would momentarily relax. As one nurse described sharing a joke with a patient, “she threw back her head and laughed, she just transformed.”

Transcending the Moment

Combined with kindness and sensitivity, gentle hu- mor had the capacity to transcend an individual moment into something meaningful that extended well beyond that moment. Two nurses recounted a story of taking a patient outside in his bed for a contraband cigarette in the middle of the night. Joined by a second patient as passenger on the same bed, the quartet shared delight in escaping the confines of the institution and shared what proved to be a last cigarette for a dying man. Just telling the story brought tears to their eyes. No single detail makes the story funny. Yet the com- passion and good humour with which it occurred lingered long past the event.

Humour as Survival

Humour can be profound, an essential quality of how one approached the world in sickness or in health. Several participants spoke of humour as an integral part of their survival despite the ravages of illness.
Physician: “So you’ve had pain for 3 years? How have you survived and still maintained such a good sense of humour?”
HP: It’s because of the sense of humour that I’ve survived. Without that I wouldn’t still be here.“

One team member told a moving story of serious illness in her youth.
As consciousness returned, she was aware of intense pain, feeling foggy, drifting in and out, and terrible depression, nearing despair. Each time she struggled to consciousness, her roommate would speak with her and offer good-natured humorous anecdotes and encouragement. She came to see those moments as her lifeline, something to draw her back to consciousness and the world of the living. She now believes that they were what gave her the strength to endure the pain and depression and to fight back to recovery. She has remained ever grateful to that man and to the profound effect she had on her life.

Humour so profound as to contribute to survival is a deeply personal experience. There was a qualitative difference to these stories. The palpable sense of meaning and intensity with which they were told spoke to their authenticity.

Tension Relief/Lightening the Heaviness

In an environment where the heaviness of death, the demands of a fast-paced workplace, and bureaucratic pressures sometimes collided at a crossroads of tension, humour helped to offset the heaviness and lighten the burden. Laughter, sometimes in the company of tears, sometimes as an alternative to tears, served as a means of relief from accumulated tension.

It ’s def initely a morale booster, sometimes when you have the most stressful day and you’re ready to cry, sometimes it’s easier to bring out a sense of humour and take it the other direction instead of bawling on somebody’s shoulder for half an hour.
On a particularly busy and stressful morning, tension was in the air. There had been three deaths within an hour, call bells were incessant, and phones kept ringing. Reaching to answer a second phone while holding the line on another, one nurse broke into a pantomime of a two-headed Sesame Street character. With neither patients nor family mem- bers present, laughter erupted, dispelling the ten- sion, and creating an unexpected and welcome sense of relief.

Maintaining Perspective/Providing Support

Patient care conferences were an important as- pect of team work and were also a forum where humour enjoyed a heyday. Fieldnotes included this illustration.
The conference today is remarkable for the wit- ticisms that are flying around the table. The patient who is being discussed does not want to be discharged, she feels safe here. Dr. GL: “Dan- ger, danger @imitating a siren light turning# pa- tient feels safe on palliative care.” “There’s a joke if I ever heard one.” The whole room fills with laughter.
Anyone entering the room was immediately drawn into the good humour and kibitzing that prevailed. Team members went away feeling supported and renewed. Humour enhanced the sense of team spirit and community.

During the course of the fieldwork there was a story in the local newspaper that shed an inaccurate and unfavorable light on the unit. Staff were dismayed and subdued. Several days later, the team began to regain a sense of perspective about what had happened. The next team conference was punctuated with outrageous suggestions for possible headlines, “Patient forced to return to home without provision for groceries” and others. Distress was diffused as staff regained the ability to laugh about their situation.

Keep reading in Part 4 …

Part 1 – Introduction, background & Methods
Part 2 – The reseach, Part 1 – Building Relationships
Part 3 – The reseach, Part 2 – Contending with Circumstances
Part 4 – The reseach, Part 3 – Expressing Sensibility
Part 5 – Discussion