The joke sounds like a mordant New Yorker cartoon, or a crack from Dennis Leary’s stand-up routine: A pizza delivery guy lies dead from a gunshot just steps from his destination. The waiting customers find the pizza and one asks “How much do we think we should tip him?”
But this really happened to a real pizza delivery guy and a group of hospital doctors who ordered the pizza, leading one of those doctors to ask Northwestern University bioethicist Katie Watson a question: “Was it wrong to make the joke?”
Watson, writing in a report for the Hastings Center, a bioethics think tank in Garrison, New York, answers no. “To me, the butt of the doctors’ tip joke is not the patient. It’s death,” she writes in the report.
Gallows humor is a time-honored coping mechanism. Soldiers, emergency room doctors and nurses, reporters, cops, even families facing the imminent death of a loved one engage in gallows humor, much of it utterly unprintable here. One of the funniest people I know worked as a “death counselor” for the terminally ill and tragically injured, and it was amazing what she could do with material like stab wounds and brain cancer.
In the case of the doctors, when they found the pizza man, they struggled to save his life and failed. Yet they had a shift to work at the hospital and more patients to help. Cracking a joke, as crass as it may seem upon reflection, helped them do that.
“Doctors are not robotic systems for healthcare delivery,” Watson said in an interview. “They are human beings. Yet they are expected to behave as if vomit doesn’t smell, and death is not scary.”
Some of what Watson calls “backstage” humor -- jokes and stories told among doctors, or teachers in a teachers’ lounge, or war reporters in a bar -- is a way to relieve tension and excise demons.
Which is not to say it’s always OK. Watson believes doctors, or anybody else, should be guided by the thought of harm. Who will a joke hurt? Is the humor making somebody a punching bag when a doctor’s real anger is toward, say, his or her boss? Could future patients be harmed in any way?
Of course not all doctors, or reporters, or school teachers, or firefighters, want to publicize the fact that they make cracks behind closed doors at all. One surgeon, Watson said, “was upset with me for discussing it outside the healthcare profession. She worried it would make patients trust doctors less.”
To which we say -- nyuk, nyuk, nyuk – give us the doctor who laughs.
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