Critical Care Medicine - List
http://www.pitt.edu/~crippen/

The Essence of Humor in Medicine

David Crippen

Now let me tell you this was one beautiful girl...........Black Irish....... milky white complexion, raven black hair, piercing blue eyes, perfect proportions from stem to stern........except for one unmerciful trick played upon her during the constructin phase. Unfortunate woman was flat as a board. She still could do the usual feminine maneuvers involving legs (creative leg crossing and panty hose scrinching) but any attempt at a Security Bosom Clutch just yielded a lot of ribs between both arms.

Now you have to understand that we surgery residents saw and handled a lot of breasts.....a LOT of breasts..... from Breast Clinic on Tuesdays through private office stuff of the attendings and of course in our own domiciles whenever we got lucky and could stay awake long enough to perform a successful seduction. We KNEW about breasts and could speak articulately about roundness, firmness, pertness, ptosis, tilt, protuberance, tumescence, areola-to-skin ratios, pore saturation, EVERTYHING. Olga was a sniveling amateur compared to us.

This situation was esthetically unacceptable. Our sense of duty and honor as physicians was seriously alienated by the cruel joke nature had played on this innocent creature. Our sense of propriety, parity and balance was offended enough that we resolved to rectify this glaring omission by giving Mother Nature a little assistance from Dr. Bard and Dr. Parker. We were after all physicians and that job came with a God given mandate to relieve human suffering, including our own.

She was amenable. On the QT, we kept her NPO after midnight, ran her into the OR early in the morning for some flap revision........ and gave her breast implants under local anesthesia. It wasn't a big deal, a little field block with some xylocaine, an infra-mammary incision then you stick a gadget that looks like a pancake flipper in there to lift the breast tissue off the chest wall, revealing more or less gristle and ribs. Stuff the bags right in there, pull out the pancake flipper and sew up the defect with running subcuticular nylon and steristrips. No muss, no fuss and back to the room in less than an hour.

Like Michelangelo.......we reveled in our creation and it was, of course, necessary to examine it frequently to insure all was well in the healing phase. Our aim and mission as physicians and humanists became articulated immaculately before us. We gave this girl her life back. (Sniff) In addition to the armamentarium of creative leg crossing, panty hose scrinching, eye batting and pouting, she quickly learned to toss her head, do an impeccable security bosom clutch and flit off just like Cindy and Claudia do it.

Some of us actually made apartment calls following her discharge to insure complete follow up just like real doctors used to do it in the 50s. Never saw her again after I left. At least I never saw her weep and wail in public about them (coincident with the introduction of her new talk show or her new book).

Anonymous:

Sounds like sexual harassment or molestation to me. To be frank it is very unprofessional. Makes a woman such as myself extremely leery of male doctors who might have this same immature attitude.

David Crippen:

For those too obtuse to grasp it, this piece is an example of satire and irony. What is satire? Satire is a lyrical method of making strategic points, usually of a social or political nature, through exaggeration and irony. These qualities act as a hook to catch the listeners ear for subjects that have jaded listeners over the long haul and open up new ways of looking at old concepts. Those who take such things literally are destined to miss much in a life does not conform to the expectations of those with rigid personal agendas. The subtlety of humor is not knowing exactly where the reality ends and the fantasy begins. That is called "license" and it is virtually impossible to laugh at anything without it.

If you think about the nature of humor intuitively, you find that there (at least) three platforms from which humor is built:

1) Observations about the human condition.

2) Observations about human differences.

3) Observations about caricaturized stereotypes.

Observations about human foibles are generally self depreciating and rarely attract criticism because they tend to cut across social taboos. When your kid tells her teacher about the funny position she saw you and your wife in one morning or that you fell on your butt after slipping on a banana peel, everyone laughs. No one complains about "America's Funniest Home Videos" because it portrays all Americans in the same boat.

Observations about human differences garner criticism depending on the quantity of dehumanization brought to bear. I am sexually straight and Mike Darwin is Gay. We are close friends. We share a joke about the Gay condition that illustrates how different we are and yet how much the same. We do not share jokes that make each other appear to be less than authentic members of the human race.

Then comes observations about societal stereotypes. There are two types; those intended to denigrate classes or groups and those who use caricature to make points by allegory. The differences can usually be discerned by the presence of any "mean spirited" flavor.

This piece is representative of Class #2. Males like breasts. Women like men liking breasts. Breasts are a big part of culture. It is the human condition, and as such it is fair game for satire and irony because these things enhance and expand the potential to find humor in life.

Accordingly, I occasionally elect to expose the CCM-L subscribers to satire as an art form because it adds to the flavor of life. I use a lot of license in things I write, apparently successfully. Remember the piece of Spontaneous Human Combustion (see Med-Jokes archives). I got two serious inquiries as to this research requesting abstracts. The goal of satire is successfully obtained if readers can't quite discern it.

So, you say, "what was the point of this satire, if there was one?"

The point was to portray in humorous terms that medical trainees are multidimensional creatures even while working 120 hours a week, and can find fun and humor even in the most stressful circumstances. Now, I could have simply stated the obvious: "Hey folks, us medical types are regular guys even in the clinch of death and disorder". Gee, that really paints a vivid picture doesn't it. How long would you stand and contemplate that one. So I elected to use the tools of satire and irony (and exaggeration) to paint a picture than someone would stand for a moment and contemplate instead of walking on by.

I presented medical trainees as humanistic in that they really liked and enjoyed things that most everyone else like too even though the media stereotype depicts them as as cold, aloof, insensitive and money oriented. I casted all the players as multifarious players in the human condition comedy as a multidimensional process. Needs of patients are not necessarily conventional and methods of benefiting patients are not necessarily traditional. Along the way, I took a poke at those whose personal agendas equate fashion contrivance to real social problems and lip service to real solutions.

Nothing in this piece has anything to do with sexual harassment or human rights any more than Jonathan Swift's Modest Proposal really advocated the upper class eating poor people. It was written to ask people to see medical residents in perhaps a more interesting light than their stereotype, a light fueled by real the real human condition, not faddish social conventions. None of you know anything about the reality of this situation because you don't know what REALLY happened. All you know is what I intentionally spun of that reality. You are conjuring what your preconceived notions desire to believe about it. Those notions tell you more about yourselves than they do me, which is exactly the point of all satire, and as such has made this piece wildly successful. I wish I could now be as successful in convincing you all that it was just a piece of fluff generated to paint a picture everyone would enjoy to varying degrees and maybe think about.

I didn't say satire was socially correct, I said it would draw out individual perception in different ways and it would be more interesting than the usual pap we all get. You can all decide what you will make of it. As your FL, I would be remiss if I sloughed off "alternative" forms of looking at social issues impacting medical care ;-).

Life is not a spectator sport. Don't like it? Don't pay me.