This piece is on my Substack today, paired with an essay on the same topic by Lilian White, MD who is in her first year of practice. We have a little series going called early and late career collaboration.
On our way home from Friday’s housecalls I had to swerve for two dead ravens in the road. I don’t usually joke about death, dying or dead bodies, but suddenly found myself blurting out “two birds with one stone”. My assistant, who was a firefighter before entering the medical field, broke out in near-hysterical laughter.
“Gallows humor”, I said calmly.
“Exactly the word I was about to say”, she responded. “You don’t hear that word very often.”
Originally, the expression referred to when those convicted to public hanging at the gallows tried to be funny to relieve their own fear of dying. But now any joke about life or death situations can be called gallows humor.
We spent the last mile or two of our trip talking about how medical people and emergency workers seem to be able, or even have some sort of need, to make fun of situations that don’t seem funny to lay people.
In some ways, finding something comical in situations that involve death or disaster is a way of distancing ourselves from the tragedy of what we are witnessing. And at the same time, sharing a joke about it is a way for us to bond with other people who also must deal with tragedy on a regular basis in their work.
Of course, any public sharing of these macabre coping mechanisms of us life-or-death workers would be offensive or hurtful in most situations. But privately, between colleagues, I think it can be valuable in helping us carry on, no matter what.
As physicians or any other worker in this field of helping the sick and tending to the dying, we must live up to the expectations our patients have of our demeanor. Just like clergy, we have roles to play in people’s lives that are incompatible with lightheartedness or flippancy. This goes back thousands of years, to Hippocrates and beyond. Gallows humor is our secret little safety valve when the pressure of living up to these ancient standards threatens to be too high.
A Country Doctor Writes: 
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