Cheryl and Susan arrived at the hospital at 6:30 AM. As was their routine, they stopped for their Starbuck’s latte and shared family stories as they walked toward the ICU. The two were well known pranksters but were widely respected for being top notch ICU nurses. The whole crew there was like a family. They went to baseball games, picnics, and vacations together. Today was like most other days. They were laughing as they walked into the ICU to meet up with the night shift, but could immediately see something was wrong.

Room three was, in ICU lingo, a disaster scene. There was a crash cart with defibrillator in the room with all drawers open with multiple vials and kits removed. IV poles, procedure trays, towels, drapes, and instruments seemed to tell the story of a failed heroic effort to save a patient, now under a sheet on a gurney.

The night crew was really bummed out. Carol, the night lead, told the story. A 32 year old woman had been admitted in severe sepsis, probably from a liver abscess which ruptured. She had severe internal bleeding, went in to shock and all efforts failed trying to stabilize her for surgery. She died about two hours ago. The heartbroken family had just left.

Cheryl and Susan immediately shifted in to professional mode in order to help Carol and the other RN’s, by saying “What can we do to help? Look, you have a bunch of calls to make and lots of charting to do before you can leave. What can we do for you?”

Carol responded, “The best thing you could do to help is to take the body to the morgue while we finish up here. We’ve prepped the body and it’s on the transport cart. We hate to ask but ….”

“We’ll do it.”

Cheryl and Susan were glad the hour was early, that the family had left, and that they we’re unlikely to bump into visitors coming up the back elevator. They could see the form of a fairly small woman under the sheet, but neither of them wanted to look. They were familiar with death, but this case was different. It felt close to home. They were silent in the elevator as they went to the sub-basement where the cold lockers in the morgue were located.
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It was fairly dim in the long sterile hallway, the only noise being the rubber wheels of the squeaking cart. Then they heard the noise. It sounded like a moan, “oooohhhhh”. They stopped, stunned and looked at each other. They knew that gases can escape from deceased bodies making noise on occasion, but this was weird.

After another 15 feet down the hall, the noise came again, even louder, “ooooooohhhhhhmmmmm”. Then it was quiet. As they approached the morgue doors, again “ooooooohhhhhmmmmm” and the body began to sit up.

Cheryl and Susan had had enough! They both screamed and ran away leaving the body now sitting upright on the cart. They ran down the hall straight into the arms of their laughing colleagues. The “body” was a co-worker, an RN target of prior pranks. “Revenge” was sweet.

Comment: Gallows humor seems to have a place in high stress occupations such as nursing, medicine, fire fighters, police, teachers, etc. It seems that if we can laugh we can deal with stresses much more effectively. Freud, as might be expected, had a much more complex view: In his 1927 essay Humour (Der Humor) he states his theory of the gallows humor: “The ego refuses to be distressed by the provocations of reality, to let itself be compelled to suffer. It insists that it cannot be affected by the traumas of the external world; it shows, in fact, that such traumas are no more than occasions for it to gain pleasure”. An interesting theory, but I personally view gallows humor as a only a temporary release and a momentary deflection with the reality of the traumatic situation remaining at the center.

Gallows humor is often a topic in the New Yorker cartoons which have been reviewed in an interesting fashion. Also it has surfaced in Presidential comments and as the subject of a review concerning its appropriateness in seriously ill cancer patients.

The above story I know is true. I walked into the ICU that morning just as the hilarity was underway. The RN’s are still really good friends. The names, of course, have been changed. I hope you won’t offended by this story which may appear disrespectful to some. But I’d agree with George Bernard Shaw who said, “Life does not cease to be funny when people die any morethan it ceases to be serious when people laugh.”

Jim deMaine is a pulmonary physician who blogs at End of Life – thoughts from an MD.

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