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Humor in Nursing Homes

Written by Grace Rudolph, LSW

Writers often use humor as a foot in the door when they want to slide in a heftier message. It was used effectively in the movie, A Beautiful Life, a movie about concentration camps and Nazis; Ira Levin used it in Death Trap, a play about murder, greed and mayhem, and Elizabeth Berg used it in Open House, a novel that dealt with a betrayed woman's feelings of grief, abandonment and anger. Without humor writers would be lost. Without humor, life for those working in nursing homes, and their clients, would be grim.

When I began thinking about humor in nursing homes I thought I'd better settle down and take the subject seriously. If I was going to write something on the topic I'd go for a scholarly approach. I went to the ‘Net and dug up reams of material dealing with the chemical and biological effects of laughter. Dry stuff. I was on the right track. Laughter, it turns out, is a very serious business. For one thing, I discovered that nurses with a job that involves blood and excrement have a bawdy sense of humor but, take that same nurse and put her in a classroom where she's teaching ethics or documentation and - voila - she'll have a loftier approach to humor.

As a child my goal was to read the dictionary from cover to cover. I still find it impossible to search for a word in a dictionary or thesaurus without getting sidetracked for hours on end so you can imagine my delight when I discovered the ‘Net. The world was my oyster. I intended to steal material right and left and plagiarize to my heart's content but the notion of this mythical nurse having a dual sense of humor kept nudging its way into my mind. For some reason it was such an interesting concept that I found myself thinking about nurses instead of social workers. Since I'm a social worker to the core I feel I can justify focusing on them for a moment because the disciplines of social work and nursing go hand-in-glove. Also, if you look at the ratio of social workers to nurses in nursing homes you'll find they've got us outnumbered, really outnumbered, big time.

It's to our advantage to make friends with these people because if you don't, your life can become a living hell. Granted, they have a different mind set than ours and at times they seem like a different species. They order pizza and wolf it down while passing around Polaroid shots of Stage III bedsores and discussing wound care. We order pizza and have a nice little salad with dressing on the side, and a glass of house red while discussing the cardiac benefits of red wine versus gin.

I've always suspected there's a direct correlation between patient care in nursing homes and the level of humor on a unit. If nurses don't see life's funny side, if they just don't get it and you do – watch out. I once worked on a unit that on the surface looked great but, in reality it was the unit from hell. On that unit ‘life was real, life was earnest.' It was also very grim. So much so that if I even hinted I wanted the other social worker to cover for me she'd recoil and say, "Me? Go up there? Are you nuts?" If you smiled on that unit you were immediately suspect which, in a way made sense since there was rarely anything to smile about. When humor and joy are pushed out of a resident's life they seem to fall out of bed frequently, bedsores blossom and there's usually finger pointing and anger. No one's happy.

William Fry, a psychiatrist known as "the granddaddy of laughter research," believes humor may even "enhance our bodies ability to protect us." I agree. When I worked on that infamous unit I often got panic calls ordering me to "get up here right away" to break up dog fights. I was terrified of dogs. It took me a long time to accept that one of my responsibilities as a social worker was animal control, which incidentally I couldn't find in my job description. But eventually, at the administrator's insistence, I accepted my fate and was breaking up fights between Pit Bulls named Daisy, and Finnish Spitz' named Beelzebub. Once that ‘fight or flight' thing kicked in I even began to feel more comfortable with the whole situation and, by the time I got use to grabbing choke collars with spikes and pulling my shoes out of foaming mouths, I had developed an ability to communicate with canines. Today I look snarling dogs in the eye, growl ‘Don't even go there!' and they whimper and back off. So far.

After surfing the ‘Net I know what Alpha males have always known. Top dogs finish first. Top dogs have enough adrenalin and endorphins raging through their bodies to ward off attacks. Dr. Fry was right. A sense of humor protected me. I could see how ludicrous the situation was and humor became my sword and shield. I think my mother said there something in the bible about that. ‘In the midst of fear there is humor.' On the other hand, maybe it was only my hysterical laughter during dogfights that threw Daisy and Beelzebub off guard long enough for me to escape.

While researching humor I unearthed enough scholarly insights and information that, if marketed properly, could be sold as a cure for insomnia. I could have you yawning and snoring in ten minutes or less if I shared all I learned about humor. Instead, here are the ‘cliff' notes.

It wasn't until the mid-80s that researchers began to focus on the connection between humor and the immune system. I don't know when the movie Patch Adams was released but the doctor who was the inspiration for that movie was in the vanguard of promoting the concept before then. The final results aren't in but there appears to be growing evidence that humor can activate T-cells, endorphins and even increase the cells that produce immunoglobulins in bone marrow. In short, there's a strong suspicion that humor may be beneficial in fighting off everything from colds to tumors to sleepless nights.

I've had a lot of experience with sleepless nights. Especially, when trying to meet a deadline for an article. I'll toss and turn until three a.m. but, let one funny zinger work it's way into my imagination and I know that blessed sleep is around the corner. A good laugh at three in the morning beats Ambien any day, or night. Research indicates that laughter may, perhaps, have changed my oxygen saturation levels, decreased my cortisol levels and even released some endorphins. As I think my mother used to say, ‘In the midst of insomnia there is sleep.'

The only negative involved in all this is that by the time I've mumbled and chuckled my way through a story line, enjoyed a good laugh and have finally drifted into the arms of Morpheus, my husband is alert, wide-eyed and then falls asleep ten minutes before his alarm goes off.

On units where the staff thinks outside the box, and isn't that what humor and creativity is really all about, there's a stronger sense of community. There are generally fewer call outs and less burn out and so it follows, as night follows day, that residents will do better physically and emotionally.

One of the under appreciated benefits of working in a nursing home is that often we're surrounded by residents who just naturally think outside the box. They help keep our humor on track because they view the world from a different angle. They know it's possible to catch a bus at the nurse's station or, if not a bus, at least a beer.

On one of my favorite units both residents and staff thought outside the box. During the day the place buzzed with activity, but in the evening life wound down to a soft hum because Ruby, a young Irish nurse with freckles and masses of curly red hair, believed that as the sun goes down the lights shouldn't go up. Ruby had a unique approach to sun downing and I have to admit it did seem to work on that unit. In the early evening, as shadows lengthened, she straightened surfaces, dimmed lights and put on Frank Sinatra CDs. A gentle quietness settled over the unit like a comforting patchwork quilt.

I sat beside her at the nurse's station one late winter afternoon as we finished our paperwork when suddenly a lanky WWII Navy veteran, lured out of his room by the soft music and dim lighting, shambled up and leaned his elbows on the counter. Ruby glanced up and dazzled him with a smile. "What can I get you?" she asked.

He winked, gave her a slow grin and said, "Got any Coors back there?"

"Gee no," she said. "But if I did I'd share it with you. How ‘bout some apple juice instead?"

Well, this poor guy looked up and down the near empty halls and you could see the disappointment in his face. The only sign of life, besides Ruby and myself, was a 98-year-old woman bundled in shawls and nodding off in her wheel chair at the far end of one of the halls. "Nah," he said, "I'm not gonna get any action around here. Might as well go home." As he shambled back to his room he muttered, "What kind of a bar is this anyhow!"

And that brings to mind a hazy childhood memory about another almost remembered quote passed on to me from mom. ‘In the midst of sorrow there is humor.' Maybe it was just something she made up after being cooped up in the house all day with no adults to talk to and I came home from the battlefields of the schoolyard in a whiney mood. But since the day she passed on those words of wisdom I've always been able to find "comedy in crisis." It's a hard concept to accept and you have to dig deeply into your psyche but finding "comedy in crisis" is therapeutic.

A few years ago I co-led a men's group. One of the men, Sol, was an elderly gentleman who wore cardigan sweaters, bow ties, and carried a cane. He had snow-white hair and a trimmed moustache. If God were clean-shaven He would look exactly like Sol. The other residents, regardless of age or sex, looked up to this dignified man as their guru. He was soft-spoken and saintly, one of those rare souls who exuded an aura of goodness, peace and harmony. He was our Gandhi incarnate. Everyone turned to him for advice and comfort.

On the day Emily, an elderly resident, was told her daughter had suffered a second heart attack and was not expected to survive Emily became distraught. After the first heart attack Emily was told not to get her hopes up because the prognosis was poor, especially if her daughter suffered a second heart attack. Emily was sure that if enough of us prayed to God directly, no going through saints, He would intervene. She enjoyed a deep and personal relationship with God and her faith sustained her. But, on the day she struggled with the news about her daughter's second heart attack she withdrew to grieve in private. No one could comfort her. As she started down the hallway towards her room we stood by helplessly. You can imagine our relief when Sol appeared from around the corner and slowly made his way towards her, until she shouted, "Hey! You!" An internal alarm went off in my heart. Remember that old warning on Sesame Street? Danger. Danger. Sol looked around the hall then pointed at himself and raised an eyebrow. "Yes. You!" Emily began thunking her walker against the floor and the thunks got louder and more forceful with each step.

"It's YOUR fault," she shouted. Sol was baffled. He hadn't heard about her daughter. He was just an innocent bystander on his way to Bingo. When she got close enough she began jabbing her finger against his chest and for a moment I thought she was going to dislodge his pacemaker. "Listen here, God…." she shouted, "I prayed, we all prayed." We looked at each other, looked at Sol and shrugged. "But did You listen? Ohhhh no! Not You!" Sol looked to us for help but we were frozen to the spot. A Haitian aide made the sign of the cross and closed her eyes so she wouldn't witness Emily being struck by a lightning bolt and fused to her walker. "Don't expect me to pray to You again," Emily said. She picked up her walker and tried to beat up Sol. Fortunately, her gait was unsteady and her aim poor. Sol still didn't know what he had done wrong but he began to defend himself with his cane until two burly aides stepped in and broke up the fight.

Later that day her son-in-law called. Her daughter was still in intensive care but Emily smiled for the first time as she explained that the little incident with Sol was just a case of mistaken identity. She saw the incongruity of the situation and that faint glimmer of humor shrouded in uncertainty and sorrow, helped ease her tension. Humor, like a good cry, has the power to cleanse the soul. She was finally able to accept emotional comfort. Even from Sol. From God? That may still be iffy.


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