Cindy Lauren was lying on the gurney at the University of California, Los Angeles, Medical Center, scared out of her wits. There she was, surrounded by specters in masks and gowns, and soon they were going to cut into her breast and remove a cancerous lump.
As she was trundled toward the operating theater, her surgeon, Dr. Susan Love, walked with her, holding her hand and treating her to joke after ribald joke. Lauren arrived at the theater in giggles.
"It was one of the most terrifying moments of the whole ordeal -- but it was also one of the best," she recalls. "She made me feel so much better about the whole thing. I will thank her till my last breath for that."
When people have serious illnesses to deal with, being able to laugh can help them. Dr. Patch Adams, the doctor-clown played by Robin Williams in Universal Pictures' new movie, knows this full well. But he's not the only one. Long before Adams, the ancient Greeks built their healing houses next door to their theaters, so that the sick could enjoy the comedies performed there.
"A merry heart," wrote King Solomon, "doeth good like a medicine."
Today, there are many health care professionals, clowns and other performers who think just like Solomon and are doing their best to bring some levity to the lives of sick people. Some are everyday doctors and nurses who just naturally banter and quip as they go about their jobs -- perhaps as much to help themselves, not just their patients, cope with the hardship and stress of medicine. Some are patients who have turned to stand-up comedy or the humor to be found in support groups to help themselves and others better deal with hard times.
In fact, there's even a society devoted to mirth in medicine, called the American Association for Therapeutic Humor. In January, the society will present Patch Adams with an award for his work. And they'll round off the conference with a "joke jam," with past and present officers and the audience pitching in with their favorite anecdotes and one-liners.
These people aren't saying that serious illnesses like cancer are a great big ha-ha. More important, they're not saying that humor is a substitute for proper medications, medical skills or compassion, or that all you need to do is laugh 10 times a day or put on a clown nose and everything will be fine. But they do think that humor's an essential part of the medical tool kit.
"I can't change a person's diagnosis," says Patty Wooten, a nurse from Santa Cruz, Calif., who travels the world giving talks to hospital nurses. "But I know that I can improve the quality of their life. If I'm with a patient who's had a tough day, and I can at least get them to laugh, then at least they've had a bit of joy amidst all the stuff that I can't do anything about. And if people feel joy, and hope, and optimism, more of the positive emotions, they tend to fare better in their illness."
The idea that the mind can affect the body is no longer outrageous. It's a respectable research field, with its own unwieldy name: psychoneuroimmunology. Our minds, scientists are finding, can "talk" with our immune systems and other organs, using chemicals and electrical signals from nerves.
There are studies suggesting that this might make a difference to disease. Studies showing that people under stress (such as medical students and elderly people caring for sick spouses) have somewhat weakened immune systems, and are more likely to catch colds or the flu. Others suggesting that psychological support can improve survival in patients with various kinds of cancer. Still others, on the flip side, showing that negative emotions like anger, insecurity and distress can increase one's risk of heart disease and stroke.
Few studies have focused on humor itself, but here, too, there are hints. In a series of experiments, researchers Lee Berk and Dr. Stanley Tan, both of Loma Linda University, drew blood from college students who were watching funny videos. They found that levels of disease-fighting antibodies and immune cells went up. Levels of cortisol -- a stress hormone -- decreased.
And it's important to laugh, stresses Wooten. Becoming a clown had a miraculous effect on her own life. It was 1973, and a grim time. Her husband had left her. She was struggling to support herself and a 3-month-old baby.
"I decided I needed to jump-start my spirit to get the laughter back into my life," she recalls. "So I went to clown school. And it was wonderful. I didn't just learn how to apply makeup, do magic; I learned how to approach situations differently. Clowns approach everything with joy."
Pretty soon, Wooten brought her clowning skills to the nursing home where she worked. The residents -- Alzheimer's and stroke patients who spent hours each day staring at walls -- loved her japes. "The nurses said, `Wow, we've never seen the patients with such energy,' " recalls Wooten. " `They're starting to talk and smile. Could you teach us?' "
But one doesn't have to be a clown or performer to inject humor into the care of a patient. Some people, like Dr. John Messenger, cardiologist at Long Beach Memorial Medical Center in California, just do it.
"Ha ha ha ha," is heart surgery patient Michael Rivard's first response when he's asked about Messenger. The second is unbridled enthusiasm. He can't quite put his finger on what Messenger does (it's "real cornball stuff," says Messenger) but he knows it makes him feel better.
Humor really matters, says Rivard. "My wife says, `I don't know how you can make jokes through all this stuff' -- but if I lose my sense of humor, it gets ugly," he said.
Jane Hill, who discovered she had breast cancer six months after taking a stand-up comedy class, feels much the same.
Seven years and four surgeries later, Hill, has made a second profession out of stand-up comedy, performing for cancer patients and health care workers at fund-raisers and conventions around the country. She's one of a number of cancer patients who've turned hard times into humor this way. Cancer has provided her with a wealth of material -- more than she ever needed or wanted.
Prosthetic breasts floating out of her swimsuit at the pool. Ghastly wigs. HMO horror stories. Sufficient hours in the surgery to rack up "enough frequent gurney miles for a free operation." Much of the humor is dark. But often, says Hill, that's just what helps.
Laughter and humor, caution Hill, Wooten and others, should not be foisted on people. Many, especially in the first shock of dealing with a serious diagnosis, aren't ready to see the macabre or funny side of what they're going through.
Humor is also very individual, they say: You need to find out what works for you, or the person you're trying to help. And patients should never feel that they're to blame for their disease because they didn't laugh enough, or their disposition wasn't sunny enough.
Just use humor and laughter where it helps, agree caregivers and patients alike.