Gallows Humor in Medicine, on TV and in Real Life

The surgeons are waiting in the ambulance bay. An ambulance screeches to a halt in front of them. A paramedic jumps out, and breathlessly gives report: “Speedboat accident! Nineteen year old female. Lost vitals twice but BP’s holding in the low 80’s. Both arms amputated at the scene and right leg is holding on by a thread.” 

Owen Hunt, tall redhead trauma doctor, asks: “Did you recover either of the arms?”

The paramedic shakes his head. “No, they’re probably at the bottom of Puget sound. She was thrown from the boat and got pulled into the propeller.” 

Hunt grunts. “Okay, get a central line in her, let’s go!”

Surgical resident Christina Yang barks orders as they push the stretcher: “Type and cross her and get as much O-negative as possible!”

Just then a car speeds up and a beautiful young woman in a bikini and short shorts tumbles out, carrying a bloodied bundle of something: “Wait, I found them! I found them! Her arms!” She thrusts the bundle into Yang’s face. “I found them in the water, you have to take them. They were just floating in the water.”

A second beautiful young woman in similar belly-button-revealing garb pops out of the car and demands to know: “You can sew them back on, right?”

Yang cradles the arms in her arms and generically reassures them: “We’ll do everything we can.” Then she rushes into the hospital. 

The bikini girls just stand there for a moment, and then one looks at the other. “Oh my God JoJo, that was sooo gross.”

***

So what is this, a memory from ER shifts past? Nope, this was the premiere episode for Season 6 of Grey’s Anatomy, a really fun doctor drama that my daughter and I are binge-watching. 

I had never watched this show before, or ANY television for many years. I swore it off for medical school and it was so extremely effective for productivity, I just kept going.

And wow, I missed out on some real fun. Now, my daughter and I started from Season One and we intend to watch the whole damn 17 (or however many there are) seasons. We’re bonding over blood and guts and plenty of soap-opera-level sex-and-intrigue. 

I’m sure many reasonable and responsible people would consider this show totally inappropriate for a 12-year-old, but I see it as chock full of educational moments. Like the one around this dismembered arms storyline. 

In the episode, a beautiful young woman named Clara had been rushed to Seattle Grace Hospital after a horrible boating accident involving her and a revving speedboat propeller. Both of her arms were neatly amputated and of course, she had to be aggressively and entertainingly  resuscitated in the ER. 

Then, the one orthopedic surgeon on staff somehow had the technical skills and knowledge required to reattach the limbs, despite having just graduated from residency a few seasons earlier. 

So that happened, but oops, they couldn’t reattach her dangling right lower leg so she’s stuck in the hospital for the rest of that episode and some of the next one, too, which is a heck of a long time in TV-land so she becomes quite depressed.

Here’s the teaching moment part of it: The residents refer to her as “Ceviche”. 

Why “Ceviche”, you ask? Let’s let trauma surgeon Owen Hunt and his girlfriend/ gunner resident Christina Yang explain this gallows humor reference, as they’re talking about friend and colleague’s George O’Malley’s funeral (which is a whole other storyline we won’t get into here): 

So, I actually paused the show here and I asked my daughter what she thought of the residents referring to this poor girl as “Ceviche”. 

She didn’t even need to think about it. “I think it’s awful, really awful, and I want to know, did you guys do rude stuff like that?”

And it is awful, really awful.

So we talked about it. I explained: “I think they’re making the point that working in a hospital, you see such horrible things that don’t make any sense and also make you really uncomfortable, and one coping mechanism is to deflect these confusing and painful feelings using dark humor. Like, see how Christina can’t even deal with thinking about George’s funeral, so she cracks the Ceviche joke instead?” 

I pointed out that the show is full of memorable examples of exactly this coping mechanism in action:

Then I thought back to my own medical training. Were we that awful?

Yeah, we were. Probably worse. 

The gallows humor emerges early. For us, it started in the very first semester, in Gross Anatomy. We had a class of about 80 students, and I think twelve bodies for dissection, each one in its own covered metal table and shrouded in formaldehyde-soaked cloth. 

We were all more than a little weirded out and nervous. I mean, we’re seeing real dead people here. And, Gross Anatomy was rumored to be a culling course, meaning, some people would fail it and possibly have to drop out of med school. (Which was true, as I recall we lost at least one student that fall.) 

You would think we all would have been dead serious 100% of the time. 

But right off the bat, there was so much off-color inappropriateness. I’m thinking of the mnemonics we used to memorize things like the 12 cranial nerves. The nerves are Olfactory, Ocular, Oculomotor, Trigeminal, Trochlear, Abducens, Facial, Auditory, Glossopharyngeal, Vagus, spinal Accessory, Hypoglossal. 

The study guide helpfully suggested “On Old Olympus’ Towering Tops a Finn and a German Viewed Some Hops”. 

But medical students before us had come up with “Oh Oh Oh To Touch And Feel A Girl’s Vagina, Ah Heaven”. 

Guess which one worked better? Pretty much any effective mnemonic featured preteen-boy-level sexual or scatalogical references. 

As the course went on, we became accustomed to the horrific formaldehyde stench that seeped into our clothes and hair. Though we weren’t supposed to eat in the lab (for many, many good reasons), during long study sessions people totally snuck in food. I even saw people rest their half-eaten PB&Js right on the metal table while slicing and dicing the plasticized flesh inches away. I think we should be concerned about all the carcinogens we were exposed to, inside and out. 

Then, there was Halloween. We were pretty far into the abdominal dissection and there was an exam coming up. It was common for students to creep back into the lab at night for extra dissection and hands-on studying. So a small group of practical jokers (not me) went around and hid realistic-looking plastic spiders in the crevices of the bodies and then parked themselves, waiting for victims. 

They were not disappointed. One girl almost fainted. Her scream rung out far and wide. Security even came up to check out the situation. Of course no one snitched– honestly, those pranksters (not me) could have been kicked out for pulling disrespectful shit like that.

And then… there was Table 7. 

It wasn’t clear at first that the 70-ish year old male on Table 7 was much different from anyone else. Dissection etiquette called for only exposing the part of the body that we were studying, and keeping the rest covered and moist. We even had recycled kitchen spray bottles with chemical liquid we had to spritz over any exposed tissue so it didn’t get shriveled and leathery. Like beef jerky. 

But when it came time for the reproductive system dissection and that damp cloth was pulled down, it was, well, revelatory. 

Table 7 was a very well-endowed gentleman. Like, world-record-level. John Holmes had nothing on this guy. 

Classmates gathered around and gawked, and I’m sure also tried to imagine how this gentleman may have brandished such a formidable weapon during his breathing time on earth. As they pondered, the men looked sheepish, and the women, a little scared. 

And then the giggling started. It never really stopped, for the duration of the course, which was several more weeks. I recall at one point glancing over and the group of med students around the table were all collapsed and convulsing with laughter, I mean, crying with laughter. People peed their pants. 

Here’s the thing though: Despite what sounds like the most reprehensible behavior imaginable, everyone was extremely grateful to the people who donated their bodies so we could learn. Just, everyone was also trying to make sense of it all, and underneath the bravado, we were all really uncomfortable. 

It’s hard to be so confronted with death, while at the same time reminded with every single anatomical lesson how important it is for our future patient’s lives that we learn. Plus all the pressure to ace the course, or at least, to NOT fail. There’s tension, a lot of tension. It’s stressful. And humor is very effective for releasing tension and relieving stress. 

It’s hard to imagine how anyone could behave the way we did, honestly… and yet it’s also not hard at all. Just like it’s shocking and disgusting that the residents referred to poor speedboat accident amputee girl as “Ceviche”… and yet I get it. It makes sense, to me. 

The prevalence of gallows humor in medical training is controversial for sure. Is it a healthy way to cope with otherwise uncope-able situations? Or does it impede with the ability to empathize with others?