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And finally... |
Beneath the consultant's grim exterior, however, lurks a wicked sense of humour. Or at least, that's what we like to think. After all, the juniors laugh at our jokes, provided they recognise them. Deep down we know this owes more to their politeness than to our comic timing but we still enjoy it. As long as the SpR is smiling, the consultant is happy. (But please, SpRs, don't overdo it.)
Long ago, when I was a senior lecturer, jokes were straightforward. Your anaesthetist provided a fresh supply each week, generally about an Englishman, a Scotsman and an Irishman or perhaps the number of orthopaedic surgeons needed to change a lightbulb. Then things started to change. Comic stereotypes slowly became unacceptable unless they were Frenchmen or NHS managers. And your anaesthetist began to disappear behind ever-larger anaesthetic machines and finally stopped talking to you altogether.
So now, instead of jokes we have witty banter. The Irish are masters of this (think Terry Wogan or Neil McClure) but Scotsmen like me are at a serious disadvantage. Our sense of humour is often described as ‘pawky’, an Old Norse word meaning ‘non-existent’. Sydney Smith, an English cleric who worked in Edinburgh around 1800, famously commented, ‘It requires a surgical operation to get a joke well into a Scotch understanding’. Later, a Scots character in a play by JM Barrie responded: ‘What beats me, Maggie, is how you could insert a joke with an operation’.
I've always enjoyed epigrams. As a boy I was a fan of the American journalist HL Mencken, who wrote quips like: ‘Conscience is the inner voice that warns us somebody is looking’ and ‘Every decent man is ashamed of the government he lives under’. The art is not dead and the new edition of The Oxford Dictionary of Modern Quotations has some gems, including: ‘The email of the species is more deadly than the mail’ (Stephen Fry, 2001) and an observation attributed to Peter Kay: ‘All castles had one major weakness. The enemy used to get in through the gift shop’.
But putting jokes onto paper is a hit-or-miss business. You can't wink at readers to hint that they shouldn't take the next bit seriously and the feedback you get can be depressing. Years ago, when the fad for water birth first appeared, I thought I would satirise it by writing an article on ‘Caesarean section under water’. In deadpan prose, I described how the technique had been invented in an operating theatre with faulty plumbing. I paid tribute to the assistant who had succumbed because there were only enough oxygen masks for the surgeon, anaesthetist and midwife. After publication I received a request for details about this important new procedure.
When you're teaching you have to ration your jokes. It's boring to tell the same ones to every new group but you can't be too spontaneous because it confuses the students. What joy, though, when you discover someone who is on your wavelength. Medical educationists talk about the ‘appropriate use of humour’, a heartsink phrase that takes away your will to live or to work in a modern medical school. Humour isn't a tool to be selected cold-bloodedly like a Langenbeck retractor. It bubbles up from within and sometimes escapes despite your best efforts... (no simile here, I think).
It's possible, but risky, to joke in the consulting room. Last week I was taking consent from a tricky patient. As I filled in the vast form with all the things we might do in the theatre, one of her companions said, ‘She’s thinking about getting married'. I murmured, ‘Not under the same anaesthetic’. The patient was the one who laughed the loudest. Phew!
James Drife, MD FRCOG FRCPEd FRCSEd HonFCOGSA, Professor of Obstetrics and Gynaecology1
1. University of Leeds, UK
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