Updated on: June 10, 2020

Laughter Still the Best Medicine

Original story posted on: June 9, 2020

On our COVID floors, we have big flat-screen monitors that are scoreboards in the COVID race: heart rate, QT interval, and, critically, oxygen saturation. They are a kind of electronic cheat sheet that allows you to handicap a patient’s chance of winning the COVID contest before you even meet them in person.

I went into a room this morning with the impression that a patient wasn’t going to either win, place, or show in their race with COVID. The patient, it seemed, had come to the same conclusion, and had chosen neither to be resuscitated nor intubated.

It was a sound bet to make. We were pumping in all the oxygen we could, and her oxygen saturation was still low enough to qualify for home O2. She would finish this COVID race under her own power – one way or another.

I asked the medically rhetorical question, “how are you doing?”

The patient answered, “do you know why aunt…” Her voice trailed off behind the hermetically sealed BiPAP mask she was trapped in.

“What about your aunt?”

“Not aunt! Ants, ants!”

“You mean the bugs?”

The BiPAP-masked patient nodded in assent and shouted through a positive pressure of 18/8 cm, “do you know why ants don’t get sick?”

“No, I don’t. Why.”

And through a positive pressure-enhanced smile, the patient answered, “because they have anty-bodies!” Then she laughed upstream against the onrushing BiPAP airflow. 

I laughed an N-95-stifled laugh – it was laughter, even if it was only PPE laughter. My laughing choked off as I watched her oxygen saturation drop from a very low 87 percent, to a really, really low 84 percent, to a breathtakingly low 81 percent.

“Take slow breaths!”, was my post-joke advice. “Slow and deep.”

“Thanks,” she kind of coughed.

“Thanks for what?” I asked back.

“For getting my joke!” she chortled. It was a hypoxic, anti-COVID chuckle. She was one of the rare COVID patients to make me feel a little bit of glee. Hers was one of the few COVID rooms I left feeling better coming out than going in.

I went back to the medical scoreboard. Her O2 sat was still only 84 percent. I watched it until it got back up to 87 percent. Then satisfied her joke wasn’t going to kill her at the moment, I walked on.

I do not know if ants get sick, I do not know if she will win her COVID race, but in her own joyful way, she had already beaten COVID, even though the scoreboard flashed that she was losing.

Michael A. Salvatore, MD, FACP

Dr. Michael Salvatore was a pulmonary medicine/critical care physician for 35 years. Since 2012 he has been the physician advisor and medical director of the palliative care team at Beebe Healthcare in Delaware. After earning his MD at the University of Arizona, he trained in internal medicine and PULM/CCM at Duke University. Dr. Salvatore is a member of the RACmonitor editorial board.

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