Time marches on. It doesn't really seem that long, but for the past eight years,
we've been pleased to publish installments of Sharon Farber's "Tales of Adventure
and Medical Life" series, our longest running continuing feature. It's also been
our most popular feature, at least from the amount of readers' comments we've
received. Every article in the series has been humorous and entertaining to read,
but this is the first installment that deals with humor itself as its main
There are two kinds of ethnic jokes. The ones told by outsiders -- usually prejudiced and harsh -- and those told inside -- usually incomprehensible to the outsider, and not very funny even when explained.
Last time I promised to tell the unfortunate tale of my rotation on obstetrics. But for the past year and a half -- thanks to a vicious stab in the back by people I had considered friends -- I've been having to work 12 to 16 hours a day and have been stressed to the max. (The scoundrels' actions backfired and actually improved my practice. A Pyrrhic victory, at best.) The last thing I want to do today is remember County Hospital and the insane resident who wanted to hurt medical students.
So instead, I'm going to tell some of the jokes that doctors tell about each other.
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Every culture has its subclass of fools and innocents. Growing up in San Francisco, we deplored Oakland or Chico (where they sold Velveeta in the gourmet aisle). Los Angeles made fun of Pasadena. New York scorns everyone. In Tennessee (with it's motto "Thank God for Arkansas and Mississippi" -- the states that keep it from being fiftieth in everything) we snicker at our neighbor Alabama. (What has 40 teeth and 80 legs? An Alabama family reunion... Why did O.J. Simpson move to Alabama? Because everyone has the same DNA there.)
In medicine, most jokes traditionally are at the expense of the surgeons, a practice probably dating back to the times when doctors had clean hands and surgeons cut hair on the side. Surgeons are portrayed as, well, less than intellectually gifted. Or as an orthopedic surgeon I once dated bragged, "I'm as strong as an ox and twice as smart."
An internist and a surgeon come to an elevator. The door is closing, so the internist inserts his hand.
"Why'd you do that?" asks the surgeon.
"Well," the internist answers, "you use the least important part of your body to stop an elevator door."
They go into another wing, and approach another elevator. It's closing. So the surgeon sticks his head in.
This joke has had less play locally since a woman tried this downtown. Unsuccessfully.
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The classical doctor joke, from which infinite variations spring, is The Duck Joke.
A general practitioner, an internist, and a surgeon go duck hunting. A duck flies overhead, and the GP says, "Gee, kinda looks like a duck," and shoots it.
Another duck flies overhead, and the internist sights it. "Duck, rule out pheasant, rule out goose," he says, and shoots it.
A third bird flies overheard. The surgeon raises his gun. BLAM! BLAM! BLAM! Then he looks at the others. "What was that?" he asks.
Variations usually feature other specialties. One I recall has an internist calling, "Duck, duck, come back! I want to examine you!" then the psychiatrist yelling, "Duck, duck, I want to talk to you!" and then BLAM! BLAM! BLAM!
My surgical chief resident, Frank Psychosis, told me his version of The Duck Joke once. "There's this room," he said, "and the internist goes in and after an hour he comes out with a bunch of notes. Then the surgeon walks in and turns around and comes out and says, 'That's a duck'."
He laughed uproariously. When I realized that that must have been the punch line, I said, "Good one, Frank."
My favorite version of The Duck Joke makes fun of radiologists. (Nowadays most radiologists work long hours, do all sorts of procedures, and contribute to patient care. But twenty years ago they came in late, read a few films, and left. There are still a couple of hospitals I know where they disappear early and get very upset if you ask them to do something out of the ordinary, like look at an emergency scan and call you if there's a hemorrhage.)
An internist, a surgeon and a radiologist go duck hunting. There aren't any ducks, so they start bragging about their dogs. Finally they decide to have a contest.
They put down a chocolate chip cake. The internist points to the cake and says to his dog, "Sic it, Osler!"
Osler trots to the cake, takes out a notebook, and writes down all the ingredients, in descending order by concentration. Then he carries the note back to his master and wags his tail.
"Good boy, Osler! Impressive, huh?"
The surgeon snarls and says to his dog, "Get it, Halsted!"
Halsted runs over, takes out a scalpel, divides the cake into equal sections, dissects out all the chocolate chips and puts them in a container to sent to pathology. Then he goes back to his master.
"Good dog, Halsted," the surgeon says smugly.
"You haven't seen anything yet," says the radiologist. "Okay, Roentgen!"
Roentgen runs over, eats the cake, screws the other two dogs, and gets home by 3 o'clock.
Usually after I tell that joke to a radiologist (who always starts to protest "But we aren't like that anymore!") I defuse the situation by telling the only neurologist joke I know.
(Before the advent of CAT Scans and MRI -- and often even with them -- a neurologist would perform a lengthy physical examination in order to tell what part of the nervous system was involved, 'localizing the lesion'. Of course, most conditions were -- and still are -- untreatable. A famous neurologist in the fifties once described his job as "Diagnose, adios.")
Two neurologists are hot air ballooning when clouds come up and they realize they're lost. They go lower, and suddenly the clouds part and they see that they're passing over a field where a man is on a tractor.
One of the neurologists leans out and yells, "Hey! Where are we?"
The man on the tractor looks up and shouts back, "In a balloon!"
Then the clouds swallow them up again. The first neurologist smiles. "This has been a great day! We saw good scenery, we put back some brewskies, and now to make the day complete, the first guy we meet is a neurologist too."
"Wait a minute!" interjects his friend. "That looked like a farmer to me. What makes you say he's a neurologist?"
"Well, think about how he answered our question. He gave us precise localization and it didn't help a bit."
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In recent years medical care has been become the hostage of insurance companies. They decide if tests and treatments are appropriate, who can do them, and where. My office staff spends half the day trying to get basic tests approved, and more time arguing when they decide not to pay for it anyway. And few things can be more infuriating, in the middle of a busy day, than to receive a phone call saying you have to send a patient home because he isn't approved for further in-hospital days.
I met a new patient in the emergency room with a cervical spinal cord lesion -- paralyzed legs, bowel, and bladder. After treatment he was able to walk again, Six months later he came to my office with difficulty breathing and inability to urinate. Fearing his disease was flaring -- fearing he would become totally paralyzed and die -- I admitted him to the hospital. Luckily it was a false alarm.
The insurance reviewer called me up to complain. "You shouldn't have admitted him. In fact," she went on, "you shouldn't have admitted him last time."
"Last time... But he was paralyzed!" I protested in disbelief.
"Paralysis," she sneered. "You could have handled that outpatient."
So you can imagine how much we all love this joke.
Three doctors die and go to heaven. "Why do you think I should let you in?" asks Saint Peter.
"I was in medical research," the first doctor replies. "I worked on vaccines, and I saved millions of lives."
"Go on in," Saint Peter says.
The next doctor says, "I didn't save millions of lives, but I was a rural family practioner and I helped a lot of people with little reward."
"Go on in, it's a pleasure to have you with us."
The third doctor smiles proudly, "I was medical director for an insurance company."
"Go on in," says St. Peter. "But you're only approved for three days."
If you think insurance companies are bad, managed care and HMOs are worse. I heard this while rounding Christmas week.
Why did Mary come to Bethlehem?
That's where the nearest obstetrics provider was.
Why did she give birth in a manager?
She wasn't approved for in-patient days.
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I'll end with my favorite joke from residency. I suspect it was adapted from an army joke -- I can just hear the roles being taken by a captain, a sergeant and a private -- but I like it anyway.
The resident and the attending are talking while the intern charts orders. "I dunno," says the attending. Lately it seems like sex is 90% work and only 10% pleasure."
"I respectfully disagree with you," says the resident. "It's 90% pleasure and only 10% work."
They argue for a while and, unable to reach a consensus, decide to ask the intern.
"What I think," replies the intern, "is that it must be 100% pleasure. Because if there was any work involved, you'd have me doing it."
Title illustration by Charlie Williams