HEALTH CARE * LES SOINS
IOttawa lodges ad huniour to armamentarium in fight against cancer
Bill Trent N o one remembers who told it first, but the story gets a laugh from a group of patients gathered in the lounge of an Ottawa cancer lodge. A woman had had a mastectomy and was wearing a prosthesis to replace the lost breast. She was swimming when the apparatus slipped out of her bathing suit and floated away. "Look", she called to friends. "It's doing the breast
stroke all by itself." It has been a heavy day at the lodge. Tests, workups, chemotherapy and all the discomforts and anxieties that plague cancer patients have left a pall over the place, and stories like that one help to remove it. Now a second woman has a breast story to tell and the patients become quiet. She had been trying to lower a window at the cottage when a 30-cm shard of glass fell from the frame, missing the remaining breast but cutting through her prosthesis. What's so funny? The prosthesis is called "Nearly Me". Sick jokes? Halcyone Henderson, chairman of Ottawa District Bill Trent is a freelance wvriter living in
Patient Services for the Canadian Cancer Society, says no. "These people have their act together. Their mental healing is working." Laughing does not cure cancer but it has long been regarded as a coping mechanism for people under stress. In some American settings it has been accepted as an
Humour has made a serious bid for recognition as a healing tool in the US in spite of detractors who put it down as a trendy fad. It has been making inroads here, too, even if academic approval is lacking. Where is the proof that laughter works? critics ask. Such research is in short supply.
"If you have a pain in your body and you pinch yourself somewhere else, you don't feel the first pain as muQh. Laughter is like pinching the mind in one area and distracting it from the hurt in the other." -
effective therapeutic tool in oncology nursing. Those who believe in the benefits of laughter like to support their claims by pointing to US author Norman Cousins, who boasted that reruns of Candid Camera and Marx Brothers movies had helped him overcome a disease in the 1 970s. A few good belly laughs, he said, allowed him to enjoy hours of pain-free sleep.
Dr. William Evans
Humour is used widely at the two lodges of the Ontario Cancer Foundation's Ottawa Regional Cancer Centre, which are linked with the city's Civic and General hospitals. Most patients suffer from lung, breast or head and neck cancers, and many are very ill. All are from the Ottawa area and spend 5 days a week at the lodges, going home on weekends. CAN MED ASSOCJ 1990: 142(2)
Martin has worked among patients for several years, first in the Radiotherapy Department of the General's clinic and now at the lodge, and she says laughter has helped lighten many a desperate situation. "Patients have cancer so much on their minds", she says. "Everything is cancer. They can't eat because of it. They can't sleep because of it. It's a constant thing. It's a very severe stressor." She remembers her hospital days: "We used to laugh a lot in stressful situations. It was a kind of protective mechanism. It kept cancer
Entertainment at Alta Vista Lodge takes many forms
Humour is dispensed in many forms. Patients may watch comedy films on video cassette recorders, listen to audio tapes, leaf through books, or perhaps just sit around swapping jokes. It's all optional - humour is not imposed on anyone. "Humour has become much more visible in institutions in recent years", says June Davidson, nurse-manager of the Civic's 60-bed Maurice H. Grimes Lodge. "It's a positive thing and we encourage it." Twelve years as head nurse of the Civic's cancer unit and 10 years in charge of the lodge have taught her a lot about cancer patients. She knows, for instance, how frightened they can be when they first arrive and how much the treatment - the throwing up, the hair loss - worries them. It's no fun being that sick. Fridays are the bad days. Patients become tense as they go through their final treatment of the week, pack up their things and wait for families or volunteer drivers to take them home. Mondays have a downside, too, as patients return, some of them exhausted by their activities. Nurses try to lighten them up by slipping tapes into the VCR, one at 3 p.m. on Fridays, another at 10 a.m. Mondays. Bill Cosby, the staff 164
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maintains, has worked wonders with distraught, often depressed, patients. "Working in a place like this can be pretty heavy going", says Davidson, "and to be able to deal with it, you have to brighten things up. We often share with patients our own frustrations with the system, the food we get, what we like and don't like." She takes her humour seriously and so do the nurses on her staff, several of whom belong to a small organization called Laughing Does Matter that was created by retired Ottawa high school teacher Marjorie Mann. The group recently published a book of jokes, with cartoons by Ben Wicks and Cuyler Black. The nurses often dip into it when there is a joke exchange at the lodge. "We're out to promote laughter, particularly among the elderly and the sick", says Mann. "We really believe that laughter is the world's best medicine." At the General's 30-bed Alta Vista Lodge, nurse-manager Irene Martin has put humour in its place - a room devoted exclusively to laughter. It's the place where small groups of patients can gather for movies, browse through humour books or just exchange stories. Posters add to the ambience.
Martin says laughter has been shown to have both physiological and psychological effects. But how beneficial is it? Does humour really work? Dr. Cyril Danjoux, head of radiation oncology at the Civic, is cautious. "We offer humour as an option. We don't say it works for everybody, or even that it is necessary for everybody, but it does work for some people. It is not part of hospital routine but is encouraged in the lodges. "I'm sure there's a place for humour among patients. It depends, of course, on the stage of their disease. In the case of those who have just been diagnosed as having cancer, it would be inappropriate to try to make them laugh. Later, when they have come to grips with the fact of their illness, humour might prove use-
Danjoux says people have different ways of coping with their situations. They might, for example, be attracted to occupational therapy, music, or educational seminars, but humour has its own merits. If you can laugh about your problems, he says, you may accept treatment more readily. Dr. Rebecca McDermot, a radiation oncologist at the Civic for many years and currently district medical adviser for the Canadian Cancer Society, sees nothing inFor prescribing information
congruous about the link between humour and pain. "Laughter and tears are very close", she explains. "Laughter is a very useful method of achieving relaxation, and if you use it to advantage and do not go to extremes, I think you can reduce tensions. Then, in time, patients may be able to get along with fewer analgesics for pain, if indeed they do have pain, and get a better perspective of their situation." Pitting humour against science, however, raises questions of proof. Where is the research to A volunteer (right) with patients at the Alta Vista Lodge: patients have different show that humour works? "I'm ways of coping with cancer going out on a short limb here", says Dr. William Evans, a medical stress reliever in various circum- it's difficult to talk of laughter in oncologist at the Civic and direc- stances. "I guess when your mind terms of therapy. "I think it does tor of the Ottawa Regional Cancer is fixating on something humor- improve the quality of life of paCentre, "but there is a lack of ous it's not fixating on something tients", he says, "but whether information generally about like cancer. If you have a pain in there are benefits beyond that is whether any interventions, be your body and you pinch yourself something we haven't determined. they relaxation techniques, imag- somewhere else, you don't feel the If the patient's frame of mind is ing, counselling, or laughter, really first pain as much. In a way, improved, the individual seems to help a person fight the disease or laughter is like that for the mind. react better to treatment. But it's live longer." It's like pinching the mind in one difficult to prove."' The techniques may make area and distracting it from the American studies have shown people feel better, even cope bet- hurt in the other. But it's hard to that heart rate and blood pressure ter, he says, but it's a hard thing prove." increase during laughter. The into quantify and express in a way Staff members who work with creased pressure is followed by a physicians will find believable. cancer patients and see their period of relaxation and a subse"Those who are convinced that smiles no doubt believe their ef- quent decrease in pressure below laughter rooms and meditation forts are working, he says, adding: its original level. Maroun says and relaxation tapes are great "If it's not helping the patient, it's such physiologic effects can also stuff will recommend that you use certainly helping the staff. It's eas- be derived from exercise. "I'm not them and point anecdotally to pa- ier to deal with a person with a sure there is anything specific to tients who have felt better as a smile on his face than one sitting laughter in that sense", he exresult of them", he says. "Juxta- there looking morose." plains. "There are those who say posed against them are those of Limited health care resources, that if you're in a happy frame of more scientific bent who say, however, make it difficult to find mind, your immune system is bet'Show us the randomized control money for research in areas like ter. But again, these things are trials of laughter versus no laugh- this. "When you have trouble get- difficult to substantiate. A patient ter and an outcome that produces ting funds for a machine that who has a positive attitude, of serious results.' People are start- gives radiation treatment that is course, may well be better able to ing to question the value of these known to be curative in certain fight the disease." things and want to examine them situations", he says, "you realize Maroun thinks Martin's idea in a scientific sense. In due course you have your work cut out for of a humour room is a good one we may learn that they do have an you trying to sell something to a and he supports it. "We don't important impact but at the mo- provincial bureaucrat when you have any special humour program ment it's largely a question of, have no hard data to back it up." in the hospital itself', he says, well, you're an enthusiast, or Dr. Jean Maroun, head of the "but we're going to see how the you're not. I'm somewhere in be- division of medical oncology at lodge idea is perceived by the tween. I take the attitude that it the General and the Ottawa Re- patients. It might be something can't do any harm." gional Cancer Centre's Ottawa the hospital will want to look Evans believes laughter is a General Hospital Division, says into."166
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