Life does not cease to be funny when people die any more than it ceases to be serious when people laugh.

George Bernard Shaw

My article “Joy, Suffering and the Goals of Medicine” was not easy to publish. It was rejected by several other journals before being accepted by JAMA-Neurology. I never got a reason from these other journals why they rejected it. The New England Journal of Medicine rejected two versions of it—taking a week to reject the second version, a personal record that I’m proud of (they usually reject articles they won’t consider within less than a day). I strongly suspected that these serious journals were rejecting my essay, at least in part, because they didn’t consider “joy” a topic worthy of their esteemed attention.

Honestly, though: what could be more important than joy? Particularly during a serious illness?

The importance of joy is most often appreciated (outside of serious medical journals) during the toughest of times.1,2 Expressions of joy on social media have notably increased since the start of the pandemic.3 Why were these editors not getting it?

It’s possible that medical editors hate something even more than joy – fart jokes.

In another article that I got published, “Medical Aid In Living,” the editors forced me to remove a fart reference, saying it was inappropriate for their readers. Before sharing the fart reference, I would like to remind readers of my blog that readers of medical journals are not only used to seeing words like anus, vagina, penetration, borborygmi (a fancy word for gut gurgling), trichobezoars (a fancy word for hairball), and intractable vomiting, but deal with these things daily, and even share pictures like the following without batting an eyeball:

Here is the text that was censored:

While everyone else in the room was tearful, she was calm and poised. Curious, I asked her if she thought there was anything after this life and she said there was. She had plans to come back to visit her family and they knew how to detect her presence.

Her family smiled knowingly. I asked her how they would know she was there.

“I’m going to come back as a fart.” I laughed and told her that wouldn’t work in my house…

I don’t think even changing “fart” to “flatulence” would have satisfied this reviewer. The problem was not the word, but the humor. 

When I shifted my career to palliative care, I fully expected to see more tears and suffering. And I did. But what I didn’t expect was to see more joy and laughter. This is the human experience. Hearts break and hearts heal; the best medicine, when you can find it, is joy and humor.

I think it’s important that people (including doctors and patients) have permission to be whole people, regardless of their circumstance. If you’ve found joy or humor in dark times or circumstances–funerals, dialysis units, faculty meetings–please share it in the comments below.

1. Folkman S. Positive psychological states and coping with severe stress. Soc Sci Med. 1997;45(8):1207-1221.

2. Strzemien A. 14 ways we’re getting through these terrible times and even finding some… JOY. The New York Times.  Published 2020. Accessed May 18, 2020.

3. Lwin MO, Lu J, Sheldenkar A, et al. Global Sentiments Surrounding the COVID-19 Pandemic on Twitter: Analysis of Twitter Trends. JMIR Public Health Surveill. 2020;6(2):e19447.

3 thoughts on “Fart Jokes, Medical Aid In Dying, and the Battle to Bring Joy into Medicine

  1. This is how I survived the death of two of my favorite people. My mom’s passing and a few years later my brother. Both died in my presence, a truly painful and beautiful moment. But humor is what got us through. Tasteless, smart ass joking around is what got us up to the final moments. Both died peacefully. I want to believe it is because there was genuine love and humor in the room and each of them felt it.

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  2. Good Doctor Benzi: bringing joy into medicine resonated with me. In January 2010 when you diagnosed me with PD you stated that you had patients 75 years old and older who were still doing all of the things in life that they truly enjoyed. For whatever reason the 75 year old benchmark stayed with me. I progressed slowly at first ( obviously due to your brilliant doctoring and boxing skills) but by August 2016 I hit rock bottom both physically, mentally and emotionally. I was a shuffling sandwich board that listed all symptoms and proclaimed “I have PD and it really sucks”! I had the most vivid dream/vision of my entire life where I was this fragile hoary ghost like visage of my former self attending a family gathering. I saw myself sitting slumped over in the corner all alone and hearing my two young grandsons whisper “ There’s Papa Nedly. Let’s go pat him on the head and get the heck out of here”! As I shared this with my wife I sobbed and sobbed and sobbed uncontrollably. I told her if this is as good as it gets and it is only going to get worse then I have a serious decision to make..To be or not to be, that is the question “. A couple of weeks later on September 15, 2016 at my regularly scheduled semi annual check up, upon seeing me you, in your most empathetic and reassuring voice stated “Ned, you look like shit but we are going to change your medicines and you will be better than before “. Hippocrates could not have been more prophetic. Literally within a few days all symptoms either disappeared entirely or were greatly minimalized. I had my life back! On November 24,2020 I celebrated my 75th birthday. When asked how am I doing my stock reply is “If my life was any better I would feel like a thief !”
    Joy provokes gratitude which inspired me to write the following:
    Thank you Lord
    for this precious day
    To live
    To laugh
    To love
    And pray
    to be the best that I can be
    To honor this path
    You have chosen for me
    But if I stray and start to roam
    Please cup my heart
    and carry me Home.
    I am thankful to you my friend. Keep doing what you are doing. You have found your path.

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