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.