Working Without a Script- The thrills and spills of using Improv in medicine.

U of T Med Magazine has done a great edition on humour in medicine. I was honoured to be included. To have a look at the other articles please go to UofTMedmagazine.

I’ve been an improviser for a long time, worked for The Second City in Canada and abroad, and to me there is something almost magical about improv.

When I was recovering from cancer, I noticed that when I went to improv shows, good things happened. I would laugh with friends, and then feel noticeably better for days. I had been in and around improv for years of course, but I wondered if this was having a positive effect on my ability to cope with life after cancer. Improv became a tool for me to deal with my condition.

I started making jokes and shows out of my situation and I was invited by some very generous people to teach workshops at Princess Margaret Cancer Centre for patients, and at the Faculty of Medicine for second-year students.

What could improv possibly do for physicians in training? Picture this: You’re in the centre of a windowless room and all eyes are on you. Sweat glistens on your forehead. You’re part of an intense improvisation game called Zulu, where the participants have to make up names for imaginary products on the spot. There’s no right answer and you can’t study for it. You have to get an idea and blurt it out. In other words, you have to be vulnerable.

I know you hate not having an answer the way my dog hates squirrels. I continue to point at you and wait for a response while 40 colleagues look on. I can see your intense desire to win but I wonder if you have difficulty connecting with people. Unfortunately, this lack of vulnerability reads as arrogance. And, as patients, we know it the instant we feel it.

I had an oncologist who shared this characteristic. He was technically competent but so arrogant and distant that he literally dismissed me from his office because he had a dinner reservation at Centro that evening. He wasn’t a bad physician, he had just forgotten how to be a human being. In that moment I felt a desperate sense of isolation. Later, I realized that the worst part about being sick for me was not feeling pain or discomfort, but experiencing isolation and fear.

That’s how I got the idea to bring improv into medicine: It came from my intense desire to increase the sense of connection between people in health care.

I’ve seen improv comedy in medicine do incredible things. I’ve seen it open up a room of physicians, patients and their care givers so that they can actually talk to each other in a meaningful way. I’ve seen cancer patients in real trouble somehow laugh at their situation and then share resources they didn’t know they had. I’ve watched as med students realize that they can relax a bit with patients; that they can (dare I say it?) be a human being with the people they serve.

Many times the laughter itself is enough to help us. Heck, who can argue with something that has been proven to increase serotonin and dopamine levels? Often though, it’s the good stuff that comes afterwards that has the real payoff. After people laugh, the natural release of oxytocin that occurs helps people bond together in an almost tribal way. They are more prone to trust each other and be generous to each other. What does this mean in medicine? It means that by using improv comedy to sneak by the sometimes brittle facade of our intellects, we find a way to our silliness, our vulnerability and our humanity. It creates a safer space for us to collaborate in a meaningful way.

To simply say that “laughter is the best medicine” is a platitude that floats by too quickly. These simple things called laughter and improv comedy can be the doorway to feeling better. There is profound good here that we can use to great effect and we have just scratched the surface.

That was a real person in my improv class, by the way — a terrified second-year medical student. I stayed silent and the group didn’t even breathe. There was no way out for him but to say something, anything. The question swirled in his brain: “What is the name of a car that should be invented?” He looked at me. I saw the light of an idea flash in his terrified eyes. “The Fartinater!” he cried.

The class roared with laughter. I applauded and declared him the winner. His face lit up like a 10-year old who has just had the best birthday ever. He was connected, with himself and those around him. Any sense of arrogance was demolished in the joy of experiencing a huge laugh from his peers. I saw a crack in the protective facade he presented to the world and I hoped that would translate to his work with patients in the future. ■