Pre-script for Patient Communication: Your words are powerful

"A kind word often goes unspoken, but never goes unheard."

November 2010, Columbus Ohio: My surgery for a perforated bowel was as much of a surprise as it was an emergency. There was no time to prepare but in a very important sense my preparation had already been underway because I used a particular surgery preparation method for my hip replacement a few years earlier.

I feel certain that because I had practiced the program for an earlier, planned surgery, my brain was already unconsciously "mapped" for the emergency episode.

Thanks to my nursing entourage: wife & Wonder Woman Pam, Deborah Harbinson, and Susan Stewart, this has also been true for my subsequents surgeries. There were no surprises, no emergencies, lots of preparation, and tons of support from friends and colleagues.

Both Deborah and Susan are RNs and Certified Laughter Leaders (CLLs), and Deborah is also certified in a method created by Peggy Huddleston, RN, called Prepare for Surgery, Heal Faster

If you or a loved one is facing surgery, I highly recommend that you learn and apply this method. If possible, give the patient a month or more of lead time to practice and prepare.

The audio relaxation and imagery program is excellent; it was powerful for me. Huddleston claims it will reduce anxiety before surgery, lead to using less pain medication, and help you recover faster. I used then both before and after each planned surgery, and I am convinced that it works!

My favorite imagery is the "pink, fuzzy blanket". It is so comforting to imagine being wrapped up like that. And it helped to feel the support of friends who referred to it in e-mails, text messages, and get-well card. Some even sent actual blankets!

My other favorite part of the program is writing a script for the doctors and nurses to say while I am going under the anesthesia. The unconscious mind responds to statements made within earshot of the patient. You want only positives, and lots of them, going in through the auditory channels.

Happy to report: My health care professional teams have always been cooperative and supportive.
Here is the script I used for my most recent trip to the operating room:

FOR PATIENT: STEPHEN H. WILSON, D.O.B. 1/5/1941

TO: My dear Dr. Zochowski, my anesthesiologist, and the super OR staff:
I am looking forward to the surgery you will do for me on Tuesday morning.

Part of my preparation is using the program created by Peggy Huddleston, RN, “Prepare for Surgery, Heal Faster.” I used this a few years ago when I had a hip replacement, and believe it was helpful. It makes use of  goal-setting, visualization, progressive relaxation, and a short script for the OR staff. That’s where you come in. I earnestly request that you and the nurses and any other professionals present during the surgery take a minute or so to speak the script below.

As I am going under the anesthesia, please say:1) “Following this operation, you will feel comfortable and you will heal very well.” (Repeat 5 times.)

Towards the end of surgery, say:2) “Your operation has gone very well.” (Repeat 5 times.)

3) “Following this operation, you will be hungry for chocolate protein shakes. You will be thirsty and you will urinate easily.” (Repeat 5 times.)

4) “Following this operation, your bowels will ‘wake up’ smoothly and comfortably. At home, you will resume your program of exercises for recovery and health.” (Repeat 5 times.)

THANK YOU for what you are doing for me!.

We had copies of the script in the pre-op area, handed them out, and reviewed the instructions. Following Huddleston's advice, I also had a copy of the script pinned to gown in the middle of my chest. It was a very friendly experience that helped to put my mind at ease. I always let them know I am grateful for what they are doing for me, not what they are doing to me.

When I was wheeled into the OR and transferred to the table, the staff immediately began saying all those reassuring things to me. I remember smiling and feeling reassured. The nurse to my right, held my hand and even ad-libbed her own, sincere assurances. The anesthesia too hold gently and the surgery was a terrific success.

More On Patient Communication
Edward Leigh, a good friend and a cancer survivor, has created The Center for Healthcare Communication. (CHC). Eddie is also a Certified Laughter Leader. (If you see a pattern here of many of my friends being health care professionals as well as Certified Laughter Leaders, I believe it is a reflection of our shared humanistic orientation to our practices.)

CHC is a results-oriented organization focused on using evidence-based information to create productive healthcare organizations. They work with a variety of healthcare organizations, including hospitals, long-term care facilities, healthcare associations and medical practices.

Mission and Vision
The CHC mission is to increase patient satisfaction/safety and decrease communication-related medical errors. They accomplish this by:

• Establishing an open and empathic environment for patients and their families.
• Providing superior training, coaching and consulting services.
• Creating a productive and positive environment for people to work.
• Finding the best practices, refining them and incorporate them into other organizations.
• Providing resources to help healthcare organizations achieve excellent patient care

Their approach is comprehensive in that they work with everyone in the system (doctors, nurses, administrative professionals, etc.) to create a thriving healthcare environment.

Anyone facing surgery, and everyone who is part of a healthcare professional team, would do well to be sure they are in synch with the CHC philosophy and methods.

Therapeutic Laughter: A humanistic orientation

The World Laughter Tour, Inc. logo

A Would Laughter Tour, Inc, Laughter Therapy Photo Album

 

In the World Laughter Tour (WLT) model of therapeutic laughter, great care is given to creating a particular psychological environment in which the therapeutic laughter activity will take place.

Being quite familiar with activity therapy in general as well as the specific applications of music, art, and recreation as therapeutic modalities, and with the help of astute scientists and practitioners in the field of applied and therapeutic humor and laughter, I was able to develop a therapeutic prototype based on a humanistic orientation toward what variously might be referred to as “sense of humor abuse” or “a deficiency of authentic laughter”. It contains psycho-educational activities, attitudes and techniques with which to effectively work with those who seek a therapeutic or remedial experience.

The presumption of trauma
The WLT therapeutic laughter program assumes that virtually everyone suffers from some degree of humor/laughter trauma. With rare exception, and most of the exceptions are people who have had or practice a therapeutic laughter type of program, I have never met a person who was satisfied with the amount of laughter in their life. It is common to hear, "Of course, we could use more laughter at work (or at home, or wherever). Who doesn't need more laughter?"

I believe that this serious and nearly ubiquitous condition of laughter deficiency prevents people from getting the most enjoyment out of life, interferes with constructive human relations, and keeps us from being as healthy and happy as possible. In previous writing I have addressed the likelihood that there is a natural minimum RDA (Recommended Daily Allowance) of laughter, which I estimate to be about fifteen minutes in the aggregate.

Trauma to one’s humor/laughter apparatus can be inflicted by abuse, by accidental injury, and in the normal course of human life events. We will look at the abuse type of trauma in some detail in this writing.

The accidental traumas would include the ingestion of various substances including alcohol, manganese, anesthetics, and narcotics; and could include brain injury, tumors, and other neurological conditions including dementias. Life event traumas that affect, i.e., compromise, humor and laughter would include misconceptions and misinformation, grief, PTSD, physical illness, mental illness, addictions, and other significant life stressors. I believe these can often be successfully addressed by laughter therapy.

Elsewhere, about twenty years ago, I have written about the conditions resulting from this trauma under the coined term “Sense of Humor Abuse”. I defined this abuse as (1) the continuation of harmful, painful, unwanted actions toward the victim even after the victim has implored for them to stop; (2) inflicting damaging actions upon the victim even if the victim does not ask for them to stop, but taking ill advantage of a difference in strength or power of the perpetrator over the victim; or, (3) the perpetrator teaches the victim false, erroneous information and/or beliefs that weakens the victim’s ability to develop adequate emotional and physical defenses and, hence, inadequate functionality as a mature adult.

Now, with a deeper understanding of the science of laughter, and a lot more experience with the results of laughter therapy, I can expand on and update my thinking about the process. For one thing, I would add that the method being developed addresses significant deficiencies in authentic, true, mirthful laughter.

This new therapy is a necessity based on the assumption that many cultures precipitate widespread emotional trauma by prevalent toxic humor and toxic --including erroneous-- attitudes about laughter. These traumas manifest in many ways. We assume that almost everyone who would seek or benefit from the therapeutic laughter experience has experienced one or more types of this trauma, and would find it advantageous to have a suitable remedial experience. I will give just a few examples here.

Laughter/humor trauma often begins with the victim in childhood. It may be inflicted by a peer or adult. It can cause people to reach the point where, among other symptoms, they express that they have “lost their laughter” or “forgotten how to laugh”; they stifle their uninhibited joyful, mirthful laughter for fear of criticism; and, they do not develop humor and laughter as resources for a healthy, balanced life. These are just some examples.

Almost every person who attends a therapeutic laughter session remembers being on the receiving end of sense of humor abuse (a figure of speech that we will have to work with for now), such as:
“You laugh too loud.”
“You snort… or cackle… or sound like a horse laughing.”
“Stop your giggling and settle down!”
“Grow up!”
“Laugh before breakfast and you will cry before supper.”

The victim gets, often repeatedly, ego-deflating criticism, blame and even punishment for laughing. Humor/laughter abuse may also show up in the familiar blame-the-victim scenario associated with teasers, ridiculers, and other abuses delivered as insults or ‘zingers’. The abuser hides behind rationalizations of blame by which the victim may be admonished as:
“You can’t take a joke.”
“I was only kidding.”
“You are too sensitive.”
“You have a lousy sense of humor.”

Having felt the mortifying sting of rejection or the implication of being flawed, the victim typically attempts to modify something about their laughter, which may have been perfectly natural and genuine for them. In hopes of find acceptance and love, they adopt a false laugh by modifying the pitch, tone, timing or frequency of their own laughter. They practice this false laugh until they forget that there ever was an original, authentic, natural laugh. Such false laughter can never induce the mirth nor have the powerful physiological correlates of authentic laughter. The victim arrives at adulthood with less than adequate ego defenses and resources for happy, fully functional maturity. The therapeutic laughter experience contributes to correcting this condition.

Getting the laughter therapy cart and horse in the correct order
We would not withhold cough medicine and give it only when the patient has earned it by stopping coughing. The medicine, especially in our program, often mistakenly looks like the reward but should not be withheld until the cure is effected.

In the WLT method, Certified Laughter Leaders (CLLs) expose participants to the therapeutic potential of mirthful laughter through a systematic, repeatable, and educational program. More or less, the fun comes first, last, and if we can manage it, in a manner of speaking, always. Such experiences turn out to be emotionally corrective.

Fun, mirth, attentiveness, support, encouragement and proper information are the heart of the experience in the laughter therapy circle, along with the invitation to examine and adopt a healthier life style through healthier attitudes. This is done systematically and is quite advantageously repeated until the participant can carry on the process independent of the formal laughter therapy session, with self-education and, perhaps, occasional returns for ‘booster shots’.

The adage says that “all work and no play” makes Jack dull because it is an unhealthy, unbalanced lifestyle. A full, rich life echoes with laughter, and is anything but dull. Conventional wisdom has it that fun, relaxation and laughter are rewards that come after being earned through hard work. This is also known as “saving the best for last.” WLT takes the unconventional position that the remedial experience is, of necessity, mirthful and uplifting, i.e., it is one of eating dessert first.

The ability to participate in and create spontaneous, uninhibited, joyful, mirthful laugher with others and for one’s self is one of the most important characteristic goals of the therapeutic laughter method. Fun and laughter and loving support are both the “medicine” and the sign that it is working.


People who fear laughter
I will sometimes refer to those who have been traumatized by sense of humor abuse as people who fear laughter. It is a figure of speech I will use for now, recognizing that it deserves further elaboration down the road. It is not the laughter that they fear but the awful repercussions they have come to associate with laughter.

They need to be heard, listened to, protected from further trauma, and given remedial corrective emotional experiences.

Creating a laughter therapy environment
Albeit quite fun, the WLT CLL has training, education, and support for creating the environment most likely to engage the participants in corrective emotional experiences. Techniques, including specific attitudes and group leadership, are used by CLLs to help participants be amenable to enthusiastic participation.

Programming is largely about imparting accurate information and ego support and encouraging participation that gives each person their own ‘data’ upon which to judge the values of the experience. The CLL often begins by pointing out that many different activities and aspects of laughter have been described or proven to be beneficial; gradually, over time, these benefits are enumerated. Typically an activity may be viewed by adults as silly, or as a diversion. The CLL explains and demonstrates that these ‘therapeutic devices’ are actually exercises in life-skill development, in socialization, in stress reduction, and a supplement to their education, or other healing processes in which they may be engaged: physical, mental, emotional or spiritual.

Above all, the process of the therapeutic laughter activity must be managed so that it does not damage anyone, for example by deliberately highlighting a known weakness. Beyond this, it needs to be able to release tension, minimize frustration, and accommodate to the group’s cognitive development and also to any norms of the group, start gently, finish gently and only go on for as long as conditions are favorable.

A CLL Training Class

The CLL training has three over-riding objectives. Successfully completing the basic training course, the CLL will be better able to
•  Use information from many sources including Gelotology (laughter science), Positive Psychology findings, knowledge of ancient practices, and modern clinical, counseling, healthcare, educational, consulting, corporate, and volunteer work.
•  Help their clients use life energies to choose and modify their life and work directions, and bring mirthful laughter to life.
•  Identify emotional and attitudinal factors that improve health and increase happiness & life satisfaction for clients, patients, residents, and students.


Based on the anecdotal evidence provided by more than 6,000 people already trained in laughter therapy, I believe that a well-founded, systematic, humanistic therapeutic laughter program can successfully address concerns of humor/laughter trauma and health & happiness, and bring about improvement in a wide variety of conditions. I eagerly await and encourage the gathering of scientific evidence as well.

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The Audacity of Laughter: a salute to the laughter troops

au•dac•i•ty–noun.
1. boldness or daring, especially with confident disregard for personal safety, conventional thought, or other restrictions.
2. effrontery or insolence; shameless boldness
3. Usually, audacities. audacious acts or statements.
Synonyms 1. nerve, spunk, grit, temerity, foolhardiness.
2. impudence, impertinence, brashness.

Starting with cave dwellers and proceeding through jesters, wits, and witty fools, there has long been an unconventional cohort of people who have the temerity to assert that the world can be a better place if only we can generate enough laughter and humor. They are not claiming that laughter alone can cure the world’s apparently human-influenced ills: famine, war, hatred, disease, etc., but they do ardently believe that human beings have the power to bring about some pretty significant improvements.

Not only do they have confidence in their belief that they can make a difference in the right direction, but they dare to offer their contributions through laughter and humor. They have done it in the face of rejection, resistance, and opposition and, talk about temerity, they even did it at times when laughter was considered extremely un-fashionable, or when they have to break laws to do it. Take Lord Chesterfield, please! (c. 1770): "I would heartily wish that you may often be seen to smile, but never heard to laugh while you live. Frequent and loud laughter is the characteristic of folly and ill maners...In my mind, there is nothing so illiberal, and so ill bred, as audible laughter."

Seemingly undaunted, they have had the grit to proceed and persist in helping us keep the funny side up.

People have enlisted in this laughing legion from all walks of life, some accidentally, some intentionally. Some seem to be “naturals” while others work hard at developing a talent or craft or strategy. Their initial motivations are quite varied and sometimes difficult to fathom, but they have two things in common: the desire to evoke mirthful laughter, and the nerve, the chutzpah, to fly in the face of traditional and conventional thinking, even defying some religious beliefs that laughter is merely an immature waste of time, juvenile, puerile, trivial, trifling, and unholy.


I like these people and salute these laughing troops. I am one of them. I consciously joined this laughing army in 1984, making it my life’s work.
Some scientific, anthropological laughter theorists contend that we humans have been laughing for about 4 million years; it’s a social thing. In fact, they tell us, we probably laughed together before we had language and could talk to each other. Now, that’s pretty funny.

"I've got a million of 'em! Don't forget to tip your waitress."

The Philogelos is collection of Greek jokes that were being told 3,500 years ago. And, can you imagine an even earlier prehistoric, pre-linguistic knock-knock joke?
Grok-grok!
Ungh grmph?
Oogloish.
Ooglish urp?
Ooglish hurmph kblemr!
(Yuk! Yuk!)

Through the ages we have gone by many names and played many roles:
Jester
Fool
Comedian
Humorist
Poet
Shaman
Healer
Teacher
Swami
Clown (Class, circus, or hospital)
Clergy
Psychiatrist
Traveling salesman
Husband, wife, mother-in-law

I salute the kindred spirits who have the audacity to provoke laughter, to embrace laughter, to cherish laughter, and to believe that we can make a difference with laughter.

Very punny, without apology

Energizer Bunny arrested - charged with battery.
A pessimist's blood type is always b-negative.
A Freudian slip is when you say one thing but mean your mother.
Shotgun wedding: A case of wife or death.
I used to work in a blanket factory, but it folded.
If electricity comes from electrons... does that mean that morality comes from morons?
Marriage is the mourning after the knot before.
A hangover is the wrath of grapes.
Corduroy pillows are making headlines.
Is a book on voyeurism a peeping tome?
Dancing cheek-to-cheek is really a form of floor play.
Banning the bra was a big flop.
Sea captains don't like crew cuts.
Does the name Pavlov ring a bell?

It has been said that the most typical response to a pun is a groan. They may be delivered in the short form illustrated above, often called "groaners", or they be even more groanful when they appear as punchlines at the end of long, drawn-out tales known as a "shaggy dog stories."

An apocryphal story has it that as a young boy George Bernard Shaw was an incessant punster. One day, his father was so irritated by all the punning that he put George into a closet and threatened to not let him out until he had made a very great pun. Whereupon, according to the story, young George immediately implored his father to, "O-pun the door!"

Where are you on the pun spectrum? Some people love this kind of word play; others hate it; still others are indifferent. Some just don't get the jokes. Some people seem to be natural-born and even habitual punsters.  I love them and admire the well-constructed pun. I don't typically think them up until someone or some thing gets me going, then I can usually bounce them back and forth fairly readily.

MY ADVICE: If you are a punster, don't expect peals of laughter from your audiences. You would do well to learn to expect and be pleased with groans more so than laughter; and if you also get rolling of the eyes accompanying the groans, that is a bonus sign of appreciation for your well-delivered pun. Just say, "Thank you!" and take a bow.

USE THE COMMENT SECTION BELOW TO SHARE YOUR FAVORITE PUNS.

Yours Truly featured in Oprah's blog

In Oprah's July 11th Spirit newsletter she has an article on laughter followed by Dr. Oz's contribution. I am delighted to have been a source for the information in this report.

Here is the link:
http://www.oprah.com/blogs/Laugh-Until-You-CryOr-Your-Heart-Rate-Slows

Click here to lo learn more about how to bring the remarkable spirit-lifting and other benefits of mirthful laughter into your life.

The Time Bank

True mirthful laughter is both a therapeutic ally and signal of health. Remarkably, for human beings, it is both like a medicine and also the sign that the medicine is working.

Barbara Hee is a popular Certified Laughter Leader (CLL) in Philadelphia. She sent the following piece to the communications network of CLLs, who are always sharing inspiration and encouragement with a cadre of dedicated pioneers leading the world to health, happiness and peace through laughter. It reminded me of the saying, "Yesterday is like a cancelled check, you cannot spend it anymore; tomorrow is like a promissory note that may or may not be paid off; today is cash, spend it wisely."


Imagine that you had won the following prize in a contest:  Each morning your bank would deposit $86,400.00 in your  private account for your use. However,this prize has rules, just as any game has certain rules. The first set of rules would be:
          Everything that you didn't spend during each day would be taken away from you.
          You may not simply transfer money into some other account.
          You may only spend it.
          Each morning upon awakening, the bank opens your account with another $86,400.00 for that day.

The  second set of rules:
The bank can end the game without warning; at any time  it can say, "It's over, the game is over!"  It can  close the account  and you will not receive a new one.

What would you personally do?
You would buy anything and everything you wanted right?  Not only for yourself, but for all people you love, right?  Even for people you don't know, because you couldn't  possibly spend it all on yourself, right?  You would try to spend every cent, and use it all, right?

ACTUALLY, this  GAME is  REALITY!   Each of us is in possession of such a magical  bank. We just can't seem to see it.

The MAGICAL BANK is TIME!
Each morning we awaken to receive 86,400 seconds as a gift of life, and when we go to sleep at night, any remaining time is  NOT credited to us. What we haven't lived up that day is forever  lost. Yesterday is forever gone.  Each morning the account is refilled, but the bank  can dissolve your
account at any time....WITHOUT  WARNING.

SO, what will YOU do with your 86,400  seconds? Those seconds are worth so much more than the same amount in dollars.       

Think about that, and always think of this: Enjoy every second of your life, because time races by
so much quicker than you  think. So take care of yourself, be Happy, Love Deeply and enjoy life!

Here's wishing you a wonderful and beautiful day.
Start spending.