Health & Medicine

When is dying a laughing matter? Hospice humor gains a following

Niels Billund, a registered nurse and case manager for Fairview Home Care and Hospice, visited hospice patient Roy Cato at his home in Minneapolis.
Niels Billund, a registered nurse and case manager for Fairview Home Care and Hospice, visited hospice patient Roy Cato at his home in Minneapolis. TNS

Roy Cato is dying. But that hasn’t stopped him or his caregivers from finding a way to keep laughing.

Whether it’s jokes about enemas (“the enemy,” Cato calls them) or his long-term planning (“I need a calendar”), he has embraced humor as a necessary part of life — even as he nears the end of his own.

“I’ve always kept it light my whole life, so why would I stop now?” he said, resting recently in his Minneapolis living room, which is adorned with yellow smiley faces.

On this particular morning, Cato, 66, an artist, was joined by a few friends and by a hospice worker who shares his take on the power of humor to help cope with serious illness and to enjoy life at all stages.

It might seem counterintuitive, but laughter is a useful and often-used tool in hospice care, said Niels Billund, a registered nurse and case manager for Fairview Home Care and Hospice, who visits Cato at least once a week.

“People really want you to do what you do, but they certainly want you to see who they are,” he said. “Most of us like a good joke, a good laugh.”

The therapeutic humor movement is catching on.

Last year, the Minnesota Network of Hospice and Palliative Care, which serves Minnesota, Wisconsin, Iowa, and North and South Dakota, closed its annual conference with a session from a humorist. This year, the conference will open with a session on laughter yoga.

“Laughter, of course, is a healthy thing,” said Susan Marschalk, the network’s executive director. “It’s certainly good for people who are caregivers. It’s really good for hospice providers and the people who are working with patients who witness people dying every day. They need laughter.”

The connection between humor and health also is recognized by the Association for Applied and Therapeutic Humor. Based in Illinois, the group was started by a registered nurse and has members in Minnesota from various professions, including scholars, psychologists, nurses and doctors.

Therapeutic humor is “any intervention that promotes health and wellness by stimulating a playful discovery, expression or appreciation of the absurdity or incongruity of life’s situations,” the group’s website says.

“There is a very close relationship between laughter and tears,” said Mary Kay Morrison, president of the association and a self-described “neurohumorist.” “Laughter is a relief. When you laugh so hard that you cry, there is a close connection there. It’s something that brings relief from the stress and anxiety.

“If you have someone in hospice who is very angry or who is not willing to talk or laugh, you absolutely need to honor that,” she said. “It depends on the person. Humor is definitely appropriate when you have confidence that your impact is not going to be harmful.”

As any comedian knows, timing is everything. Billund, Cato’s case manager, understands this, too.

“I just lost a patient, Rhonda. I will miss her,” he said, his voice growing quieter. “We just had so much fun. We would goof off, and then we’d get serious. We would cry and talk and then have fun again.”

Humor isn’t something that he plans for on his patient visits. “It comes up in the moment,” he said. “I have a lot of ‘lightness of being’ in me.”

By all accounts, so does Cato. He was found to have cancer in August, and he has been in and out of the hospital.

“When you get old, that’s where you meet,” Cato joked, referring to his friends. “You say, ‘I’ll meet you at the hospital.’”

With the cancer progressing fast, he’s receiving hospice care at home. His friends and family visit him often, filling up the living room.

“It’s a special time,” Cato said. “Somehow I still feel lucky in all of this mess. I can’t believe how many people are out there that care about me and support me.”