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

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 adorned with yellow smiley faces.

On this particular morning, he 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.

Although it may seem counterintuitive, 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. In between checking blood pressure and asking medical questions, he chats up his patients, using his quick wit to engage them and, hopefully, induce a smile, too.

"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, North Dakota and South Dakota, closed its annual conference with a session from a humorist. And 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.

"Even in hospice, I believe when someone is able to laugh about the situation, you know they are starting to accept it and starting to cope with it," she said.

Her personal experience sitting in hospice with her mother, who was dying from Alzheimer's, taught Morrison how to grieve while still laughing.

"We did use humor to cope," she said. "I think humor is a coping skill that is critical for people who are going through any type of difficult situation. My mother was able to still laugh and find humor in certain things. Even toward the end of life, once in a while she could."

But there are limits to when humor is appropriate.

"It's always a balancing act, depending on the patient and the family and what is important to them," Marschalk said. "Part of this is you have to find the right people who can make that balance work. They have to understand it and have done some of their own work to really understand what humor might look like. So it isn't slapstick or silly and ridiculous."

It's also best not to force it, Morrison said.

"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 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, 66, an artist,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."

When visiting with his caregivers, he said, "there's more laughter than tears."

He added, "I think you've got to keep laughing."

Allie Shah • 612-673-4488

@allieshah