2022/Feb/19 Microphone On, Medial Prefrontal Cortex Off

          When I was interviewing for neurology residency, one of my interviewers said, “So with your background in stand-up comedy, surely you must know the neurobiology of humor.”

If you were standing outside the door of that office, you would have heard my nervous laughter continue for a little too long as I tried to stall. I had no idea. The concept had never even crossed my mind. I fumbled through an answer that just listed some random brain structures (prove me wrong that the medial subnucleus of the oculomotor nerve is not involved in joke telling) and was promptly corrected by my interviewer. She then asked me to do a “quick” chart review and send her what I found out. With EndNote open, while I questioned everything in my life, I actually turned to my copy of Mike Sacks’s “Poking a Dead Frog: Conversations with Today's Top Comedy Writers,” signed by Bill Hader. The title is based on this quote by E.B. White: “Humor can be dissected, as a frog can, but the thing dies in the process and the innards are discouraging to any but the pure scientific mind. Humor won’t stand much poking. It has a certain fragility, an evasiveness, which one had best respect.”

I bet you thought I just sent that quote to that interviewer in an envelope with no return address.

I did not. Because I still needed a job.

As one of my attendings would later say, “Oh, so medicine was your Plan B.” That is 99% false. I was pre-med all throughout college (silly me), and I took two years between college and medical school to work in the medical field. But everything in between all those major landmarks was probably comedy-related. I grew up watching sketch comedy and started doing stand-up comedy in college. My college stand-up group workshopped material multiple times a week and then performed sets around the city. When I started out, I thought I’d be good at it because I thought I was a funny person. I was completely incorrect. My first few shows were horrific. In my opinion, pity laughs are worse than silence.

Contrary to what people may want to believe, you also cannot just “do comedy” by “being funny.” Whenever I sat down trying to come up with a bit, I would frequently draw a blank. Overthinking has been my enemy in school and in comedy. My best content was revealed to me via “the shower effect,” like when I was walking to class or drifting off to sleep. It was basically a hypnic myoclonic jerk in the form of an idea. I think the comic’s mindset thrives when they “get out of their head.” But that’s just the spark: the craft of “trimming the fat” and perfecting the punchline demands to be practiced regularly.

During my gap years, I continued stand up, sketch comedy, and acting in New York, but this was only after clocking out of my 9-to-5 job. As I progressed in my medical career, comedy became more and more irrelevant in the official sense (it’s only in the “Hobbies/Other Work” sections now of my CV). I still find doing a research presentation much more daunting than doing a stand-up set. It’s probably because I’m at the start of my medical career, and my presentations are to an audience where everyone knows more than me. I fear the raised hand, followed by the “Well, actually…”. While with comedy, I can say anything I want as my truth. People can and will heckle you, but their comments are (generally) not specific enough to tell you that you’re wrong.

Residency has been tough, but it has provided a fountain of content. During my intern year, one of the creators of a network medical drama came to talk to us about their job. It became very clear that her main goal was to sniff out new ideas. Here are four that I pitched. Guess which one made it into the show?

1) The residents go on a wellness retreat, and they do an escape the room game. It’s just a clinic room, and it’s just a chatty patient who won’t let them leave.

2) Olympic commentators follow an intern around the hospital. “Ooof, he only ordered the liquid formulation of potassium. That one’s gonna hurt, and you know that’ll be a deduction, Jerry.”

3) An entire episode where the ICU team just rounds and rounds, West Wing style. Each round, the nurses look slightly different, like they’re wearing glasses or change haircuts, to show that so much time has passed, and ICU rounds are forever, and we will never escape this reality that is ICU rounding.

4) An intern spends the entire episode going from printer to printer around the hospital to find out where his handoff printed out.

You’re right! It was none of them. Because they are all stupid. But they made ME laugh.

I’ve learned there are more similarities between the comedy world and the medical field than I thought: both comedy and medicine are incredibly saturated. Every millennial like myself thinks their friends are hilarious and people would love to listen to a podcast of them just talking about nothing. Every physician with a social media presence thinks tweeting “Listen to your patients. They are telling you the diagnosis” is some truth-bomb we’ve never heard before. Perhaps everyone is right, but maybe you should remember that everyone else is also right—and being right all the time is kinda boring. But also, both worlds have humbled me tremendously. As soon as you nail a punchline or a diagnosis, you bet you’ll bomb the next one. People are incredibly predictable in that you can guarantee they will always break your heart but then gift you with the stained-glass art of soldered shattered pieces. My ego will rise and fall as quickly as a QRS complex. (I don’t feel good about that analogy either. Let’s just move on.)

Neurology is my career, and comedy is my craft. I personally like to keep them separate, but on occasion, I get to combine the two. Almost none of my patients comment on my fake mustache and real monocle when I first meet them. I spent so much of my medical training being as professional as possible so attendings and patients would take me seriously. Now that I’m a little more comfortable with my role as a medical provider, I do let my personality shine through when the moment is right. I think people appreciate it. I mean, most of the time they don’t get it, but that’s okay, too. There’s a lot of humor in neurology, whether it be in my interactions with patients or as a coping mechanism for difficult days. I guess I’ve realized that I’d rather not seek out the neurology of humor. It actually thrives more when I turn my brain off completely.

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Amalie Chen is a Mass General Brigham neurology resident and Vanderbilt University School of Medicine graduate. She is an alumnus of UPenn’s “Simply Chaos” stand-up comedy group. Follow her on Twitter @amalie_chen.