by Carol A. Westbrook

I'm a big fan of stand-up comedy, and I especially enjoy live performances. I try not to sit too close to the stage, though, because then I'm fair game for the comic. I don't mind being the butt of jokes, but I don't want to embarrass the performer.

You see, I'm a perfect target. I'm easily twice the age of the rest of the audience, and I suppose I do look like a granny with my little spectacles and the grey highlights in my hair.

It usually begins with something only mildly insulting, such as “Did you knit anything interesting today?” or “Are these your grandchildren?”

But woe betide the comic who asks me what I do for a living!

“I'm a doctor.”

“What kind of doctor?”

“An oncologist–a cancer specialist.”

That usually brings the fun to a screeching halt.

The younger comedians, and the typical comedy club audience– GenXers and Millennials–hear the word, “cancer” and think “death.” Perhaps they remember the funeral of an elderly relative. Or they saw a movie or TV show depicting someone dying of cancer. Or they recall an unenthusiastic visit to a hospital with their parents to visit a dying relative.

It doesn't matter. The mood is gone. The room is suddenly quiet.

I'm always amused to watch the comedian try to recover from this. Usually he will quickly change direction and turn to another, younger, audience member, asking what she does for a living. Or the comic will start to talk about prostate exams, or colonoscopies–which usually causes the show to deteriorate into penis-and-butt jokes of the sort that were popular in 6th grade, from which there is no comedic recovery.

No, there is nothing funny about cancer. What is funny, though, is how awkward it is for most people to talk about death, or to even think about it. It makes us squirm in our seats. Pointing this out to the audience, and having them laugh at their awkwardness, takes a very insightful and experienced comedian, who understands the difficulty that we have in facing our mortality. It takes a mature, seasoned comedian to seize a moment like this–and to turn it into an occasion for laughter.

Take Rich Voss, a really funny guy whom I had the pleasure of hearing a few months ago. When he made the mistake of finding out that I was a cancer doctor, he seized the opportunity to recount another experience that he had with cancer and doctors in his audience a few years ago.

According to Voss, he was hosting an open mike, stand-up comedy session. Open mike attracts any number of amateur wanna-be's, as well as seasoned comics honing their material. Voss recalls that one performer, an amateur, was not funny at all, and the audience was getting bored and restless.

Voss, trying to regain control, asked the amateur why he was even bothering to try stand-up comedy.

“It's on my bucket list,” the performer answered.

He went on to say that he was dying of a brain tumor, didn't have any medical insurance, and couldn't afford to pay for his brain surgery. He was going to die in a few months. So he decided to spend his last few months completing his “bucket list,” that is, doing the few things he always wanted to try before he died. This included stand up comedy.

Whereupon another audience member jumps to his feet, and says, “I'm a surgeon! I can help you! Come to my office next week and we'll schedule your brain surgery. I will do it for you for free!”

The audience applauds. Voss, however, asks the doctor if he is a brain surgeon.

“No,” he admitted. “I'm an orthopedic surgeon. But brain surgery is on my bucket list.”

Everyone laughed, the awkward moment was forgotten, and Mr. Voss went on to finish another successful comedy show. Voss is a very talented guy–you should see him if you get the chance. He clearly has had more life experience than the younger folks in the audience. He recognized something that we oncologists learn from caring for patients who are facing a terminal illness–that people come to terms with their diagnosis and with their own mortality. Most of them become very matter-of-fact about facing their own death. Their friends and relatives, on the other hand, generally have a lot more trouble dealing with the concept, and will avoid discussing it, even to the point of avoiding the friend with cancer. The thought makes them squirm, it makes them uncomfortable. They don't know what to say, and it's easier to avoid the subject completely.

That is because in our society, which values good health and longevity, death has a bad name. Many cultures accept death as being a necessary part of life, but we don't — even though it is as inevitable as taxes. And coming to terms with death is something that every cancer patient will do. In my experience, most patients faced with the diagnosis of a terminal illness ask realistic questions, make plans, and try to face it in the best way they can. No longer taboo, death becomes something they can talk about, something they can even laugh about it, something they can look in the eye and poke fun at it.

Take one patient of mine, a jovial man at the VA hospital who was dying of leukemia. He joked about his demise continuously.

“My doctor told me not to buy any long-playing records,” he said, “and my insurance agent gave me a new calendar this year that only had 6 months.”

Sadly, the old Vet didn't even make it to six months, but I'll be he died laughing.

Doing stand-up comedy is on my bucket list, too. Doing brain surgery is not.