Clowning Away the Frowns

At the grocery store, Kelli Dunham called her girlfriend Heather MacAllister to ask if she needed anything. When MacAllister, who was living with a terminal illness, replied, “How about three-quarters-pound of a will to live?” Dunham answered, “They only have organic, and now they’re all out.” MacAllister shot back, “Damn. I had a coupon.”

“She was trying to communicate something to me,” says Dunham about her girlfriend, who died seven weeks later. “Her fight was waning, which is a very important thing for a family member to communicate, and she needed me to take it with the same lightness that she threw it to me. That was a difficult exchange, but it was much different because of the humor.”

The deaths of MacAllister and another partner motivated Dunham to pursue a career making serious situations a bit lighter. Leveraging her bachelor’s degree in nursing and clinical experience with stints as a stand-up comic, Dunham speaks at conferences and nursing schools, offering tools for health care providers to use humor to combat secondary post-trauma response and compassion fatigue.

It doesn’t require the wit of Robin Williams, she says.

“People get scared it’s going to be like a ‘Patch Adams’ thing, like, I’m going to make people wear a clown nose,” says Dunham. “It’s not about being funny, it’s seeing the funny. … It’s not about you having to be the funny person. It’s about responding to patients’ humor. It’s about seeing the humor in things.”

Lightness in heavy situations is sorely needed in the high-burnout field of medicine. The COVID-19 pandemic drove about 100,000 registered nurses to quit, according to the National Council of State Boards of Nursing. The government projects an ongoing shortfall of more than 275,000 nurses through 2030.

Dunham didn’t expect to specialize in this type of work. She went from living in a convent to standing up in comedy clubs, with some years at Drexel along the way, before launching her current consulting business. After two years with the Missionaries of Charity in Harlem, Dunham realized religious life was “a terrible fit,” and the order agreed. It was a Sunday night when a superior with the order took Dunham to Port Authority transit station, where Durham blurted “Philadelphia” when the older woman asked for a destination. Dunham knew that her sister lived there. “I was in a desperate situation,” says Dunham, who had volunteered in Haiti with the nuns before joining the order.

Dunham wanted to continue helping people “but not be broke,” as she puts it. “I wanted to stabilize my life in some way and have something concrete to offer besides my smile,” she says. A friend suggested nursing, and Dunham enrolled at Hahnemann Hospital School of Nursing soon before it merged with Drexel and became the College of Nursing and Health Professions. Dunham earned her associate’s degree in 1998 and then her bachelor’s degree in nursing in 2000 from Drexel through the RN to BSN program.

Thanks to the William and Theresa M. Rubert Memorial Scholarship Trust, Dunham received a full ride for academics. “It just gave me breathing room,” says Dunham about being free from student loans. “I can make choices based on what I would like to do and what is going to make the world a better place.”

Dunham worked for Drexel for nearly a decade, including roles in Stephen and Sandra Sheller 11th Street Family Health Services — where she was the first primary care nurse — and the Nurse Family Partnership, where she trained new mothers in their homes. She also was a community school director for the New York City Department of Education, tutoring students to help them prepare for pre-nursing exams, among other duties. Through those jobs, Dunham saw firsthand the stress absorbed by nurses, social workers and others immersed in fields that focus on helping people.

During nursing school, Dunham began performing at open-mic nights. As the youngest of seven children, Dunham grew up on a farm in Hartford, Wisconsin, and always wanted to be a stand-up comic. “It really helped to be the funny kid,” Dunham says about her big family. “I used to tell jokes to the cows.”

After losing two partners to cancer, Dunham believed she couldn’t be a comic anymore — she wanted to talk about serious subjects like death instead. But then she realized a perfect intersection of everything she had done: comedy for people who work with trauma, such as nurses and victim advocates. Dunham decided to teach them how to intentionally insert more humor into their serious jobs.

She began speaking at conferences, equipped with a CEU-ready curriculum. Her 2000 book, “How to Survive and Maybe Even Love Nursing School: A Guide for Students by Students” — now in its third edition — prompted invitations to speak at nursing schools. In 2013, Dunham published “Freak of Nurture,” a collection of essays.

During the pandemic, Dunham pivoted to Zoom shows and virtual presentations, finding her comedy even more relevant. “It did open up a window in some ways. We had a little moment when people wanted to address grief, and so many people were grieving,” she says.

Dunham’s presentations include practical advice for bringing levity into a caregiving workplace.

One tip is to celebrate everything. Dunham was working with people who were advocates for prisoners at Guantanamo Bay, and the crew made a banner “Welcome Home from the Post Office” after someone had run a mail errand. “We were just going to celebrate everything because there wasn’t a lot to celebrate, right? Think about celebrating the smallest, most ludicrous, little positive thing,” Dunham says. “It can make a huge difference, especially in a job where you don’t have a lot of wins. You might not make things better. You’re just trying to keep things from getting worse.”

Dunham emphasizes letting the patient take the lead related to humor, especially for health care professionals working in hospice. Using a baseball analogy, she says, “The patient throws [a joke], but your job is to catch it and you can throw it back. But only after they’ve thrown it to you first and no harder than they throw at you.”

Using humor to highlight incongruent situations is a way to charm and disarm listeners while granting them permission to discuss loaded topics like death, says Eric A. Zillmer, Carl R. Pacifico Professor of Neuropsychology and director of the Happiness Lab at Drexel.

“Humor can provide a door to walk through to manage this taboo topic, and it’s not the person walking through, it’s the situation that we’re dealing with as a group,” Zillmer says. “I like it when [practitioners] are actually not funny, but the situation is funny, and everybody kind of pointed it out, and by doing that, they came together as a team.”

Zillmer, who worked in hospitals and directed athletics at Drexel, understands how humor relieves stress in high-intensity settings where teams need to work together while the clock ticks.

Still, it is crucial to be aware of sensitivities to avoid insulting a coworker, patient or loved one. “You don’t know what people find funny, so you want to stay nuanced… You want to find a way to use humor so it passes from the mind to the heart, so to speak. And if you can do that, without offending people, then it’s truly medicine. It’s comfort food for the soul,” Zillmer says.

Humor can be as simple as telling a story, an artform that Dunham deploys whenever she steps up to a microphone.

“I think that storytelling and improv together is a great way for professionals, health care and otherwise, to laugh at themselves a little and to share both the good and bad of the worlds they inhabit to help them cope with sometimes really difficult situations,” says Michael Yudell, interim dean and professor in the College of Health Solutions at Arizona State University.

When he was a professor at Drexel’s Dana and David Dornsife School of Public Health, Yudell helped start Philadelphia-based Study Hall, a performance where professionals of all industries deliver a lecture and then comedians create an improv routine on the topic, serving up a show of learning and laughter. Aware of sensitive topics — which could range from racism to autism, as well as lighter subjects — the cast works to ensure they are never punching down.

“We want to elevate the material in a way that may include satire, it may include laughing at ourselves, but we are never laughing at anybody in particular,” says Yudell.

But you don’t need to stand on a stage to make coworkers or patients smile, Dunham advises. She recommends intentionally adding humor to the physical space, such as keeping a hand puppet or other conversation-starter on your desk. Dunham recalls how an employee taped New Yorker cartoons on the outside of an office door near where EMTs and cops gather in the emergency department.

“It was a very soft offering,” Dunham says. “I think of humor as an option. It can be a productive way of dealing with things, but like any coping mechanism, it can’t be stuffed down people’s throats.”