You have to laugh.

It is 6:30am after an unusually slow night shift. All my patients are either discharged or admitted upstairs, and the chart rack is empty... which is always an invitation for something to happen. Into the beckoning chart rack, the triage nurse drops a chart: "Buttock Laceration." "Slipped in the shower and cut herself on the faucet," it reads. I have flashbacks to cases I've seen in the past of tumblers and other fun things lodged way too far up into the rectum after, according to the chart, someone had "cleaned the house while naked and slipped," landing on said object. I have to laugh as I reach for the chart.

To do what I do and see what I see, you have to be able to find humor in things. However, to maintain professionalism, the nurses and I suppress our laughter to giggles audible only at the nurses station, for such injuries are not, in my experience, funny to the patient in the least.

So, I grab the chart, which in and of itself was an act worthy of comment from the nursing staff: "Wow, doc. Most of your colleagues would have let that sit for the 7 am doctor." What can I say... I didn't get where I am today by being a lazy-ass. Anyway, with chart in hand I prepare to hear the dramatic saga of the morning shower and to try to calm another emotionally and physically traumatized victim.

Much to my surprise, I walk in the room and the patient is laughing as hard as I wanted to about the whole thing. "Hi, doc," she chuckles. "Crazy things always seem to happen to me." She's a very obese women laying face down on the exam table with a wadded-up paper-towel stuffed between her butt cheeks. She recounts with a grin how she actually lost her balance and felt the hard metal of the bath-tub fixtures gauge her between her butt cheeks, then turned around and noticed blood trickling down the drain. "I tried to look at it in the mirror, but it was too hard to see, so I just put a paper-towel back there and came on in."

I start by plucking out the paper-towel. It has only a quarter-sized blood stain on it, so I figure maybe she just had a small nick. But I can't see anything with her generous gluteal tissue blocking my view. So I put one hand on each buttock and spread, spread, spread and spread some more... and when I finally lay eyes on the wound, the tables are turned -- While the patient is calm and laughing about the whole thing, I'm the one being dramatic and let out a gasp as I see the extent of her injury. There, in the depths of her butt crack, just above her rectum (thankfully not involving the sphincter in any way, which would have made the injury a lot more complicated), is what looks like one of Cole's puzzles: a big triangle flap that obviously fits back into the big 2" by 3" gaping triangle wound. And, yes, from what I can tell, it looks like she actually did slip. "Wow," I tell her. "You really got yourself good." The laughing ceases. I revert to my comforting role, ideal for those patients who play the victim role ("Don't worry," followed by an explanation of how I would make it all better)... Except this lady, happy and laughing, was not supposed to be a victim. I was the one who had just gone and upset her. Laughter really would have been the better medicine here.

I walk out of the exam room and, since there's nothing else going on in the ER, all the nurses are eagerly waiting to hear the juicy details. "Well," I explain to the nurse assigned to her room, "It's gonna take some sewing, so I need you to glove up and stand there and hold her butt cheeks open for me so I can fix it." More suppressed chortles and snickers from the nursing staff. "Don't worry. This lady's cool. She was laughing at herself too."

So we go in and the patient lays with her jigsaw puzzle ass in the air, the nurse retracts her cheeks, and I stand sewing with my face right in her butt. The three of us get through the procedure by just laughing at the ridiculousness of it all. I ask her if she needs a tetanus, and she starts laughing harder. Turns out she got her tetanus 6 months ago when she came to the ER after sticking her curling iron in her eye. "Crazy things always seem to happen to me." Despite the pain in my back after 20 minutes of contorting myself to get the optimal view of her butt crack, it was refreshing to be reminded that patients also appreciate the humor that can come through those ER doors and that they, too, have to laugh.