Humor, Cancer and Chronic Illness

“I’m not afraid of dying.  I just don’t want to be there when it happens.”  Woody Allen

 
Pat’s hand gripped mine tightly– her eyes glistened with mischief. “I so look forward to your visits. Everyone else around here is so darned serious!  I wish they’d just lighten up a little.”  I looked around the room and she was right. Her 58-year-old husband and 32-year-old daughter sat on the couch, looking as if a smile would shatter their faces into a million pieces.  “Tell me something funny that happened to you this week,” she continued. “What’s that little boy of yours been up to now?”

Pat was one of several patients that I made home visits to as a nurse, following up after her chemo and radiation for a tumor in her neck and jaw. Physically she was doing fine and her outlook was tremendous. However, her family had an attitude that could sink a battle ship. Even though Pat valued laughter, her family felt her condition was much too serious to permit using humor.

 
Despite the tremendous advances in cancer treatment, just the word “cancer” evokes a visceral reaction in many people. This includes family, friends, and even some health care providers. One of my patients shared that when she attempted to make a joke about her condition, her husband reprimanded her: “Honey, you shouldn’t be making jokes.  Don’t you realize how serious your condition is?”  This came as no surprise to me. A survey of terminally ill patients showed that over three fourths of them said they wanted more humor but that their family would not joke with them.

Does humor serve a purpose for those with terminal or chronic conditions?  Absolutely. Humor serves many purposes, including relieving anxiety, managing painful feelings, and releasing anger in a socially acceptable way. Humor is a wonderful coping mechanism that can help by reframing or seeing situations in a new light.

Distraction serves as another useful purpose. Sometimes humor helps to divert our attention, instead of focusing on what’s stressful to us at the moment. Humor can often provide relief, whether it’s from an uncomfortable needle stick or the unpleasant side effects of a medication. Scientists are collecting more evidence every day that humor, laughter, and positive emotions have numerous physical benefits, including a decrease in muscle tension and an enhanced immune system.

 
Where do you find humor? Fortunately it’s all around you. You just have to be looking for it. It’s a mindset, an attitude. It is not the same thing as joke telling, which may come as a relief to some of you. However, if you want to learn to tell jokes, practice telling a joke out loud to yourself seven times before you attempt it with someone else. (Once you blow the punchline, there’s no saving it.) 

Better than jokes are personal experiences or embarrassing moments. Few adults have not locked their keys in their cars, or found their zippers unzipped, or discovered a colorful piece of food stuck between their teeth when trying to impress someone. When sharing these universal events, we share our vulnerabilities and our willingness to trust others.  If you can see any humor in it at all, try sharing an embarrassing moment with a friend or family member.

Schedule some time for play daily. Many folks this frivolous and their lowest priority, but research now indicates that those who are too serious to allow time for play wind up seriously ill. Make a “list of things you find pleasurable and fun to do (some of these ideas should be of little or no cost). Then when you are most in need of lightening up but unable to think of anything fun to do, pull out your list and make an agreement to do at least one thing. You will feel better afterwards.

 
Get out of your rut. Do something out of the ordinary. It can be something as minor as sleeping on the other side of the bed, listening to a different type of music than you’re accustomed to, leaving for work 20 minutes early to take the scenic route, paying for the toll of the guy behind you, sending a cartoon to a coworker, taking a bubble bath by candle light, calling an old friend from high school— just use your imagination!  I once watched in bewilderment as a friend tossed his loose change into the couch in his hotel room.  “What are you doing?!” I exclaimed.  He smiled and said, “Even though I won’t be here to see it, someday someone’s going to have fun discovering the money in this couch.”

No matter what your physical condition, humor can benefit you.  Plan a daily humor break and reap your profits. Make the most of every day– lighten up!

Today’s Nursing Crisis: A Laughing Matter?

Did you hear the one about…?  According to a recent study, one of every three U.S. nurses surveyed under age 30 plans to leave their jobs within the next year. One in five nurses plans to leave the profession within five years because of unsatisfactory working conditions. According to the Bureau of Labor Statistics, 450,000 additional registered nurses will be needed to fill the present demand.  Experts worry about the year 2020, when the registered nurse shortage is projected to reach 500,000 positions, coinciding with the increasing needs of healthcare in an aging U.S. population.
It is obvious that the state of health care today is no joke.  But it may be a laughing matter, if one understands the premise that humor oftentimes is generated by painful circumstances.  There is nothing funny about unlimited resources, job security or a physician who responds quickly and cheerfully to a nurse’s request. The things that make nurses laugh tend to be the very things that drive nurses crazy.

Whether it’s a picky patient, a cranky coworker, or a demanding doctor, nurses frequently have no control over the stressors that arise in their work setting. They do, however, have a choice in how they respond to those pressures.  No single tactic will be appropriate for every situation, so a healthy nurse needs to have a variety of strategies. Numerous means of coping with stress in a healthy manner are available, and one of those ways is with humor.

There are three primary roles of humor in the healthcare setting: psychological, social, and communication. 

Psychological.   As nurses become more anxious and their focus becomes narrower, they become less creative and are more easily upset. Stress may not come from the event, itself, as much as from the nurse’s perception of that event. Humor provides a perceptual flexibility that can increase one’s sense of control. Learning techniques such as catastrophizing the event, where one takes the situation at hand and looks for the absurdity by asking, “How could this be worse?” may help the nurse put the event into its proper perspective.

Social.  As Victor Borge, a well-known comedian, said so eloquently, “Laughter is the shortest distance between two people.” When two or more can share in amusement, there is a commonality experienced among them, thus creating a bond. Some types of shared humor, such as self-effacing humor, reveal one’s own flaws, ‘humanness’ and vulnerability. This ‘revelation’ creates an environment where the listener feels that it’s safe to share, helping to develop rapport and establish or strengthen relationships. For that moment, the humor helps to diminish the perceived hierarchy, such as nurse/patient, doctor/nurse, or teacher/student while all involved participate in the fun.

Communication.  Sometimes a joke is just a joke.  But often, true words are spoken in jest. It may be helpful for the nurse to know that frequently people will present a serious concern in the guise of a joke. A patient may joke about an embarrassing or frightening situation. If her nurse responds in the manner that she had hoped, she has achieved her desired outcome. However, if the nurse doesn’t recognize the serious nature of her comment, then she has the ability to “save face” with the rationale that she was “only joking.” The skill for nurses is in learning to listen beyond the laughter, whether the person addressing them is a peer, patient, family member, or doctor.

 Physiological effect.  In addition to the functions of humor, the physiological effect of humor is identified as a benefit.  Most nurses have experienced at least one negative physiological effect of stress: Muscle tension, cold hands, headaches, gastrointestinal disturbances, among others. While researchers have spent years identifying the negative effects of stress on body systems, they are now looking at the therapeutic effects of humor and laughter on the human body.  These include decreased muscle tension, deeper respirations, and positive increases in the immune system.

As nurses practice to improve their abilities to use and appreciate humor, they also enhance their skills.  “Humor appreciation involves responding to humor produced by others or being a good audience. On the other hand, humor production involves thinking of things on your own to amuse yourself or others,” says Michelle Newman, PhD. When using humor as a coping mechanism, one cannot always count on being able to find an external locus of amusement.  “Of the two, humor production is the more portable skill,” says Newman and adds, “From the standpoint of coping, it seems to me to be less important whether you can amuse other people than whether you can amuse yourself.”  The implication for nurses is that while they may gain benefits from humor when enjoying it passively, there are even more benefits in being active participants by producing a humorous state of mind for themselves. 

Some nurses have shown themselves to be highly creative. One nurse carried a marker to decorate disposable gloves and masks on isolation carts.  A critical care nurse took a couple of adhesive EKG patches, attached them to the bottom of her shoes and “tap danced” her stress away during her break.  At a medical-surgical nurses station, whenever someone would shout “Massage Train!” everyone on hand would line up, put their hands gently on the shoulders of the person in front of them and soothingly massage. Before disbanding, they would switch directions of the line so the person on the end wouldn’t be left out. The whole procedure lasted only a minute or two, but everyone proceeded to their next task with a big smile.

Unfortunately, there is no “one size fits all” list of fun things for nurses to do. Because everyone’s sense of humor is unique, the techniques used to create humor must be highly individualized. The methods need not be flamboyant to be effective. For example, some nurses might be comfortable wearing a small decorative pin with an amusing picture or statement on it, particularly at seasonal times. Colorful clothing with festive accents might be an option if dress codes do not forbid. Some nurses are subtle, wearing Looney Tunes socks or Mickey Mouse jewelry while others walk the halls wearing a red sponge nose or carrying a rubber chicken! Posting cartoons and illustrations can brighten up any nursing unit.  Sharing jokes, stories, or embarrassing moments are other ways to generate laughter.  Humor baskets, carts and humor rooms are means of creating a more humorous environment.

Nurse researcher Vera Robinson once said that a sign of a profession’s maturity is its ability to laugh at itself. The profession of nursing is surely mature enough to be able to laugh at itself, and yet many nurses still refrain from using the skill of humor on the grounds that it is not “professional.”  Humor is not the equivalent of “goofing off.”  Indeed, it is important for nurses to maintain high standards and high expectations on their units and to take their work seriously. It is also important for nurses to be able to take themselves lightly. Sad is the nurse who cannot learn to separate the two– and that is no joke.

Stress Busters

There’s no one coping mechanism that will work for every stressful occasions. People need a variety of skills to stay healthy. These could include deep breathing exercises, progressive muscle relaxation, and meditation just to name a few.  But the benefits of humor and laughter are so plentiful, so convenient, and so cost-effective that people would be foolish to leave these awesome coping tools out of their coping toolbox. 

Here are a few quick stress busters. Try one the next time your energy level drops and your attitude is sagging:
 
Call your own answering machine or voice mail to leave a humorous message that you can enjoy later. Bonus—you get to laugh twice: Once when you leave the message and again when you play it back.  (For example: “Just calling to remind you to be careful when you go by the post office to pick up stamps and be sure to wear clean underwear because you never know when you might be in an accident!”)

Keep a file folder at your desk with clippings, cartoons, and e-mails you find entertaining. Pull it out and refer to it when you’re put on hold or when you feel those shoulders tightening.
 
Keep a book of word games, crossword puzzles, or cards at your desk. Re-spark your creativity and energy by taking a daily 10-minute ‘play break’ and you’ll recognize how important it is not to wait until you feel better to play. Play and then you’ll feel better.
 
Got a problem that’s bugging you?  Practice playing with your pain by asking yourself “how could this be worse?” Exaggerate the situation until you can make it absurd enough to put things in their proper perspective.
 
Smiles and laughs can diminish muscle tension. They’re also contagious. Practice wearing a smile to share with others and notice how their responses make you feel better, too.
 
Gain maximum benefits by proactively seeking humor every day.

Humor Appreciation: Taking It to The Next Level

I sipped my coffee and listened to my friend vent about her company’s merger. “I was so stressed out about the new changes being implemented at work,” Susan explained while rolling her eyes. “Then someone said something silly and I just lost it.  I laughed and laughed until I was limp as a dishrag.  Nothing had changed, but I just felt better for having laughed!”

It’s becoming accepted knowledge that positive benefits can be acquired from appreciating humor and laughter. Psychologist Michele Newman supported previous studies that found humor has a buffering effect and reduces the negative effects of stress. This study extended previous findings by demonstrating that humor is beneficial even for people who do not typically choose to use it to cope with stress. This finding was consistent with the belief that the ability to use humor to cope can be acquired rather than being a fixed, unchangeable trait.”

“Humor appreciation involves responding to humor produced by others or being a good audience,” reports Newman. “On the other hand, humor production involves thinking of things on your own to amuse yourself or others.” When using humor as a coping mechanism, one cannot always count on being able to find an external reason to be amused.  “Of the two, humor production is the more portable skill,” says Newman and adds, “From the standpoint of coping, it seems to me to be less important whether you can amuse other people than whether you can amuse yourself.”

Through my years of studying humor and laughter, I’ve observed three basic levels of humor appreciation:

Passive humor appreciation: At this most basic level, we appreciate humor that happens vicariously: A coworker says something funny, we observe a child’s comical action or expression, or we experience some absurdity that happens by chance. With this most basic level of humor we enjoy many of the functions of humor and the basic physical benefits, although the humor may occur infrequently and is purely unintentional.

Active humor appreciation: At this level, our awareness level is raised and we intentionally seek humor opportunities. We make it a point to read the daily comics, we ask others to share a joke or story, we become aware of humor we might have otherwise missed if we had made the assumption: Nothing funny happens here. We incur benefits more frequently, although not necessarily on a regular basis.

Proactive humor creation: At this advanced level, conscious effort is involved.  We attempt to create humor opportunities. We schedule time for play and entertainment in our daily schedules. We purposely create situations to amuse others or ourselves. We establish goals to utilize humor on a regular basis and attempt to make humor a habit. We enjoy the positive functions and benefits of humor on a regular basis.
While we may gain benefits from humor and laughter when enjoying it passively, there are even more advantages in being active participants by producing a humorous state of mind for ourselves. By incorporating a ‘humor habit’, we gain maximum profit from the wide and wonderful range of benefits at our disposal. Why not get the most bang for your yuck? Make humor a habit!

Mirth Managment: Kudos to Cosmoflex

Kudos to Cosmoflex, Inc. in Hannibal, MO and to the ingenuity of Operations Manager, Max Nicholson and Safety Committee Member, Mike Allen.  The task: A 3-year safety certification required by OSHA for all 50 employees at the plant.  The creative solution: A rodeo with a forklift—No bull!

Over the course of 2 days, all four shifts at Cosmoflex (a subsidiary company of Goodyear Tire and Rubber Co.) participated in a certification process like none before.  Outside the plant, a course involving all the necessary skills for using a forklift was laid out and put into place.  Exercises included a ‘Loaded Figure 8’, the ‘Stack and Back’, the ‘Ram and Jam’ and removing a basketball from a pylon and dropping into a basket.  The safety committee judged the employees individually and as teams on knowledge, accuracy, speed, and safety.  During the competition, everyone enjoyed an outdoor barbeque, drinks and music.

The initial goal was simply to complete certification for all employees.  When asked if there were any unexpected benefits, Nicholson and Allen agreed that they hadn’t anticipated the amount of strategizing and teamwork they observed.  “You can’t force teamwork,” said Allen.  “We saw great communication and tons of enthusiasm.  People were hooting and hollering, and lots of laughing.” He added, “This really perked up everyone’s attitude, and in a small plant—attitudes are contagious.”

This year’s winner, Brad Pemberton (with an individual time of 6 minutes and 36 seconds), won a gift certificate for Lula Belle’s—a popular local restaurant/bed and breakfast.  Team winners enjoyed a pizza dinner at the plant.

Was there a downside?  Nicholson said, “Just that the employees didn’t want to return to their posts—they enjoyed watching their coworkers compete.”  Even though the certification is good for 3 years, Cosmoflex plans to repeat the event because of the overwhelmingly positive feedback.

What Trips Your Trigger?

Humor that’s constructive and doesn’t target others feels good when we experience it.  It’s a pleasurable experience usually accompanied by a smile and a laugh.  And yet experts find it elusive as to what humor really is and just what triggers that humor response within us.

There are numerous theories about what evokes a humorous response. One of those theories revolves around developmental stages.  According to psychiatrist Christian Hageseth, author of A Laughing Place, there are 3 ways to elicit the humor response: Nov-verbal interactive; the stimulation of forbidden subjects; and verbal humor (jokes and word play).

Non-verbal interactive:
What is one of the very first things that evokes a smile in a young baby?  Obviously his brain isn’t developed enough to understand the concept of absurdity or incongruity. The baby laughs at a smiling face, which in return smiles back, usually evoking even more smiles.  Pure pleasure! 
As we grow, such interaction generally continues to evoke a pleasurable response, until we are conditioned to think and respond otherwise.  Even in the advanced Alzheimer’s patient, when she’s no longer able to remember faces, dress herself or even feed herself, a big smile accompanied by eye contact will evoke that same pleasurable response and usually a smile in return.

The stimulation of forbidden subjects:
As a child develops his sense of humor, one of the first things he finds funny is body noises– particularly those that evoke a startled response in adults. Eventually, as the child grows, his sense of humor also evolves, but occasionally we meet folks that seem to become stuck at that particular phase. (Usually they are know for statements, such as “Pull my finger.”) While many find toilet humor distasteful, the movie industry makes billions of dollars each year from movies like Dumb and Dumber or There’s Something About Mary.

Many occupations, especially those that are involved with tragedy and death, have their own inside humor that others might label ‘disgusting.’  Indeed much medical humor is known as gallows humor or ’sick’ humor, and usually involves one of three topics: body fluids, dismemberment and death. Nonetheless, this humor serves as a coping mechanism to people like Cyndi, a nurse in California, who says, “If I couldn’t laugh about the smell of poop or the texture of sputum, I’d probably be flipping burgers, and asking the person across the counter, “Do you want fries with that?”

Verbal humor (jokes and word play)
While most people think of this category first, language dependent humor actually comprises a very small percentage of what elicits a humor response. Indeed, it’s been speculated that only around 3% of the population remembers and tells jokes well. Most of shake our heads sadly and say, “I can never remember the punch line.” Fortunately jokes aren’t crucial to experiencing humor. 

 
If this tactic appeals to you, seek jokes and funny stories from others, listen to your favorite comediennes, pay attention to television sitcoms. There are joke-a-day services on the Internet. Most magazines and newspapers have a section that involves humor and word play.

And if you decide that you would like to learn the skill of joke telling, it’s really not that hard.  Start with jokes that are short and easier to remember. Practice telling the joke out loud to yourself, preferably in front of a mirror, at least 7 or more times. And once you feel confident, go out and tell your joke to your friends, family members, and those that look like they could use a good laugh!

Granted, we respond to all three categories above. But usually we can identify more with one area than another.  Our sense of humor is as unique as our thumb prints. What makes you laugh may leave another completely clueless. What’s most important isn’t what trips your trigger, but what you do with that knowledge. Merely raising your awareness about what you find fun and funny is a good first step. To gain the most benefits from humor, however, you need to move from a passive role, to an active one.  Discover what trips your trigger and causes you to experience mirth and laughter. Then seek the experience, practice positive humor and enjoy feeling good.

Humor: The Heart of the Matter

Scientists continue to support what we’ve known to be true since Biblical times: “A merry heart doeth good like a medicine.”  Studies in psychoneuroimmunology (PNI) have demonstrated that humor, laughter and positive emotions have a positive effect on the immune system, the respiratory system and now evidence shows a link between a healthy heart and a sense of humor.

A team of Maryland medical researchers found in a study of 300 people (half of whom had histories of heart problems) that people with heart disease were 40 percent less likely to laugh in humorous situations than those with healthy hearts.  “The old saying that laughter is the best medicine definitely appears to be true when it comes to protecting your heart,” said Michael Miller, director of the Center for Preventative Cardiology at the University of Maryland Medical Center.

The people with heart disease were much less likely to even recognize humor. They also laughed less, even in positive situations, and generally displayed more anger and hostility than people with healthy hearts.  The question remains: Does humor help prevent heart problems or do people with heart problems tend to lose their senses of humor?  “The ability to laugh — either naturally or as learned behavior — may have important implications in societies such as the U.S., where heart disease remains the No. 1 killer,” Miller said.

Speaking of humor…

Lou Heckler is a real master in the professional speaking industry. Addressing other professional speakers on the topic of humor, he gave 3 important tips on developing a humorous story:

1) Reflection: What things have you seen or overheard that struck you as funny? Spend more time sitting and thinking about moments that have amused you.

2) Misdirection: How can you take your listeners down the path with you to that moment of the unexpected and then let them experience the derailment?

3) Connection: How will your audience relate to the experience? It will only be funny to them if they can personally identify with it.

Whether you’re a professional speaker, a CEO, a nurse, a volunteer—anyone can benefit from the ability to tell a funny story. It builds rapport, good will and a sense of camaraderie. (And of course, a sense of humor is one of the top qualities sought in a mate!)

Just recently my husband and I went to see a theatre production: Man 1, Bank 0, a one man show by Patrick Combs. His incredibly funny story draws audiences from coast to coast because it’s something almost all of us can relate to: wanting to see the underdog win in a battle with Corporate America (especially when it’s our bank!). His ability to take the obvious, misdirect the audience and then connect with them on a what-is-most-personal-is-most-universal level is what makes his story such a hysterical success.

Take Lou’s advice: reflect, misdirect and connect. And then drop me a line and tell me your story!  (Thanks, Lou!)

What was he thinking?!

Obviously, he wasn’t. Thinking, that is. Michael Richards, better known to the world as Kramer, took his funny and light-hearted image he’d established over his successful career with Seinfeld, and flushed it down the tubes. I can just picture him skidding into Jerry’s apartment, shaking like an electrically charged, over-caffeinated baffoon, uttering “Oooooooooooohhhhhhhhhhhhhhh nooooooooooooooooo!”

“Oh no” is right. Whether you’re dealing with hecklers, irritable coworkers or cranky customers—insulting them is a bad idea. Comediennes anticipate that these things will happen, and they have comebacks that are so practiced that they can appear to be spontaneous—but few professional comics will leave those situations to chance.

There’s something you can learn from Michael Richards’ common sense infarct. We all have times when have to deal with hostility from others. A lot of times, if we’d thought about it, we could have anticipated these episodes.

And when those situations do arise, we have choices. In his book, The Light Touch, Malcolm Kushner suggests:
We can respond seriously to the complaint.
We can refuse to respond.
We can pretend to respond (picture the doctor that overwhelms the other person with medicalese or the lawyer that responds with legalese).
We can respond with humor.

All of these choices, mind you, are appropriate choices at one time or other. But not every one of them will fit every occasion every time. You have to use good judgment (which apparently some people lack).

When responding with humor, the idea is not to derail the other person so you can totally avoid the conflict. You want to unbalance the other person, even momentarily, so that you give yourself a moment to think, regroup, and then respond in the best possible manner to the situation at hand.

Take for instance the waiter who has forgotten your request for water. Twice. When you ask him a third time, an appropriate response for the waiter might be, “I’m sorry. My memory is really very good. It’s just very short.” (pause). “I’ll be right back with your drink.”

The waiter addressed the concern; used a quick one-liner (doesn’t have to be fall-down-funny) that he has thought about ahead of time, and then responded to the need.

In one of my workshops, a manager said that an irritable customer once demanded: “How long have you worked here?”
His humorous response: He looked at his wristwatch, smiling, and asked, “Well, let’s see… What time is it???”
The customer looked surprised and then smiled. From there, they were both able to move forward in a more positive frame of mind.

Anticipate and prepare. Comics do it. Politicians do it. And so should you.

Here’s your homework assignment:
Make a list of the hostile questions you might deal with at work.
Now come up with a list of humorous responses.
Force yourself to come up with at least 10.
The rationale? Because the first ones you come up with are going to be absolutely hysterical—and they’re probably going to get you in trouble! Flippant is funny—but in this case, you need to stretch further to find something that is funny but not offensive. It takes a little more work, but it’s worth it.

Use humor in your workplace proactively and you’re going to find that you have a lot more fun AND a lot more profit!

What happened to The Journal of Nursing Jocularity?

Doug Fletcher, Publisher JNJ

Thanks for asking. I was Vice-President of the JNJ during its eight year stint and best friends with publisher, Doug Fletcher. Doug had a great vision when he created the JNJ and left a tremendous legacy. His untimely death, and the deaths of our friends and colleagues Bob Diskin (Too Live Nurse), Georgia Moss, and Diane Rumsey, left a huge void in the world of healthcare humor. In Doug’s honor, AATH has named its Lifetime Achievement Award after Doug (see www.aath.org)

Below is an announcement I created when we ceased publication of the JNJ. Barely a day goes by that I don’t think of Doug and smile.

The Journal of Nursing Jocularity was a quarterly publication for nurses and health professionals that was written, edited, illustrated and published by nurses and health professionals. The first issue was Spring, 1991; the last issue was the Spring, 1998. Filled with satire, true stories, cartoons, and all around funny stuff related to nursing and health care – it established its place in nursing history as the only humor magazine for nurses.
With the death of Doug Fletcher, Diane Rumsey, Georgia Moss, Bob Diskin, and Debra Woodbury on May 1, 1998 the Journal of Nursing Jocularity ultimately ceased publication.
Below is the news report from the Albany Times:

Tragic Accident Results in End of an Era

ELIZABETH BENJAMIN, MARK McGUIRE, and JOE PICCHI Staff writer

A fiery head-on collision between a tractor-trailer and a sport-utility vehicle left five people dead and three injured Friday morning on Route 20.  The dead were registered nurses scheduled to perform in a comedy show Friday night at the Theater Barn in New Lebanon. The show — “Who’s Got the Keys?” — was supposed to run three nights. A representative of the theater said Friday afternoon that the show had been canceled.All the victims, three women and two men, were in a 1994 Ford Explorer. One woman was thrown from the vehicle onto the road. The others remained in the Explorer, which caught fire after the tractor-trailer rolled over it, police said. A third car, a 1987 Chevrolet sedan, also was involved in the 10:24 a.m. accident.  The Explorer was registered to one of the victims, a Columbia County resident. The others were from Florida, Michigan, Pennsylvania and Arizona, State Police Capt. John Byrne said.The names of the dead were being withheld pending notification of their families, Byrne said. They were pronounced dead at the scene by Columbia County Coroner Angelo Nero.State Police Sgt. G.E. McGreevy said the Explorer pulled out of Jefferson Hill Road onto Route 20 and into the path of an eastbound tractor-trailer laden with about 1,300 used tires. The vehicles collided head-on.  The crash also involved a third vehicle that was heading west on Route 20 toward Nassau, which police surmise might have collided with the tractor-trailer before it rammed into the Explorer.  The condition of the wreckage and the death toll made it difficult for State Police to immediately determine the accident’s cause, Byrne said.

Three people were pulled alive from the crash scene and taken to Albany Medical Center Hospital, one of them by helicopter. The accident closed Route 20, a two- to four-lane road that twists through Rensselaer County en route to Massachusetts.

Truck driver Byron Chacon, 30, of West Haven, Conn., is in fair condition, authorities said. He underwent surgery for injuries to his right arm and suffered multiple abrasions, according to hospital officials.  His co-worker, Jose Ardon, 38, also of West Haven, was in fair condition with a head injury, facial cuts and burns to his hands, officials said. He was taken to the hospital by helicopter.  Donna Brightman, 36, 921 Saratoga Ave., Ballston Spa, the driver of the third vehicle, was released from the hospital after being treated for a head cut and a knee injury.

Police said the tractor-trailer began its trip from the West Haven offices of Inter-East Tires, which collects used tires and brings them back to Connecticut. The truck had made several stops in Albany and Troy, and was en route to Pittsfield when the accident occurred. “I feel terrible,” said Inter-East Vice President Steve Briley. “This fellow (Chacon) has been an excellent employee. We’ve never had a problem.”

Brightman’s westbound sedan, which was damaged on the driver’s side, careered off the road into the woods about 100 yards from Jefferson Hill Road. Broken glass and parts of her car were strewn along the road, uphill from the crash site.

Byrne said it was too early to determine what happened, but police have developed a working theory: that the tractor-trailer was heading down a moderately steep hill on Route 20 while the Chevrolet was headed uphill toward the village of Nassau. The Ford Explorer was on Jefferson Hill Road, which is about in the middle of the hill. Police think the blue car might have hit the tractor-trailer first, causing the truck to plow into the Explorer as it pulled out of Jefferson Hill Road heading toward Nassau.

The Ford Explorer was reduced to a twisted, blackened hunk of metal. The vehicle appeared to be squashed, as though the tractor-trailer had driven directly over it — which Byrne called “one possible scenario.”

The impact of the trailer hitting the Explorer was so great that the vehicle’s license plate was found deep in the woods. The Explorer caught fire and was fully engulfed when the members of seven volunteer fire departments arrived.

The tractor-trailer plowed over the north side guardrail on Route 20 and flipped, scattering the used tires onto the road and into the woods. The trailer stretched halfway across Route 20, blocking the road.  Two hours after the accident, fire and police were still extracting the dead from the Explorer.  “You get pretty messed up when you see people burning and can’t do anything about it,” said Tsatsawassa Fire Chief Jay Kreutziger, who arrived at the scene moments after the crash and saw the Explorer engulfed in flames.

Kreutziger said a nearby resident, who was unidentified and could not be found, hurried to the road with a fire extinguisher in an unsuccessful effort to douse the flames.  Both truckers were able to get out of the vehicle on their own despite the fact that the truck’s cab was upside-down.  Traffic was diverted to side roads off Route 20, which remained closed as of 11 p.m. Friday but was expected to reopen by midnight.

At a news conference Friday night at Troop G headquarters in Loudonville, Byrne said he confirmed that several of the victims were nurses who were supposed to perform the night of the accident in a production called “Who’s Got the Keys?”  The show was part of a Nurses Week celebration, following a demonstration at the state Capitol by a grass-roots nurses organization called the Florence Project that publicizes problems related to health care.

Bright yellow fliers advertising the show were strewn about the accident scene at the intersection of Jefferson Hill Road and Route 20.  The fliers described “Who’s Got the Keys?” as a musical comedy put on by a cast of 20 singing and dancing health care professionals. The show was to be about an exhausted nurse who “discovers the real meaning of being a nurse” by battling an evil, four-headed HMO monster with help from a wacky cast of characters.

Katherine Smeland Pebler, the New York state coordinator of the Florence Project, said the five nurses who died in Friday’s accident had just rehearsed “Who’s Got the Keys?” at the Theater Barn and were heading to Albany to attend the rally at the Capitol steps.  A nurse who had been at the rehearsal but declined to join the group heading to the rally and instead went home to her 4-year-old son assisted the police in identifying the victims, Smeland Pebler said.

“Our profession has experienced a great loss,” said Smeland Pebler, reached by phone at her home Friday night. ”The fact that these RNs, who have been working so hard on this play to bring to light the demise of health care in our nation, died, is tragic. Further, it disturbs us with the Florence Project that they were on their way to our rally.” Oster
contributed to this report.

First published on Saturday, May 2, 1998
Copyright 1998, Capital Newspapers Division of The Hearst Corporation, Albany, N.Y.

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