Article Content

A doctor sits alone, probably late at night, catching up on paperwork. A patient slips in and sits beside her. Intrigued, the doctor strikes up a conversation and is surprised when the patient reveals that she has been dead for 3 days.


"My name's Tiffany," cackles the elderly patient, "probably the oldest person in the world named Tiffany." The audience of newly hired nurses and healthcare staffers snickers nervously.


Tiffany is really nurse Elisabeth "Libby" Tsubai, RN, BSN, MS, CHPN, and is the main character of a sketch that Tsubai wrote to illustrate the dilemma of a patient dying with too much pain and too little dignity. She uses comedy as a device to take the edge off the subject.


Tsubai is the director of operations at the Institute for Palliative Medicine at Methodist Hospital, part of Texas Medical Center, in Houston, TX. A nurse for 30 years, Tsubai writes and performs stand-up and sketch comedy. Some of her work is currently being performed at a theater in New York City's Times Square, and she is a former member of the Third Coast Comedy improv group.


She combined her two passions to create Tiffany as a way to educate Methodist hospital staff and others regarding palliative care, which focuses on a patient's comfort and the relief of physical and nonphysical suffering.


Tsubai calls her Tiffany presentation an "edutainment," an art form combining education, comedy, and nursing knowledge to present a message about end-of-life issues to nurses and other audiences.


In the performance, Tiffany recounts the repeated and often painful attempts by medical staff to keep her alive, when all she wanted was to be allowed to peacefully slip away. The sketch is a way of reminding healthcare professionals to continually consider all of the patient's needs, emotional and medical.


"Pain takes on many forms:physical pain, spiritual pain, and the loss of control over one's destiny," Tsubai explains. "Tiffany is presented mainly to people who deliver healthcare, to teach them how to listen to suffering, and to do something about it."


She performs the sketch every 2 weeks to newly hired staff at the Methodist Hospital, but Tsubai has also taken "A Conversation With Tiffany: Listening to End-of-Life Suffering Through Comedy" to conferences and workshops such as the Texas Partnership for End-of-Life Care annual meeting, the Texas-New Mexico Hospice Association Conference, the American Nurses Credentialing Center Eighth Annual Magnet Conference, and the American Academy of Hospice and Palliative Medicine Annual Conference.


"Tiffany is well-traveled," says Tsubai. "She seems to always make an impact on people."


The Methodist Hospital Foundation awarded Tsubai a grant 2 years ago to develop "Conversation" into a short film, which is now in postproduction.


"I hope to show the film whenever I can, but I still want to present Tiffany to audiences in person," Tsubai says. "People have reactions that run the gamut, but most respond in a very personal way."


One nurse gave Tsubai the greatest compliment she says she has received. "She told me she saw a performance of the sketch some time ago, and she remembered how Tiffany felt embarrassed and exposed at being naked while others tried to resuscitate her," Tsubai says. "Because of that, the nurse says she always remembers to keep her patients covered during CPR."


Performing Tiffany for years, Tsubai has noticed her own performance evolving. "There is a part in the story where she talks about being separated from her husband; for a long time, I had a hard time getting teary-eyed for that," she says. "But recently, I've been able to really get into it, and it helps to really make the point that she is suffering."


Methodist Hospital has been developing a palliative care program that is both comprehensive and innovative. In July 2006, the hospital will open a five-bed unit, with Methodist staff providing palliative care and personnel from Houston Hospice providing hospice care.


"We envision the unit to be a unique hybrid of both palliative and hospice care," Tsubai explains. Tsubai will offer the current nursing staff the benefit of her insight when hospice patients arrive on the unit later this year, and surely, Tiffany will play a vital role in that training.


"Tiffany grabs everyone in some way, which is one reason I think she is so effective," says Tsubai. "Her experiences are very personal, and everyone has a personal response. But her experiences are also very universal, which is why she is such a great tool for education."


For more information, visit