Secondary Logo

Share this article on:

Commentary on “Laughing With,” lyrics and music by Regina Spektor

Bates, Erica

doi: 10.1097/01.ACM.0000444256.08164.f7
Medicine and the Arts

Dr. Bates is a first-year resident in internal and emergency medicine, University of Maryland Medical Center, Baltimore, Maryland; e-mail:

Lyrics stripped of their rightful musical context can take on new meanings. In print, the words of Regina Spektor’s “Laughing With” could be read as sanctimonious, or worse, darkly satisfied. However, listening to Ms. Spektor’s haunting performance, accompanied beautifully on the piano, there is no trace of mockery. Her delivery is gentle, a statement of fact rather than an argument.

Despite the overtly religious subject matter, this compassionate song is less a call to worship than a reflection on our natural instinct, as human beings, to look for a greater meaning when confronted with fear and uncertainty. Serious thoughts are easy to dismiss when we feel confident and in control, emboldened by the security that most of us take for granted in our daily lives—“God could be funny at a cocktail party.” But when that sense of security is ripped away suddenly, even the naturally glib sober up quickly. Famously, there are no atheists in a foxhole, and “No one laughs at God in a hospital.”

This song often comes to mind as I walk through the halls of the hospital and watch the fearful faces of the patients and visitors who pass. The hospital is not a hospital to me, a medical student, in the same way that it is to them. For me it is a school, a library, a workplace, somewhere to meet friends for a cup of coffee before class. I am a healthy young person, and this building has no frightening personal memories attached. Familiarity has made me comfortable here, and although I do not take my clinical responsibilities lightly, in some sense, I am at a cocktail party while my patients are in a war.

The brilliance of this song for anyone who works with patients is that it conjures moments in our own lives when we have felt truly visceral fear. We can all recognize our own potential for devastation in the possibilities Spektor describes. I have never sat in hospital room fearing the worst, but listening to this song, I am taken back to a night four years ago, when the airplane I was in began shaking uncontrollably. In that moment, completely terrified, no intellectual arguments about the odds or air safety could touch me. I am taken back to the time in college when I awoke from a dead sleep in the middle of the night to a phone call from my sister, and for one horrible moment all I could think was that there must have been an accident. “No one laughs at God when the doctor calls after some routine tests. No one’s laughing at God when it’s gotten real late and their kid’s not back from the party yet.”

The point of this song is not that we need to be somber all the time, even when the situation is grim—“No one’s laughing at God”—but, sometimes, “We’re all laughing with God,” and plenty of people choose to maintain their humor in the face of terrible personal tragedy. What this song does, at least for me personally, is serve as a reminder that terror is a real part of the patient experience, even if it is rarely discussed. We have all taken that swift, cold kick to the gut, and remembering that panic can make us more alive to recognizing fear in others. My sister was fine, but when I step into a patient’s room to discuss test results, he is waiting with the same sinking feeling to hear if a terrible accident has happened in his own life. Sometimes it has.

Even if it doesn’t change the end result, I would want a doctor who knows that air safety statistics are not particularly comforting when the plane is shaking.

Erica Bates, MD

Dr. Bates is a first-year resident in internal and emergency medicine, University of Maryland Medical Center, Baltimore, Maryland; e-mail:

© 2014 by the Association of American Medical Colleges