other people's emergencies: random thoughts of an urban paramedic

For more than twenty years I've worked as a paramedic for the city of Boston, Massachusetts. The opinions expressed in this diary are mine alone, and do not represent the views of Boston EMS. Names, dates, locations, and physical characteristics have been changed to ensure patient confidentiality.

Friday, May 29, 2009

What's So Funny?

Health care workers have long enjoyed a reputation for their dark senses of humor. They are amused by situations that other people would find appalling--situations that often involve death, disease, and even mental illness.

They do this, of course, as a defensive mechanism. Subjected constantly to images of suffering, they realize that they must either make light of a particular situation or become depressed by it. Think about the old TV series, M*A*S*H. Hawkeye, Trapper John, and B.J. found humor in just about everything. They had to, or else they couldn't have done their jobs. That's how it is in the world of medicine. To avoid becoming a casualty, you have to develop a thick skin. In the process, you learn to laugh about topics that make other people uncomfortable.

This behavior is not limited to those who work in hospitals, of course. Police officers do it, too. And firefighters. And EMTs and paramedics.

Last week, a man in China threatened to commit suicide. He stood at the edge of a bridge for several hours, tying up traffic as public safety authorities negotiated with him and readied an air bag below. Finally, a retired soldier decided to take matters into his own hands. He approached the would-be jumper, reached out to shake his hand--and shoved him over the edge. Asked in a newspaper interview why he did it, the man said that it had been selfish of the jumper to keep so many people waiting, especially when it was clear that he didn't have the courage to actually kill himself.

I found this story amusing, not because I have anything against people who contemplate suicide, but because the retired soldier actually did what others surely were thinking. There have been times, while negotiating with would-be jumpers, that I've thought to myself, "This is ridiculous. You're never going to jump. So why are we even up here?" I'd never say that out loud, of course, but I couldn't help thinking it. And here was this guy in China, actually carrying out those thoughts. The story would have been better only if it had been the rescuer, instead of a passerby, who had pushed the guy over the edge.

When finding certain things amusing, we sometimes forget that the experience of the public is not the same as our own. Outsiders will hear us laughing about the antics of a homeless person, for example, and they'll become incensed by our callousness. But there's generally nothing mean-spirited about any of this. It has more to do with familiarity. We deal with homeless people every night of the week, and at times, they do things that happen to be funny.

The same holds true of death. For the most part, resuscitation is a serious business. You're trying to bring someone back to life, after all, and nothing can be less funny than that.

But even during a cardiac arrest, with CPR in progress and all sorts of medical procedures being frantically performed, humorous things occasionally happen. It generally begins with an observation of some kind--Why did it take so long for that woman to call 911? Didn't she notice the dead body in the middle of her kitchen?--and then additional comments are made until finally we're laughing so hard that tears are streaming down our faces. To an ordinary person, this scenario is completely unacceptable. Death is a sacred topic, and besides, the rescuers on TV and in the movies always take everything so seriously. But you have to remember that this is our workplace. We've worked hundreds, or maybe thousands, of cardiac arrests, and we can do most of the necessary procedures in our sleep. Every so often, something funny is going to happen--just as it will in any workplace--and it's going to make us laugh.

Of course, some things are never funny, not even to us. If a patient goes into cardiac arrest, and his relatives are within earshot, then of course we're not going to laugh during the resuscitation effort. That would be callous. Likewise, you'll never find an EMT or paramedic laughing about a tragedy involving a child, or about certain kinds of terminal diseases.

Because while we may be thick-skinned, we're not heartless.


The story about the would-be suicide in China was reported in several places. Here is one link: http://news.bbc.co.uk/1/hi/world/asia-pacific/8064867.stm

19 Comments:

Blogger Norma said...

I saw that story about the men in China, and I thought it was AWESOME...that guy did the the practical thing, basically called the faux-jumper's bluff. I loved it! And I know that dark sense of humor from my stint in the ER; it's definitely a defense mechanism for most people on the front lines of medicine, where the situation and characters can become absurd.

12:31 PM  
Anonymous Anonymous said...

I must be callous, I'm not in the medical field and still found that story highly entertaining. A 'be careful what you wish for' kinda justice.

12:57 PM  
Blogger Gábor said...

Great post! I read the story about the Chinese man the other day in the newspaper. I think people in general need to lighten up a lot, far too many people take far too many things seriously. I've got a bone marrow disorder which is essentially a sort of cancer and I joke about it fairly often, my friends know that a well timed joke on their part can cheer me up a lot too so not only do I not mind this but I condone it. People are sometimes shocked with the slightly gruesome jokes we come up with and just don't understand why, it's easy to explain but difficult to make them really understand. *shrug*

2:58 PM  
Blogger TS said...

Norma:

You understand what I'm talking about. Unfortunately, some people don't, and that can get me in trouble. Several times I've posted stories on this blog that caused readers to become enraged, prompting them to write angry responses that said, essentially, that they don't ever want me to work on them in an emergency, because I clearly don't care about my patients.

What they don't seem to understand is that this kind of humor is essential. If we took everything seriously on every call, we wouldn't last very long in this line of work. And who would respond to their emergencies then?

Thanks for the comment.

4:12 PM  
Blogger TS said...

Anonymous:

Obviously, you're an evil, mean-spirited individual.

Or perhaps you're just an ordinary person, capable of seeing more than one point of view.

4:18 PM  
Blogger TS said...

Gabor:

That's the same kind of thing as what health care providers do--you choose to laugh, rather than be upset about something you have to face, but can't control.

4:21 PM  
Blogger Renee said...

"What they don't seem to understand is that this kind of humor is essential. If we took everything seriously on every call, we wouldn't last very long in this line of work. And who would respond to their emergencies then?"

Burn out IS a problem, and those of us who have lasted for years and years have learned the coping mechanisms, including a nasty sense of humor. For those who have been through horrible things, they too learn to cope, otherwise, they would go mad. Seriously.

And for those who think we need to have other coping methods aside from humor... we do. Humor is just one method. I'm sure I am not the only one who has screamed into a pillow, yelled under water, written down some of those haunting thoughts when we think back on those BAD cases we deal with, or even those colleagues of ours who unfortunately choose EtOH or other substances to quiet the thoughts raging through their heads. Personally, I feel humor DOES have its place!

5:08 PM  
Anonymous JAM said...

This post reminds me of a book by Samuel Shem, The House of God: The Classic Novel of Life and Death in an American Hospital.

Great book dealing with hospital doings.

5:22 PM  
Anonymous Beverly said...

Worse, the older you get, the darker your sense of humor.
Is there a Black Hole of humor??

8:47 PM  
Blogger TS said...

Renee:

Well put. Thanks for bolstering my position.

JAM:

Great point! The book is full of dark humor, from beginning to end.

Beverly:

So true. I suppose that we gradually lose our naive outlook, gradually becoming more cynical--and more willing to be amused--the longer we work.

8:59 PM  
Blogger Linda said...

You want to see a "gallows sense of humor" in action then come spend some time in the dispatch center - we 911 operators have it going on in spades and we have to our else we'd go home crying every night.

12:16 AM  
Anonymous MichiganEMT said...

One night a few years ago, my partner and I responded to back up the City of Taylor Fire Dept for two patients, one a cardiac arrest and the other unconscious. When we got there we found out we werent' needed as Taylor fire called the ME. A couple was having sex in the dark. The man was a heart patient and used nitro cream. The couple had decided to have anal sex and the man reached, in the dark, for a tube of KY jelly. You guessed it; he grabbed the tube of nitro cream. Her blood pressure bottomed out and she died. He almost died. We arrived after the city ambulance transported the man. Everyone on scene was laughing; the cops, fire/rescue, and us. It wasn't funny but then again, it was. TS, I understand completely.

1:14 AM  
Blogger TS said...

MichiganEMT:

Holy cow. That is an amazing story. I don't even know what else to say.

6:25 AM  
Blogger Mr. 618 said...

TS: Re MichiganEMT, how about "carry a flashlight!!!"?

But you and your commenters are right. If we didn't find some where -- no matter how twisted -- to find some 'humor' in some of the things we deal with, we'd go stark raving mad.

Well, madder than we were to go into these fields in the first place.

7:31 AM  
Blogger Last Angry Man said...

I've been in three professions throughout my life in which we had the same kind of dark humor (Army, medical, the homeless world). In those fields, I always said if one ever lost their sense of humor (dark as it is), they'd have to quit their job.

You're exactly right, TS, a sense of humor is essential.

7:38 AM  
Blogger EMS Chick said...

Great post, you really explain it all so well. I saw that story and laughed, my husband looked at me like I had 2 heads. He doesn't quite undestand the sense of humor we use to cope.

4:46 PM  
Blogger TS said...

EMS Chick:

That's exactly the trouble. Many people don't understand it. Unfortunately, this can lead to misunderstandings in which we are perceived as callous, when that's really not the case at all.

11:35 PM  
Blogger Joan said...

If you were callous, you would not have chosen the career that you have. Laugh if you need to.

6:16 PM  
Blogger TS said...

Thanks, Joan.

7:31 AM  

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