Q&A: Steve Berry on humor as a way to handle EMS stress

Paramedic Steve Berry uses cartoons to describe the highs and lows of being an EMT or paramedic

Article updated December 4, 2017

In the 1980s, while Steve Berry was working as a teacher at the Colorado School for the Deaf and Blind, one of his colleagues had a heart attack. Berry rushed to his aid … sort of. “I kept telling him to lie down, which of course he didn’t have to do,” he recalls. “I was totally useless. When the paramedics got there, I was in awe of them and what they could do.”

The experience led Berry to become an EMT. While doing a “third ride,” or ride-along, during his training, his first call was for a cardiac arrest. “It was overwhelming,” he says. “You’d like to be brought into it slowly, maybe a cut finger or somebody puking. I was so naïve; I was shocked when paramedics didn’t save him. They were looking at me like, ‘We’re shocked when we do.’”

But the combination of the adrenaline rush and the ability to help in life-or-death situations had Berry hooked. To the surprise of his EMS instructors (not to mention his wife, although she gave him her full support), he gave up teaching for a career in EMS. “They thought it was a very stupid decision. As a teacher, you had a stable job, summers off, lots of holidays and decent pay. When I applied for a job in EMS, they tried to talk me out of it. They said, ‘This is what you do before you get a real job.’ But I wasn’t to be swayed.”

Berry went on to become a paramedic with a private ambulance service in Colorado Springs and later put his teaching skills to work to become an EMS instructor. Early one morning, after a particularly difficult shift, he began doodling about what he’d seen as a way to vent his frustrations and relieve job stress. He’d never expected to show his drawings to anyone besides his partner, Kim Madison. (Madison died in 2005.)

With no art training, Berry says his earliest drawings were amateurish. But he kept working at it and refined his style. Soon his fellow paramedics started posting his cartoons in the ambulance base and in paramedic lounges at hospitals. He eventually compiled his cartoons into a self-published book, "I Am Not An Ambulance Driver!" in 1991.

Soon, he had drawn so many cartoons that he published a second book, which was reviewed in JEMS. When JEMS decided to start publishing his cartoons, Berry became known nationwide for his humor, but also for his ability to speak to paramedics and EMTs more deeply by capturing their most poignant, painful moments in his illustrations.

Since then, he has published 10 books and drawn some 2,000 cartoons. He’s become a sought-after speaker at EMS conferences nationwide, appearing at an average of 26 each year. 

While often described as a humorist, Berry says his most meaningful work has been in dealing with the weightier issues faced by EMS personnel, such as knowing how to handle families in crisis situations and making sure the community knows EMS personnel are more than just “ambulance drivers.” After taking time away from the field for the past few years to focus on speaking and drawing, he has recently started working as a paramedic again with Southwest Teller County EMS.

Berry spoke with Best Practices about the role of humor in EMS and how he sees EMS continuing to evolve.

How important is humor in EMS? 

There’s a lot of cumulative stress from working in EMS, and each medic tries to find a way to survive that. There are few other jobs that, when you go to work, you know you are going to see tragedy.

You have to find a healthy outlet for that stress. Some people do sports. Some people find negative outlets like drinking or pills. I’ve always said, ‘If you can laugh at what hurts you, you will survive.’

Why the title "I Am Not an Ambulance Driver!?"

Nothing pisses off an EMT or paramedic more than being called an ambulance driver. It stabs at their heart. You don’t call a police officer a police car driver or a firefighter a fire truck driver. I also wanted to educate the public.

What’s your favorite cartoon of all time?

That’s like saying what’s your favorite child!

The best cartoon is when you don’t even need words — it’s just visual. And I love it when a medic laughs and someone outside the field looks at it and goes, ‘Huh?’ We have our own language.

But the cartoon that is the most meaningful to me is a medic who is coming home after a shift. He’s thinking of something he saw at work: an image of a bicycle with a baseball hat lying next to it on the street. At home, his son is nervous because he’s played baseball around the house and has broken a window. There’s a silhouette of the father staring at the son, then picking him up and giving him a very hard hug.

That cartoon says that tragedy happens. But it helps remind medics what is meaningful to them in life. That one gets a very strong reaction.

I drew it when I was going through a difficult time with some bad calls. I drew it for myself. At first I didn’t want to share it, but my friends said, ‘You have to get this out there.’

If you are going to laugh, you have to be willing to cry, too. When I reveal these cartoons, I’m exposing my soul. There’s a risk there. And I think people appreciate it.

You said you were warned away from EMS when you decided to leave teaching. Would you give the same warning to young people considering entering the field today?

I’m the father of a 22-year-old son and a 19-year-old daughter. People ask me if I would want my kids to do it; my protective instinct as a parent is, ‘Don’t do this.’

However, I have seen how EMS has evolved in my 25 years as a paramedic, and I have great hope for the profession. There are a lot of growing pains it still needs to go through, and I don’t think you can do it for your whole life.

Physically and emotionally, I don’t think it’s healthy. So I would say, ‘Be a paramedic. Great. But continue your growth in medicine. Maybe become a nurse or a doctor.

Always look ahead.’ I have had so many friends who were disabled because of the job. I would encourage them to pursue EMS, but look ahead to what’s next.

How did you become a speaker at EMS conferences?

My late partner, Kim Madison, started it. We were partners for 10 years; we could finish each other’s sentences. One day she said, ‘You need to get out there and start bringing your humor to conferences.’

I always said no — I thought it was too much pressure. So she signed me up for a conference in Denver without me knowing. She showed me the brochure … I was a nervous wreck.

What do you see as some of the major issues facing EMS?

The decrease in volunteerism is a big one. Across the nation, about 70 to 80 percent of EMS are volunteers. But we are not seeing an influx of new volunteers from Generation Y or the Millennials. The question is: How do we capture them?

I hear a lot of old-timers complain about those generations. Well, stop complaining about them. Instead, figure out who they are and what their interests are and draw them in with what attracts them. We know they grew up in a different world than we did. They grew up with 9/11 and knowing how fragile the world is. They are also a generation that needs constant praise. We took video cameras and put them in their face and told them how wonderful they are from the day they were born. So praise them more. And don’t forget to remember how irritating you once were to the generation before you. It’s the job of every generation to irritate the hell out of the generation preceding it.

You’ve spoken about the difficulty attracting and retaining young EMTs and paramedics in paid positions. Why is that, and do you have any idea about how to combat it?

The requirements to become a medic are much harder than they used to be. The job requires more training, yet the wages are still terrible. Just like nurses had to evolve, so does EMS. We have to get to the point that paramedics have a bachelor’s degree and that the requirements are nationally standardized. Both need to happen before we can be respected. We can’t expect others to respect us until we respect ourselves.

How can EMS show that it has self-respect?

We can take a lesson from police and fire. We don’t honor our profession in the same way firefighters and police officers do. They have a history and tradition, and people honor and respect that and want to be part of it. We need to honor our dead. We also don’t look sharp. We need to look more professional, in our dress and in how we present ourselves. Firefighters and police know how to do this.

Let’s face it: There are not a lot of fires out there. So why do people want to become firefighters? They know the public loves them, adores them, worships them and respects them.

In EMS, we have no identity. We trudge along and try to tell people we are not ambulance drivers. Or they don’t see an image that portrays respect. As a profession, medics are horribly overweight, yet we represent public health. I tell the medics, you can’t be sitting around ambulances eating pizza all day. We need to look healthy so we become role models. In Colorado Springs, I worked with one medic so out of shape he was using the oxygen on himself whenever we had to climb a hill to get to a patient.

Though you’re known as a humorist, you also give talks on the most difficult aspect of EMS: death scene management. Why is it important for EMS to better understand how to handle these situations?

I always insist that if I’m going to do a humor talk and make them laugh, then I get to do a heavy talk on death scene management so they get the full range of emotions. Medics are always taught, ‘Don’t get emotionally involved in your calls.’ But we are human. When we see a dead child and try to say it doesn’t impact us, it’s ridiculous. Not only that, there is very minimal training for how to deal with family members, such as what to say and what not to say. 

On calls in which someone dies, what do paramedics and EMTs need to know when dealing with distraught family members?

You have to consider their culture, their background and their level of emotional involvement. Don’t pick up your equipment, walk out and leave them. The survivors are now your patients. What you can do for them is get them through this process and help them survive this. For the rest of their lives they will remember the moment you told them their loved one is dead. That is an incredible responsibility. I learned by winging it, which is a horrible way.

What I learned is there is nothing you can say. Mainly, you are there as a kind presence. You are not going to give them answers; you are not going to make them feel better. But you are going to be there. You assess them, care for them, get them the resources they need. Ask if you can call someone for them: a family member, friend, a minister or someone of their faith.

What’s Sentimental Journey?

It’s an incredibly powerful program I started with my late partner in 1998. Today, it’s in 33 states. I am more proud of that than any of my cartoons.

It got started when my partner and I were taking a hospice patient home to die. He was struggling to look out the window and said, ‘I want to see the Aspens one more time.’ It was fall, and the leaves were changing. So we pulled off the route, drove out to a meadow and let him sit there for awhile. Afterward, we decided we should create a program in which we work with hospice to take people on one last ride.

We’ve taken people to watch the sunrise, to bars to party with their friends one more time, to church to be with their congregation. … We’ve taken people Christmas shopping who knew they might not be alive to see their kids open their gifts. One man was going to die in hours. He was agonal, but his wife wanted us to bring him home to cook a meal for him one more time. We thought, ‘This is crazy. He’s semi-conscious.’ When we got to his house, his wife had an elaborate meal cooked. We said, ‘Ma’am, he’s not going to be able to eat it.’ She said, ‘I don’t care. I just want him to smell my cooking.’ She didn’t want the food to go to waste, so we sat there with her and ate the food.

I don’t know if the patients or the medics get more out of it. It rejuvenates medics. Sometimes they can get cold and frosty, then they see this, and it reminds them why we all got into this profession, which is to help, even though sometimes help doesn’t mean saving lives.

For more on Steve Berry’s humor, visit iamnotanambulancedriver.com. Berry also makes the Sentimental Journey protocols available to anyone interested in starting the program. 

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