Guest Editorial: Don't Open the Box

EMS providers understand full well that while 4x4s stop the bleeding, there are wounds only laughter can heal.


A sealed box is an innocuous and enigmatic thing, an object of mystery with the promise of glad discovery. It brings visions of children shaking brightly wrapped gifts, or families discovering long-lost memories in creaky old chests in a loved one’s attic. The only way to solve the mystery is to open the box, which as we all know does not always end well. Ask our good friend Pandora (and I do not mean the music program), whose curiosity released all the evils of the world, and it was only dumb luck that Hope snuck out before the box shut.

A box is synonymous for containment (box it up), restraint (boxed in) and even creativity—or lack thereof (think outside the box). If you close the box, then you put it away; if you go home in a box, you’ve died. Here at home, a “box” also means ambulance. Ultimately, one way or another, we all end up in a box of our own design.

If you say “box” aloud in a crowd comprised of the people I work with, it is a pretty safe bet that one of them will snicker and make a vulgar reference. Why? They can’t help themselves. EMS folks rely on any number of tactics to keep their psyches intact, and humor is just one of them. It does not matter how tragic your circumstance is, at some point someone will objectify it enough to view it from a perspective that will result in a comical observation. We can, will and do laugh at circumstances that are often horrific.

The idea of humor in the face of death is nothing new; “gallows humor” (galgenhumor in German) has been around for centuries. Possibly the first documented case of laughing in the face of death comes to us from Catholicism’s St. Lawrence in the 4th century AD. This early church official must have really upset the Romans, for they opted not to speed him to the pearly gates atop a cross or at the end of a spear, but rather through roasting him over a charcoal fire. At one point he is alleged to have turned to his executioners and instructed them, “Please turn me, I am done on this side.” For his ability at keeping his cool under pressure (yes, I went there), the Church made him the patron saint of comedians…and cooking. Who says the Church doesn’t have a sense of humor?

In his 1927 essay Humour (Der Humor), Sigmund Freud put forth the following theory behind the nature of gallows humor: "The ego refuses to be distressed by the provocations of reality, to let itself be compelled to suffer. It insists that it cannot be affected by the traumas of the external world; it shows, in fact, that such traumas are no more than occasions for it to gain pleasure." Basically he felt that by turning the perceived enemy or circumstance into something comic, we make it smaller and manageable, actually resulting in a sense of pleasure at being able to now overcome it. In Freud’s rationale, the psyche is lazy and because it would rather expend energy at pleasurable pursuits, it turns a stressful situation into one the ego would rather deal with.

This use of contrived bravado to shield us from the sights and experiences of our daily traumas does not work for everyone, and certainly not everyone is funny. People who work in EMS long enough—no matter how psychologically sound you think you may be—will be broken. We are simply not wired right and our perspective on daily life shifts dramatically from “normal.” There are different avenues for everyone when it comes to developing coping skills, not all are successful. One of the other theories on the use of gallows humor has to do with an inherent inability to express discontent or process stress in a different fashion. Making a joke of it provides an outlet when open dialogue is impossible.

Studies done in the early 1990s showed that health professionals who actively use humor as one of their outlets have some of the highest rates of job satisfaction and senses of personal accomplishment. Those same studies also demonstrated that we know our version of funny isn’t for everyone and that we often deliberately shield our loved ones and those not in the field from it, yet another factor that pushes us out of general population and toward socializing only among ourselves.

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