For my first shift as a student paramedic, I was eager to impress. I arrived early and sat in the crew room until my mentor appeared. As the night crews returned to station and the morning crews turned up for their shifts, jobs from the past 12 hours were being discussed and one of them had been particularly difficult. To my surprise, after describing the job, the attending crew began to joke about it rather crudely. I remained quiet, but after seeing my widened eyes, a more experienced student paramedic informed me that I'd soon get used to it.
As the placement weeks passed, I did become accustomed to the so-called dark humour, otherwise known as gallows humour, used on a regular basis; but I struggled to understand why it was part of paramedic culture. I had been told it was a genuine coping mechanism for dealing with emotionally challenging jobs, but I wasn't sure if that was just an excuse used to justify an old-fashioned tradition of the ambulance service. I couldn't comprehend how using comedy to diminish the seriousness of trauma and fatalities could be appropriate. If I had been a relative of the patients involved in these jobs, I'd be astonished at the callous nature of health professionals. Then I went to my first job that required a debrief from a team leader, and began to appreciate the need for dark humour.
At the end of the debrief, we were told to take as long as we needed to think things through before putting ourselves back into service. We sat, thinking through how the job went and I wondered how I'd be able to focus on assessing another patient when all I could think about was the doom and gloom of the previous job. Thankfully, a crewmate made a joke about the job and instead of thinking of the insensitivity as I had done when I'd heard it before, I laughed. I hadn't been involved in a serious job before, so the use of humour hadn't made sense to me, but that experience made me understand. Laughing with colleagues brings a sense of camaraderie, even with a crew that I hadn't worked with before, and we soon responded to our next job. There's no doubt that dark humour cannot replace a proper debrief but it certainly helps to lighten the mood following a difficult job. It also helps to be able to talk about the job, which I believe helped to build my resilience to tragic jobs.
Dark humour can be misinterpreted by those outside of the emergency services and our use of it can make us appear dispassionate. If I can remember the sense of shock I felt when I first encountered its use, I understand how insensitive it can sound to members of the public. As such, I know to use it with caution, and only around those who understand its purpose. It can make us seem uncaring, as though the patient was just another job to deal with, but dark humour allows us to detach from the job enough to move on from it. Making light of a situation is an effective coping mechanism when used alongside, but not instead of, debriefing to protect our mental health and allow us to continue practising.