It's Saturday and the New Year's weekend is just getting started.
He knows what that means. About 40 miles away tens of thousands of people are gathering in the Imperial Valley Sand Dunes Recreation Area — along with other off-roading areas of the Valley — to enjoy a long weekend.
That means accidents will occur. That means people will be hurt, some severely.
During the Thanksgiving weekend, the ER on one day saw 160 patients. There were head injuries, spleen injuries, broken bones, an arm torn off, to name just a few.
And. if the New Year's weekend is anything like the Thanksgiving weekend, there could be injuries from violence.
Berger, 57, an experienced ER physician, is ready for what could be a busy day. The ER's nursing staff and the rest of the team also are prepared. The staff has been increased to handle the wave of patients.
While there are normally two shifts for doctors — one from 7 a.m. to 7 p.m., and the second from 7 p.m. to 7 a.m., a third shift has been added — noon to midnight.
On this day, Berger will be joined come noon by Dr. Sean Deitch, 30, chief resident in the ER at University of California San Diego Medical Center.
The mission Saturday is twofold: meet the needs of dunes' patients while continuing to provide quality care to the local community.
Berger, since taking over the ER, has made it a policy that patients are to be seen by a doctor within a half hour of "coming through the door."
He says that goal is reached at least 70 percent of the time. He adds that policy does not change on holiday weekends.
Even without patients from the dunes, the Pioneers ER does not stay quiet for long.
Before the first dunes' patient arrives, Berger must tell a 63-year-old local man he has lung cancer that has spread to his brain, deal with two people suffering from chronic back pain, treat a man suffering from heroin withdrawal and see a baby who may have come in contact with rat poison.
Berger talks with a reporter as he makes his way from patient to patient.
"The local community still has its emergencies, too," he says.
He adds, "I know it is going to be busy. It is the variability of what happens. There could be a 100 patients with no one coming from Glamis."
Today that is not the case.
By 10 a.m. the dunes start to take their toll and the injured start to arrive.
Jeff Laubscher, 28, of Orange County is brought to the hospital by friends. Although he was riding his motorbike in the Ocotillo Wells area and was closer to El Centro Regional Medical Center, his friends were more familiar with Pioneers and brought him here.
He is struggling to breathe and there is concern he may have punctured a lung — a result of a bad landing from a jump.
Berger sees Laubscher and calls for X-rays to see if a lung has been punctured. Laubscher is given treatment to help him breathe.
The treatment works. While his chest still hurts and his breathing is labored, he starts to relax enough to talk to a reporter.
"I took a jump and hit the ground with the front wheel first," he says. "All I can remember is looking up at the sky. I couldn't breathe."
Soon the X-rays are ready. Laubscher is lucky. His lungs are fine. Still, he could have damaged his spleen and broken ribs.
Berger calls for a computerized tomography scan using a device that can provide a three-dimensional view of the body's inner systems.
Laubscher is again lucky. The scan shows his spleen is fine. Another X-ray reveals he does have a cracked rib that will have to heal on its own.
Laubscher is just the first of many dunes patients — patients who will not be as fortunate as he is.
Nineteen-year-old Matt Gilbert of La Verne is brought to the hospital by his father. He must be wheeled into the ER.
Earlier in the day, Berger told a reporter that often at the dunes, those injured may delay coming into the hospital for various reasons. He said doing so can often be a mistake.
Gilbert is such a case.
The previous night he was riding his quad in Glamis in an area known as Competition Hill where off-roaders race. Gilbert was hit by another vehicle. He says it was a jeep.
Gilbert tells a reporter he delayed coming to the hospital because it was late when the accident happened and he thought the ER would be crowded. He also thought he had only been bruised.
What Gilbert didn't know is the accident left his right wrist and right tibia broken. The wound to his leg was open a bit, which means infection could set in.
It also means Gilbert will have to have surgery — as soon as possible.