“Go, man, go,” I say to John, who is in the driver’s seat now.
We’re out at the hospital a minute later.
They have a full trauma room staff waiting for us. I give the report. “Shot through the chest. In one side, out the other. Not breathing when we found him.”
“How long has he been down?” the doctor asks.
“Ten minutes, five minutes, not long, but probably long enough.”
I step back as they take over bagging and compressions. They throw some epi down the tube and put in two chest tubes. I have the rider stay to watch while Chris and I walk down the hall. She goes out to clean the ambulance and I get a run form and sit down. The waiting room is mobbed as everyone from the club has come down the street to find out what is going on. I’m on the phone with Suzy, getting my tag and times when I start hearing a woman cry, “Oh Lordy Jesus, oh Jesus, oh God, oh Lordy Jesus!”
“What’s all the shouting?” she asks.
“They must have just told his mother,” I say. “The waiting room is packed with people from the club. It’s a mob scene.”
I drop my paperwork in the trauma room, where the young man lies naked and motionless on the gurney, two chest tubes sticking out of his side, blood on the floor, the ET tube sprouting out of his mouth. Only two staff members are still in the room, finishing the recording notes. On the table, I see his effects—car keys, a beeper, wallet, some change.
I collect my crew, we get in the ambulance, and get the hell away.
Recognize
The eighteen-year-old muscled male was brought in for altered mental status, smoking crack and drinking. He is put in the crisis unit, where they take his clothes and dress him in a hospital johnny. He is reluctantly cooperative, if sullen. Then his beeper, which is in the bag with his clothes, goes off. The ER tech won’t let him have it. The young man becomes combative and a security alert is called. He kneels on the bed, breathing hard, his muscles flexed. The guards stand around him, latex gloves on, straps in their hands, ready for the word to move in.
“Don’t you disrespect me,” he says to the tech.
“You can’t have your beeper,” the tech says. “Now sit down and calm down.”
Another tech touches his shoulder. He knocks the hand away. “Don’t touch me. Now gimme my clothes.”
The guards step closer, but his chest expands and the veins in his neck bulge. They step back.
“Listen! You got to recognize my rights!” He is breathing hard. “Recognize! Recognize! Recognize!”
“You’re not getting your beeper. You’re in the hospital now.”
The other tech moves closer and he whirls on him. “Don’t touch me.” The guards pounce on him. The tech puts an elbow into his throat and a knee hard on his chest. He is strapped to the bed. Overwhelmed, contained, he lies there, breathing heavily, muscles tensed.
“Act like an animal, you get treated like an animal,” one of the guards says.
The young man’s eyes burn with rage.
Sterling
Two kids are playing basketball in the street in front of a makeshift hoop attached to a telephone pole when we pull up in the ambulance. Each looks to be about ten years old.
“Who you looking for?” a fat shirtless kid says. “You looking for Sterling? Everybody looking for Sterling. Sterling live over there. Up the stairs. You come for Sterling, right?”
We walk up the creaky stairs of the dilapidated house and go in through the open door. There is Twenty-Love graffiti on the ceiling. Twenty-Love is the gang that makes the north end its home.
On the second floor landing is a broken window; there are drips of fresh blood on the floor. A handwritten sign on the door reads: “Do not knock. Do not even think of coming in. Do not in any event try to disturb.”
We go up to the third floor and knock.
“Who dere?” a voice demands.
“Ambulance,” my partner says.
The door opens. A short, barrel-chested young man stands there. “Second floor. You looking for Sterling. I call the ambulance for him. He got beat up and he need to get checked out. He waiting for you on the second floor.”
My partner and I look down the stairs at the sign on the door. “You want to call him for us?” I say.
“He waiting for you.”
We walk hesitantly down the stairs, and standing to the sides of the door, knock on it. There is no answer.
My partner knocks again this time with the radio. “Ambulance!” he says.
Still no answer.
The guy comes down the stairs, and also standing to the side, shouts, “Yo! Sterling, man! Sterling!”
The door opens a crack and a tired-looking woman in her forties stares at us.
“Ambulance,” I say.
“They looking for Sterling,” the guy says.
“You’ve got to go up the other stairs,” she says. “His room on the other side.”
“We’re here now, why don’t you let us through,” my partner says, stepping in. We walk through several rooms, each separated by a curtain, each a different home. In the back room next to the bathroom, a tall, muscular, bare-chested man looks out the window. A woman rubs his shoulders.
“Yo, Sterling, man. It’s the ambulance,” the guy says.
Sterling turns and looks at us. He has a gash on his forehead, his face is bruised. He is holding his hand in a bloody towel. He says nothing, just nods and walks toward us. The woman stays behind. We walk back through the other rooms, their tenants eyeing us silently. “Excuse us,” I say.
As we come out, the two kids stop their basketball game and the fat one says, “I tole you that’s where you find him. That’s where you find Sterling.”
Sterling steps into the back of the ambulance with my partner, as I go to the front to drive.
At the hospital, the nurse sits him in the triage room, then cleans the dirt from the scrapes on his hand, chest, and head.
My partner tells me the story Sterling told him. A young man from the south side heard a north-end guy named Sterling was pushing his mother into a life of drugs. He and two of his buddies piled into a car and came looking for “Sterling.” He was the first Sterling they found. It didn’t matter that he was the wrong one.
Heroin
Going up the stairs, I think I have been here before. I know I have. There is a constant feeling of déjà vu on this job. The addresses and the calls meld together, but you sense the familiar: a dog outside on a chain, eye-catching graffiti on the wall, a couch in the hallway, the same neighbor.
She is lying on the single bed, eyes open, dilated. Oh, man. Cool to touch. Rigor in the jaw. The needle on the bed, inches from her hand. “No,” I say to my partner, who has the radio to his mouth to call for backup. I look at the tattoos as I put her on the monitor. The butterflies, the heart. Flatline.
“Where are the kids?” I ask the neighbor, the old woman.
“Took away,” she says.
I stand there in the spare dirty apartment. A world in disarray. I can smell the garbage. A cop arrives, and we turn the scene over to him. We walk out carrying our gear. At each doorway in the hall, people watch us leave, taking no one with us.
Darkness
At home I sit up in the dark. I think about the city—the streets I work—this world.
I think sometimes what I’d like to do is get a great giant syringe and fill it with Narcan. Then drive it deep into the ground, into the city’s heart, down where the waters lie. Push it all in. Clean out the whole system. Chase the bad medicine away. Then in the morning the water will run fresh out of the faucets and give the city’s tired soul, all of us, a new start.
BODY COUNT
Where the tension lies is not in the day-to-day call, but in the long-run view. What is this doing to me?
Dead Man’s Poker
We get sent for an unknown. When we arrive, a man who does not speak English points up a set of outdoor back steps that lead up three flights. I grab the O2 bag and monitor a
nd follow him up the stairs. We go into a small kitchen, where several people are sitting around a table. There are beer cans on the counter and on the table, where they have been playing cards. “Who is sick?” I ask. “¿Dónde está el enfermo?”
The man points to a man sitting against the wall. I look at him for a moment. He is sitting up straight, his elbows on the armrest of the wooden chair, his hands on the table, still holding his cards. His eyes are closed, and his complexion is gray. While I am looking at him for only a split second, it seems like I am staring at him for ten or twenty seconds. This man is dead. He is not breathing. He is completely motionless, like a wax figure. I grab him and whirl him down onto the floor, and shout at my partner, Marisa Monnaccio, to call for backup. The woman at the table immediately starts screaming, which sets off the others. The man is flatline on the monitor. Marisa starts CPR while I intubate him and fire a milligram of epinephrine and one of atropine down the tube to try to jump-start his heart. The room fills with people, all screaming, crying. The fire department shows up to help us carry him downstairs. The woman throws her right arm across her forehead and does a swan dive to the floor.
“You need another ambulance for this lady,” a firefighter says.
I glance at her, and her eyes open briefly, then close. I say, “She’ll be all right.”
“Is he going to be okay?” one man asks, as we lift our patient up on the board, still doing CPR, never anything but flat line on the monitor.
“No, he’s dead,” I say.
The woman, who has revived herself, screams, and faints again.
We work him all the way to the hospital, and they work him about ten minutes there, then call it.
I have no idea how long he was sitting there at the table—probably about five minutes, given our response time. They must have gotten concerned when he was taking so long to play his cards. A final long look at the hand he’d been dealt.
Storm Inside the Calm
Paramedics and EMTs can, in the midst of an emergency, appear to be the calmest people on the planet. Race lights and sirens to a call ten times a day and, after a while, you learn to nap on the way, so long as you’re not the one driving. Or like in the famous car chase scene in The Blues Brothers, while Jake and Elwood are racing through the shopping mall being pursued by the cops, they comment on the mall’s stores and wares. Enough shootings, cardiac arrests, diabetic comas, and it becomes pretty routine. Where the tension lies is not in the day-to-day call, but in the long-run view. What is this doing to me? Does what I am doing matter? Does anyone care? Do I? And what will become of me when I can no longer do this? A bland job? An obnoxious boss? The path to death. Arthritis in my bones. Bloated legs. Sick at the heart. Fluid in my lungs. Blue lips. Faceless EMTs coming through the door. An IV in the arm. Mask over the face. A tube down the throat. Vomit. V-fib. Shocked. Flatline. Pounding on the chest. A rough ride. Sirens fading out. Left on the table. Lines pulled out, but ET tube still in place. Rolled down to the morgue.
Asthma Code
We’re covering downtown when we hear the call go out—asthma on Kensington Street in the north end. They give it to 875—a basic car. “They’ll call us if they need us,” I say when Arthur looks at me as if to suggest we offer to take it.
Ten minutes later we hear 875 on the air asking for a medic. The dispatcher says, “I don’t have any nearby. Are you loaded? Just go to the hospital.”
“We need a medic,” she insists. “She’s really bad.”
Arthur, radio in hand, is about to volunteer us, when the dispatcher calls. “Four-seven-one, Kensington Street for the asthma.”
“We probably should have just taken it the first time,” I say.
“No, they should have dispatched us.”
We’re several minutes away. Maybe a minute less with Arthur driving. Asthma can be frightening as people gasp for breath, the airway passages in their lungs narrowed and plugged with mucus from the sudden onset of the disease. Our standard treatment is to give them a Ventolin breathing treatment, .5 cc of Ventolin mixed with 1.5 cc of saline water dropped into a plastic nebulizer chamber and hooked up to an oxygen line that turns the mix into vapor the patient inhales. We tell the patients to take deep breaths through the mouthpiece. If they are too weak to hold the nebulizer, we can fit the container into a O2 mask that we strap to their heads. They receive nonstop treatments until they clear up. If they are really bad, we can call for orders to give subcutaneous epinephrine. I always start an IV line: fluid moistens their dried-out lungs and loosens the mucus. At the hospital, they can use the IV access to give steroids to further open up the patients’ breathing.
Asthma is a common call in the city, particularly on dry, cold days like today. A lot of people let their medications—little pocket Ventolin inhalers—run out, or they overuse their inhalers so they’re not effective when a real attack comes on. Sometimes the panic is almost as bad as the disease, the fear that they can’t get a breath. The first thing I do is listen to their lung sounds. In an active asthmatic I usually hear a high-pitched teakettle sound as the air tries to force its way through the narrowed bronchioles. I listen not just for the sound, but for the quantity of air being moved. A high-pitched wheeze is better than no sound at all. No sound means no air getting through.
We pull up on scene and 875 has their back door open, their patient already loaded. I grab the blue bag, which has the O2, my airway kit, and the nebulizer setup in it. I get in back. One EMT has the ambu-bag out and is trying to ventilate the patient.
“She’s stopped breathing,” she says.
The patient is a woman in her thirties. She is pale, cyanotic, and still as death. I reach for the red airway kit and open it up. The EMT tells me the patient was gasping for breath when they got there and they had to drag her outside. The family said she had been getting steadily worse all day.
“Get the monitor,” I shout to Arthur. I unzip my airway kit, pull out a number seven tube, slide in the stylet, attach a ten cc syringe to the end. I grab the laryngoscope that has a number-four curved blade in place. “Get out of my way,” I say to the other EMT. I kneel down by the head of the stretcher. I put the blade between her teeth, sweep the tongue to the left, and lift up. I have to get the tube. The light illuminates her throat. I can’t see anything. I lift higher. Still nothing. I pull back. Nothing. She needs air right away. I don’t want to pull out. I have to find the cords. Come to me, come to me. Wait, I see white, but no opening. It’s the cords. They are closed shut. I have never seen this before. I lose sight of them and pull out. I grab the ambu-bag and try to ventilate, but I’m not getting much air movement. With the cords shut, her trachea is closed off. She’s not getting any air into her lungs. I have to get air in.
I go in again. I lift up. I still can’t see the cords. “Give me some pressure,” I say to Arthur.
He pushes down on the cricoid cartilage just below the Adam’s apple, where the cords lie. They should drop into view, but I’m not seeing them. I pull back some on the blade. I see them again, still closed. I pass the tube into the mouth, and angle it down toward the cords. I twirl the tube, but keep hitting low. I can’t get them to hit against the cords. I swear. I pull the tube out, reconform the shape with the stylet, then go back in. I see the cords. I bang against the white and feel something give way. “I think I’m in,” I say hopefully.
“I didn’t feel it pass,” Arthur says.
That is bad, but I try to ignore it. Maybe he’s wrong. I inflate the cuff, a small balloon, which secures and seals the tube in the trachea. I get the ambu-bag ready. I secure the other end of the tube with the tube holder, a bite block that tapes around the head with Velcro. Arthur connects the ambu-bag. He squeezes it while I listen over the lungs with my stethoscope. I hear lung sounds on the right. “Positive.” I hear them on the left. “Yes!” I listen over the stomach. I hear sounds. I swear I’m in, but I don’t know. I didn’t feel it pass. I look at the balloon on the end of the cuff. It is not inflated. I may
have torn it, while passing the tube. That could explain the air escaping into the stomach. The trachea is not sealed off. But maybe I’m in the esophagus. If I’m not in the trachea, she’s in serious trouble. She may already be done for. I swear and yank the tube out.
“Ventilate,” I say. I disconnect the ambu-bag from the tube, but the mask has fallen to the floor and I can’t find it. I need to reattach it to the bag. I’ve got it. I fumble to get it on.
“We need to start CPR,” Art says. He has her on the monitor, and she is in an agonal rhythm, just a few complexes. He starts thumping on her chest. I am trying to get up but am wedged between the stretcher and the wall. I am losing control of the scene and the patient. It’s all going horribly wrong. Arthur shouts at one of the EMTs to take over compressions. He forcibly lifts me up, frees me. The family is in the front of the ambulance. If we had left right away, we’d be at the hospital by now. I made the decision to work her on the spot because she needed it right then, but I haven’t delivered. I bag, but not much is getting through. I grab the laryngoscope, a fresh tube, and go in again. I can’t see anything. Then I think I see the cords, so I go in with the tube.
“I didn’t feel it,” Art says, but I shove it through. I listen. I hear lung sounds right. Lung sounds left. I listen over the belly. Air sounds. Fuck. I yank the tube. I feel hopeless. Give me the minutes back. Let me start again. I want to quit. I wish I’d never been on this call. I grab another tube, set the stylet. “Last time,” I say. She may already be gone, but the same decision holds. I decided to make my stand here and I have to live with it. She needs the tube now, not in seven minutes at the hospital. Now.
I use the three curved blade. There are the cords. There is a slight opening. I pass the tube, pushing through. “You got it,” Art says. “I felt it that time.”
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