Flatline: NYC

For Compassion, an Elegy

We found him sitting on the curb, crying, drunk, and surrounded by firemen.

"They kicked me!" he howled, "like I'm not even a person."

I looked at him and thought, well, you are a drunk...

The fire department lieutenant looked at me and smirked. "Yeah," he said, "one of my guys gave him a little shot in the ribs to, you know, make sure he was still alive and everything. We found him passed out on the sidewalk...Now he's saying something about having chest pain."

I nodded and motioned for the man to stand up. I find that with drunks it is easiest to grab them with two hands, one on the belt, another on the collar. You can control their movement that way. Especially if they're really hammered, you can kind of throw them onto the stretcher and prevent them from falling. I grabbed him and helped him into the bus.

"Twenty years ago," he sniveled indignantly, "no one would have ever dared to kick me."

Oh yeah, right, back in the good ol' days, I thought.

I had never picked the man up before, which is something of a rarity with drunks, especially homeless ones. The man was Puerto Rican, named Jose, and the 14th of 14 children. He had served as a Marine in the Vietnam War and been a Corrections Officer for most of his life. I was moved by this, but not surprised. I had met two retired Corrections Officers--that is, prison guards--on the job, and they were both trainwrecks.

A lot of EMTs want to be cops, and sometimes it's easier to get a job as a prison guard than a regular cop. I beg them with my eyes not to take the job, not to volunteer for prison duty. Prison engulfs you, it cages your soul and estranges you from the world outside. It's not just a place but a state of mind, and come-and-go as you might, your mind stays there, trapped.

Jose keeps crying and whining about being treated like a dog. I ask him if he had ever kicked anyone while he was in prison. No, he said, he would never do that. I was dubious, and looked away.

At the hospital, he thanked me profusely for being so kind, as drunks tend to do. He offered me his hand, but I didn't want to touch it. I was afraid it was dirty, that maybe he had wiped his ass with it or jerked off in the morning. That's what I told myself at least.

I shook his hand nonetheless, and wanted to wash it immediately. It really wasn't the grime that bothered me so much as his humanity. By touching his hand and accepting his thanks, I had to recognize him as a person, not just a drunk. I didn't care about him, really, or at least I didn't want to. He was just another fucking drunk with a story. I hate fucking drunks. Kick 'em all you want, FDNY, it's fine with me. But in touching his hand and meeting his eyes, I couldn't help but feel a little sorry for the guy. He had worked at an honorable, if thankless, job his whole life; he had served in the military and gotten shot in the knee; and now, here he was, drunk and homeless in New York City.

I felt uncomfortable, perhaps a little guilty.

A long time ago, when I was 18 and I had just become an EMT, I thought I was gonna save the world. I remember one day I went over to People's Park, where all the homeless slept, and offered them whatever medical assistance I could.

Jesus, I think to myself now, what was I doing.

Medicine--EMS--has changed me, made me less sympathetic to the world. I try to remember how I thought about the world and about people before I was in EMS, and I can barely remember it. That person that I was seems so foreign, so distant from who I am today.

When I first started working as an EMT, I would tell my friends how much the job makes me appreciate the fragility of my own life and how much it compels me to adopt a Carpe Diem outlook on life.

Yeah, that phase is over. Don't get me wrong, I still love my job, but I'm not a bright eyed kid anymore. I look at patients with one eye and another fixed on the cold calculus of self-preservation. I could care about you, but that would mean giving some of me to you, and I don't have that much of myself to go around. Empathy is dangerous--it can get inside you, remind you of the you you might become. It can make you imagine your father's heart attack or your sister's suicide. It can make you feel like you might be a patient, and that's all well and good when you're a kid with heart and love to spare. But I ain't that kid anymore. And here, today, on my stretcher, you're just another fucking drunk and I don't have time for your bullshit.

I know this post isn't as polished or dramatic as my usual writing, but it's the straight shit, it's how I feel, unedited, and the thing is, I want to be a good person and I still want to make the world a better place. But sometimes, I don't. Maybe I'm a bad person for feeling this way and thinking these things, but surely, I'm not alone.

the best job in the world

There is a tendency in EMS--at least in urban areas--for paramedics to diminish the importance of our work. I mean, don't get me wrong, we deal with a lot of nonsense, but still, it's not all bullshit.

Take today.

My plan was to come home and write a funny story about heroin addict we saved. The man shouted at us indignantly, "You didn't give me Narcan, did you?"

Well, in fact we did.

The man left the ER minutes after we arrived.

Note to self: don't do mouth-to-mouth on a junkie, even if you're alone. They don't deserve it.

But then we picked up an old guy with asthma. He didn't speak much English, and for that matter, he couldn't say a whole lot given his level of distress.

We hit him with the whole kit & capoodle: Albuterol x 4, 2 grams of Mag, and 125mg of Solu-Medrol. (For those of you who don't know, that's a fairly aggressive asthma treatment regimine). By the time we got to the ER, he didn't even need oxygen or his breathing treatment.

His daughter, who spoke broken English, thanked us profusely.

I smiled as I did the paperwork. There's this feeling, you know, when you feel like you really did the right thing. I didn't have to get on the phone and call for Mag or Solu-Medrol. I could have just taken him to the hospital, ya know, he would have lived. But he needed the good shit, he needed what we could give.

It was just so...so gratifying to see this guy 180. I mean, we fixed him, we did it.

The doctors in the ER give the orders. The nurses execute them. But me, I get to do both. I use my brain and my hands.

Last week one of the docs at work asked if I was thinking of med school. Nope, I said, what I'm doing no is my favorite part of medicine. I mean, being a doc would be cool, but you're not as directly involved in patient care. I mean, sometimes you are. But it's not your job to provide for the whole of the patient's needs. Doctors are the brains, nurses are the heart, but paramedics get to have both.

I mean, I'm young man, and EMS is a young man's profession. But still, I love my job. I love the fact that I get to make decisions--I mean, we're talking real decisions here, life or death shit--and then I get to execute them. It's just so damn gratifying.

In my other life, I am trying to be a writer. It's a cerebral world, ya know, but when I am here, at work, I feel present, I feel alive in way that I don't in anything else I do. I lose myself in medicine, and that...that is the best feeling in the world.

Christmas

"She don't need to go to no hospitals," the woman said, "I know what they do in there."

"Umm," I said, "Ma'am, could I just get some information about your mother, an ID card or something?"

"Oh," she said, "you're going to arrest me? You're going to call the cops on me, is that what you're going to do. I see..."

"No," said the Angry Black Man. "We're not going to call the cops. My partner just needs to write down some information."

"I have a frying pan and I'm willing to use it!" the woman was growing increasingly defensive. "No one is going to take my other to one of those hospitals. She's ninety-five years old, she's got no medical problems, she takes no medications...."

The apartment was musty and cluttered with out of fashion candles and other antiques, but like the woman, it felt somehow proud. Grainy pictures of family members long gone lined the walls. In one corner sat an African statuette. On the couch lied a bright yellow headscarf--the kind middle aged black women wear in America to show off their African pride. Opposite the couch hung a wide mirror, buttressed by fake plastic evergreen boughs and christmas lights. Practically invisible in the darkness, the old's woman's best friend sat in a dark chair next to the window.

In the background, ABM and the old woman's daughter were talking. I greeted the old woman's best friend.

"How ya doing today, ma'am?" I asked.

"Just fine," she returned, nodding.

As she silently smacked her lips, watching me, I turned to a picture on the wall. It was the grainiest of all the photos. Five girls and an older man stood outside an old house. They were probably sharecroppers somewhere in the south.

"Is that your parents?" I asked.

"No. No." she said, pointing to the old woman. "That's her on the left, wearing the little hat."

"Well no sh..."I said, catching myself. "Well I'll be...that's an old picture."

"Yes it is," she said. "That's in Georgia."

ABM was still talking to the old woman's daughter. The old woman had choked on a piece of angel food cake, but was fine by the time we got there. I mean, as fine as you can be at ninety-five. She was gaunt and frail looking, as though a wind might knock her over or a fall might break her in half. She didn't say much, but then again, she didn't have much of a chance with her daughter being so insistent and agressive. I let the ABM deal with it because I saw that she saw my presence as an unwelcome threat. I might throw her in jail or call on the cops to beat her, but ABM, well, he was alright.

"She just needs to go to her doctor and get some herbs," the woman's daughter explained. "She needs a vitamin drip, that's all. I don't want her in no hospitals. I know what they do in there. All the chemicals, and the corporations, it's run by the corporations. They'll just take her in there and never let her come back."

I darted my eyes at the ABM. He was listening and nodding attentively. Sweat was dripping from his brow.

"Okay ma'am," he said, "I just need to have you talk to my doctor. He's the one who makes the decision if she can stay or not. It's out of our hands because of how old she is."

"I understand," she said, "you have to cover your behind because there's always someone who wants to sue you. But I'm not like that. I don't believe in that."

"Okay," ABM nodded, "great....Yeah, hi doc, this is 13 Zebra calling in to secure an RMA..."

As ABM explained the situation to the doctor, I did something that no one had done so far: I spoke to the old woman. "How you doing there, ma'am?" I asked. "Do you want to go to the hospital?"

"No," she said, shaking her head.

"Okay," I said, "just checkin'."

After a few minutes, the telemetry doctor approved the Refusal of Medical Assistance (RMA) for the old woman. As we packed up our bags and walked out the door, I said goodbye. "Merry Christmas, and take care now..."

"Okay," the old woman's daughter said, quickly locking the door.

In the elevator, I turned to the ABM. "Dude," I said. "I'm so glad you were here for that."

"Yo B," he said, smiling, "I thought she was gonna take you out with a frying pan. All that vitamin drips and herbs and shit, what the fuck? She's fucked in the head, B."

"Yeah," I said, "I'm just glad she didn't try to kill me."

the Christmas Spirit

The Angry Black Man was standing over the woman. Christmas lights shone softly on her wrinkled features. She was 95.

"Are you having stomach pain," he demanded, "or chest pain?"

"No, Senor." She said, pointing up and down her left side. "It hurts here. Pero, no es....It hurts for three days."

"Naw B." He said, shaking his head. "Your stomach or your chest...which one is it?"

"Pero Senor," she said, pointing again. "It hurts."

I motioned for him to get started on the paperwork. "Dude, I think I got this."

He looked down at the old woman and shook his head. "Whatever B."

It was a confusing story, I'll admit, and her bad English didn't exactly help, but we didn't need to make the woman angry. Instead, I tried to be polite and listen so as to decipher the exact nature of her complaint. ABM had his own thing going.

We gave the woman some oxygen and made our way to the hospital. When we arrived, the hallway was full of patients and paramedics.The triage nurse was an exasperated looking woman in her mid-forties. She had long, straight hair that hung lifelessly from her shoulders. I waved at her when we stepped into the ER. She saw me and shook her head, muttering quietly. Above her hung large letter cutouts from the ceiling: "Merry Christmas"

The nurse picked up a triage form and sat down at the front desk. Next to her was a miniature Santa.

"I need a new job," she said, glaring at our old lady. "What the hell's wrong with her?"

"It's a little confusing," I said, "but I narrowed it down to left lower quadrant abdominal pain. We did..."

"Ok honey," she said, walking over to the woman. "Where does it hurt?"

The old woman pointed to the left side of her chest. "It hurts."

The nurse looked at me and shook her head. "That's not the left lower quadrant of her abdomen."

Before I could respond, the old woman pointed somewhere else, then somewhere else again.

The nurse's eyes narrowed. "Where does it hurt? You need to tell me exactly where it hurts."

"Yes," the old woman said, nodding her head "it hurts."

"No," the nurse said, grabbing the woman's arm. "Point to where it hurts. Point to it. Tell me where it hurts. This..." --the nurse began pointing aimlessly around the room--"is not good enough. Point. Point to it."

"But..." the old woman stuttered, "it hurts. I.."

The nurse turned towards the desk again. ""This is so not challenging. How do I know if this cardiac or not? Egh.." She sighed. "Did you run a strip?"

"In fact," I said, "we did an EKG and a 12-lead. They both came back as normal, well, borderline sinus brady. But whatever, when you press on her left lower quadrant, it hurts. That's where the pain is coming from."

The nurse continued writing for a few more seconds, then stopped again. "I'm being so unprofessional today, I'm sorry. I just...I need a new job. I'm so sick of this. I hate working triage."

She looked at the old woman again, who was visibly upset, and shook her head. "Put her back out in the hall."

"Alright mami," I said to the old woman, pushing the stretcher into the hall. "They're going to take good care of you here."

She glanced at me, then shrugged, pressing her palms into her cheeks. She began cursing under her breath.

"Take care," I said, patting her foot.

Taking a hand from her face, she made a shoo-ing motion.

As I walked out the door, I passed the triage nurse again. She shook her head, muttering "I think I'm going to have a nervous breakdown."

Outside, it was a cold night; and it didn't feel like Christmas.

the Hammer

We were waiting in line at the deli when it all started.

"13 Zebra," the radio crackled.

Hesitating for a moment, I answered back. "13 Zebra."

"13 Zebra you are backing up 26-Boy at 137 East Main for a 51 year old male having seizures."

I looked hard at the man behind the counter. "Any chance you could finish making my sandwich in the next 30 seconds?"

He shook his head.

Damnit, no dinner for me.

I whistled to my partner, the Angry Black Man, as I headed for the bus. Driving to the call, he was worried about the alternator on his car, which had died that morning in the snow.

"Yo B, I hope it starts again," he said. "That's another $500 if I have to get it replaced."

"Well maybe it was just a wire or something," I said.

"Maybe, but if it doesn't start I'm going to have to call a tow..."

Just then 26 Boy, the BLS unit that had called for us, pulled out 100 yards ahead of us.

"What the fuck is this?" ABM said, slapping the steering wheel. He got on the radio. "Central, this is 13 Zebra. Tell 26 Boy to pull over. We're right behind them."

A voice from the radio responded, "Ten-Four."

"I know these guys, B," explained ABM, "they're idiots. The one EMT who was on the radio is called 'the hammer.' He's a fucking moron."

Great, I thought, just what we need: the Hammer.

We pulled up behind 26 Boy. The hammer opened the back door. "What the hell are you leaving for?" ABM asked, angrily.

"Uhh, ya see..." but the ABM pushed the Hammer aside before he could finish.

"Shut up."

I peeked inside. Lying on a backboard made of red plastic was a man in his fifties. A hard grey collar held his neck firmly in place. I stepped closer to look at his face. Hmm. I squinted my eyes.

"Umm, dude," I said to ABM, "get our shit. We need to start bagging this guy." Bagging is medic-speak for artificially breathing for someone, so called because of the "bag" you squeeze to push air into their lungs.

"So what the fuck happened to this guy?" I asked.

"He had a seizure," stuttered the Hammer, "he fell, hit his head, had another seizure, then had another seizure when we showed up. I was just going to start bagging him..."

"Uh hu," I said, reaching for my intubation kit. "I see."

ABM threw our keys at the Hammer. "Drive...but first give us a minute."

As I started bagging the man, I looked at ABM. "Why don't you get a line," I said, motioning with my head to the IV start kit, "and then let's get some Lidocaine on board before we intubate this guy. Just...a 100 milligrams should do."

ABM was breaking a sweat. I yelled for the hammer. "Hey, rip me a piece of tape like 24 inches long." I needed it to secure the ET tube once it was in place. The ET tube is what I was about to stick in the guys throat. I would use it to breath for him. If the tube became dislodged, it might go into his stomach, and he would stop breathing. That was the worst case scenario. Paramedics get in trouble for stunts like that.

A few seconds after ABM announced that the Lidocaine was on board, I unstrapped the grey collar from the man's neck and stuck my flashlight-tipped laryngoscope into the man's mouth. I pulled the blade--a long, straight plastic piece--towards me. After a second, the little squared-off tongue shaped flap that protected the opening to the man's lungs came into view. Theoretically, I was supposed to see the man's vocal cords and place the tube in between them. But to do that, I would have had to crank the man's neck back, changing the allignment of the spine, forcing spinal damage if their was a hidden fracture.

It's a game we play, this guess-work. Am I in? I think I'm in, but I didn't see it go thru the cords. Hmm. It was a dangerous gamble, but when I squeezed air into the tube, I felt the man cough. He came around a little bit, meaning he started to fight us, which problematic but was also good. All signs pointed to yes, I was in. This may not seem like a big thing, but I hadn't done this particular skill in over a year and a half, and if I wasn't in, I was in the the stomach, and that would have been very, very bad. Besides, I was rusty, and it was a bad skill to be rusty on.

"Okay," said ABM, wiping sweat from his brow. "Let's get this shit on the road!"

We started moving.

"You alright man?" I asked him. "You look a little diaphoretic there?"

"Shutup," he said. "I get that way."

I chuckled quietly as he wiped himself dry.

At the ER, a group of young doctors sat casually around a table. "Whatcha got?" they asked, sounding bored.

"Intubated head trauma," I said, their eyes growing wide as we wheeled past them on our way to the trauma room.

"Call Respiratory! Call a Trauma Alert!" a doctor yelled. "Nobody called us!"

"B. We're here now," said the Angry Black Man. "Whatcha want me to do about it?"

ordinary drama

"You don't understand," she said, wiping away tears. "We don't have any money. How are we going to get home?"

"Uhh..." I said, turning to my partner. He broke in.

"I have an idea. Hold on one minute."

As he called our supervisor with his cellphone, I looked at the little girl. She sat quietly on the couch as her mother cried. She didn't look too bad, I thought. Maybe she could wait a few hours for the medicine. I listened to her lungs again. They seemed mostly normal, with only the faintest sound of wheezing on one side. Her mom said she'd woken up at 4am with trouble breathing. Her mom said she had to crawl into bed with her to make her go to sleep. It was 11am now and she was better, apparently.

Everybody has asthma in this part of the city. It's just a sad fact of life. Her aunt was supposed to be over at 5pm with an inhaler, but the doctor told her to call paramedics. He thought we could just give her a breathing treatment--which she needed--and leave. It doesn't work like that. If we give the kid the medicine, she's gotta go to the hospital. It's not our choice; it's just the way the system works.

"How are we going to get home?" her mother cried again. "We don't have any cash. Their father left us"--she pointed to her three children, ages 1, 2, and 3--"and now he only sends money when he feels like it. I don't work, I don't have a job. I have to be here, taking care of my kids."

She looked away, pausing for a moment. "We just got kicked out of our old apartment because we couldn't pay the rent. That's why we are here now. Her aunt is supposed to come by at five with her inhaler....what do you call it? Alb-..."

"Albuterol," I said. "An albuterol inhaler."

"Yeah, that's it." she said.

My partner got off the phone and motioned for me to setup the breathing treatment. "Okay, here's the deal," he said. "If we go to St. Francis hospital, they will give you a metrocard or cab voucher or something so that you can get back home."

She stopped crying, for a moment, and almost smiled. Almost.

I turned on the oxygen for the breathing treatment and asked the little girl to hold the nebulizer and put it into her mouth. She didn't want it, and now she too was crying.

Her mother got serious. "Hija," she said, "this is going to help you, now hold it in your mouth and breathe." After a few minutes of struggle, the girl calmed down. I listened to her lungs again. The air movement was louder and I could hear a distinct popping sound on the right side. What I had taken for normal was in fact quite dimished. The girl was a lot sicker than I had thought. The popping sound was in fact pneumonia. She had been sick for a week, and the infection had spread to her lungs.

As we meandered over to the ambulance, I looked at the woman and her family. They poor, but they were cute. The girl even had a bunny rabit beanie to wear. I smiled as we helped them into the ambulance.

Later, at the hospital, as my partner and I bullshitted with the other paramedic crews, I looked back at the little girl. She was climbing onto her mother's leg. She smiled at me. I smiled back, and her mother, seeing this, smiled at me too.