Population: 485

by Michael Perry

  Later, while writing up the report I try to imagine myself in court two years from now, facing some lawyer armed with the patient assessment and scene-control portions of Emergency Care in the Streets. Rescue organizations devote entire four-day seminars to scene control—this particular circus would be the perfect study. The algorithm has not been designed that can cope with Tricky Jackson and his posse. The old-timers tell me that from the 1920s right up until the late 1970s the whole town used to turn out for the Free Show, a free open-air movie sponsored by the Commercial Club. The screen was set up in what is now my backyard. Videos and cable television killed the Free Show, but for a couple hours on a warm June evening, Tricky Jackson revived it. It is an accident scene, it is community theater, reality TV, and improv, all rolled into one.

  By the time it is all over, Tricky may or may not have been arrested—I have seen him in and out of handcuffs twice—Elmo is on his belated way to the hospital with Bill, Travis is in the approach path to the Luther Hospital helipad thirty miles away, and Shirley was last seen north of Slinger Joe’s, thumbing for a ride. We pick up the bandage wrappers, sweep up the glass, roll the hose, and engage in all the mundane little chores of denouement you rarely get to see on Paramedics. The crowd pretty much dispersed once the helicopter cleared the trees on Elm Street. The rain stopped a long time ago, and when I get back to my car, I find that the windshield wipers have been running dry for so long they are melting, leaving rubbery black streaks across the glass. On the drive to the fire hall, I see the townspeople filtering home, some of them visiting for a bit on the sidewalk. Their children course ahead of them, running and skipping, or pedaling furiously on colorful tricycles. The sky is gray, the night is warm. The grass in the yards is deep twilight green, and the rain seeps into the earth, draining the excitement from the air.

  Oliver Goldsmith died in 1773. He had just completed the dramatic comedy She Stoops to Conquer, which assured him of a spot in The Oxford Companion to English Literature.

  Cut to New York State, 1804. The citizens of Hardenburgh Corners are pleased to learn that the state commissioners intend to designate their town as the Cayuga County seat. Disquietude displaces pride, however, when certain members of the citizenry—apparently whelmed with the stately implications of this county seat business—opine that the name Hardenburgh Corners is an embarrassment of multisyllabic yokelism, a moniker neither dignified nor manageable (consider the letterhead), and wholly lacking the sense of eminence required of a county seat. It was an issue, wrote Henry Hall in an 1869 history, of propriety. “The subject,” he continued, “was therefore agitated.” Everyone clustered at Bostwick’s tavern and began kicking names around. Quite immediately, a Dr. Crossett suggested the adoption of “Auburn,” after the town in Goldsmith’s “Deserted Village.” Based on the lyrical implications (“…loveliest village of the plain”), Crossett’s suggestion was received with general approbation until a certain eponymic Colonel Hardenburgh pointed out that while Goldsmith’s Auburn may have been lovely, it was also the most neglected—indeed, deserted—village on the plain, and to redub Hardenburgh Corners so would foreshadow its decay and decline. Among the alternative names subsequently proffered were the foreshortened “Hardenburgh,” a stately “Mount Maria,” and, plainly enough, “Centre.” A roisterous debate ensued, followed by a vote, and Auburn emerged the favorite. Efforts to reverse the decision were mounted, and a second vote taken, but again, Auburn was the majority choice.

  We move now to western Wisconsin, 1856. A preacher named Priddy hikes into the area and sets up shop at the confluence of a creek. The spot will become Bloomer, Wisconsin. Priddy hails from New York State and has relatives in Cayuga County. When it comes time to carve up western Wisconsin and name the chunks, the township adjacent to Priddy’s settlement is christened Auburn Township in honor of Auburn, New York. Up the trail nine miles, a man named C. M. Tarr is so taken with the name, he starts a little village and names it Auburn also. Eventually, this Auburn will be subsumed into Cartwright Mills, only to resurface during the liquor license controversy of 1902. On August 3, 1904, the handwritten entry in the Village Minutes reads, “That the village of Auburn henceforth be called New Auburn.” The Oliver Goldsmith loop was complete.

  We wind up the Tricky Jackson call with the usual smoke-and-joke session. We talk about what went well and what didn’t go so well, and how we might handle the next incident in which a carful of five people hits the laundromat—an exercise that speaks to both the importance and futility of emergency planning—but mostly we just shoot the breeze, an underrated joy. We stand among the trucks. Instead of the traditional red, they are painted bright yellow. And on the door of each truck, in reflective gold leaf, it says New Auburn Area Fire Department. It tickles me sometimes, when we’re standing around the fire hall talking about coon hunting and stock cars, to look at those truck doors and think of Goldsmith, bent over his desk, composing in pentameter, crafting verse, a fragment of which would survive to be pasted on our fire trucks. It is a tangible thread to the past. Establishing a connection between the peeing plywood boy and the Mannekin-Pis is an exercise in corollaries, aimed at deflating pretension. Linking our fire trucks to eighteenth-century literature is an exercise in map reading. We find a trail leading back over the landscape of time, and we find ourselves bearing forward the remnants of a distant aesthetic not immediately evident in our detritus, but ours to claim, nonetheless. Whatever else he did, Goldsmith put a name on the place I have always called home, no matter where I stood at the time I invoked the name.

  4

  SILVER STAR

  PUKE IS THE GREAT CONSTANT. Sick people puke, dying people puke, excited people puke, people puke while they’re having heart attacks, they puke when their lacerated brains swell, they puke because they get carsick lying on the cot looking up at the dome lights.

  I got the puke christening early. I was in training, still doing ride-alongs as the third wheel on a two-man crew. The page came during a swampy stretch of weather—humidity and temperature readings had been crowding the high nineties for a week. I pulled open the apartment door, and the stench rolled out like warm fog. The living room was packed with family. As I trotted past the kitchen table, I saw piles of trash and dishes and a capacious tureen heaped with onion skins and potato peelings. The patient, Helen, was in the bathroom. The bathroom went about five feet by eight feet, and Helen went about five feet by 350 pounds. She was on the toilet, wedged between the sink and the tub. It was upward of 90 degrees in there, and she was wrapped in a voluminous flannel nightgown. From the smell of things, there were bits of Helen that had seen neither air nor water for a long, long time. I stood in the tub. Donnie and Todd, the two veterans training me, shoved the cot in and stood watching from the door. The cot took up all the remaining floor space. I guessed I was on my own. Helen’s daughter poked her head between Donnie and Todd. “She’s been sick for a couple days. She had a seizure today. She can’t stand up.”

  I tried to help Helen stand, but she just hollered. I looked to Donnie and Todd. They were giving me the rookie smirk. Behind them, I could see the faces of the family, arranged in an arc, peering at me expectantly. I began to sweat. In the end, a fireman wedged himself in the tub with me, and between the two of us, we convinced Helen to wriggle while we tugged and pushed, and after violating every safe lifting technique ever proposed, wrestled her to the cot. She immediately began to retch. Donnie slapped a towel to her chin, but only succeeded in deflecting the subsequent explosion of dark brown vomit across the wall and over the blankets. It was a copious projectile eruption that left the cot drenched. Like a flu-ridden chorus line, the arc of family bent at the waist and barfed on the carpet. We see this sometimes. It’s what you call a sympathy puke.

  We loaded the cot, and Donnie and Todd sprinted for the front seats. It is not standard training procedure to abandon the rookie in the back. Helen squinted her eyes shut tight, howled, and puked again. There is a little door between the front and
the rear of the ambulance. It is never closed. Todd snapped it shut. Helen howled, paused again to hurl, then howled nonstop to the hospital. I never could figure out what the trouble was. She wouldn’t talk. The floor was slick with soupy brown spew. The air was rank with the smell of onions and something vaguely Parmesan. The windows opened out at the bottom, only about an inch. I’d hold my breath while taking Helen’s vital signs, then lurch to the base of the window to inhale. The howling was unceasing. Todd kept leering through the little communicating window in the latched door. One day he will reside in a lower circle of Hell.

  The thing was, other than the soles of my boots, I had managed to stay vomitus-free. I probably tracked a little into the hospital when we got there, and I had Donnie grab an emesis basin before we took the five-floor elevator ride to the medical floor, but Helen’s howling and eruptions had waned to nothing, and my uniform was still dry when we docked the cot beside her hospital bed. It took six of us to lift her across the gap. I was positioned at the head of the bed, about a foot from her face. Right mid-lift, when I had her great weight in my arms, she swiveled her head, looked me in the eye, and bound up her guts for one last mighty heave. Donnie slung the emesis basin at me, and I managed to catch the first few bursts, but she just kept puking. The basin became full. I called for another. Everyone just stared. The basin overflowed, and vomit hit the floor, splattering my pant legs and pooling on my boots. There was a slight pause, and then Helen loosed a convulsive woof!, launching a final horrific geyser just past my right ear. I leapt back, but I was too late. She got me in the right shoulder, across the chest, and as a sort of sloppy coup de grace, sent a few trailing dribbles down the front of my pants.

  Down in the ER, I tried to clean up, but it was just silly. The boys put me in the back of the rig, shut the communicating door, and drove me home. When we stripped the cot, a glistening chunk of unchewed onion the size of a nightcrawler fell to the floor. I resolved to stay in the shower until shrunken.

  But I didn’t puke. And I never have.

  The thing about ambulance work is, you cannot dip your toe in the pool. You don’t know if you can stand the water until you dive in. When you’re training, long before you answer your first page, you wonder how you’ll handle the blood, you wonder how you’ll react to distorted limbs and protruding bone fragments, and you wonder if dead people will make you want to turn and run. I never remember wondering how I’d handle the puking. There’s no way to find out other than to get out there in it.

  The first heart attack I ever worked was near suppertime, and I and my partner, Fred—a part-time hospital orderly and experienced EMT—had just picked up sub sandwiches. They slid around the console as we whistled down the highway, out to a farmstead. Following the family, we ran up a hill behind the house, where there was a man lying on his back, looking waxen in the grass. While Fred set up the defibrillator, I popped out my pocket mask and prepared to start rescue breathing. The family dog ran around and around us. I remember being wound tight inside, scared and humming like a high line, but I also remember being thrilled that I wasn’t panicked, that I could remember the cardiac-arrest protocol, that I had no qualms about bringing my face near to that of a dead man. And so I gave him that big first breath—the trouble was, I forgot to attach the one-way valve to the mask, and on the exhale, the man blew a geyser of creamed corn in my face.

  I didn’t puke.

  I called for suction, jammed the one-way valve on the mask, and gave him another breath.

  Fifteen years and hundreds of patients later, I have never forgotten the one-way valve.

  We worked the man all the way back to the hospital. The sweat from my brow splashed on his bare chest every time I did compressions. Once when we careened around a corner I smacked my head on the overhead cupboard. We hit the ambulance bay going full steam, and they shocked and poked a while longer in the emergency room, but the man died.

  I wondered how I’d feel, but it all seemed okay. I felt we could look at the family and know we’d done what we could. What we were trained to do. I felt respectful of their grief, but I wasn’t distraught myself. We shut ourselves in a little room at the back of the emergency department to review the audiocassette playback from the defib machine. As the tape rolled, I heard myself breathing and grunting, and Fred talking through the protocol, and I could hear the plasticky tunk of jostled equipment, and the rattle and snap of the cot straps, and through the whole thing, that dog—circling us again and again, barking and whining as we shocked, pummeled, and abducted his master. The creamed corn, the dead man, those didn’t bother me. That dog set me back some.

  I was introduced to the techniques and terminology of emergency medical service—EMS—through a series of night classes held in a high school library under the aegis of the Wisconsin Indianhead Technical College. After 115 hours of training, I received sanction from the National Registry of Emergency Medical Technicians by passing their written and practical examinations. The state of Wisconsin then issued me a license to practice at the EMT-Basic level. Officially prepared, I set out to learn the trade of rescue. The guts, and the art.

  I entered into an apprenticeship with a passel of renegades.

  The headquarters of the Silver Star Ambulance Service consisted of a ratty apartment attached to a funeral home. If this strikes you as a creepy conflict of interest, right on. Regulations now prohibit such arrangements, which were an outgrowth of the days when the local hearse did double duty as the ambulance. Existing services were grandfathered in, however, and Silver Star was one of the originals.

  The proximity of the funeral home had its pros and cons. We were always being recruited to shuttle caskets and move bodies. When we washed and polished the ambulances, we were expected to do the same for the hearse. When it snowed, the funeral-home owner would summon us to his house on the hill and make us shovel the drive. I always figured that looked pretty good—an ambulance pulls up, and two uniformed medics jump out with snow shovels.

  On the other hand, the presence of caskets and dead bodies kept us well stocked for pranks. Whenever new medics hired on, we took them on a tour of the funeral home and made sure to point out that the bunk room and the embalming room shared a wall. That night, we’d assign them the bunk against that wall. After lights out, the dispatcher would sneak into the embalming room and scratch on the tiles. Sometimes you’d cook up an errand that would send a rookie through the casket room. We’d plant a veteran in one of the caskets, and when the rookie got close, the veteran would moan and pound on the lid.

  I used to say I would trust the Silver Star crew with my life, but not my sister. The city fire department, with its union wages and tough admission standards, tended to attract experienced career-minded individuals. Silver Star, with its low wages and cursory background checks, tended to attract part-timers, novices, and talented rogues. When I signed on, I found myself part of a merry band whose personalities were as fractured as their rescue talents were solid: Jacques, the French-Canadian Sioux who cheerfully referred to himself as a “blanket-assed wagon burner.” Before turning in at night, he stripped down to his leopard-print bikini briefs and cut muscle-man poses. He and I spent a lot of time in the brush behind the ambulance garage, rigging figure-four rabbit traps and taking archery practice, city ordinances notwithstanding. Leif, who shagged anything that would stand still. Donnie, the sawed-off veteran with the most seniority who wore cowboy boots and refused to do anything other than drive. We used to wind him up just to watch his bald head turn red. Todd, vein-skinny, sardonic, and utterly unflappable. Baz, who lived on coffee and cigarettes and spent half the shift in the bathroom with the newspaper. Phil, the gentleman among us, with a sweet wife and little boy. And Porter, who got lit at the bar one night, tried to ride home on his bike, and ran smack into a two-story brick medical clinic.

  Silver Star was managed by Arnold, the owner’s son. Arnold had high blood pressure. Under stress, he tended to spring nosebleeds. He’d be in his office chair, chewin
g you out, and all of a sudden he’d tip back and pinch his nose, and you knew you were getting to him. The day I applied for a position at Silver Star, we were five minutes into the interview when the pager went off. Arnold tossed my résumé on the desk and jumped up. “C’mon!” We picked up a sick little old lady. She was on the floor in her nightgown, hands clenched over her belly. We carried her out on a backboard and put her on the cot. Halfway to the hospital, she relaxed a little, and a basketball-sized mass of flesh rolled out from under her nightgown and thumped to the floor. It remained attached to her abdomen by a thin, fleshy umbilicus. Arnold and I exchanged a glance across the cot. Then Arnold picked the thing up and popped it back under the nightgown like it was the most natural thing in the world. Never said a word. The lesson was twofold. Number one, failure to detect a free-floating tumorous mass the heft and circumference of a supermarket watermelon reflects a certain inattention to basic patient-assessment protocols. Number two, be cool. And if you can’t be cool, act cool. The patient will draw comfort from your demeanor. Another day, your countenance should say, another little old lady sprouting giant flesh balls.

  The human body is subject to an infinite number of maladies and injuries in an infinite number of combinations. This can put a little whoops in your gut if the pager on your belt designates you to sort them out on the fly. The what-ifs are daunting. The good news? It’s likely you learned the most fundamental element of EMS clear back in kindergarten. In EMS, no matter what happens, no matter how tragic or banal the call, all patient treatment is predicated on an algorithm, and that algorithm begins with a three-letter mnemonic: ABC. A = airway, B = breathing, C = circulation. Whether grandma stubbed her toe, had a heart attack, or got hit by a Mack truck, your primary responsibility, as one of my instructors used to put it, is to make sure air goes in and out and blood goes ’round and ’round. No matter your level of practice—first responder, basic EMT, paramedic—you begin at ABC and ride the algorithm home.