“I need to go in to school around eleven,” she said. “I may have a lot of work to do tonight. And I hadn’t seen you in two days. I figured I’d swing on by and spend some time with you before I went to work.”
“It’s great to see you.” I put my beer down. “I’ll make some coffee. I don’t want to fall asleep on you.”
“If you’re on me, you’d better not fall asleep,” she said with a wicked smile. “But isn’t it a bit hot for coffee?”
“We’ll take it on the terrace.”
“The terrace?”
“Terrace, fire escape. Whatever.” I sliced two bagels, put them in the toaster while the coffee brewed. “We’ll let the place cool down while we have breakfast.”
I had a small table and two chairs out on the fire escape. I also had a completely illegal grill out there, but since everybody who might be called to investigate it knew me and wanted me to show up when they got hurt on the job, I figured I was safe.
I brought a plate of bagels, some butter and two cups of coffee out the window onto the fire escape. Sarah took a seat and smiled. She stirred some sugar and cream into her coffee and looked out over the river. “It’s actually a nice view out here.”
“Welcome to my place overlooking the Immigrant City Riviera,” I said as I buttered my bagel. I know it should have been cream cheese, but I had none in the house. “The breeze is nice up here. What do you have to go into school for today? Aren’t you on vacation?”
“Big changes in the English department,” she said. “My old office mate got promoted, and she has Big Ideas.”
“With capital letters and everything?”
She nodded as she chewed. “Mary is all about the capitals. She’s from an academic family.”
“So you get your own office all to yourself?” I asked.
“Not a chance. I’m getting a new roomie.”
“Met her yet?”
“Him,” she said. “I’m getting a poet. An acclaimed poet.”
“Do we still acclaim poets?” I wondered.
“Only in the rarified circles of academia that we intelligentsia inhabit,” she replied. “And he’s probably taking a job at a small college because poetry pays so well.”
“The job’s not going to interfere with his gazing out at the Breathless Promise of Spring and other poetic pursuits?”
“I’m sure he’s been hired for the prestige of his name. He’ll teach a seminar on poetry, lecture two hours a week, and have a merry band of grad students as assistants to do his paperwork.”
“Nice work if you can get it.”
“I wouldn’t know,” she replied. “I am doomed to toil unnoticed in a niche specialty. Understaffed, underpaid and forgotten.”
“Well, if they forget you, that means you can sneak out for the occasional quickie.”
“Trust you to find the bright side. You think they’ll let you sneak out of work?”
“Hell, I don’t even have to. So long as I have the radio, I can do pretty much anything I want.”
“So you can come by in the ambulance if I’m feeling lonely?”
“Pete or Nique would cover for me. We can respond to the love emergency at the library.”
She rolled her eyes. “Your stories do so much to restore my faith in emergency services.”
“Have you met this poet yet?”
“No. But he’s supposed to be very charming. I figure I’ll be chasing lovestruck undergrads out of the office all day.”
“Do I need to worry?” I asked. “Step up my game?”
“If I find out you haven’t been giving me your best all this time, then you should worry. But about this new guy at work? No more than I have to worry about you spending twenty-four hours at a time with Monique.”
“I am reassured,” I said, rubbing my back against the chair to scratch it.
“If you want to hop in the shower, wash the city off, I’ll have another coffee and enjoy the view.” She kissed me. “And you could shave. You’re a little scratchy.”
“I’ll be out in a flash,” I said. “Smooth chinned, scrubbed fresh, the residue of despair and trauma from the huddled masses washed away.”
“Maybe we’ve spent too much time talking about poets today,” she said. “Get your day- drinking ass in the shower. The clock’s running.”
“Dylan Thomas?” I asked, climbing through the window.
I closed the bathroom door and peeled off my tee shirt. I had spent a twenty-four hour shift in the heat of summer wearing it, so I wasn’t offended that Sarah seemed eager to get me in the shower. I shaved before I hopped under the spray. I liked to rinse all the stray foam off in the shower.
I stood under the water, enjoying the feel of it beating on my back, rinsing the sweat and grime of the night away. I love indoor plumbing. I still feel a little thrill every time I get nice hot water at the turn of a knob. Until you’ve hauled a bucket in from the well and heated it over a fireplace, you can’t appreciate just how decadent a shower is.
I washed my hair and was rinsing the lather when I heard the bathroom door open.
The curtain was drawn aside and Sarah stepped naked into the shower. “Hi,” she smiled. “I got lonely. And I only have a few hours before I have to go to work. It would be a pity to waste it.”
I took a moment to appreciate her curves before wrapping my arms around her. “This is a nice surprise,” I said as I kissed her.
“Mmm. I do like you better when you’re clean.”
“I like you better when you’re dirty,” I replied, kissing my way down her neck.
She laughed, which, since she was slippery and naked and held tight against me, was worth the price of admission in and of itself. “I guess we’ll call this a win-win, then.”
As my kisses traveled across her breasts and she pulled me closer, I thought again just how much I loved showers.
Chapter 3
I WALKED INTO THE BASE the next morning, bagel in my left hand, coffee in my right, and saw a new face. A young woman, eager smile, brand new EMT uniform clean and pressed, boot shined so you could shave in them, expensive new stethoscope around her neck, and she even had the company collar pins on.
God, what a boot, I thought. I hoped she would be riding with somebody else. I like teaching, but the naive enthusiasm gets old fast. Plus, she was a pretty young brunette, all eager smiles and eyes wide and shining with excitement. With her on the truck, all the firefighters, cops, and EMTs we ran into would be circling like sharks. They tended to circle Nique at a wary distance, but the novelty and perkiness of the new girl would be like blood in the water.
“Hi!” she said, extending a hand. “I’m Samantha.”
“Sean.” I held my bagel in my teeth and shifted my coffee to my left hand, then stuck out my right.
“Pete told me I’m going to be riding with you and Monique today,” she effervesced.
“I’m surprised he didn’t want to take you.”
Pete shrugged. “The bosses seem to think you guys are a better first day kinda crew. I mean, Nique is smart and you’re all nurturing and empowering and keenly empathetic and nonthreateningly gay.”
“Ah,” I replied, resuming my breakfast.
“Once you guys gently ease her into the bosom of EMS, then Juan and I can show her the ugly underbelly of the mean streets. Introduce her to the world of gangs and drug overdoses and shootings an d hookers and– ”
“Surfing the couch, yes.”
“A moment of rest snatched from a pause in the constant train of human suffering, stupidity and danger that is our sad lot.”
“Pete, stop scaring the new girl,” said Nique, not looking up from her book.
“It’s our sacred duty to scare the new girl,” he replied. “If we scare her off, we’ve saved her from a life of underpaid, underappreciated hard labor among the drunks, the gangs and pathogens, and we save EMS from somebody who can’t hack. If we don’t scare her off, that means she’s damaged enough that she might be a decent EMT
one day.”
Monique tossed her head in exasperation. “Our duty is to show her what being an EMT is, so that she knows whether it’s what she wants.” She turned to me. “Sean, you speak Neanderthal. Can you explain my point to him?”
In truth, they were both right. And they were both my partners, so letting them each feel they’d scored points was important.
“Well, Pete isn’t exactly wrong,” I told Samantha. “The pay is lousy. The benefits are lousy. We’re not Civil Service like police or fire. The turnover is crazy. FlatLine uses new EMTs up and spits them out. This city breaks people. It can be dangerous. Pete and I both got cut last year. You need to understand that before you commit to this job. Wouldn’t be fair to you if somebody didn’t let you in on it. And since it’s a tough, dangerous job, we need to trust the people we work with, so if you’re not cut out for this, it’s not fair for us to have to carry you until you do quit.
“But,” I continued, “if you are cut out for this, if you can look at this job and still really want it, it’s the best job in the world. If you’re one of the twenty- five percent who don’t wash out inside six months, you’ll be ruined for real work. I mean, we all bitch about it, but you see the same old faces on the truck, year after year. Today, if you really want this, just step up and show us you can hack. We don’t need to scare you off. Philips Mills will do that unless you’re supposed to be here. And if you are, you’ll be a lifer.”
Samantha fiercely maintained her eager grin throughout our discussion, but it had taken on a strained, uncertain quality.
“So, what do you say?” I asked. “You in?”
She gave me a shaky nod.
“Ok, let’s look at the truck. Lose the collar pins.”
“But they’re part of the uniform.”
“You’ll lose the backings, then you’ll throw the strap of a bag over your shoulder and drive the pin into your clavicle,” said Nique. “And don’t sweat the uniform thing too much. Look around and tell me if you see any two medics dressed alike.”
She was right. I was wearing one of my cotton shirts that looked almost but not quite like the polyester ones FlatLine provided, but with a third less heatstroke and a pair of navy blue cotton tropical weight utility pants instead of the heavy poly official ones. A serviceable but not very expensive stethoscope was stuffed in the right cargo pocket. I didn’t even know where my collar pins were any more. I threw enough polish at my boots so they were black, but they hadn’t shone in a long time.
We went out to the truck and showed her the equipment.
“A lot of this you’re not going to use,” I said. “You’re an EMT, so you’ll work on a BLS truck. This is a paramedic truck, so it’s got all the ALS stuff—”
“ALS?”
“Advanced Life Support,” said ‘Nique.
“Oh, right. Sorry.”
I was getting used to this. The state was pretty sloppy about credentialing EMT training programs. So long as the students soaked up enough information to pass the exam they were given a shoulder patch, a certificate and unleashed on the ill, the injured and the infirm. A big part of our job as senior medics was to help minimize the damage they could do.
I’d spent centuries trying to teach green conscripts not to get killed in their first fight or sleep on sentry duty, so teaching people really important stuff that nobody else had bothered to was just second nature.
“First day,” I said. “Don’t sweat it. Once you’re on your BLS truck you won’t have the cardiac monitor, or the IV start stuff or most of the drugs. Don’t get overwhelmed. Ninety percent of EMS is jut patient assessment and staying calm. Just keep moving the patient in the right direction. When in doubt, that’s the ER. ”
She looked concerned.
“Keep it simple. You’ll have–should have– a senior partner. Depends how desperate FlatLine is to keep the truck staffed. So don’t be afraid to ask your partner’s opinion. If you feel you’re in over your head and the patient is beyond you, call for ALS. If ALS isn’t available, the right answer is always ‘O2 and screw.’ Put the patient on oxygen and drive to the hospital.”
“It’s not that hard,” said Nique. “Half these guys can’t dress themselves and they’re all doing it.”
“And you get so much respect from your co-workers,” I added.
The radio cut our conversation short.
“Paramedic twenty, P 20. Respond to the corner of South Broadway at Salem Street. Parking lot behind St. Patrick’s Church for the unresponsive.”
“Father Jim giving a boring homily today?” I asked.
I hopped into the passenger seat and Samantha climbed into the back of the truck as Nique pulled out and hit the lights. This hour there wasn’t much traffic, so she kept the use of the siren to a minimum. Another reason I liked her.
St Patrick’s Church was just around the corner from the ambulance base, so for once we beat the fire department. A bystander was in the parking lot, cell phone in one hand, pointing with the other at a man sprawled on the ground.
“Thank God we have that guy to point out the patient,” said Nique as we pulled up.
“Hey, that man is the first link in the chain of survival,” I reminded her.
“Silly me,” she said as she threw the truck into park.
I hopped out, went to the side door. “Sam, you’re with me. Grab the monitor.” I took the big jump kit and moved to the man on the ground.
It was my turn to tech, so I went right to the patient. Nique’s job, as the driver, was to talk to the bystander, get his story, and most importantly, keep him from getting in my way and talking over me.
I looked down at the patient. He was unresponsive, but he was breathing. His color wasn’t too terrible, he had a nice strong radial pulse.
“What’s wrong with him?” asked Samantha.
“The cumulative result of several decades of poor life choices,” I replied. “Not sure what the more acute problem is right now.”
She stood and stared.
“He’s breathing, he has a pulse. Grab the cot and we’ll get him in the truck and figure it out en route to the hospital.”
She hesitated.
“The cot is generally located in the truck.”
“Oh, umm. Right!” she babbled. “Sorry!” She ran to the back of the ambulance while I did a quick assessment. It looked like drugs. No smell of booze, no vomit, pupils small but not heroin small, breathing not slow enough for just a narcotic OD. Polysubstance maybe?
Samantha arrived with the cot, Nique a moment behind her, her blue eyes blazing with Gallic outrage, her lips compressed into a hard line. When they reached me, Nique squatted down and took the man’s legs, I grabbed him under the shoulders and we lifted him onto the cot.
“The guy who called didn’t know anything,” she said. “He was driving past and saw somebody lying on the ground, called 911.” We wheeled the cot around to the back of the truck, lifted it in. “What’s up with him?”
“No idea,” I replied. “Maybe an OD. I’ll start a line, check a sugar, maybe give him some Narcan.”
“Need anything from me?”
“Other than your undying devotion? No, just get us to the General. I got Samantha for an extra pair of hands. I’ll let her see the Coma of Unknown Etiology algorithm.”
“Take care,” she replied. “Scream if you need me.”
There was a straight line in that somewhere, but I was off my game and let it go by.
I climbed into the back of the truck, moved to the patient. Samantha hopped in and did her best impression of a deer caught in the headlights.
“Why don’t you throw on an oxygen mask and grab a blood pressure.”
“Oh. Yes.” She looked around, all nerves.
“Cabinet over your right shoulder. Non-rebreathers are on the left.”
“Got it.”
I started an IV line, drew blood for the ER. By that time, Samantha had managed to get the non-rebreathing mask out of the packaging but was stil
l struggling to unsnarl the tubing. I always believed there was some guy working at the oxygen mask factory making minimum wage who tied the things in knots out of spite.
Since I didn’t expect her to help me any time soon, I checked a blood sugar off the IV catheter before putting it in the sharps box. One thirty-four. So, not a sugar problem. His pulse was nice and strong and regular, so even without the blood pressure that I’d have no faith in, I was pretty sure it wasn’t a volume problem.
So what did that leave? I wondered. Drugs?
That’s hard for me to detect. I can feel a sluggish heart, but I can’t always tell you what caused it.
Well, I reasoned, a little Narcan never hurt anybody. It annoyed some people when it ruined their high, but all it did was block the opiate receptors and stop the heroin from working. I drew up 2 milligrams into a syringe.
“How we coming on the pressure?” I asked.
“Uh...”
“In the red bag. In the middle. Look for the cuff.”
I drew up the medication, found a saline flush to chase it. Samantha had the blood pressure cuff on and was inflating it.
“Just a tip,” I said. “Grab a pulse before you pump that up. That way you know two things. Whether he has enough pressure for a radial pulse, and where to find it if you do need to palpate it.”
“Palpate?”
“If you can’t hear the beats start and stop with your stethoscope, you check the pulse as you let down the cuff. The point at which you feel it gives you the systolic pressure,” I said. “That’s the big number.”
That may have carried a trace of sarcasm, but there are a few things that you need to absorb in EMT school. She might not have been the slowest new EMT I’d seen, but she was in the running.
“So his sugar’s fine, his heart rate is fine, his breathing’s not too terrible and his color is OK,” I reviewed as she fumbled her way through taking a blood pressure. “So I’m guessing overdose. It’s a little like a heroin OD, so I’m gonna try to wake him up with Narcan.”
“OK,” she replied.
“You have that pressure?”
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