“But she said there was no chance.”
“Look at her pants. That’s not pee, she broke her water.”
Her sweatpants were soaked at the crotch. The smell wasn’t urine.
Troy had the IV in. “Give me some mag.”
Andrew fumbled with the one-cc syringe as he tried to stick the needle into the small vial of magnesium I had handed him from the med kit. He pulled the plunger back. The drug drained into the chamber.
“Easy, my friend,” Troy said. “Get it in there and push it slow.”
Andrew again had trouble as he tried to stick the needle through the rubber port on the IV line.
“Easy,” Troy said. “That’s it. Now push slow.”
I felt a tension easing in the girl’s arms. The seizure stopped.
“Get your airway kit out,” Troy said.
The woman lay still. Her chest wasn’t moving. She wasn’t breathing.
“Bag her,” Troy said. He tossed me the ambu-bag as Andrew unzipped his airway kit and fumbled to get out the laryngoscope.
I applied the mask over her face, holding a tight seal around her mouth and bending her head back to keep her airway open as I squeezed the bag.
“How my daughter doing in there?” the man shouted.
The cop barred the doorway.
“Just fine,” Troy said to the man. “I’m shutting the door.” To us, “She still has a good pulse. Tube her.”
Andrew nudged me to the side and stuck the scope in her mouth and swept her tongue to the side, peering in looking for her vocal cords.
“She’s bradying down,” Troy said, “Get that tube in.”
“I can’t see the cords.”
Troy reached up and pressed on the front of the woman’s neck.
“I think I’m in,” Andrew said.
“You’re not,” Troy said. “I didn’t feel it pass.”
“Heart rate’s thirty,” I said.
“No, I’m in.”
“Pull it out,” Troy said.
Andrew attached the ambu-bag to the end of the tube. Gave one squeeze. The bag didn’t reopen. I saw the belly rise. He pulled the bag off. Vomit surged out of the tube.
“Listen to me next time,” Troy said. “No, leave the tube there. Go in above it. Don’t go in so deep this time. She’s anterior.”
Troy handed him another tube. He went back in. More puke came out of the other tube.
Andrew’s partner turned his head. I could hear him vomit.
“Rate’s fifteen.”
Troy pressed his fingers against the neck again, just below the Adam’s apple. “That’s it. I felt it pass.”
Andrew attached the bag. This time you could see vapor in the tube. Good chest rise. Troy listened with his stethoscope while Andrew bagged. “Nothing in the belly. Good on the left. Nothing on the right. Pull back a little. That’s good. Solid placement. Tie it off. Yank the other tube.”
“Rate’s coming up,” I said.
But Troy wasn’t looking at the monitor. “We’ve got company.”
“What?”
Troy had pulled the woman’s sweatpants down. There between her legs was a bloody motionless baby.
“Throw me a blanket.”
I handed him a towel that was by the bedside.
Troy lifted the child and rubbed it with the towel. He brought the baby up to his mouth and gave it two breaths. He moved his fingers up and down on its chest. In between breaths, he told Andrew how to set up a magnesium drip, while Andrew’s partner bagged the woman through the tube.
“Drip set,” Troy said, “Hang it from the wall hanger. Lee, get her on the board and strapped tight.” He gave the baby two more breaths. “Andrew get the infant ambu out, then get the OB kit and let’s get the cord cut.”
It was hot in that room, and I was sweating too, lifting and turning the woman to get the board under her and the straps around her fat. I was so busy I didn’t have time to stop and admire Troy, the calm he displayed. He kept us focused. At his direction I unhooked the woman from the monitor, and applied patches to the baby, who they laid on the short board on the dresser. Its color wasn’t quite as mottled. Troy had a tube in the baby’s mouth, and coached Andrew inserting a small catheter into the umbilical vein.
“Nice job,” he said to Andrew. “A little epi, a little atropine, and maybe things will be all right. You know the dose?”
“I have a field guide.” He reached for his side pocket.
“Point-oh-one per kilogram for the epi. Point-oh-two for the atropine,” Troy said. “Let’s make it point-three-five ccs for the epi and one cc for the atropine.”
The baby’s rate came up to one forty. Troy stopped the compressions. Its color was close to pink now. “Attention all,” Troy announced. “In case you haven’t noticed. It’s a boy.”
When we got to the ED, they had a team from labor and delivery down there with an incubator. The baby weighed five pounds, but the doctor said he appeared to have good reflexes. The mother was stable too. Her pressure was down close to normal. She was breathing well enough on her own that they were able take the tube out of her windpipe.
“Excellent work,” Dr. Singer said to Troy. “You guys did a hell of job. Strong work. Strong work.”
She seemed to lighten up around Troy.
“Andrew was the man,” Troy said. “This was your first delivery, isn’t it?”
“Well, yeah. If you could call that a delivery.”
“I foresee a great future for you.”
“I don’t know,” Andrew said. “I was sort of losing it there.”
Troy slapped him on the back. “You hung in there. You were a stud. They should name the kid Andrew in your honor.”
As Troy walked down the hall, the others looked at him—two nurses in the station, Melnick, Dr. Singer, who’d come out of the room behind him, even the cleaning lady looked up from her mop as he passed—and I couldn’t help but admire him as they did.
Chapter 5
David Nestor was one of the city’s original paramedics. Now at forty-eight, he weighed over three hundred pounds. He’d been taken off the road due to his arthritic hips and cardiac problems, not helped by his three-pack-a-day cigarette habit. Others said the hospital had quietly yanked his medical control to practice because he had been unable to adapt to changing protocols and techniques. His job now was to read through the previous day’s run forms, sort them by number, and make certain all the signatures and insurance numbers were in place before the forms were sent on to the billing department. He often came to work unshaven. His uniform no longer fit. His prodigious gut hung over his belt. He looked like a broken-tusked walrus. Instead of sitting at the desk in the back office, he sat on two chairs at a table in the crew room where he liked to hold court.
“Melnick, how can you wear that medic patch on your sleeve?” Nestor said. “I’m looking at this form. You write this guy had rales and you didn’t give him lasix? Didn’t they teach you anything in school?”
“I thought he might have pneumonia.”
“You can’t tell the difference? Didn’t they teach you assessment?”
“Yeah, but you need an X-ray.”
“An X-ray? Bullshit. All a medic needs is a good head on his shoulders and a twenty-dollar stethoscope. A medic doesn’t need an X-ray to see the patient’s in failure. Just reading the form, it’s clear he’s in failure. He’s got JVD, no fever, pedal edema, rales, BP’s up, he’s tachycardic, sat’s in the low nineties despite your non-rebreather.”
“He’s got a pneumonia history. He wasn’t that bad, I didn’t want to take a chance and dehydrate him.”
“Are you a paramedic? You gave him nitro, go ahead and give the lasix. He’s on sixty a day, give him one twenty and hand him a urinal. Case closed.”
He turned to see what everyone else in the room was looking at.
Troy, sweat on his brow, stood in the doorway with that demon gleam in his eye. “Nestor, you worthless slug,” he said.
Ne
stor narrowed his eyes suspiciously like he wasn’t sure whether Troy was serious or just toying with him.
“Nestor, I wouldn’t let you get within ten feet of me with a placebo.”
A few moments ago the EMTs in the crew room had been bullshitting away while they checked their equipment and strapped on their bulletproof vests. Now they were silent.
Nestor looked confused and irritated.
“You old paramedics don’t know half what the newest medic coming out of school today knows,” Troy continued. “There’s a new breed on the street. Fifty dollars says Melnick knows all his pediatric doses off the top of his head, and that you would only know them by pulling out your field guide, unsticking its pages, and putting on your bifocals.”
“Listen to you,” Nestor said to Troy. “Go take your medication.”
“That’s right, Melnick,” Troy said to the young medic. “It would do you some good to take some lessons from a real paramedic, not some washed-up old dinosaur like Nestor who has killed more people than Son of Sam.”
“You wouldn’t know a medic if you saw one,” Nestor said. “When I first worked the city medics were special—they were giants of the street. You had to earn the patch. Now days all you need is a pulse and you get hired. Medics are a dime a dozen, but they’re not worth the paper their card is printed on. Shake and Bake medics. Chia Pet medics. No wonder no one respects us anymore.”
“You make a good case for the giant part. The size certainly attests that they were exceedingly large, but like the stegosaurus they had tiny brains and made large shits wherever they went. When’s the last time you took a bath?”
“Psycho,” Nestor mumbled. He looked down at his run forms.
The EMTs in the room smiled like jackals and grinned at Troy, like they’d just crowned him lion king. Nestor was red-faced.
“Atropine point-oh-two milligrams per kilogram,” Melnick said. “Epi…”
“Shut up, Melnick,” Troy said.
I went out to the car. Troy might have been a phenomenal paramedic, but he grated me. We all traveled our own roads and took our own lessons. I guessed his were ahead of him.
“Four eighty-two, you available to sign on yet?”
“Just about,” I answered. “Give us a couple minutes. Troy’s in a meeting.”
“Tell me once he’s finished his paperwork, I need you to sign on and cover Newington.”
“Understood,” I said.
I went back into the crew room. “Have you seen Troy?” I asked Nestor.
He shook his head without looking up from his run forms. “I’m not his keeper.”
I looked in the bathroom, but no one was there. I glanced in the supply room. I saw no one. Then I did a quick double take. Troy lay on the floor in the corner of the room, half hidden by several stacked crates of IV fluids. He wasn’t moving. When I approached I saw his eyes were glassy. His skin was gray and beaded with sweat. I shook his shoulder. “Are you all right?”
He was unconscious, his skin cool to the touch.
I turned for help just as a tall broad-shouldered medic came in the door. He was about Troy’s age, blond and fair-complected, wearing a Boston Red Sox hat. He went right for Troy. “Yo, bro!” He rubbed his knuckles into Troy’s sternum.
Still no response.
“Don’t worry,” he said to me. “He does this all the time. It’s his sugar. Now go close the door.”
I knew Troy was a diabetic. I’d seen him checking his sugar with his pocket glucometer, pricking his finger to produce a drop of blood for the test strip, but certainly I hadn’t expected to see Troy Johnson like this. The medic talked gently to Troy as he put a tourniquet around his arm. “Sometimes he resists, so you have to be careful. He’s being good today.” He took an alcohol wipe and rubbed it over a large vein in the crook of Troy’s arm. He stuck a needle in. I saw the blood flash back. “Get me some D-fifty from the shelf.”
I handed him the blue box. He took out a large Bristo jet and a glass ampoule of dextrose, screwed them together, and then stuck the Bristo jet needle in the rubber port of the IV line. He pushed the ampoule deeper into the jet, pushing the sugar water into Troy’s vein.
Troy’s eyes were still closed, but his skin was less diaphoretic.
“Shit,” he said, groggily. He looked up at us. “Gimme some gauze."
“You know you have to eat,” the medic said.
“I got a headache. Don’t push it so fast, you know that.” Troy grabbed the four-by-four dressing I offered, placed it against the IV site, then ripped the line out of his arm, and bent his elbow. “That hurts.” He got to his feet. “What’d you use? A sixteen?” He walked out of the closet and went into the bathroom across the hall.
“Nothing better than a grateful friend,” the medic said. “I’m Pat Brothers.”
“Lee Jones.” We shook.
“I’ve heard about you. I guess no one gave you the spiel on Troy. I’ve been on vacation or I would have.”
“I’ve got part of it. Not this part.”
“He’s a brittle diabetic, and you’ve got to watch him constantly. As long as his sugar stays above seventy, he’s got your back. It dips below; you have to have his. Are you any good at IVs?”
“I’m not IV certified.”
“That’s all right. I’ll teach you.
“This happens frequently?”
“Yes, it does, though it runs in spurts. He can be fine for months, and then it’ll happen every day for a week. The company knows he has a problem, but not to the degree it happens. There isn’t a medic here that hasn’t had to sit on him once or twice or five times to get some sugar in him. If you’re going to work with him, you’re going to have to learn how to do IVs.”
I could have answered that I wasn’t an IV tech, but from looking at the light blue of the EMT rocker on my shoulder he already knew that. I saw how things were, and I’ve done worse deeds than look out for a coworker.
Pat grabbed two EMTs out of the break room, and despite their protests, had them roll up their sleeves. He gave me a quick course. I stuck each of them twice, and Pat three times, getting veins in the crook of the elbow, the forearm, wrist, and hand. “Excellent, you’re a natural,” he said. “You’re all set.”
Troy came out of the bathroom ten minutes later, looking hung over, his hair out of place. He put on his Yankees cap and walked right past Nestor like nothing had happened between them.
“A pity the young are so frail,” Nestor said.
I thought Troy would go home for the day, but he sat in the ambulance, and we went out on the road. He said nothing about the incident.
“You’ll learn to see it coming on,” Pat said to me that day. “He starts doing crazy things. Make him eat. Don’t take anything he says personally. He just needs a little sweetening from time to time.”
Chapter 6
“Troy Johnson’s a punk,” Nestor said. “Good for entertainment, a few yuks, but that’s about it. He thinks being a medic is a gag, a gig for himself to strut his hoodoo.” He shook his head. “He doesn’t know where he’s from. He’s got no sense of history—the people who came before him. We deserve some respect for the path we forged.”
I was driving us back from Hartford Hospital where we’d gone to pick up a Kendrick extrication device—left by a crew who’d brought in a trauma earlier—along with extra backboards that were overflowing the hospital’s EMS locker. It was Troy’s day off and Victor had to take his wife to the doctor, so I didn’t have anyone to work with until the afternoon when Andrew Melnick was going to come in on overtime. Nestor, bored with his paperwork, had invited himself along for the ride.
“Hartford was a great city once. It’s all crack houses and burned out buildings now. I’m glad I’m not out on the streets anymore, though I would be if the company would let me. Maybe in another year the doctors will give me the go-ahead again if I can just drop some weight, though fuck, my hip hurts just walking. Too goddamn many carry-downs. Takes a toll on the body. All tha
t lifting. I worked seven days a week. Everybody knew me. People were always coming up saying ‘Remember me. You took care of me. You took care of my mother. You took care of my grandfather. You delivered my sister.’ I’d say, ‘Yeah, how’s everybody doing?’ I didn’t remember them. After awhile the people—the calls—they all flow together. I delivered twenty-seven babies. Called the time on a cemetery full of people. I’ve got stories.”
I could see being in an ambulance lifted his spirits.
“Let’s go see Sidney,” he said. “You been introduced to him yet?”
“Sidney?”
“Sidney Seuss—the Boss—the man who started it all. May he rest in peace. Not likely.”
He directed me to the Zion Hill Cemetery. We drove through the gates and up to the crest of the hill. We got out and walked across the grass to a site he pointed out.
A big marble tombstone. “Sidney Seuss, Beloved Husband and Father, Founder of Capital Ambulance.” By its base were nearly thirty matchbox ambulances of different types and styles.
Nestor reached into his pocket and took out another small ambulance and laid it down beside the others. “Another car for your fleet, old man,” he said. “You’re still the king.”
He stared at the tombstone. It was quiet except for Nestor’s wheezes and the faint hum of traffic.
Nestor laughed then. “The old bastard’s still watching over us. ‘How come you’re not out humping a stretcher right now, Davey boy?’” he said in an oddly high voice. “‘I don’t want to see you slacking today. There’s money to be made out there.’” He laughed, and then sighed deeply.
From the gravesite, you could see downtown Hartford below, the capitol dome, the downtown skyscrapers, Bushnell Park.
“Sidney owned this town,” Nestor said. “Some people thought it was an embarrassment to work for him, but I admired him. You had to. He was one of a kind. You know how he started? He was a tow-truck driver. He’d listen to his police scanner for accidents. He always beat the ambulance to the scene. He did it so much; he started carrying medical supplies in his truck. He felt bad standing there not being able to help. This was back in the late 1960s before there were EMS systems. There was no regulation, no EMTs. Sidney saw a business opportunity. He went out and bought himself an ambulance, then two, then three. Next thing you know he was running the town.
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