“Wouldn’t Helen be opposed to that?”
“I don’t know. Sidney’s partners are in a fight over what to do with the business. I think Helen wants them to sell. I don’t know. It’s hard to figure. I just come to work when I’m in the book and go where they tell me. As long as my paycheck clears at the bank, I’m not complaining.”
“That’s a good way to be.”
“The senator wants to learn something valuable, he should talk to that old man over there,” Victor said.
A man with a weathered, leathery face sat in a wheelchair in front of a bogata, smoking a cigarette watching the scene on the street.
“That’s Papi Ruiz. His son is Hector Ruiz, you’ve heard of him?”
“No, should I have?”
“You stay working here long enough. He’s in jail now, but he may win his appeal. Maybe you’ve seen him when he was on Sixty Minutes?”
“I don’t watch much TV.”
“His older brother Ramon got sent up for murder. Hector took over the streets for him, but he had a different approach. He had his boys doing community service projects, food banks, helping old ladies with their groceries, organizing athletic events for the kids. They are not a gang, but a social club, committed to cleaning up the neighborhood, teaching pride to young people. He had people fooled. He is charismatic. He was always on TV giving sound bites. For a while things did seem better. The shootings were down. He engineered a truce in their main rivals.
“The drug trade, while still going on, was off the street corner, making it harder for the cops to pin it on them. Then Hector’s brother Jaime got shot on the corner of Park and Lawrence. A drive-by—he got hit fourteen times. We expected hell. The city flooded the streets with cops. The governor sent in state troopers. But there’s Hector out in the street, preaching peace. They held a candlelight vigil. He got written up in Time magazine, profiled on Sixty Minutes. The next thing you know Hector is going to win the Nobel Prize the way they’re talking about him.
“Then one night we’re sitting down at Capitol and Broad and we hear the pop pop pop sound of gunfire. ‘Four sixty-three, shooting, Park and Lawrence, multiple victims.’ ‘Four fifty-one, shooting, Hudson Street.’ ‘Four seventy-two, Main and Capen.’
“Five fatalities, another ten wounded. One guy is thrown dead on the steps of fifty Jennings Road—the PD station. The trigger finger of his right hand is cut off. They found it in his rectum. The cops couldn’t pin any of it on Hector. Every time they got close to getting the story, somebody else got shot. They finally got him on a drug possession. I think they planted a joint on him. He claims he is a political prisoner.”
“And you and he were friends?”
“No, we just went to school together. Started out he was going to be the one in his family that did well in school and went to college. One day when we were thirteen, some dudes had come down Hamilton and were spray-painting their graffiti in our neighborhood. When they were spotted, they jumped back in their Camaro and took off. Hector’s little sister Maria was in the street. They slammed into her. Killed her instantly. The same thing as happened later; the cops knew there would be trouble so they locked down the neighborhood. They arrested his brothers just to get them off the street. Two nights later, the driver was found tied to the rear of a stolen car that was smashed driverless into a rival clubhouse, his corpse was dragged over a hundred yards. After that Hector was in the gang.”
“And you never joined?”
“My grandmother wouldn’t let me, and I was more afraid of her than anyone in the street. She even told Papi Ruiz she would come after him if I ever ran with his son. They knew each other well because he had been friends with my father.”
He was quiet for a moment, then nodding toward the senator, said, “This is a poor neighborhood,” he said, “but it is not about welfare and food stamps, it is about what you hold inside, how you see yourself. It is about pride.”
We watched as the senator and his staff got into a black Lincoln that pulled up for them, and they were off, gone from the world of Park Street. Helen Atreus and Perry Santiago got into a white convertible and drove slowly back east on Park Street. Santiago had his arm around her like a high school boy around his Saturday night date.
Papi Ruiz lit another cigarette.
“I want to show you something,” Victor said. “Take a left on Zion.” He directed me around the corner and pointed to a billboard, overgrown with vines. “Check that out.”
There was a picture of the senator, standing in front of the Capitol. “Joe Lamb for Senate, Leadership for Connecticut.” The paint had faded and peeled. Someone had graffitied “Lolpop” on it. “You know what that means? Lollypop. It’s a dis. Gangs spray it over other gang’s graffiti. That’s been there for years. Nobody has told him. That’s how much the big politicians know this community. He has no eyes on this street.”
Our radio cackled, “Four eighty-three, Respond to Park and Spring, man shot in the leg. On a one.”
“Summer in the city,” Victor said.
I hit the red lights on.
Chapter 11
Victor lacked Troy’s brilliance, but he did his best for each patient in his workmanlike manner. While at times he could be rash and hotheaded in his emotions, in his work he was thorough and bullheaded when he had to be. He didn’t take shortcuts. A minor motor vehicle with a case of “oh, my lawyer hurts,” another medic might take the patient’s blood pressure by “The Seer” method. Without laying hands on the patient, the medic would study the patient a moment, and then write down on the run form, “Blood pressure 120/80, pulse 80, respirations 18.” Victor took everyone’s blood pressure. He listened to their lung sounds. He gave them all a full physical assessment. You were old or sick and you lived on the second floor, Victor insisted you were carried down the stairs in a stair chair. No buts. Victor used a Kendrick extrication device on most of his motor vehicle patients. The device was strapped on them while they still sat in the car. It was like a suit that completely immobilized their neck and back. If you were going to immobilize them, do it right. If they were standing when he arrived, he did standing long-board takedowns. People made fun of his by-the-book method, but they respected him nonetheless. He wasn’t doing it because he necessarily thought they were hurt. He was doing it because that’s the way he practiced his medicine. His routine, his rigidity of method gave him strength. You couldn’t argue with that.
“When my grandmother was still alive, she had congestive heart failure,” he told me. “Her legs would get very swollen with edema. It was very painful for her to walk. She was a heavy woman. She liked to eat and cook. She believed food was love. She never let us go hungry when we came to visit, and when she moved in with us, she would sit in the kitchen and help my mother and sister cook or just talk with them while they did because she could not stand for long periods of time. One day the visiting nurse came and told her she needed to go to the emergency room. Her feet and legs were swollen. The ambulance came, and I will never forget the paramedic and his partner—they made her walk. They said she was too heavy for their chair, and if she was able to stand, they would help her down the stairs. She was big, but she wasn’t too big for their chair. They just were lazy.
“She made it. But she cried all the way. They were very impatient with her, saying ‘Vamos, vamos, senora,’ when she paused to rest. You can be sure if she was a rich white lady living in West Hartford, they would have carried her because there they would have gotten a complaint if they didn’t. Here with the poor Spanish lady, whose eyes were there to see?
“My job is to help the patient, no matter what. Who am I not to take them seriously if they say they are hurt or sick?”
Victor seemed to always get into altercations with staff at the nursing homes and the triage nurses at the hospital. He was one of the few paramedics I’d seen who dared confront physicians if he felt the patient wasn’t getting the attention they needed. Most people who knew him accepted that as who he was
and let it slide if he grated on them. He had the ability to cuss and swear at someone, and then the next time he saw them to smile and ask how their wife and kids were as if there had never been any problem between them.
One afternoon we got called priority one for a thirty-three-year-old man with chest pain at the Bellevue Square public housing complex. My reaction was it was going to be another bullshit call—maybe a guy whose chest hurt because he’s coughing up yellow phlegm.
We found the man sitting in his apartment watching a big-screen TV movie Dead Presidents. You could smell marijuana coming from another room. The man wore a Michael Jordan basketball jersey and had a beeper on his belt. He rubbed his chest with his muscled arms and said, “I just got this pain here.”
Victor had me check his pressure and pulse while he questioned the man. I reported his pressure was good, 130/80, pulse 76, respirations 20, lungs clear. The man told Victor the pain had come on while at rest. He hadn’t felt short of breath. Yes, it hurt more if he moved. No, he hadn’t had a cold or been coughing up anything. No, he hadn’t done any heavy weightlifting—nothing out of the ordinary. I had him pegged as a candidate for the waiting room.
“What exactly does the pain feel like?” Victor asked.
“It feels like someone is sitting on my chest.”
We exchanged glances. That wasn’t a good thing to say. Still, the man was only thirty-three and looked perfectly healthy.
At the time we just carried the Lifepak 10, which was a three-lead monitor that was good for getting a heart rhythm, but not for the more comprehensive twelve-lead electrocardiograph of the heart done by the most sophisticated machines at the hospital. I attached the leads on the right and left arm, and left leg, and ran a strip showing each of the three leads views of the heart, which I then handed to Victor.
He nodded. From the rudimentary EKG, it looked perfectly normal.
“Let’s do the modified chest leads,” Victor said.
It was a trick he had learned from his reading, one that only a few other medics, including Troy, had picked up on. By moving the red left leg lead and placing in the same positions on the chest that standard chest leads were placed when doing a twelve-lead, and then viewing those leads in Lead III on the monitor, you could closely replicate a twelve-lead ECG. The point of this was it gave the paramedic a view of the anterior side of the heart, which was not seen by the basic three-lead, which saw the inferior and part of the lateral side.
As I moved the lead to the fourth position, I saw an anomaly. There was what we call a huge ST elevation, a tombstone pattern—indicative of a massive heart attack.
Victor rechecked my placement, and then ran the third and fifth leads himself. “Get the stair chair,” he said.
“I can walk,” the man said, but Victor, who’d already given him aspirin and put an IV in his arm, would not allow it.
We humped his two hundred twenty pounds down four flights of concrete stairs, and out to the ambulance where Victor ordered me to drive on a one.
He patched to the hospital requesting medic control—to speak with a physician—instead of just telling the triage nurse what we were coming in with. You requested a physician for consultation or for orders to give certain drugs, such as morphine, for which we did not have standing orders.
“I have a thirty-three-year-old, no previous medical history, experiencing substernal chest pressure. Five on a one-to-ten scale. He says he feels like someone is sitting on his chest. It came on at rest, increases slightly on movement. He’s alert and oriented, skin warm and dry, lungs clear. Vitals one thirty over eighty, pulse seventy-six, respirations eighteen. Sating at one hundred percent. I do have him on a cannula, have given aspirin, and two nitro, but with no relief. My major concern is his modified nine-lead shows massive ST-elevation across the anterior leads. Looks like a cath lab candidate to me. I’m six minutes out. I’d like permission to get him started with two mgs of morphine IV, followed by another two in five minutes if his pain persists and his pressure holds. Any questions?”
“How old did you say he was?”
“Thirty-three. That’s three-three.”
“Thirty-three. Yeah, hold off on the morphine and hold the nitro as well.”
“Could you repeat please?”
There was no response.
“Four sixty-one, please repeat.”
A nurse came on. “The doctor says hold off on the drugs till we can evaluate the patient.”
“Hold off. He’s got massive ST elevation. Tombstone! He’s having an MI. He’s infracting! Hello? Hello?”
He slammed the phone down.
When we reached the triage desk, there was no one there. “Screw it,” Victor said, “They must be in the cardiac room.”
We started in that direction, but just then the triage nurse came out of another room. “Hold it. I need to triage you.”
“This is the C-MED call.”
“What’s your patient’s name?”
Victor showed her the strip. “Mr. I’m Having an MI Right Now,” he said. “Mr. Get Me to the Cath Lab on Time.”
She looked at the strip. “What lead is that?”
“McL-four. It’s a modified chest lead comparable to V-four. Can we go to the cardiac room?”
“Hold on.” She spoke into the mike. “Dr. Bertell to triage.”
The doctor, whom I did not recognize, was in his early thirties, a neatly groomed, bow-tied young man, who was new at the hospital.
He looked at the patient and you could tell he wasn’t impressed.
Victor handed him the strip.
“Its likely early repolarization,” the doctor said. “It’s common in young African-American males. Look at your patient. Does he look like he’s having an MI?” He said to the patient. “You lift weights?”
The patient nodded. “But this doesn’t feel like that kind of pain.”
“Thirty-three, healthy-looking, good vitals, early repol. Don’t rely on your monitor.”
He started away.
“Come back here and look at this,” Victor said. “Do your own twelve-lead, but this man needs attention.”
The doctor turned around and put his finger right in Victor face. “Listen. There are lots of sick patients here who need my attention. The triage nurse will assign you a room. Now here’s some advice for you. Go spark out at some other hospital. Not this one.”
“Spark out? What are you, an idiot?” He turned to the triage nurse who was standing on the sidelines with me. “Get Dr. Patrick Braun. Get this guy a twelve-lead and get him to the cath lab before young Dr. Kildare here gets his state license revoked for malpractice.”
I tried to step in between Victor and the doctor, but they were shouting at each other so loudly now, the nurse had to call for security.
“Oh, my god,” the nurse said.
Our patient was seizing, his head turning purple.
“Victor,” I said.
Victor broke free from the grasp of the security guard. I could see the squiggly lines on the monitor. Our patient was in ventricular fibrillation.
Victor pulled the paddles off the monitor, and pressed them against the man’s chest. “Clear!”
He zapped the man, who sat up quickly grabbing at his chest. “What the fuck.”
“Dr. Braun,” Victor said, recognizing the head ED doctor, who’d been drawn by the attention. “He just went into v-fib. He’s back in a sinus but he’s still got massive ST elevation.”
“You have access?”
“Two lines.”
“Let’s get him some lidocaine and get him up to the cath lab now.”
He grabbed the stretcher and started pulling it. The other doctor stood there like he’d been hit by a stun gun.
“Was I out of line?” Victor asked me in the EMS room, as he wrote the call up. “The guy almost killed my patient.”
“You’re not out of line, but you might want to think twice before going at a doctor that way. We all screw up, but they know a hell of a lot
more than we do. You don’t want them to become your enemy because they can make your life miserable. Right or wrong. Shit runs downhill. They have the juice. We don’t.”
“He can’t take criticism, fuck him, just don’t kill my patient.” He stalked off.
I worried about Victor’s temperament. His quick fuse was going to lead him to trouble. He might forget an incident as soon as he calmed down, but other people wouldn’t, people who didn’t know him. To them he probably seemed like a macho hothead, when in truth he was a thoughtful and considerate guy.
I kept waiting for the call to come to report to a supervisor, but even after we’d turned in our run envelope at the end of the day, no one said a thing. The next day I was at the hospital when a nurse called me. “Hey, you remember that guy from yesterday who coded in the ED? They took him upstairs and cathed him. He had a hundred percent blockage of the LAD—the widowmaker. The angioplasty went great and he’s doing fine. Tell Victor that was a great pickup. You guys saved his life.”
Chapter 12
I came into work to find the crews in an uproar. Instead of checking out their ambulances, they were clustered in the office.
“The paper is screwing us again,” Andrew Melnick said.
Victor handed me a copy of the newspaper. There it was on the front page—“Ambulances Fail To Meet Response Standard.”
“There’s more inside,” he said.
I opened the paper up. The stories covered two full pages along with photos and sidebars. “Councilman Questions Response Times,” “Dial 911 and Pray,” and “Not 1st Time Capitol Investigated.” On the editorial page was another “Overhaul EMS System.”
“This is BS,” Victor said. “I’d like to see them do our job.”
Melnick read aloud, “When Rosalind Fuentes came home to find her mother passed out on the kitchen floor, she dialed nine-one-one. She had little idea that it would take fifteen minutes for an ambulance to arrive. She blames Capitol Ambulance for her mother’s death. ‘If they had gotten there quickly, she might be alive today,’ a grieving Fuentes said in the Vine Street apartment she has shared with her infirm mother for the last eighteen years.”
Mortal Men Page 6