The rottweiler turned onto 137th Street, and turned again into the medic parking lot. LaFontaine ran up and shut the gate, and that was that. The dog was trapped inside.You could see LaFontaine at the gate, this big pale white guy with reddish blond hair and a crew cut, standing on squalid 137th Street, looking pleased with himself.
“You guys need me to solve any other problems, just let me know,” he called out.
The crowd of kids and teenagers ran up to the fence and started banging on it, shouting at the dog, throwing empty bottles at it, while Verdis knelt to the kid with the bleeding arm and took four-by-fours and stretch gauze from the tech bag he always carried around with him. He bandaged the wound. The dog dodged the empty bottles, barked, and ran back and forth among the cars, trying to find a way out. There was no way out. He was trapped. A teenage kid, maybe sixteen years old, took out a small pistol from a backpack and aimed carefully.
“He bites my friend, I whack him. That’s it,” the kid said.
Rutkovsky called for a rush on PD. LaFontaine motioned dismissively.
“Forget the cops, Rut. Dog bites him, they shoot the dog. Tit for tat. Long as he doesn’t hit my car, that’s justice.”
“That’s trouble,” Verdis said, looking at the crowd.
We could hear sirens in the distance, but the guy with the pistol was already aiming. Rutkovsky held his radio to his ear, listening intently. I hesitated a moment, then ran for the ambulance. I got something from my backpack, then ran back to the gate and opened it. As soon as the gate was open the dog wheeled, took a few quick steps, barked and growled and barked again.
“Aw, man ...look’t this Einstein,” the guy with the gun said.
“What the fuck’re you doin?” LaFontaine yelled. “Shut the fucking gate!”
“Gimme a minute,” I said.
Verdis looked up while holding the kid’s arm.
“Take it easy, Cross.”
“He’s got no brains, and soon he’ll have no balls,” LaFontaine shouted.
Everyone in the crowd laughed, except Rutkovsky, who watched silently. I took a step in, still holding the gate.
“Hey pup,” I said.
“If that’s a pup I’d hate to see his mother,” I heard someone say.
“Get ready,” LaFontaine said to Verdis. “You’re gonna have another patient.”
He wasn’t joking.
I stepped all the way inside and shut the gate behind me. I fingered what I had in my pocket. I took it out. It was a corned beef sandwich. I took a few steps forward. I tore a section off. I tossed the meat on the ground. The rottweiler looked at me. Looked at the meat. I backed up slowly. I tossed a little more meat. The rottweiler sniffed the meat. Snapped it up. I tossed a little more. He ate that, too. I tossed half the sandwich and the dog ate it up. I took its collar. The dog licked my hand. A minute later the cops were pulling up. Some of the crowd slipped away as the sirens wound down. I was walking with the dog, holding the collar. Rutkovsky stepped up and opened the gate for me. I handed the dog over to one of the cops, who put it in the back of a squad car as a muscle-bound guy in a tank top and a black fez ran up. He was holding a choke collar.
“Where’s my dog? Who the fuck’s got my dog?”
A kid with a machete hidden in a sheath inside his shirt stepped up. I could see the handle sticking up behind his head. He said, “Your dog just bit my brother.”
“Where’s my dog?”
“That dog bit my brother. I’m tellin’ you now, I’m gonna get that dog.”
“You hurt my dog, I hurt you,” the guy in the fez said.
Rutkovsky stepped between them.
“Dog’s fine. It bit a kid.”
“You might apologize,” LaFontaine said. “Rather than bein’ an asshole about it.”
The guy in the fez started shouting.
“Where’s my dog? Where the fuck’s my dog?”
Rutkovsky looked like he’d smack the guy, but Verdis jumped up between them. “No one touched the dog, sir. The dog bit a kid. Look! That kid with the bandage. Your dog bit him. Some people wanted to hurt the dog, but he saved him.” He motioned to me. Verdis waited for the guy to thank me. He didn’t. All he said was, “Enough of this bullshit. Where the fuck’s my dog?”
“Talk to the officers,” Verdis said.
The guy in the fez let himself be led away. As soon as he was out of earshot, LaFontaine said, “You see that. You saved that gorilla’s dog. Did he thank you for it? Fuck these people, right?”
“Yeah, fuck ’em all,” I said sarcastically.
Rutkovsky laughed. LaFontaine hesitated, then said, “Gotta love this guy. He lets the patients die, but saves the dog.”
“I gotta start somewhere,” I said.
“I gotta start somewhere,” LaFontaine said slowly, turning it over in his mind. “Shit. I’m starting to like this guy.”
Rutkovsky tapped my shoulder.
“You ready, Cross? They want us in service.”
“Aw, come on,” LaFontaine said. “Call him The Coroner.”
“Come on, Cross,” Rutkovsky said pointedly, and kept walking.
At the ambulance I put the other half of my sandwich in my backpack. For a moment, when the dog lunged forward, I’d been terrified, and the fizzling feeling afterward remained. I fumbled with my pack, hands trembling. Rutkovsky looked away and pretended he didn’t notice.
“People are more compassionate than they let on, and that’s particularly true for paramedics. In New York, where the disparity in wealth is so obvious, where the years of social cutbacks have left rotting shells in the inner cities, you are the front line in what is seen by many as an unjust system. You are the people they’ll see as representatives of that system. You will be blamed for it, blamed for everything that’s gone wrong. The reaction to this constant assault is apparent indifference.”
The tick tick tick of the kitchen timer, merengue music drifting in from the courtyard, the sound of water running in the bathroom and the tap of Clara’s glass bottles of lotion and makeup on the sink, a ragged piece of bloodstained lace from the nightgown of an old lady beaten to death with barbells, the tiny curled hand of a stick baby found starved to death in his crib with Mom standing over him eating a hot dog in a white-bread bun, saying, “Yeah, he been sick a while,” and jumbled numbers and letters and formulas:26) Pbl2[s] was separated and mixed with 15.0 mL of 0.300 M Na2CO3[aq]. A white precipitate of PbCO3[s] formed. All of the Pbl2[s] was converted into PbCO3[s]. Which of the following reactions depicts the formation of the gas?
a. PbCO3[s] + 2 HCl[aq] = PbCl2[aq] + CO2[g] + H2O[l]
b. Na2CO3[aq] + 2 HCl[aq] = 2 NaCl[aq] + CO2[g] + H2O[l]
c. PbCO3[s] + 2 HCl[aq] = PbC2[s] + Cl2[g] + H2O[l]
d. PbCO3[s] + 2 HCl[aq] = PbC2[s] + Cl2[g] + H2O[l]
I put the pen down and leaned back. The weekend, 9:00 AM, in my little studio. I was trying to study, but in my mind I kept seeing jobs from the week—an old lady beaten to death, a dead baby, a diabetic woman with peripheral vascular disease who said a strange smell came from her infected foot. I’d put gloves on and peeled her gray socks off and as I did a few black toes fell out.
I looked out at the dim, gray courtyard with the crisscross of clothing lines and a few potted plants in windows that got maybe an hour of sunlight a day. I turned the dial on the timer back so it seemed I had forty minutes left. A moment later the door opened and Clara stood there in jeans and a Northwestern sweatshirt.
“Mister Diligent,” she said, seeing me with my book open.
“Oh, yeah, definitely.”
“Already studying. Good for you.”
She was obviously pleased. She sat on my lap and put an arm around my neck.
“I have midterms. I’ll be studying at my place all week.”
“I have to work anyway. You know that. I’ll see you next weekend.”
“See you next week,” she said.
She kissed me. She glanced at the test and the number of questi
ons I’d answered and at the timer. I was glad I’d given myself the extra minutes. She stood. I picked up my pencil and leaned over the test like I was really working hard. As soon as she was gone I put the pencil down and leaned back and pushed the test away. I looked out the window at the gray courtyard. When the timer dinged I put the book away without checking the few answers I’d given.
St. Nicholas Avenue just south of 145th Street.
“My apartment. I live here,” Rutkovsky said. “Come on.”
I got out of the ambulance and followed Rutkovsky up a narrow stairway that led to a two-room, wood-floored apartment with a single barred window. The kitchen was separated from the living room by a counter. Through a half-open door I saw a metal cot stolen from the hospital and a black-and-white TV resting on a gray, fold-out chair. In that front room there was a bookshelf with many paperbacks and a few medical textbooks.There was a wooden chair that looked like it had come from the deck of a pool. The apartment was neatly arranged and clean, but also dim, small, and depressing. As we walked in he said, “This place sucks, I know, but I don’t care. My kid gets all my money.”
“You should see my place. At least you have two rooms,” I said, and he was visibly relieved. I realized he thought I’d judge him for his squalid place. I was surprised he cared what I thought.A moment later, as if remembering something, Rutkovsky tossed a Littmann Cardiac on the couch next to me—a 150 dollar stethoscope.
“I had it lying around.You want it or what?”
“I can’t take that.”
“Why not?” he said, pissed off. “You see that dust on it. It’s ten years of dust. I got one. I don’t need another. You’re my partner. We aren’t down at fucking Bellevue. We’re at Station 18. We look out for each other. Take it.”
I reached out tentatively and picked it up. It was a good scope, much better than the one I used. With a one-and-a-half-inch bell you could hear lung sounds through clothing, take a blood pressure without rolling the sleeve up.
“A Littmann Cardiac! Thanks, Rut.”
I put the earpieces in. I tapped the bell. I listened to my own heart. I listened to my breathing. I hung the scope gently around my neck. I started to thank Rutkovsky again, but saw he really didn’t want me to talk about it. He was one of those people who were uncomfortable with gratitude, so I said nothing. A minute later we walked back to the ambulance and he didn’t mention his apartment for the rest of the tour, but after that day we stopped by his place two or three times a week, so he could change his shirt or wash up or get a coffee. I realized it was his normal routine to stop by his apartment during the tour, but it had taken a month for badass Rutkovsky to admit that he lived in a small apartment on St. Nicholas Avenue. Once he did show it to me, and saw that I didn’t judge him for it, we stopped by all the time.
White feathers were stuck to blood on the kid’s chest and around his face and in his hair and in the puddled blood on the pavement. The firemen had cut the kid’s North Face jacket to get it off him and the cut jacket was tossed to the side now, a ragged lump of shredded polyester, down feathers spiraling out and clinging to every surface. I stepped ahead of Rutkovsky and took the lead. I wanted to show him I’d learned something over the last month, that I knew what I was doing. The firemen were already doing CPR when I got there. I threw my equipment down and said, “Board and collar, then let’s get going. Everything else en route.”
“Let’s go, let’s go!” they shouted. “This guy’s not breathing.”
Rutkovsky stood back, unmoved.
“Look at him, Cross. You really gonna work him?”
“Definitely. He just coded,” I said.
Rutkovsky tilted his head and looked away. I could tell he thought it was hopeless, but he wasn’t going to argue about it.
We put the patient on a board, lifted him onto the stretcher. I intubated the guy in the ambulance. I got two lines running. Attached the monitor leads. I was doing CPR as we pulled into the ER. I felt pretty good. A month before I couldn’t have done all that in the short transport time to the hospital. I was getting faster. I was learning.
There were four doctors waiting in the trauma room. We rushed him inside, transferred him to the trauma stretcher, and slipped out as the doctors and nurses converged on the patient. Less than a minute later three of the doctors walked out, one puzzled, and the other two laughing. The fourth doctor, a short guy with a beard and an energetic way of moving, strutted out, looked about briskly, and said, “Who brought him in? Was it you? Come here.” He jerked me back into the trauma room. “Look at him. You really think we can save this kid?”
The patient was off the board now and with his head turned to the side I could see he was missing the back half of his skull. The entrance was through his mouth. There was so much blood I missed it. The bullet had come out at the base of his neck. I could actually peer into his skull and see that about half the brain was missing. I spent the next five minutes listening to a condescending lecture about how busy doctors were, how they couldn’t be wasting their time on unsalvageable patients, and how a patient without a brain could not be resuscitated. When I walked back out I found Rutkovsky leaning against the ambulance. He knew what had happened.
“I got excited,” I said before he could say anything. “I made a mistake.”
As soon as I took the blame he relaxed and seemed relieved.
“You’re a rookie,” he said. “You’re supposed to want to treat everyone. You’re supposed to get excited and make mistakes. Long as you don’t get on your high horse no one gives a fuck.You learned something. We can’t be treating every unsalvageable patient. Don’t let the family or FDNY or the cops or anyone else tell you what to do. Keep your eyes open. Stay calm. And always check the back.”
“Students ask what are the qualities needed to spend ten or twenty years on the ambulance. In my opinion, it’s not so much toughness or grit as a simple desire to do the job. That’s it. The desire to treat patients. Everyone talks about the ability to stand blood and gore, to live through tragedy, but the real quality needed is altruism. That cannot be faked. And though it’s commonly deprecated, genuine altruism is a strength. Without it, the job becomes a relentless tour of the worst parts of life. Without some form of altruism, the job is unbearable.”
LaFontaine was the most abrasive guy at the station. Reddish-blond hair, a mustache, a receding hairline, freckles on his cheeks, he had a thick neck and huge biceps from lifting weights. He swaggered when he walked, all the items on his utility belt clinking. He carried a large flashlight that doubled as a weapon, a telescoping billy club, a multi-utility tool with a clamp, a window punch, two knives, blue gloves held fast by a leather loop with a silver snap, and a taser. On the visor of his ambulance he kept a snapshot of himself holding a fourteen-year-old girl’s head like a bowling ball with his fingers in her nostrils, and in the alley in the background, forty-ouncers set up like bowling pins, as if he were about to roll her head at the bottles. He was proud of this photograph and showed it to me twice in those first months. Maybe it was just to shock me. But I think it was also because he was proud that he was the sort of guy who could hold a fourteen-year-old girl’s head and not get rattled.
After work I’d see LaFontaine in the medic parking lot with Marmol and Lieutenant Rivett, drinking, smoking pot, the doors to LaFontaine’s pickup flapped open and Lynryd Skynyrd or the Allman Brothers or Metallica blasting out into the Harlem night. Other times I’d see him slipping away into an abandoned building where the five-dollar prostitutes hung out. He’d gotten a divorce the year before and I guess he went back there two or three times a week. That gravel parking lot was his hangout, his kingdom. And if anyone complained about the music he turned it up louder.
Like me, LaFontaine worked from four to midnight. There were three medic units on this tour and when someone didn’t show up there was a complicated system of replacement, so the medics on tour three—Rutkovsky, Verdis, LaFontaine, Hatsuru, Marmol, and me—all ended up working wit
h each other.
“Homeless fucks don’t get out’ve the way. They want you to hit em. You don’t believe it, but it’s true. Think they’ll make money off it. Sometimes I’m tempted.”
It was my seventh week and I was working with LaFontaine for the first time.
“You whacked anyone with the ambulance yet?”
“No,” I said. “Have you?”
“Twice,” he said. “Though not on purpose. These skels keep walking in front of me, what’m I supposed to do? Haven’t killed anyone yet, but, hey, three’s a charm.”
LaFontaine drove really close to a guy standing near the crosswalk. “Look at him, stepping off into the street.” He smacked the coffee out of his hands with the side-view mirror, then watched the guy’s indignant reaction, grinning his big, yellow teeth at me. “That’s what you get. Standing in the street. Teach him a lesson.” Then, “Guess what day I’m on?”
“What?”
“Seventeen,” he said. “Seventeen days without anyone thanking me. I keep track. I thought I’d break my streak yesterday. We had this Puerto Rican girl. Asthmatic. Twenty-three years old. Good looking. Had a fucking rack. I give her the point four sub q. She started feeling better. I mean, a minute before she’s not moving air. Now she’s breathing twelve times a minute. Lungs totally clear. I think the least she’s gonna do is thank me. So she leans in. Guess what she says?”
“She wants Verdis’s number.”
“She says, ‘You know, you got really bushy eyebrows.’ Just like that. In her Spanish accent. ‘You know, you got really bushy eyebrows.’ And they expect me to be polite.” LaFontaine pulled to the curb near the subway at 125th Street, rolled his window down, took coins from his backpack, and lofted nickels and pennies at a homeless guy sitting near the subway entrance. The coins clattered over the sidewalk, scattering. The homeless guy didn’t move at first, and then, slowly, began crawling over the dirty concrete, picking at the tiny coins with awkward, sausage-like fingers.
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