“Don’t say I never gave you anything,” LaFontaine yelled out the window. Then, to me, “That guy’s just too pathetic. Every day I gotta toss something.”
LaFontaine sounded the siren as he rolled into the intersection, making cars slam on their brakes. There was no reason for it. He just did it for fun. He pulled to the side near Morningside Park and showed me his utility belt, which he was proud of. He showed me a handgun in his backpack. It was loaded.
“Gotta be prepared. This ain’t Disneyland.This is New York City!”
He went on and told me about homeless guys he’d beaten up, drug addicts he’d mistreated on purpose. He called it punitive medicine, and said it was necessary to reduce abuse of the 911 system.
“If you don’t do it, they just keep calling over and over. Clogging up the system.Anyway, the job sucks so much. Gotta have some fun.”
I didn’t know how much of this to believe. I’d seen patients in the ER that LaFontaine had saved. He diagnosed quickly and accurately and was really fast at starting IVs. I thought most of what he said was meant to shock me. I was the college boy who walked around with an MCAT book. I was The Coroner. I just nodded and smiled and made sure not to act indignant or surprised.
Later that afternoon, as we walked down the concrete ramp of the subway toward our patient, who was sprawled out next to a bench with a bottle next to him, LaFontaine ran up and motioned as if he’d kick the guy in the head with his big, black boots.
“No!” I shouted, and LaFontaine turned, laughing.
“Shit.You are so fucking green. I knew that’d get you,” he said.
The cluttered apartment of a pack rat—magazines and newspapers stacked everywhere, cardboard boxes with old clothing, paper clippings, cans of food. And on the bed, a pudgy, pale-skinned guy, sitting forward, fist to his chest.
“I fell asleep watching the television. I woke up. I don’t feel that good.”
“Ah, you look all right to us,” Marmol joked.
Rutkovsky ignored Marmol and started questioning the pack rat. “In what way don’t you feel good? Can you describe it?”
“I feel sick.”
“First, we’ll give you some oxygen,” Rutkovsky said, and slipped a mask over the guy’s face. I was attaching the stickers for the cardiac monitor. I watched the green light bouncing across the three second screen of the monitor. I pressed record to make a strip.
“Sinus rhythm. A few PVCs. Multifocal,” I said.
Marmol stepped from the bathroom, shaking medication bottles.
“Six months old. Bottles are all still full.”
“I don’t feel that good,” the pack rat said.
“Right. You don’t feel good. Can you describe the feeling?” Rutkovsky asked.
“Just ... not that good,” he said.
I was running my fingers over the back of the pack rat’s hand, looking for a vein.
“Open your mouth. Put this under your tongue,” I heard Rutkovsky say. Then, “You see this guy’s meds, Cross? He’s a diabetic. He’ll have no veins. Try the brachial.” Then, to Marmol, “What is he on?”
“What isn’t he on? Procardia. Pravachol. Dilantin. Ambien. Not that he was taking anything. The bottles are all full.”
The guy’s arm twitched. I looked up to see his eyes roll back a little, come down, then roll up again. “Oh, God,” he said, and fell back on the bed. He wasn’t moving.
“Rut,” I said.
Rutkovsky was reading a discharge sheet with a medical history. Verdis had been taking a blood pressure. He reached over and felt the guy’s neck.
“I think this guy just coded,” Verdis said.
Rutkovsky looked up, saw the guy lying there on the bed, flung the discharge sheet to the side, and started looking for a clear place to lie him flat. There wasn’t a space in the whole apartment.
“Couldn’t he have cleaned up before he died?” Marmol said.
“We’re gonna have to work him here,” Rutkovsky said.
Rutkovsky kicked papers out of the way. He pushed the bed against the wall. We heaved the guy onto the floor.
“Start compressions,” Rutkovsky said to me.
I cut the patient’s shirt off and did five compressions on his bare chest. My ungloved hands were right on his sternum. His skin was still warm and slick from sweat.
Marmol put an oral airway in the guy’s mouth and breathed with the BVM.The high-pitched whine as the paddles charged up. Rutkovsky took the paddles and spread the gel by rubbing them together.
“Everybody clear,” Rutkovsky said.
We all sat back so no part of our body was touching the patient. It was really tight in there: stacked boxes and old clothing and piled newspapers and magazines everywhere.We all sort of jostled against each other to get away. Rutkovsky put the paddles to the guy’s chest and pressed the button. The defibrillator clicked and the guy’s arms and legs jerked up with the shock. The green light on the monitor spiked up, then came back into the screen. It went flat.
“Asystole,” Rutkovsky said.
I started CPR again, putting my hands on the guy’s chest. Marmol intubated.Verdis got a line and gave meds. The guy just lay there, eyes open, blank, unseeing. I’d been talking to him a minute before. Now he was just this inert lump of flesh. He was dead. I went on with CPR. I pretended I wasn’t surprised to be doing CPR on him. I pretended it was an ordinary occurrence to have someone die in front of me.
Drawn-out deliveries are speeded by encouraging the mother to help, with drugs, and sometimes, a doctor gets above the mother, finds the top of the uterus, and with two hands, gives a single prolonged push.
Eighties music and someone shouting about fucking Giuliani and the clatter of glasses. We’d been at the Blue and Gold and the Holiday and now it was late and we were at the Cedar Tavern, crammed into a booth with med students and their girlfriends and boyfriends. It was just after Clara’s midterms, we’d been drinking all night, and I sat across from a classmate of Clara’s named Julian—a pale-skinned, long-faced guy with a cleft chin and a really deep voice. He’d been hanging around Clara all night, touching her arm when he talked to her, going out of his way to be really nice to me, acting like we were friends, and now it was late and I was leaning over the table, saying, “I’d have given Dopamine, but Rutkovsky, my partner, he pinched her skin. It tented. She was dehydrated. He said we should try a fluid bolus.”
“You don’t give fluid to someone with pulmonary edema,” Julian said. “I mean, that’s obvious, right?”
“It’s under the discriminatory cardiogenic shock treatments,” I said. “And the fluid was only at the bases of her lungs.”
“It’s risky,” Julian said.
“She was dehydrated, and the CHF was exacerbated by lack of volume. And it worked,” I added.
“It’s not recommended, though, right?” he said.
“It is recommended,” I said. “It’s in the fucking discriminatory options. And it worked. That’s what I’m telling you. It worked. How can you argue against it?”
“I didn’t know I was arguing,” Julian said, and Clara said, “You weren’t. Ollie’s freaking out,” and she gave me a look. A moment later I got up and went to the bathroom. I spent a minute inside looking at my bleary eyes, my flushed face, thinking of my sudden, sharp tone—It’s in the fucking discriminatory options—surprised at myself. I hardly ever argued, and definitely not with Clara’s friends.
As I came back into the main room I saw Clara at the bar. I sat next to her and sort of slumped and gave her a look that said I’m sorry, and she said, “You getting a chip on your shoulder?”
“Yeah, a big one,” I said. She looked at me. I said, “That fucking guy’s acting like he knows something about it. He’s a student. He’s probably never treated a real patient before. And he’s saying, ‘It’s risky.’ I mean, Rutkovsky’s been doing this shit for eighteen years. And it worked. I mean, what the fuck?”
Clara gave me a bored look.
“Chip,�
� she said.
I laughed. But only after a moment.
Rutkovsky leaned against the doorway of the station, smoking, and as I walked up he inhaled and looked away and said, “Chief wants to see you.”
“For what?”
“I don’t know. Ask the chief.”
Chief Burroughs had his own office on the second floor, separate from the rest of the station. The chief was a physician’s assistant, a lawyer, and had a doctorate in psychology. He taught nights at La Guardia College, worked as a medic on weekends for Bed-Stuy Volunteers, and lectured at the EMS academy. On the last day at the academy, the day before the graduation ceremony, the chief gave the famous graduation speech that encapsulated everything he’d learned about being a medic. A videotape of the speech was given to all of the medics before we were sent out on the street and we were encouraged to review it during our first year, which was considered to be the critical year in the development of a paramedic. The speech began: “This is Camellia. Camellia, say hello. How old are you, Camellia?”
The chief had been offered a central command many times, but refused the promotion in order to stay in Harlem, which was definitely not a career move. Station 18 was the biggest, the busiest, and the most unruly and intractable station in the system.
“I hear you’re going to medical school,” the chief said as I walked in. He was an enormous guy, like a sumo wrestler, with a calm, round, implacable face, and dreadlocks tied back in a ponytail. He had his collar buttoned with a tie and about ten bars over his badge—all the awards and decorations of twenty-eight years of service. He sat very still, but his eyes followed me as I sat down. “I’ve seen your MCAT book.”
“I want to go to medical school,” I said. “My girlfriend’s in at Weill. I didn’t get in on the first round or the second. I was told to raise my scores and get some experience and then reapply.”
“So, you came here?”
“I came here,” I said.
A pause, and then dryly, “Well, you’ll get your experience here, and if you go on to medical school what you’ve learned here will help you as a doctor.”
“That’s what I’m hoping. And I’m hoping to do good things as a medic. I wanted to come to Harlem,” I added. “I requested it.”
He hardly nodded. He wasn’t impressed.
“Just do your job while you’re up here,” he said. “Stay in service. And show up to work. That’s all we ask.” He tapped a radio that played softly on the Manhattan North frequency. “I heard that arrest the other day. MI to asystole.”
I hesitated, remembering the job with the pack rat. I said, “We were doing the initial assessment and he coded right in front of us. Inferior-wall MI. Did we do something wrong? Is that why I’m here?”
He didn’t answer right away, but just looked at me steadily. Then said, “As far as I could see you treated appropriately. Patients die. It’s not always someone’s fault.” A moment of silence. Then, “How is it out there with Mr. Rutkovsky?”
“He’s a good partner.”
Burroughs nodded.
“And a great medic. But he’s been out there a long time. It’s a tough job. No one can do it forever.” There was a long pause. I said nothing. “If you have any problems with him, come to me. You understand why I say this?”
“Cause medics burn out. And people’s lives are in our hands.”
“That’s right. We all have to be careful. We have to watch out for each other.”
“Well, I’ll keep it in mind,” I said.
Something a little jaunty in the way I said this, as if I were really saying, No fucking way am I coming to you with some problem with my partner. The chief didn’t say anything back. He just sat there for a long moment looking at me. Studying me, really. He rolled his head from one side to the other. He kept looking. Thirty seconds passed. It was unnerving. I had no idea what to make of it. Finally, after what seemed like three hours, the chief said, “I’m not picking on you, Cross. I call everyone up here at some point or other. I let them know they can always come to me for help. I let them know my door’s always open.”
“Thanks, Chief. I’ll remember that.”
“I’d rather you come to me than me come to you. OK?”
“OK,” I said.
“Good. Now get into service.”
I let myself out and shut the door and stood outside in the hallway for a moment, wondering why he’d called me up, wondering what that long look was about, that uncomfortable silence. The whole thing was bizarre.
A minute later I found Rutkovsky waiting outside the station. He didn’t ask me what had happened, but he knew. I later found that the chief gave that once-over to all the new medics. The chief had a doctorate in psychology. He wrote academic papers that he delivered at EMS conferences. The meeting was an examination. The chief remembered me from the academy as an upbeat, eager, college graduate. I’d been on the street for two months at that point. He was checking me for signs of psychological deterioration.
“You train for disasters. For car wrecks. For dismemberments. For maimings. For burns. It’s natural to want to test these skills. But there’s a difference between wanting to use your skills and looking forward to death and disaster. The one is the natural, benevolent response of a caregiver, and the other is a perversion of this response. Eagerness and thrill seeking in others’ misery is psychologically corrosive, and is also rampant in the EMS world. It’s a natural danger of the job. It will be something to keep under control, something to fight against.”
Reggie Verdis was by far the nicest guy at the station, and one of the nicest guys I’ve ever met. He was always saying to come to him if you had any questions or needed advice or any help at all. “Good to see you, Brother, good to see you,” was the way he greeted everyone. He lived in West Harlem off Convent Avenue, had a wife and three kids, sang in the choir at a church on his street, and was always thinking of ways to make the station as tolerable as possible. He built shelves so each of us had a mailbox. He swept up when he wasn’t on a job. He brought in videotapes and left them at the station for everyone to watch. He tended a garden behind the station that he blocked off with a makeshift fence constructed from stakes and broken longboards. In between calls Verdis would be on his knees working the soil with his bare hands. Every minute of the day he was either on the ambulance or helping a homeless person or doing some other good deed. It was sort of annoying, even to me, and maddening to everyone else. They said his excessive altruism was a mental derangement. They said no normal person could care that much. They said it was unnatural and he’d show up some day with a machine gun. But despite all this, he was well liked, even admired, at the station. He was a great medic. There was no denying that. He was always reading medical textbooks. He was always thinking of ways he could help his patients. And it was genuine. You could tell. He really believed in what we did. There was an ongoing argument about who was the best medic at the station—Reggie Verdis or Gene Rutkovsky. Verdis was much more of an overt altruist, obviously, but Rutkovsky’s supporters did not see this as an asset. They said that you didn’t want a paramedic to be a handholder, that altruism got in the way of treatment. They said that caring too much made Verdis soft.
A few days after the chief called me up to his office Rutkovsky and I came across a motorcycle lying on its side in the middle of 127th Street. The driver, a twenty-year-old Jamaican kid, was a full block away on 126th Street. The kid had wiped out on the exit ramp of the Henry Hudson Parkway going an estimated seventy miles an hour. He’d lost control of the bike and had skidded and tumbled for a whole block. We found him lying on his back in the middle of the intersection, legs all twisted and at funny angles, his belly bloating, mouth opening and closing slowly, but his chest not moving at all. Rutkovsky and I boarded the kid, put the collar on, intubated, and loaded him into the ambulance just as Verdis and Hatsuru arrived. Hatsuru started breathing for the guy. Rutkovsky went to one arm, Verdis to the other. The two glanced up at each other and we all kn
ew what was going on. It was a race. Each needed to connect the IV bag with an insertion set, run the line, and stick the guy with a needle.Verdis took a fourteen-gauge angiocath and knelt on the bag to run it through. Rutkovsky didn’t bother to wait to run the line, but put a band around the arm to make the veins stick up, then ran the bag by holding it high with one hand and starting the IV with the other. He actually did the two things at once. He was done a full thirty seconds before Verdis, who was the sort of guy who was relieved when he lost, and said, “Beautiful, Rut. Great line. Better than I could do. And with your left hand!” Verdis was more enthusiastic than if he’d done the thing himself, and he talked about it more than he would have if he’d won. He made sure everyone knew about it, and the story went all around the station: “Rutkovsky ran a line with one hand while setting the angiocath with the other.” I heard the story told about ten times, in as many different ways. No one ever mentioned that the kid died on the way to the hospital.
“Where’d it say?” Rutkovsky asked.
“In front of,” I said.
We were standing on the stoop of a graffiti-covered brownstone on 147th Street. A trail of bright-red blood led up the steps.
“He must have taken a walk,” Rutkovsky said.
We followed the blood trail up the steps. Blood coated the doorknob and the lobby floor and pooled in the metal divots that lined the edge of the stairs. On the way up, Rutkovsky muttered, “He couldn’t lie down. He just had to run up to the highest possible point, didn’t he?” Between the third and fourth floor we found our patient—a seventeen-year-old Dominican kid with drops of blood on his new leather sneakers. He was sitting on the steps with a hand up on the side of his face, blood seeping between his fingers, soaking into his shirt. He acted as if he was bored.
“What happened?” Rutkovsky asked.
“Whatta you think? I’m shot is what happened.”
“Where?”
He pulled his hand away. An inch in front of his left ear there was a single entrance wound. It looked like a cigarette burn.
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