A Thousand Naked Strangers (3 page)

When he tells us to open our books to chapter one, the only sound is the soft whoosh of pages turning.

During our first break, I meet a guy named Brian who's been working at a motorcycle repair shop. He's bored and looking for something new, and being an EMT or a firefighter or, frankly,
anything sounds better. Brian chain-smokes, and I crack jokes, and little by little we attract a couple of others until we've assembled what will be our group for the duration of the course. Aside from Brian and me, our gang includes Justin, a former high school baseball star; Randy, a thick, surly redneck bursting at the seams who burns off excess energy by racing on the dirt-track circuit; and Tim, a part-time mailman who doesn't look a day over fourteen.

None of us has a particularly compelling reason to be here other than the vague and difficult-to-describe notion that perhaps, maybe, this will be a cool job. That's probably not what Alan wants to hear, but as I'll learn, it's not uncommon. For all the talk of heroes and sacrifice and selfless service, EMS is just another job. There are, to be sure, people among us who grew up wanting to save lives, but many more enter the profession as capriciously as we did. Disturbing as it may be, the raw truth is that often enough, the people showing up to your medical emergency do so because this was the only respectable job they could get with a GED and a clean driving record.

•  •  •

For the first few weeks, the mood is light, but eventually a disquieting reality takes hold. We'll soon enter the world of EMS and be expected to perform in an environment of intense pressure. Some of us, owing to how the percentages inevitably work out, won't live up to the moment. I'm suddenly no longer the
only
one with doubts. It's clear in our faces, in the looks I get from other students—always accompanied by a nervous laugh—that say,
Yeah, I heard the lecture and memorized the words, but will I remember them later, when I'm with a patient?

Me, I feel less sure of the answer every day.

Three nights a week I drive the forty minutes to class, sit at my little desk, open my book, and listen. The lectures veer wildly from topic to topic, and after a few months I feel no more prepared to handle emergencies than on my first night. The way I calm my nerves is to remind myself that this is a nationally recognized curriculum. If I study and memorize and pass, then when I get hired, I'll be no worse than anyone else fresh out of school. I'll be exactly where I'm supposed to be. It's this thought, this little cocoon of denial, that carries me through the self-doubt.

Then one night the cocoon bursts.

It happens during our first break. We stand, stretch, wander outside, and collect into little groups. My four friends and I are standing in the evening sun just beyond the door when Justin, the former ballplayer, says he has a friend in EMT school across town. They started a week after us, but they're already doing scenarios. Every day. We all freeze. Scenarios are hypothetical emergency situations devised to put to practical use what we've learned in the classroom. Their purpose is to get us accustomed to bringing the knowledge in our heads down to our hands, which is the only place it matters. Because all of an EMT program's students are untrained and inexperienced, scenarios are the key qualifying step.

Alan told us we'd be doing them at some point, but he never said when. I'm not sure we've learned enough practical information to devise scenarios, let alone work our way through them. We've discussed a lot of things in general but almost nothing specifically. There were the two weeks dedicated to anatomy and physiology, but they felt more like a dead sprint than anything else. We learned about kinematics—the study of how force acts on the body—as a means of anticipating the different injuries in
someone who's been hurt in a rollover versus a head-on collision. But what those injuries look like, how to spot them, and what to do about them, we haven't gotten to
any
of it. That's cause for concern.

It's not that Alan is a poor instructor. He's just easily distracted. Tucked away in our corner and whispering, we come to the conclusion that the problem isn't Alan. It's our classmates. The class has formed two cliques, the four of us and everyone else. Those not in our group seem more interested in smoke breaks and war stories than learning, and in our opinion, they're holding us back. Not that our gang is necessarily any smarter. Hell, two days ago Alan pulled Randy aside and told him the only way he'd be allowed to finish the course was if he promised never to work in EMS. But we're behind, and not only are those outside our group unconcerned, their grab-assing is part of the problem.

From that night on, every time the lecture strays from the practical, every time someone derails Alan with stupid questions, every time the class ends without the passing on of real and usable knowledge, the ticking clock that's been present since day one gets louder and louder until it's no longer a clock but a freight train, steel wheels screaming as it barrels down the tracks.

“I have a quick question. If you have a second,” I say to Alan one night.

Alan nods as he tucks his books into his backpack. He's the training officer for a local fire department, and teaching is his second job. The minute class is over, he just wants to go home. I inch to the left a few feet—if he's going to slip out, he'll have to run me over to do it.

“Are we behind?”

Alan hefts his bag, slips the strap over his shoulder, and starts to walk before he realizes I'm blocking his escape.

“On the material, I mean.”

He shakes his head. “Nope.”

Oh.

He tries to get around me. I shift my weight.

“Because we're entering month three, and we haven't done any scenarios yet. Are we supposed to be doing those?”

“We haven't done scenarios?”

“No.”

“Yeah, we did a few right after we talked about ongoing assessments.”

“We haven't learned those.”

“We haven't?”

“No. Only initial assessments.”

Alan leans right, lets his bag rest on the desk. “Shit. And we're entering month two, aren't we?”

“Month
three
.”

“Month three?”

Now I'm alarmed. I feel the rattle and hum of the freight train, its horn drowning out the world.

Alan looks straight at me. “Shit.”

“You already said that.”

He does the math in his head, nods, then lifts the bag back onto his shoulder. “Wednesday,” he says. “Get here early. We have some catching up to do.”

W
ednesday passes in a blur. So do Friday, the following Monday, and every day after that. I take my book everywhere, reading then reciting the telltale signs and symptoms of impending death, matching each to its corresponding course of treatment. The nearly dead are never far. I am strange company in the waiting room.

This level of immersion creates an immediacy that borders on paranoia, on obsession.
Am I actually learning from all these flash cards, do I need to make more, who knew there were so many ways to stop bleeding?
It's all so new, so foreign, so much like that period of childhood—first or second grade, maybe—when you're old enough to know you're alive and one day will die, yet young enough to still believe that a thin vein of magic runs just beneath the surface. Everything crackles with the electric charge of wonder.

We spend half of every class studying the list of life threats EMS is equipped and trained to handle. Seizures, asthma attacks, acute problems associated with congestive heart failure, fast heart rates, slow heart rates, no heart rates, orthopedic trauma, burns, penetrating wounds, low blood pressure, high blood pressure, broken femurs, broken necks, even broken minds. We sit and listen. After an hour we push the tables aside,
break out the expired drugs, and get down to the serious business of saving lives.

•  •  •

“Hey, ma'am,” I say, nervously reciting the script to the mannequin at my feet. “What seems to be the problem today?”

“BAM! You're dead. I just shot you in the head,” Alan crows, curling his fingers into a gun and pulling the trigger. “And your partner? He stepped on a downed power line near the ambulance. He's sizzling. Can you smell it? I can smell it. Who else can smell it?”

Alan is a born taskmaster—imperious, impatient, demanding perfection. And no form of imperfection aggravates him more than scene safety. The safety of you and your partner, he says over and over, is paramount. “A dying patient becomes a dead patient if you're careless, like Mr. Hazzard here. Now,” he yells, “start over. Do it
right
.”

I'm standing in front of the class, hands in my pockets, eyes locked on the mannequin. On a table is a blue jump bag, a huge canvas duffel carrying every piece of equipment an EMT is allowed to use. I'll have to correctly use all of it before I can sit. Alan faces me in a chair, legs crossed. He repeats the dispatch: person down, problem unknown.

My voice always sounds weak and far off when I do these. “First thing,” I say, “is scene safety.”

“Louder,” Alan yells. “The people in back can't hear you. If they can't hear you in a quiet room, how will your partner hear you when the cops start shooting up your scene?”

I take a deep breath, then rattle off all the potential hazards waiting to do us harm—an active fire, speeding cars, collapsing
structures, angry bystanders, angry dogs, even angry patients. I contracted leprosy during my first scenario, so I pantomime putting on gloves. Once Alan is satisfied, I shift my attention to the patient. In reality, the patient is always the same—a naked and discolored mannequin missing his left leg—but for purposes of this class, it could be anyone, man, woman, or child. Sometimes the patient can talk, other times we get information from a bystander. Often the patient is unconscious, occasionally he doesn't speak English.

We ask questions: What's your name? . . . What's the problem? . . . Can you breathe? Alan provides answers: John, I think he's dead,
dónde está la biblioteca
. But it's not enough for us to know what questions to ask and what the answers mean. We must prioritize them by what will kill the patient first. Start with the airway, move to breathing, then worry about circulation. In that order. Even if my patient's guts are tumbling out, I have to make sure he has an open and clear airway and he's adequately breathing before I can worry that he's been disemboweled.

Tonight I quickly move through the early stages of the scenario without finding any problems. So far so good, but this is where it gets tricky. Were this patient actually a patient and not merely a dummy, the problem would probably be obvious. But it
is
a dummy, and I'm standing in front of my class. Alan taps his watch. Tick-tock, tick-tock. I launch into a battery of questions: What have you been doing, are we inside or outside, do I notice anything strange?

Alan sits up. “Where?”

“On, uh, on . . . her skin?”

“Bingo. She's got a rash on her foot, spreading up her leg. In fact, now you notice an EpiPen on the table.”

“Is she allergic to anything?”

“Yes!” Alan yells, ecstatic. “She is. But before she can say to what, she collapses.”

I quickly recheck that her airway is open, and for not immediately panicking, I'm rewarded with the following: “Outside the window, you see a lawn mower surrounded by a cloud of angry bees.”
Allergic reaction
. I launch into the treatment of anaphylaxis—at least, the portions of the treatment an EMT can provide. The studying, the notecards, they're paying off. For me, at least. Despite my near-perfect assessment and my early and aggressive intervention, the patient dies.

Alan tells me not to worry about it. This is medicine, not TV. Sometimes mannequins die.

I
t doesn't even occur to us that we haven't placed our partially trained hands on an actual human until Alan walks in and tapes three pieces of paper to the chalkboard. “Sign-up sheets,” he says. “Time for your ride-alongs.”

We're five months in at this point, three months until we finish the course. After the course, we'll take the National Registry exam. Passing it allows a person to work as an EMT anywhere in America. But before we get to all that, we have to do our ride-alongs. A ride-along is exactly what it sounds like: a daylong apprenticeship in the back of an ambulance, shadowing medics and EMTs. Someone asks what service we'll be riding with.

You can hear a pin drop when Alan says Grady.

Grady Memorial Hospital looms large in Atlanta's consciousness. To many, it's a place of horror stories and ghost stories, of lawless halls teeming with the poor, the crazy, and the critically ill. My first close view of it comes in the dark of a June morning as I await the start of a four
A.M.
ride-along. The giant lighted cross atop the hospital glows red in the dark sky, and steam from a pair of smokestacks slowly rolls out like a blanket of fog. There is a large moon in the otherwise empty sky. Somewhere in the distance, a lonely siren wails.

I'm here early, and there's nothing to do but wait. I pace, I overthink, I worry—about what I'll see, what I'll be asked to do, how I'll respond. I wonder what these guys will think of me. Grady EMS is the 911 provider for the city of Atlanta. The phones ring off the hook, and Grady medics are busy to the point of exhaustion. They're broken in, tested, and competent. They're the standard by which all medics around Atlanta are measured. They prowl the city's worst streets, wander housing projects at night, and frequent jails and crack motels. Years of working in these conditions have taught them to sniff out the signs of illicit drug use and recognize when a situation is about to go wrong, almost instinctively. Grady medics are experts in treating their patients, calming their patients, and occasionally fighting their patients. They're cocky and untucked and stand in stark contrast to their spit-polished but rusty counterparts in the fire department.