A Thousand Naked Strangers (9 page)

By now the firefighters have gathered next to us, and they help pull the stretcher out and push it up the driveway and toward the door. All the while, the family's yelling for us to hurry, screaming that she's dead and getting deader, but we can't run. Running is rushing and rushing is careless and the last thing anyone wants in this situation is carelessness.

Then it's through the front door and into the worst moment in a family's life. Death is seldom peaceful. It's loud and frantic, with lots of gurgling and thrashing and bodily fluids, all laid bare by the blinding light of panic. Standing helplessly and watching someone die is a terrifying experience, but when that person is your mother, the whole world spins at a different speed. We move through the house and pass a family in varying
stages of grief—some crying, some screaming, some muttering, arms crossed tightly over their chest, walking in nervous little circles. Somewhere a toilet flushes.

Grandma is still under the table. Chris and a firefighter grab her ankles and yank her out. Suddenly guilty, suddenly caring, one of the two warring parties who started this whole thing yells for us to be careful, that she's his mother and how about we show some respect. This belated concern is the last bit of indignity his sister can handle. She flips out and begins slapping and clawing at him and has to be lifted up and carried outside. Chris grinds his knuckles into Grandma's chest, looking for a reaction, a sign of life, but her open and milky eyes never flicker.

Now for the muumuu. Her clothes have to be removed for us to slap on the paddles, but there's no way to get through such a large and billowing piece of fabric. It's all wound up and tangled like a wet parachute, and we struggle with it for a few seconds before someone cuts a four-inch slit down the center. Chris grabs one side, I grab the other, and we yank. It splits open to below her belly button, just low enough for us to learn that Grandma doesn't wear underwear. Chris flicks on the monitor, grabs the paddles, and places them on her chest—left hand over the breastplate, right along the ribs just below her heart. We all turn to the monitor and see the flowing V-shaped waves of a heart fluttering but not beating. Chris charges up the monitor.

This has a distinct sound, a high-pitched
bing
that mellows into a whine and culminates in a series of beeps—dee-doo-dee-doo-dee-doo, doot-doot—signifying the charge is ready. Chris yells clear. We all hold our hands up, and POP! Her body hops off the floor, back arching, head flopping. The monitor shows
a brief run of the long, flat line that indicates the heart is no longer even quivering. Then, slowly, the V-shaped waves return. Chris increases the energy setting, recharges the monitor, yells clear, and POP. Another jerk. Another flat stretch of nothingness, then the waves return. Again he ups the energy setting. Again he charges the paddles. Again he yells clear and shocks her. Still no change.

A firefighter drops to his knees and begins CPR—a traumatic, almost obscene assault on the body. Two hands over the breastplate, arms locked, an unending string of compressions delivered with the full force of a grown man. The breastplate quickly breaks free from the ribs; the connecting cartilage snaps with each compression and makes a percussive pop like thick ice breaking deep below the surface. Chris reaches into the jump bag and pulls out the airway kit. I shuffle along on my knees and take hold of Grandma's hand. It's time for an IV.

There's never been any proof that drugs actually help patients in cardiac arrest, but still we give them. Call it better dying through pharmaceuticals. There's epinephrine, which hits the heart like a brushfire, a frantic and hysterical scream for it to do something, anything. Behind it, playing the role of good cop, is amiodarone. It eases in gentle as bathwater, a calming voice to whisper that everything will be all right. They simultaneously alert and reassure the heart:
Just follow us and everything will be okay.

I straighten out Grandma's arm but can't find a vein. The thing about someone in arrest is, basically, she's dead. There's no blood flowing, so the veins are flat and hard to find. I wrap a tourniquet around her upper arm, swab the area with alcohol, and, seeing nothing, plunge the needle in. Tissue that isn't
getting blood has the consistency of Play-Doh. The patient is, after all, just an official time of death away from being a cadaver. I keep digging, but before I can find anything, Chris waves me over.

He has the airway kit open and half the tools out—syringes and tubes and tape and blades—in a big jumbled mess around him. He wipes his forehead with the back of his hand and says something isn't right. He's having trouble seeing down into Grandma's airway. Something's in there. I ask if he wants to try the suction, and he nods. “Yeah, let's give it a shot.”

This is one of those moments when the reality of trying to save lives on an ambulance hits home. We don't have fancy battery-powered suction units like the hospitals do. What we have is a piece of hollow plastic—long skinny tip on one end, accordion in the middle, trigger on the handle. If Chris squeezes fast enough and long enough, it may create enough suction. We're skeptical. Chris starts squeezing the trigger, working the accordion in and out—fffii-fffoo fffii-fffoo. He's not getting anything out, but he keeps going—fffiffi-fffoo fffii-fffoo fffii-fffoo. Now the family's watching and whispering—
What the hell is that noise?
Fffiffi-fffoo fffii-fffoo fffii-fffoo.

Chris is in a full-on sweat when it works. He's shocked, I'm shocked. He pulls the suction out, and there, wedged into the hollow tip, is an entire floret of broccoli. The stem is stamped with a single set of teeth marks. “You gotta be shitting me,” Chris whispers. We look from the broccoli to each other and back.

Obstacle clear, he slips the tube down her throat and secures it with tape. It's time to go. There are more shocks to deliver, more CPR to do, meds to give. But really, it's over. Everything we've done in the last twenty minutes has had absolutely no
effect, which generally isn't a very good sign. We snatch the patient and all of our equipment and hustle outside. Two firefighters hop in the back with Chris, extra hands to do compressions and give ventilations as he shocks and pushes drugs.

As we're about to leave, a niece asks if she can come. This is a tough call. An ambulance is a small place, and if she starts flipping out, there's nothing I can do about it short of kicking her out on the highway. But she seems calm, so I open the door for her. She climbs in, buckles her seat belt, and then lets out a tortured wail that continues, at varying volume, until we arrive at the hospital.

Inside we're greeted by a coterie of doctors and nurses. Chris gives a report and the staff checks our interventions. Nothing we've done has helped, and they quickly wind down their efforts. Just as quickly as it began, it's over. Her time of death is 19:23.

Broccoli has claimed another victim.

I head outside to clean and restock the ambulance. I'm sweeping up, lost in thought, when I step on Grandma's dentures. The floor of an ambulance is steel, and the teeth break under my weight with a loud ceramic crack. I walk inside, the broken dentures in two pieces in my hand, and find the niece. She's quiet now, much calmer than she was in the ambulance. I hold my hand out, do my best to look her in the eye, and explain that I broke the teeth. She nods, takes them into her own hands, and thanks me for everything I've done to help. I'm not sure I deserve forgiveness, let alone praise, but I tell her she's more than welcome. I want to cry. I want to hug her. I want to be on an ambulance for the rest of my life.

“D
oes it matter if the patient lives?”

Chris, behind the wheel, takes his eyes off the road. “Damn,” he says. “Damn.”

I feel the subtle tug of the ambulance losing momentum as he takes his foot off the gas. His arms go limp as he lets go of the wheel. We're now coasting down the road, neither of us looking to see where we're going. “Damn,” he says again. I nod, very proud of my question. He thinks about it, comes to no conclusion, and resumes driving.

It's early spring, about five o'clock. Outside, the evening sky is deep purple and soft orange, the way it always is in April in the South. Trees are blooming. Bugs, birds—they're all coming back out. The humidity that will soak everything in a suffocating closeness hasn't arrived. It is, for the moment, perfect. And that's what we're discussing—perfection in the form of a 911 call. It's a frequent topic of conversation for us, something we discuss over breakfast, over dinner, late at night. Sometimes, when we're both asleep, one of us will pop up and throw out a suggestion. What happens if he bleeds on you, pukes on you, if you slip in his growing puddle of piss? And if it really were the Perfect Call, then would you eat there?

We discuss when in the shift it would have to happen and settle on midnight. Then there's the question of what resources we'd need at our disposal, how many patients would be involved, and what type of call—medical or trauma—it would be. We agree that we'd be on our own, no help close enough to be called in, nothing to rely on but ourselves. And it would have to be a trauma call. On Christmas we ran our second cardiac arrest together. It was frantic—a
shit-kicker,
is what people call it—because the woman was only having an asthma attack when we arrived. I was the first one through the door and found her sitting on the couch—sweat-drenched, hands on her knees, eyes bugging out, mouth wide in an attempt to suck in air. She looked at me, desperate, and gasped, “Don't let me die!”

Then she died.

We dragged her to the entryway and started CPR, and shortly after that, the fire department came and helped us get her to the ambulance. We shocked her heart back into activity, but she never regained consciousness, and after a minute or two her heart went south again and never recovered. Because it was all happening in front of us—first talking, then not talking, then not breathing, then heart not beating, then heart beating, then not beating again—it was messy and complicated, and we had to keep changing tactics and drugs and procedures, and it came so, so close.

Somewhere during the shifts between dead and not dead, it struck me that this had almost all the earmarks of the Perfect Call. I looked up to say it only to find Chris looking at me with a lunatic smile and realized he'd had the same thought. This was
so close
. But not quite. It was just her, and there was no carnage.

So it couldn't be a purely medical call. There'd have to be
blood and bones and maybe even charred remains. It couldn't be purely trauma, either. A pure trauma call means there's nothing for us to do but stop the bleeding and hurry to the hospital. It leaves all the fun to the surgeons, and fuck them, anyway. No, it would have to be all-encompassing. There'd have to be a few dead people on the scene for us to gawk at and patients who would rapidly die of their injuries without immediate intervention,
our
intervention.
Multiple mechanism
is a phrase we invent and stick to—maybe a car wreck that starts a fire and pushes someone off a bridge. Or a gunshot that passes through the first guy's head (killing him) and then nicks the next guy's liver before hitting a gas tank and igniting the entire scene in a giant orange blaze, a funeral pyre from which we rescue the wounded. Or don't.

And that's the question. Does the patient have to live for it to be the Perfect Call? Further complicating the issue is whether a good call can be elevated to Perfect Call status if we save the patient. Does saving a life trump all the other elements?

In the end, we decide the answer is no. The patient doesn't have to live for it to be the Perfect Call. And no, getting a save doesn't elevate a good call to a Perfect Call. We reason that we didn't cause the problem—we weren't the ones who sped without a seat belt or overdosed on heroin or came out on the losing end of a murder-suicide, and we sure as hell weren't the ones who dialed 911 and opened the door. We're the ones who show up. And really, the Perfect Call isn't about the patient. It's about us. It's about the experience, and for the patient, the experience is going to suck regardless. So a mundane call in which the patient lives because of our efforts doesn't trump a real shit-kicker even if the patient dies. As long as we get there first, outperform
the expectations, and do it fast and in the most extreme conditions, nothing else matters. Not every patient is going to live, so why should a death bring down the party?

And for us, it is a party. Chris and I have been partners for eight months; we're not just coworkers now but friends. We hang out after work, I attend his daughter's birthday party, meet his family. For twenty-four hours every third day, each of us is all the other has. We have the same sense of humor and complement each other in a Laurel and Hardy kind of way. I'm tall and lean; he's a man of considerable size. He's constantly in search of a bathroom. I can't poop in public. He's incredibly charming. My dry, sarcastic humor leaves people offended. He's rarely left the Southeast; I've been to Asia three times. He's an incredibly competent medic; I'm an eager pupil.

Having decided on the Perfect Call, we actively set out to find it. Management has divided South Fulton County into five zones, each manned by a different ambulance and each with its own flavor. The supervisor's office is in Zone One. For everyone else, showing up at work means being totally on one's own, but the Zone One crews sleep one sheet of drywall away from their boss. Because they can't get away with anything, the crews here either exist as rule followers or get banished. The general rule is “Don't fuck around in Zone One.”

Zone Four is known for being quiet—two-calls-a-shift quiet—and attracts the lazy and the burned out. The coolest zone by far is Five. It includes Fulton Industrial Boulevard, which is nothing but factories, truck stops, strip clubs, and cheap motels. The factories and warehouses provide plenty of trauma, and the truck drivers provide everything else imaginable. If Fulton Industrial is any indication, long-haul trucking
must be a lonely and strange existence. The truckers attract drugs and hookers—cheap, mean, toothless hookers carrying box cutters and strange tropical diseases. The hookers attract more drugs, mostly meth, and that attracts dealers and users and stickup men and drifters.