In Case of Emergency (5 page)

Ruth says there are four steps to effective mapping.

Step one: know where you are. Find your exact location on the map page and point to it with one finger
.

The pool is an unremarkable cement rectangle, and its deep end is a mere eight feet. But the light shining through the clear, still water is a luminescent invitation. I pad barefoot to the edge, toss my towel over a lounge chair, and set the goggles over my eyes, feeling the suction as they seal onto my face.

I close my eyes when I first pierce the water. There’s a familiar rush as my body registers the cold against my skin. The initial contact overwhelms my senses, but then I open my eyes and start to kick. It’s too damn small, this pool. I flip-turn at the shallow end and I’m more than halfway across before my first stroke.

Step two: know where you’re going. Make sure you are looking at the correct map page and grid, and find not just the street of the address but the cross streets as well. When you’ve got the exact block of the destination, place a second finger there.

Already I’m working too hard, wasting motion, forgetful of my limbs’ ability to be efficient. When I get into the water I always want to go as fast as I possibly can. Switching to the breaststroke, I remember how one of my coaches used to remind me that speed isn’t everything. If you get shipwrecked you’ll want to conserve energy—it might be days before you see land.

Step three: figure out your route. Work backward from the second finger to the first, like when you solved mazes as a kid, working from the heart of the labyrinth to the entrance instead of the other way around.

I cut to the surface with a gasp when I realize I don’t remember the fourth step. A two-vehicle incident. A Santa hat. Dad turning on the television, Ryan in his room, working on some project or another. He was always the creative one—the musician, the mechanic, the tinkerer. The car usually wins. And then there was me—I did
nothing
for that dying woman. I would have forgotten all about her if being so useless on my first day hadn’t reminded me. Grabbing the cement lip at the deep end’s edge, I hold on with one hand and look out at the rippling water, dangerously close to crying.

Step one: know where you are.

Step two: know where you’re going.

My legs sway in the current I created. What have I done with my life since graduation? My postcollege years led to ambiguous goals. And to learning things that had nothing to do with what I learned in school. And to Jared. My ex-boyfriend: a lovely, attractive human being right up until he wasn’t. We met at a glassblowing workshop he taught, and he didn’t act like I wouldn’t know how to use tools because I was a girl. I thought he was exotic and artistic, with eyes like flat black stones and a sly smile. He had unusual arm sleeves tattooed in heavy black ink, the lines, curves, and circles molded perfectly to the shape of his muscles and joints. I used to trace the lines after we had sex—but only then, because otherwise he found it ticklish.

We dated for four years, lived together for about two; one night we threw a party at our apartment and I walked in on my friend Elizabeth giving him head in our bathroom. I’d never made a speech before but I made one that night; I turned down the music and clinked a fork against a beer bottle and announced to about thirty of our friends that Elizabeth was a filthy whore; she was giving my boyfriend a blow job in the next room; maybe it was a good time for everyone to leave and thanks so much for coming. I moved out in hysterics that same night, leaving my CDs and potted fern behind, staying with Ryan and Malcolm at their place in Culver City for a while. Ryan tried to take care of me; when I started losing weight he force-fed me fatty foods, ramen and pizza. Later I learned Jared and Elizabeth had been sleeping together for months.

In the EMS world, you could call that particular kind of trauma a double penetrating injury, the mechanism being two knives in the back. The field remedy would be to seal the exit and entrance wounds with occlusive dressings and treat for shock.

I push off for a few more laps.

Soon after Jared and I broke up, I got the news that Mom died. Even after her skiing accident, and after the funeral, I would see the photograph she sent when I was twelve years old, as clear in my head as if it were in my hand, and I would think:
she’s not dead
. There she is, promoting river rafting in Colorado, her mousy brown hair streaked with golden highlights, her bleached teeth beaming.

Step two: there’s your career, your home life, and your social life. Pick one. Or at least that’s what Mom used to say. I guess you could say she chose social life. Dad chose career. Ryan and I were the home life nobody picked.

I get out and towel off, dripping into a puddle at my feet, no save-the-world stance. Which one have I picked? Life experience?

That’s not on the list.

As I make my way back, edges of pink in the sky behind me, I remember.

Step four: after determining the clearest route, choosing main streets and as few turns as possible, give your driver all directions up front. But also give updates. Keep an eye on your location at all times, call out when the next turn is coming up, and estimate how many miles will be spent on each street. Be ready to map a new path in case of traffic, detours, accidents, or roadblocks.

Step four: be vigilant with the task at hand.

I take a shower but don’t go back to bed. I do the mapping exercises Ruth gave me until it’s time to go to work.

7

Ruth says I need to see South Central. She throws Carl and me in the rig and drives around 710’s district. “We’re first up for all calls,” she says. “And we’re not going back until you’re better at mapping.”

She and Carl point out landmarks. The pale pink church at the corner of Van Ness and Arbor Vitae, where you sometimes respond to congregation members who’ve fainted. The crack house at 92
^nd
and Dalton, a dark green shoebox whose color contrasts sharply with the straw-colored weeds. It has a
BEWARE OF DOG
sign but no dog, the empty leash drooping from a wrought-iron fence. Carl tells me everyone wants to run a call on that place, to see what the inside looks like, but no one has.

I learn about the dive bars, the convalescent homes, the elementary schools. Which restaurants get people sick. Which intersection has the highest homicide rate. Carl points out two small parks within a mile radius of each other, explaining that the men who ride their bicycles in circles, ringing the little metal bells on their handlebars, are actually drug dealers, the ringing sound an advertisement. We pass another landmark, the abandoned warehouse on the corner of 112
^th
Street and Normandie Avenue with its tilted rusty sign and mural of gang tags, the remaining
shards of glass hanging in the frames like an ever-shrinking jigsaw puzzle. The deserted Buick on Central Avenue could almost serve as a landmark, too, covered in parking tickets like feathers, at least until they tow it away. I wonder if Ruth and Carl are as familiar with their own neighborhoods as they are with these streets. Their attitude toward South Central falls somewhere between resident and tourist.

Looping through the neighborhood, Ruth explains which avenues and boulevards are the easiest to oppose traffic on, and Carl warns against a convenience store that’s had three robberies in the last month. I look at the piles of trash on the sidewalk, the crumpled shapes and decay-coated buildings, the way the early morning light casts quiet over everything. There’s something here I hadn’t expected, a deeply rooted sense of community in this wrecked and broken place; it’s apparent in the way everyone yells their hellos and seems to know each other.

Ruth and Carl wave their own hellos at a trio of transients standing in an alley. “I’ll bet you lunch we pick up Sadie before eleven,” Carl says.

“By nine,” says Ruth.

Our first call comes in at 0816. I’m beginning to recognize my pager’s language: “57/ M ALOC” means a fifty-seven-year-old man has an altered level of consciousness. Ruth pronounces every acronym as if she were reading off the letters of an eye exam, but Carl refers to this one as “A-lock.”

Ruth hits the gas as she flips on the lights and sirens. “Map me to my call!” she yells. “If I make it before you’ve mapped me there, you’re going to polish our boots.”

I open my Thomas Guide and quickly reel off directions to 134 Kansas Avenue, but Ruth shows no sign of approval. She switches to quizzing me as she swerves around cars, her aggression clearly habitual. “What are possible reasons a person might be altered?”

It’s shocking to witness how many drivers refuse to pull over to the right.

“They could be hypo- or hyperglycemic, or it could be a drug overdose or a stroke. They could be in shock, maybe from trauma. Like a blunt force injury to the head?”

“Normal range for blood sugar?”

“Between 70 and 140.”

“What’s hypoxia?”

“Hypoxia. Hypoxia. That’s when brain cells are deprived of oxygen…” My brain is being rattled for loose change. “Oh, right! If a person has a seizure, there’s the post-ictal phase afterward, when they’re disoriented.”

“How do you treat a seizure?”

“Turn them onto their side so they can’t choke on their tongue, give them oxygen, do a rapid trauma assessment for injuries.”

“Stroke?”

“Check eyes, motor, verbal, try to get onset and duration from witnesses.”

Carl adds playfully, “I’m usually ALOC on my days off. Due to EtOH.”

“What is that?” Ruth uses even Carl’s sense of humor as a means to quiz me. “We talked about this.”

Other drivers’ faces are a blur as they ignore the emergency vehicle’s howl and flash. People talk on the phone and sing along to music. One guy is picking his nose and looks up, caught, as we fly past. I remember the jaundiced patient the other day, the way he had reeked of booze and his eyes had lolled.

“Alcohol? You say that if someone has been drinking?”

“Correct. EtOH is the chemical abbreviation for ethanol. It’s a way of saying your patient is drunk without them knowing what you’re talking about.”

She slows and parks, aligning the rig with 134 Kansas Avenue. Leaving the emergency lights on, she uses the radio to tell Dispatch we’re on scene. In front of the leaning one-story, a rusted Chevy sits on blocks in
the oil-stained driveway, and a couple of stray cats clean themselves amid the tall weeds of the front yard.

Carl puts on a pair of gloves with a loud snap. “Let’s go say hello to Teddy boy.”

We fall in line with the firefighters, who arrived moments before us, moving up the driveway, the gurney bouncing along in concert with the gaping cracks in the pavement. One of the firefighters, who looks as though he is never not in uniform, thrusts his chin in my direction.

“Who’s the boot?”

“Piper.”

“They treating you okay, Piper?”

“Yes, sir.”

“Don’t call me ‘sir,’ it makes me feel old. I’m Vick.”

“Hi, Vick.” I smile at him and turn my head just in time to see Ruth glowering at me.

The front door is ajar and leaning off its hinges; we lift the gurney inside. Vick is in charge. He calls out and there’s no answer. We walk into the next dimly lit room and see a shape sprawled on the couch. One of the firefighters searches for a light switch with his flashlight. I can just make out his reflective yellow pants moving around the room, the glow of the flashlight’s halo swiveling above.

When weak light spills from an overhead lamp, I see Vick already kneeling by the couch, briskly rubbing the man’s chest with his knuckles. The whole place smells dank, stale.

“Theodore? Come on, Teddy, talk to us.”

The man doesn’t respond. Seizure? Drug use? EtOH?

Ruth nudges me. “Go.”

I stare blankly at her and then spring into action. I don’t yet have the confidence they do, that unique assumption that I can just stroll into a stranger’s home and start touching and talking to him. But I rush to get a
blood pressure and a D-stick with my shaking hands; Carl hooks him up to the EKG monitor and the pulse oximeter.

“His sugar’s 33!” I call out as the glucometer accepts the drop of blood and a number flashes on the small screen. I am at war with a Band-Aid: I am losing. One of the adhesive ends clings to my gloves. If he’s in this kind of shape, who called 911?

But then she appears, an unconcerned woman holding a cup of coffee and a pack of cigarettes, her belly pushing out against her tank top and pajama bottoms. She tells us that he hasn’t eaten since yesterday, but she gave him his insulin as usual this morning.

As if that’s his cue, Teddy turns into a monster. A swinging, grunting, drool-slinging brute who would’ve clocked me in the face if I hadn’t leaned back just in time—and yet even after this transformation, his expression remains oddly relaxed, childlike.

This is what it looks like when someone’s brain is dying.

I’m rooted to the spot while three firefighters and Carl pin down Teddy’s violent appendages. Ruth helps Vick get an IV line ready. The firefighter wearing moon pants holds up his flashlight so Vick can get a better view of a promising vein.

My options are: (1) ask to hold the firefighter’s flashlight so at least it looks like I’m doing something, (2) try to administer oxygen to a person who’s behaving like a crazed gorilla, or (3) bum one of the woman’s cigarettes so I can smoke while I watch everybody work.