In Case of Emergency (9 page)

Carl begins the ten-minute drive to Crossroads Hospital. In the back, Ruth and I are accompanied by the lead medic, who’s giving our patient another dose of nitro. If a patient’s fairly stable, just the two-person EMT crew handles the transport, one driving and one in the back, but when a patient needs advanced life support we’re required to be accompanied by the fire department paramedic, the person who acts as the lead medical authority for the entirety of the call.

Ruth hands me the stethoscope. “You need to get better at lung sounds. He has rales in the bases.”

As I put on fresh gloves, place the earpieces in, and warm the bell with my palm, I’m acutely aware of the rig’s every bounce, the shrill wail of sirens, the conversation the medic is having with the patient, and the hissing of oxygen through the thin green tubing. I look wearily to the lead medic for approval.

He checks the man’s rhythm on the monitor before giving me the go-ahead. Leaning toward our patient, he says loudly to him, “Sir, my partner here is going to get another set of lung sounds.”

Encouraged by this small sign of respect from the lead medic, I peel up the man’s sticky undershirt and tell him to breathe in and out as deeply as he can. I hear nothing. I place the bell above, to the side, and below the fleshy part of his chest, ask him to lean forward, and press into several places on his back. I find myself pushing the bell’s diaphragm harder into his skin as well as raising the top of my shoulder to meet the side of the earpiece, in order to shove it farther toward my eardrum. At the very least I should hear air moving in and out as he sits here, sucking on high-flow oxygen with exaggerated effort.

“Anything?” Ruth asks. I shake my head, knowing better than to lie to her. “Keep trying,” she demands, giving a significant look to the medic, who smirks in response.

Yesterday, at the end of our date, when Ayla and I stood blinking in the sunlight next to the loading dock of Sustainable Living, she wished me luck on today’s training. “Just focus on doing right by the patients,” she said. “The rest will come.” I liked her shy smile, the way she didn’t quite seem to know how to say goodbye, and I especially liked her advice, the openness of it. But now I feel a selfish stirring, a resentment that has nothing to do with the man in front of me. I want to feel smart for a change. It’s really too bad my hands are prone to shaking, my instincts so easily overwhelmed, my sense of hearing so unsophisticated, because my book smart brain is much more intelligent than this job makes it appear to be.

The prongs dig into my ears, deafening the noise around me but somehow still not enhancing the sounds inside my patient’s body. I watch his slick chest rise and fall, his intercostal muscles tugging doggedly at his ribs. This is the first time I’ve seen any nakedness in a patient, and it only adds to the feeling that I’m unqualified. I’m playing doctor while a man with a busted heart tries his damnedest to accommodate me.

Crossroads Hospital is located on Hoover Street near Florence Avenue, not far from where the Rodney King riots began. I heard of it long before I ever rode there in the back of an ambulance. Most people call the hospital “CRH” and the city where it’s located “South Central,” even though Crossroads redid its sign under new management about four years ago, in an attempt to get rid of unfavorable associations. Likewise, at some point the city was officially renamed “South Los Angeles.” But they’re still CRH and South Central.

The hospital resembles a pile of cinder blocks, three bluish-gray boxes, each bigger than the last, stacked in ascending order along Hoover Street. Patients who get a window can look out at the dollar store, Ed’s Liquor, and the taco truck that crouches every day on Florence Avenue. The backside of the smallest cinder block houses CRH’s emergency room. It’s early still; when we pull in to the ambulance lot, we’re the only ones here. I put the stethoscope away and transfer the oxygen tubing from the rig’s house oxygen tank to the gurney’s portable one.

We roll our patient up the ramp; he seems calmer but he’s still trembling. Steering the foot end of the gurney, I push open the double doors to the ER and look around, unsure where to go. The emergency room wing of CRH is shaped like a horseshoe, with the outer perimeter feeding off to twelve ER rooms with three beds each. The inner perimeter contains the triage station and work areas for nurses and doctors. An arched hallway free of machinery separates the two areas, and is usually filled with loaded gurneys, ambulance crews, police officers, and ER patients who got
unceremoniously yanked out of their rooms to create space for higher-priority newcomers. I know there’s a system on how to stack patients in the hallway, but I don’t know what it is.

My confusion must be apparent. “We’re not going to park him,” Carl says. “We’ll get a room right away.”

While Ruth and the lead medic give a report at the triage station, I get the man’s squiggly signature and check some more boxes. Carl leans on the headrest of the gurney, seeming not to notice that his folded arms are inches from the back of the man’s head.

“You heard about this place?” he asks.

Our patient thinks Carl is talking to him, and his face clouds over. “Terrible,” he says, his voice muffled through the oxygen mask. “Just terrible.”

Most of the infamy surrounding Crossroads has to do with how shitty the ER care used to be, even though its reputation has improved greatly in the last four years. It was known for being overloaded, for long lines of gurneys out the door and down the ramp, and even for people dying before they ever got triaged. People sometimes waited twenty-four hours or more before being admitted. But the real scandal happened a few years ago, when the hospital was almost forced to shut down because a woman with a perforated bowel died on the waiting-room floor—after vomiting blood for forty-five minutes. People became so alarmed they started calling 911. The infamous picture someone took of her, sprawled and lifeless on the blood-and-excrement-covered floor, made the front page of the papers. And people had plenty of time to take pictures, because the body didn’t get cleaned up or removed for another forty-five minutes.

The medic gives his report, and the triage nurse calls out to us: Room 1, Bed A. Moments after Carl and I transfer him to his bed, our pagers start vibrating. Carl rushes to tuck the corners of a new bedsheet over the gurney’s mattress while I read out the call details on the flickering green screen. Female behavioral at Florence Park, just five blocks away. Ruth
appears at the doorway, barking orders, and we file after her, through the double doors and down the ramp. Carl looks thrilled.

“Are you hoping she’ll get combative?” I ask him as we race toward the rig.

The woman sits on a park bench, humming. About thirty-six years old, with a bombshell body and a very pretty face, she looks out, over, and past us as we stand a safe distance away, talking to her boyfriend, Frank. He explains that just a moment ago she’d been screaming and beating her fists against a nearby tree. It must be true; her fingernails are ripped to pieces and her hands are caked with dirt and blood. But they’re also folded serenely in her lap. The sounds coming from her throat remind me of cooing pigeons.

Ruth is trying to explain to the gangly Frank that we have to wait for the police before approaching her, and he’s frantically arguing that the police aren’t necessary, he doesn’t want her to go to jail.

“I’m sorry,” Ruth says. “Our protocol is that in any potentially dangerous situation, we have to wait for the police before approaching our patient.”

“Betty isn’t dangerous! She’s all right, I swear she’s all right, she just gets like this sometimes.”

“Well, we’ll be happy to take her to the hospital and get her checked out,” Ruth says. “But we’re not allowed to—”

Betty stands up dramatically. The humming sounds she’s been making take on a new frequency: a sudden diva quality radiates from her whole body. She looks down the small hill we’re standing on toward a cluster of maple trees on the other side of the playground and begins to run, shrieking terribly, pulling off her clothes in frenetic abandon. She’s still running, almost tripping, when her shirt ends up around her head, her arms pinned up by her ears and bound inside her shirt.

“We’re not allowed to chase after our patients,” Ruth finishes absentmindedly.

Carl would very much like to chase after and tackle our patient, judging by the grin on his face.

When her bra comes off near the base of the hill, my cheeks grow hot with embarrassment; her breasts are enormous, heaving and surging in a waterfall of flesh as Betty sprints barefoot, a trail of clothing on the grass behind her. Then, just as suddenly, she flings herself onto the ground. She appears to be making snow angels in the dirt.

“Faster than you can say ‘fifty-one-fifty,’” Carl says, and Ruth shoots him a warning look.

When the police arrive, four officers surround her. By then Frank has vanished. Betty lifts her head, looking at them with an unconcerned expression. One cop approaches Betty carefully, his voice friendly, his body rigid, his hand resting on the back of his utility belt. He coaxes her up off the ground, but when she realizes we mean for her to get onto the gurney she starts flailing and screaming again. It takes all four officers to pin her down. I hold myself together for once, determined not to get distracted by the sound of her screams. I rip open the thin plastic packaging of the soft restraints and hand the contents to Ruth and Carl; they attach a cloth handcuff to each wrist and use the long adjustable straps to tie one hand high above her head and the other down by her hip. She lies there panting, not a mark on her, glaring at us all. Ruth and I hurry to cover her up, first with a sheet, tucked under her armpits, and then with a blanket, pulled all the way up to her chin.

At 0938 we arrive back at CRH with Betty and a police escort, to find that it’s now a busy day. I hear catcalls and moans coming from the beds as ER nurses pass by with files and carts, rolling their eyes at each other. There are five patients in the hallway with their accompanying ambulance crews, and the triage station is deserted. I recognize J-Rock and Pep in the corner; they wave sullenly.

“How long have you been waiting for a bed?” Ruth asks.

“About twenty.”

We find a spot in the lineup and Carl wheels over the portable monitor to get a fresh set of vitals. I ignore everyone and focus on paperwork. I discover that there are no fewer than five places on the patient care report in which I am to document the use of restraints, as well as fill out a separate form indicating she had good circulation and sensory and motor function both before and after applying them. Which means…

I look up from my clipboard and take a step forward. As I lean over the gurney, Betty’s large brown eyes focus on me and she has a wide, helpful smile on her face.

“Betty?” I ask. “Are you able to wiggle your fingers?”

She makes a sound from deep in her throat and I bolt out of the way when I realize she means to spit on me. Carl lets out an appreciative chuckle. He’s standing behind her, and Ruth several feet away. They both have a perfect view of her, but are well out of spitting distance.

“You might just make it in this business after all,” Carl says, and then a wistful look crosses his face. “He’s lucky.” It takes me a moment to realize he’s talking about J-Rock, who’s over in the corner leaning against the wall with his hat pulled low over his eyes. “He’s learned to sleep standing up.”

Pep, however, is wide awake. He stands in the hallway, arms crossed, casting wolfish looks at any woman passing by, whether she’s a doctor, nurse, ER tech, or patient. But when a beautiful nurse wearing bright pink scrubs charges past him, shiny blond curls spilling down to her waist, he doesn’t even glance in her direction.

I look at Carl. “Let me guess. Pep already seduced that one?” He beams at me like a proud parent.

* * *

The triage nurse today is Shilpa, a plump Indian woman who exudes stern but matronly warmth and takes extreme measures in matching her accessories to her scrubs. She adores Ruth. After we have been waiting for forty minutes, she appears at the triage station, pulls a novelty pen out of her front pocket, and raps it against the counter. Attached to the end of the pen are colored springs, and they bounce brightly.

“Who else?” she says in her accent, looking around. Her socks, fingernails, earrings, and eye shadow are all the exact same shade of teal. “Has everyone given a report?”

An EMT I don’t recognize slouches forward, his shirt partially untucked, one lone glove hanging out of his back pocket. He speaks in low tones but Shilpa’s indignant voice interrupts him.

“
No
,” she says. “Look at him. You
look
at him.”

His head swivels toward his patient, as does the head of every other person in the hallway. The man sitting on the gurney is in a classic tripod position, leaning forward with his elbows on his knees, an inhaler in his lap, his breathing rushed and haggard.

In a quiet, dangerous voice that carries the full length of the ER, Shilpa asks, “Does he look like he’s 18 breaths a minute to you?” She slams her pen down. “Come back and give me a report when you’ve got a real set of vitals.” Spotting Ruth, she says, “Hi, Mama, what have you got?”

Ruth walks over and wraps an arm over Shilpa’s shoulders in a sideways hug. “It can wait its turn,” she says, “but I do have a favor to ask.” As Ruth speaks softly to her, Shilpa looks over at me and makes a clucking sound. I feel acidic. The triage nurse disappears and comes back with a stethoscope.