Soul’s Harbor – First 50 Pages!

Soul’s Harbor: True Adventures of Medic-13

Copyright 2008, 2014 by Nicholas Black

soulsharbor copy with shadow

All rights reserved. No part of this publication may be reproduced in any form or by any electronic or mechanical means, including information storage, photocopying, recording, and(or) any retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in review. Author’s note: The stories described in this work are based on actual events. The names of individuals, locations, and various details have been changed to protect their anonymity. *

The opinions and techniques in this book are those of the authors. Any medical procedure or treatment mentioned may not be current. One should always adhere to the most current AHA ACLS (Advanced Cardiac Life Support) and ATLS (Advanced Trauma Life Support) techniques.

What people are saying about Soul’s Harbor:

“. . . a backstage pass to the hidden world of blood, carnage, explosions, death, and resurrection—the fast-paced and unbelievably graphic true accounts of America’s First-responders. Oh yeah, horny nurses, meth labs, spectacular freeway collisions, and bodies everywhere! Oh the humanity. I can’t wait for the movie!” —Las Vegas Independent Media Review

Soul’s Harbor

True adventures of Medic-13.

My friend, Nicholas, asked me to tell him, at length, about my old job. It’s my fault. I began most of our conversations with, “When I was a medic…” Even though I’ve spent many years trying to forget these ghosts, I’m still walking around with them in my head.

“People need to know this stuff,” he said to me. So, I figured, this is my chance to get ’em out in the open. To release them once and for all. Clean out my closet. That was until I recalled the delivery of that baby. That one I’m gonna keep.

A wise man once told me that if I found a job that I wouldn’t mind doing for free then that is the career I should pursue. Well, who wouldn’t want to race around to rescue folks in need, meet and work with intelligent people, and never get bored? There are a number of reasons to work in EMS (Emergency Medical Services). I figured those were mine. Simple enough.

I began my seven-year career in EMS by taking a college course, which I thought would be an easy 6 credits. It wasn’t long before I knew it was my calling in life. I continued on to the paramedic program. I also attended firefighter school. You can never have enough education in the area of life saving. I gave it all I had and I got much in return.

Some good and some bad.

This work is highlights of my career for the intent of telling a story. Many EMS professionals may find some similarities to there own experiences. I do not claim a dominance in my tales to others or boast. God knows we hear enough of that. I just want to entertain and give an account. Perhaps make you smile. There’s an old Russian proverb that goes something like, ‘People like us don’t have friends, not like us’. So, people who don’t work around this environment have a hard time understanding what happens at a scene. And they have an even more difficult time understanding what we go through before and after the call.

People should know EMS is not always full of hero stuff. It is all too often we run head long into this way of life with benevolence and spunk. Then when we least expect it we become flotsam of a society that is out of control. Chewed up and spit out. We can no longer return to what the multitude deems normal. Not after years of greedy hospitals, miserable paychecks, long hours of over-time, and patients who don’t want our help.

And yet, when the call comes, we shrug and head to the ambulance.

If you’re working in EMS pat yourselves on the back and remember to take care of yourself. Better yet, pat your partner on the back. They probably need it more after putting up with you.


Ian Federov

Oh, Billy


A few years ago . . .

Imagine falling off of a roof and landing on a barbed fence post, right through your thigh. Picture sliding your left hand across a table saw, leaving your fingers on the 2×4 as your brain tries to make sense of it. Ponder tripping backwards and cracking your head on the corner of the swimming pool as you slide into the water unconscious.

Try and imagine that feeling when your windshield is exploding in slow-motion, shards of glass racing toward your face as your body is jerked around like a rag doll, pieces of metal and plastic twisting around you. Imagine that being my life.

We get called to the scene of a ‘man down!’

That’s all they say.

That’s all we know.

Could be a million different things that brought this man down. You can’t rule anything out in this business because the most improbable, unlikely of scenarios is usually what we get stuck with.

In her typical, static-laden voice, the dispatcher tells us to head to Trinity First Baptist. So we’re thinking, church people. And for the most part, church employees are relatively grounded, respectable types. These are the kind of people you can count on. These are the folks that barter with St. Peter to get us past the Pearly Gates, so they’re usually trustworthy.

So whenever they say someone is down, it’s got to be seriously.

The dispatch was explicit when she explained that the callers were “excited”. And if you think about it, there are a million horrible things that could happen at a church. Think of all the hard, pointy phallic, guilt-ridden edges that somebody might stumble upon. And get past the physical dangers, and consider all the emotional and psychological baggage that churchgoers tote around on a daily basis. The kind of people that go to church, need to be at church. They need saving.

In my mind I’m picturing divorced guys toting shotguns, angry teens carrying knives, sharpened crucifixes in the hands of jealous lovers, the out-lash of a demonic possession . . . who knows?

As we pull up to the medium-sized, white-painted wood church I realize something isn’t right. The whole scene is an instant contradiction. The Christians who ran up to us as we stepped out of the ambulance were frantic and worried, hands and eyes darting around like they’d seen Satan naked in the shower or something equally disturbing. They’re all going nuts.

The firemen and other safety workers, on the other hand, were smiling, almost on the verge of tears as they held back their laughter. I see hands over faces. Shoulders bouncing up and down. People literally biting down on their bottom lips so they don’t collapse into laughter.

“You’ve got to help him!” a young woman wearing a blue sweater nearly screamed. I could see sheer panic in her eyes.

“He’s not talking right!” a young man said, his round glasses fighting to stay in place, what with his nervously sweating face. He could be on soap operas, this guy.

“ . . . I don’t even think he’s breathing. He’s got to be dead, by now!” another woman said through her fingers.

“Hurry up!”

We go around the side of the church, stepping across the carefully manicured lawn and we see the fire Captain. He’s knelt over the patient. We approach quickly and he turns to address us. And he utters just two words,

“Billy . . . Angel.”

As our shoulders and heads collectively sag, he apologizes to us for not warning dispatch sooner. I hear my partners whispering the kind of profanity that should guarantee them a hot seat in hell. And I’m just kicking the grass at my feet.

Feeling betrayed, we all drop our gear, shoulders sloughing, sighing frustratedly. Because, really, we all know we just got duped. Don—my boss, otherwise known as Medic-23—turns to go and speak with the Christians. He rolls his eyes to me as he heads toward the group who are still pretty much shitting-in-their-pants anxious.

Picture a guy with loose-cropped red hair, a thick red mustache, and a squinting look on his face as if he was always staring past the sun at something. He had a bit of a stomach on him, but he wasn’t obese to the point where he’d get his own reality show.

Why Medic-23 got this task is that he’s the most calm, unexcitable person on the face of the earth. He routinely arrives at horrible scenes of violence and unspeakable carnage only to nod slowly to himself.

One time, when a guy’s head was on the hood of his car, several feet from his body, Medic-23 looked at us, shrugged, and said, “Shooooo.” That’s it. Nothing more. Not an “Oh my God!”, or a “Holy shit!”. No, just a shoooo. It didn’t even warrant an exclamation mark it was so subtle.

Most people, including me when I first came to work with him, attributed his calm under pressure for a lack of adrenalin in his body. We figure he just ran out years ago. I mean, how many grotesque scenes can your mind wrap itself around before they all seem trivial and tame? You get desensitized in this business. And he’s been working as a paramedic for over 30 years, so he’s seen it all . . . twice.

But the reality is, he keeps his composure under the most awful of circumstances due to his mental problems. He’s got wires crossed in that big head of his. Somewhere in the grey matter there are dendrites and axons and neurons that are fizzled and broken. So, in situations like this, he’s the guy who usually goes and talks to frantic, screaming church people.

What that means is that I’m the guy who gets to work on Billy Angel. I sigh, shake my head a few times, and kneel down. I’m looking at the curiously clean Branson, Missouri t-shirt, a pair of dirty jeans, an overcoat that is so soiled and disgusting that it might be a dumpster liner, and what look like a pair of cotton gloves with the fingers cut out.

He’s got the classic bum look, with the signature bum scent—a mixture of cigarettes, piss, hamburgers, feces, and spoiled milk. And now that I consider it, most bums have the spoiled milk smell, above all others, that instantly identifies them. And I’ve never even seen a bum drinking milk, but that’s neither here nor there.

His skin is leathery and looks like it’s been stained with Thompson’s all-weather sealant. The capillaries in his face are all busted, especially around his nose. It’s like some wrinkled road map. On his wrists are a variety of brightly colored plastic medical bracelets from the many hospitals he’s been a recent guest at.

And he’d either been drinking Listerine, or his own piss. Or maybe he’d been drinking his own piss from a Listerine bottle . . . it’s hard to nail down exactly which.

Oh, yeah, and he’s absolutely fine.

One fireman in the background says, “Hey, didn’t we send him to Fayetteville?”

And now is the point where I need to make a small admission. We had been getting so many calls for Billy Angel in the past couple of years—an average of twice a day or more—that we all engaged in a rather petty conspiracy. All the police, paramedics, firefighters, and various other safety services pitched-in to buy him a bus ticket to Fayetteville.

Somebody thought that maybe he had family there.

So we scooped him up, delivered him to the bus station, made sure he got on the bus, and wiped our hands clean of the biggest system abuser in Springfield. We thought that our troubles were finally behind us, safely tucked away behind state lines. We all figured that the quagmire that is Billy Angel was now somebody else’s problem.

But no. Here he was, staring up at me with his vacant blue eyes. You could see the yellow of jaundice in the whites of his eyes due to his failing liver. This, unfortunately, is also rather characteristic of bums.

At first glance you can’t help but feel sorry for the guy. You almost want to pick the guy up and hug him. Tell him things are going to be alright. That there’s help. But all that fades quickly.

“Hey there, Billy,” I said. “It’s been a while, huh?”

His face gets wrinkled and mean, “You, you think you’re better than me? I didn’t call you. I went to college . . . you piece of shit! Fuck you.”

My hands that could be hugging him, they could just as easily be punching the cheap vodka out of his face.

“Okay, Billy, nice to see you, again, too,” I say. I’ve seen him a hundred times in the last year, and he still doesn’t recognize me.

“Why can’t you just leave me alone? You people are always messing with me.” Then his eyes seem to fidget a bit, “ . . . hey, uh, you got a cigarette?”

The police department actually ran his prints after he got caught stealing liquor from a drive-through liquor store. It turns out that he did in fact go to college. He used to be an agent with the Drug Enforcement Agency. Word is, he got busted in some bribery scandal while he was working undercover on a drug-trafficking case. Once word hit, his wife and family left. He became an alcoholic, and it was all downhill from there.

“Are you hurt anywhere, Billy?” I asked, glancing over the myriad wounds on his body, trying to identify the new from the old.

“I didn’t even call you,” he says, glancing at the church dumpster that he occasionally calls his bed. “Dickhead,” he murmurs.

Strange thing about Billy is, he’s just intelligent enough to really piss you off. Like he’s got a gift for it. He kind of knows what people are thinking, just by reading them at a glance. Remnants of his old life as a DEA agent, maybe.

I ask him, “Do you want to go to the hospital?” I’m not so much feeling bad for that guy as I am following protocol. I have to ask that question, by law.

“Hell no, I don’t want to go to the hospital. I’m fine. Fuck you, you fucking asshole!”

I laugh to myself. You can’t let him get to you. Or at least, you can’t let him know he’s getting to you. He’s like a shark in the water, if he smells so much as a drop of emotional blood, he’ll attack.

“Well,” I reply, “then you need to sign this refusal so that the cops can take you to jail.”

His eyes grow wider by a factor of three as he clutches for his chest, “I . . . can’t . . . breathe!” Like I said, the guy knows how to use the system.

I nod, “Okay, Billy. I’ll be taking you to Medical Control today, unless you have another preference?”

He’s just doing the grabbing at his imaginary chest pain thing, now. Really selling it. And while he’s nodding at me, everyone else is rolling their eyes, looking up at the sky.

In the ambulance, on the way to the hospital, I notice the multi-colored bracelets again. “Billy,” I ask carefully, “what were you at the hospital for?”

This is important so that we don’t accidentally treat him with any kind of emergency medicines that might decide to have a sparring match in his blood stream with hospital meds.

He pulls out this folded piece of white paper, handing it slowly to me. It was on official Fayetteville Fire Department letterhead. And beneath the official address and bold print, there were big, angry, handwritten letters. No signature to be found.

And it said,

Fuck you guys! Keep your trash in Springfield.

That letter went straight to our station’s bulletin board for all to enjoy. The bad nickel that is Billy Angel had returned to haunt us.

Looking at the eerily clean Branson t-shirt, my mind was doing all sorts of back flips trying to put it together. I asked him what had happened.

He half-burped, then swallowed something that must have been awful, answering, “ . . . oh, uh, when I got to Fayetteville the fire department put me on a bus to Branson, where my girlfriend lives.” And then he smiled, licking the underside of his lips in a gesture that still gives me shivers to this day.

She must be special, I said under my breath.


“Then what, Billy?”

He stares off somewhere near the ceiling of the ambulance, “My girlfriend and I had an argument, so I caught a ride back to Fayetteville.”

“ . . . and then?”

“Oh, uh, the fire department people put me on another bus back to Springfield.” Then he laughs at me, turning his nose up, “They were professionals . . . unlike you dicks!”

“Shut-up, Billy,” I said. “Just . . . just pretend you have chest pains until I get rid of you.”

Then I get on the radio, “Medical Control, this is Metro-Three, we’re inbound to your facility with,” and I swallow, “ . . . William Angel.

And there’s this awkward pause before I hear a reply. And, following this audible groan, I hear, “Copy that Metro-Three, we’ll have his room ready.

When I look back at my career, and the perverse things I experienced, his name invariably pops-up over and over. He’s got so many ridiculous stories that surround him that it’s hard to determine what I can tell you, and what I need to try and forget.

Like the Tramp Camp riots.

Or the night he got raped.

The day he got blown-up.

All of it is pure gold. The kind of stuff no writer could ever imagine actually happening. But this is the kind of thing we deal with on a day-to-day basis. It’s not the only thing, it’s just one of the more animated parts.

When cars flip over, or industrial machinery explodes, or a hungry tiger escapes the zoo, or some clown with daddy issues pulls out a shotgun full of hatred, I might be the guy they call.

Hi, I’m Medic-13, and I’ll be your savior this evening.

Chapter 1


Mid ’90s.

The wonderful city of Springfield . . .

Welcome to Springfield, population 200+ thousand.

Springfield city is located in southwestern Missouri, near the James River, at the northern edge of the Ozark Highlands. It sits just north of the Table Rock Lake area. It was settled in 1829, but its growth and development were rather slow until the period of heavy westward migration, when pioneers were attracted to its convenient location near several major land routes.

During the American Civil War, the city was besieged and held by Confederate forces for a few months after the Battle of Wilson’s Creek (August 10th, 1861; fought 11 miles to the south). They were eventually expelled by Federal troops in February of 1862.

The legendary “Wild Bill” Hickok lived in Springfield and scouted for the Federal Army. He was acquitted there of the murder of Dave Tutt.

A rival community, North Springfield developed as a result of an extension to the Atlantic and Pacific Railroad in 1870, but in 1887 both Springfields merged.

To give you an idea of the kind of people you are dealing with on a daily basis, keep in mind that their economic mainstays are dairying, aluminum boat and barrel manufacturing, and various other agricultural ventures.

This city is, and I hate to admit this having dated many women from here, a redneck town if there ever was one. I won’t go so far as to call it White Trash USA, but I sure hear the phrase being thrown around when the town is mentioned . . . even by some of its less than sociable citizens.

It’s in the numbers. When fast food restaurant chains employ more than 50 percent of your workforce, you might have a problem. This is an entire society raised on partially hydrogenated vegetable oils and artery-clogging trans fats. They’re happily obese, and anyone that tells them any different must be stupid.

However, for all the bad dieting, risky mating practices, and suspect behavior, you also have a rare strain of kindness in these small-town folk. They care about each other intimately in a way that people from a bigger city can’t relate to.

Where I grew up, in south Chicago, people would step over a dead body to grab the newspaper. Nobody cares about you except your mother. And dad would tell you that after he belted you. Once, when I was younger, a guy was threatening to jump off a building near our house. Traffic was jammed in every direction, pissing off all kinds of people.

And the first words of advice to this suicidal man came from the mouth of a dark-skinned taxi driver who yelled, “Jump you fuckin’ fairy! Ain’t you got the balls?”

Springfield was different. People looked at each other. They cared what was going on in their community. If a road had potholes in it, there were meetings and arguments and bake sales. When a girl got pregnant, everyone knew about it as fast as a whisper can spread. People went to church, as a social event. Kids went to the same schools that their parents attended. There was a connection with each other that they all shared.

Despite their decidedly hillbilly underpinnings, they were decent people, with strong religious morals and ties. They have a host of educational institutions—Evangel College (1955), Central Bible College (1922), Baptist Bible College. We’ve even got the International Headquarters of the Assemblies of God Church here. So, we’re neck deep in the lord almighty.

And for me, this was all an incredible culture shock.

I did my EMT training at a nice community college. It looked like an easy class that I could take to steal some credits. Six months, that’s it. I mean, how difficult could it be to get cats out of trees, and rescue grandmothers who’d fallen down flights of rickety old stairs?

The next course I took was the EMT-Paramedic (Emergency Medical Technician-Paramedic). That course was over a year long. And much more difficult than I had expected. The way they explained it was, anything you can do in the first few minutes in an Emergency Room, you’ll be able to do after completing the EMT-P. And they’re not kidding. I saw things, touched things, and learned things that I had no idea were a part of emergency medicine.

So here I am, fresh out of school, bright-eyed and hungry for action. I put in applications all over the place, and land a job in downtown Springfield. Maybe it wasn’t my first choice. Or my second, third, or fourth. But it was somewhere in my list.

My first day on the job I show up at a place that is supposed to be the headquarters of Metro Emergency Medical Service (Metro-EMS). But the place I was looking at, through the windshield of my old Ford Ranger, didn’t look anything like what I imagined Metro-EMS Headquarters to be. This place was like a big red house with three huge garage doors on the side.

I drive around the block several times, checking my directions over and over until I see a large slope-side ambulance race by. I follow it back to this unlikely building where I park and head toward the front door.

As I entered, a rather frumpy, uptight group of women eyed me suspiciously, waiting for me to speak. Right about the time I was going to introduce myself, one of the women pushed her coke-bottle glasses up her huge nose, saying, “You Stubbs? The new guy Stubbs?”

“Yes, ma’am. I’m Daniel Stubbs,” I said. “I’m supposed to meet Rick Parker for my—“

“That’s a strange name,” one of the other women said, turning her chair toward me, “Stubbs. What kind of name is that, anyway?”

“I’m Irish.”

“Stubbs doesn’t sound Irish,” the woman with the bionic glasses adds.

A younger woman, maybe in her early twenties, she folds her arms across her chest, “Irish names are like O’Reardon or O’Malley. But I don’t know about Stubbs. That doesn’t seem Irish.”

And as both my family name and my ancestry are getting picked apart by women that wear skirts and blouses the colors of old Chevys, a short, chubby little man walks in the other side of the room. He looks up at me and his face seems to slacken. I’m not sure if he’s happy to see me, or frustrated that I actually made it.

“You’re Stubbs, right?”

“Yes, sir.”

One of the women says, “He claims to be Irish, but we’re not so sure.”

This chubby guy was very spirited and energetic. More than I’d expect for an obese man. He almost vibrated he was so excited. “Daniel,” he said, looking down at a clipboard in front of him. He glanced up, “ . . . so?”

So . . . what?

“So, are you Irish, or aren’t you?”

I laughed, “Uh, yes. I’m most certainly Irish.”

Ricky looked over at the women who didn’t look convinced. Even the younger woman—who as I study her closer is quite attractive in an accountant-secretary kind of way—isn’t sold on my Irish blood.

“Are any of you ladies Irish?” Rick says as he waves me to him.

As I’m walking between rolling chairs and small desks the women are shrugging, no.

“Well, then,” Rick says with grin, “since none of us are Irish, how the hell would we know one way or the other?” And then he looks at me, nods a couple of times, “Daniel Stubbs, welcome to Metro EMS. Never mind these women up front, here. They still think we faked the moon landings.”

And as they begin to voice their protests he walks me into the Day room—where people watch television, play video games, or gawk at pornography. Then he led me through the kitchen—refrigerator, table, microwave. As he gave me some of the basics we passed the sleeping quarters—consisting of six small bedrooms, one for each medic on duty.

We passed by a supply room that had the drug box and all of the medical supplies. This place, so far, had a rather worn-out, almost tired look to it. But it was also comfortable. Something between a house and an office.

And it was quiet.

I don’t know what I had expected. This place reminds me of a fire station. And I guess that’s a pretty fair analogy considering that we’re both—paramedics and firemen—meeting up at most of the same locations. All of our pagers go off at the same time.

Rick, as he’s leading me around, pointing things out here and there, I’m picking up on something anxious and almost neurotic about him. He speaks very fast, with almost a used-car salesman’s cadence and tone. I could imagine him pitching financing rates and haggling over percentage points at any moment. But that fast-talking way was just how he communicated. He would be good at reading that legal information at the end of car commercials.

He takes me by a large room, which he refers to as the Training Room. That’s where we would have all of our continuing education courses, First-Responder classes, staff meetings, CPR courses, and other procedural meetings that would come up from time to time. It was full of chairs and tables and presentation equipment.

There were mannequins and training aids, and a curious black muck near the upper edges of the walls. He sees me eyeing the walls near the ceiling and assures me that it isn’t poisonous mold. In fact, he told me that twice, which left me a little less comfortable.

Then we made our way into the garage area. When you first walk into the garage area you are in the wash bay, where the ambulances—referred to as ‘units’—drive through and hose out all of the blood and guts from the previous call.

As I’m looking around I notice a fidgety looking man approaching me. Rick says, “Wonderful,” then turns to me, “this is going to be your partner, Tim Wheeler.”

I take a good look at Tim. He’s fat. He’s got a bad rug on his head. And he’s got dodgy eyes that look to have seen something the rest of us keep missing. As he approaches, Rick whispers through clenched teeth, “He’s a Vietnam Vet.” And the way he says it, it’s more of a warning than a salute.

When he makes his way around the bay to us, we shake hands. The best way I can describe it would be shaking hands with a dead octopus. Imagine slimy tentacles for fingers. A cold, almost fishy texture to his palm. Kind of listless and creepy. I can already see myself not wanting to be left alone in a small room with this guy.

“I’m Tim Wheeler,” he says, his eyes glancing around behind us.

“Daniel Stubbs.”

“Stubbs?” he says. “What is that, Polish?”

Rick laughs, walking me to a small group of paramedics that are fiddling with a clock radio. I meet a bunch of guys and the mood is really informal because it’s a private company.

Rick then hands me off to Tim, who takes me around to the units that are parked and ready to go. It’s explained to me that I’ll be in the back of the unit, in the jump-seat, as a 3rd rider while I’m training. That’s my on-the-job training position. While I ride and assist on the calls I’ll be introduced to various hospital employees (ER nurses and Doctors), nursing home administrators and nurses, firefighters, and police officers.

They’re introducing me to the fraternity of para medicine. As far as patient care, everything that I learned in college takes precedence. I have all the tools to save lives, but I don’t know anything about actually doing it in the field.

When we got back from the unit they hand me a Medical Protocols and Procedures book. The thing is about 3 inches thick, and Tim tells me to read-up because I will be tested first thing in the morning.

They hand me a pager and a radio and we made our way into the day room where we sat down and started watching cartoons. The whole time I’m waiting for the ‘training’ to begin. But, as I soon learned, you get your training during the calls.

“What do we do now?” I asked Tim.

He was chewing on his thumbnail with a kind of psychotic zeal that made me wonder how he’s not in a mental institution. “We’ll go and check the unit in a minute, Beavis and Butthead is almost over.”

For real?

Chapter 2

Suicide Solution

Metro-EMS, HQ.

The garage . . .

After Beavis finished trying to light his farts on fire with a lighter, we made our way back out to the garage, and to the ambulance that we would be driving. We don’t have an assigned vehicle since they are constantly in and out of the shop for repairs.

We head to the second of three large bays where a large white slope-side Ford Econoline, Powerstroke diesel-turbo is waiting. The words METRO-EMS are painted in bold black on the sides, on the front doors, and on the bumper as well.

“Got to familiarize yourself with the unit,” Tim said, opening the back doors.

Part of that familiarization involves checking the O² source, the outside lights, the diesel fuel levels, making sure all of the sirens are operational—typically 5 out of 10 aren’t functional.

We then check the side doors for the various equipment: the Thumper (to manage chest compressions) and the oxygen tanks that power it, the Jaws of Life (a hydraulic-powered pry), the C-collars and towel rolls, the scoop stretcher, and the KED (Kendrickson Extrication Device)—a half spineboard used for securing patients.

Then we do an inspection of all the packs: the Oxygen pack, the Pediatric pack, the Obstetrics pack, the Burn kit, the Trauma pack, the Cardiac monitor pack, the Narcotics box (for which the crew chief has a key), and the splints.

All of this stuff is inside each and every unit, just waiting to be used. And all of it must be inspected every single time you go out on a call. Once that’s done, and any items are replaced or replenished, we take out all of the dirty linen and medical waste that has not been disposed of from the last call. In some cases, the last call could have been hours or even a day ago, so you might have quite a robust mess on your hands.

Etiquette would say to clean your unit after use, but this is often overlooked or neglected after particularly difficult calls.

Anyway, after all of this has been done, and you’re checked-in, you take the unit around the wash bay for a nice cleaning. You give it the full rub down: all surfaces, windows, and even the wheels and tires get a shine. Then it’s time to sit on your ass and watch more cartoons, or play Nintendo. You might, at a bigger station, go and run errands—collecting backboards and other miscellaneous equipment that stayed with the patients you delivered to the different hospitals.

But not us, and not right now. No, we’re just watching a mouse take aim at a cat with a shotgun. For the next few hours I’m thinking, this is the greatest job, ever. And that’s when we hear the call coming over all of our radios . . .

12:44 pm . . .

Springfield Dispatch to Metro-EMS . . . we have an attempted suicide, gun involved, police are en route.

All of the sudden we spring out of our chairs, sprinting for the unit. The crew chief—a young, quite attractive, 22-year-old girl named Samantha—was already starting the engine. Tim raced off, and by the time I got there, they’re already rolling. I had to pull some James Bond maneuvering just to jump inside before she left me!

“Nice of you to join us, Rookie,” Samantha said as I clawed my way to the jump seat.

My old, fat, burnout, Vietnam Vet partner, Tim is giggling like a chubby little pig. When I was in the day room, one of the other paramedics, a guy named Henry, told me that Tim wears the hairpiece to cover a napalm burn that left horrible scaring on his head. The government actually gives the guy a yearly stipend to purchase new wigs. Thing is, though, he’s so cheap that he keeps the cash and uses the same wig. It makes him smell like Lysol disinfectant. It’s more than spooky.

We settled ourselves in the unit, and as I got to talking to my partners I realized that they were as different as two humans could possibly be. Samantha was graceful, calm, and a consummate professional. Tim was slow, clumsy, and easily flustered and excited.

She responded, “Metro-EMS to Springfield Dispatch . . . Metro-five en route, ETA three minutes. Request status of police on scene.”

“Whenever you hear a gun is involved,” she said while driving and handling the radio, “you ask for cops.”

After what seemed like a long, bumpy ride, we arrive at the scene. There are several police cars and a fire truck parked with their lights flashing. My heart is really pounding!

Suddenly, we hear the dispatcher break the silence, “Springfield Dispatch to Metro-five . . . police and fire on scene, weapon is secure. Caller is in contact with police. They’re waiting for you inside.”

We jump out of the unit with Samantha ordering me to pay attention and listen to what she says. “Don’t think,” she tells me, “just do.”

We’re at a large, rather intimidating apartment complex that looks to be something between section-8 housing and the doorway to hell. We enter a dark, dank, seedy, wet, and downright disgusting cave of a place that seems as if it is composed of manure and rotting stucco. There are bits of metal here and there, and I feel like I need a tetanus shot already.

We’re going to the second floor. Three groaning steps up, and I want to spray-paint my brains all over the wall. This is no way to live. We made our way up, escorted by a fireman who seems hell-bent on leaving us behind. Like he’s got somewhere else to be.

After a silent, dimly lit hallway that is devoid of color we are welcomed into an explosion of sound and excitement. People are running in every direction like those bouncing rubber balls that you get in gumball machines.

The room we enter is full of smoke. And not the pleasant scented candle kind. No, this was the blue, lung boiling smoke with the Marlboro Man’s signature on it.

Police are trying to secure the family, who are puffing on their cigarettes, quietly dividing up their share of the estate. They look as interested as a bunch of janitors at a high school football game.

Samantha grabs all the relevant information from the police and firefighters.

How long has he been down?

Who started CPR?

She then grabs her radio and calls for a second ambulance.

The patient is laying on a bare mattress that is on the floor. No sheets, no pillows, just pools of sticky blood next to the aged yellow piss stains. And a firefighter is performing CPR, but with no effect because the mattress is cushioning the body so that the compressions are useless. The guy’s body is just bouncing up and down.

“Move the patient to the floor, please. You’re not getting chest compressions on that surface,” she says forcefully, but calm.

She drops her airway pack and kneels down at the head of the patient. She’s checking for the three most important things:




And as she’s checking him, she commands Tim to set-up an IV, and crack the seal on the Drug box. She finds no pulse, to go along with the bullet hole in his head.

Tim seemed lost and confused. And it was that point that I had to step-in. I think Tim was stuck back in Da Nang, taking artillery fire or something. He was completely out of his tits.

Samantha intubated the patient—lowering a scope into his throat and inserting a tube down his throat. Then they hook up a BVM (Bag Valve Mask). She’s so quick and practiced that the tube goes right in, and she makes it look easy.

Anyway, I straddled the patient and began to handle the chest compressions. Tim, at this point, can only be trusted to operate the BVM, which consists of little more than squeezing a plastic bag. He’s trying to keep in sync with me doing the compressions, but it’s nearly impossible. I compress, he squeezes, and we’re each doing our own thing.

A fireman then pulls out the Lifepack-10 (Cardiac monitor, Defibrillator/ Pacemaker) with the big defibrillator pads. One goes on the lower left side of his chest, the other goes on the upper right, just below his shoulder. They call them fast patches, and once they’re on you can see basic heart activity. He has a rhythm of some sort, then she’s shocking him.

His pulse is still not there. So we keep working on him.

Samantha then went to task setting-up an IV on the patient’s right arm. Next thing, we’re pushing fluids and drugs in to him so fast that I don’t know what’s happening.

During all of this madness, a fireman is still trying, in vain, to plug the quarter-sized entry hole, searching frantically for the exit wound.

We get the patient secured onto a backboard—packaged-up—and the six or seven of us around the backboard lift him. We race him out of the apartment, across the dark hallway, and down the rickety, unsteady stairs. We’re in such a hurry, in such a confined dark space, that one of the firemen gets his whole pinky finger pinched off along the way. But we didn’t find this out until much later because there was so much chaos that he didn’t even notice until we were loading the patient into the unit.

There’s no way to explain the kind of lunacy and madness that are sewn into every minute spent during a call. I couldn’t tell you how much time went by until I looked at when the call was received and when we left. Time doesn’t work in a linear fashion when there are so many people doing so much to keep a person alive.

Minutes and hours and seconds get all garbled and confused.

Moments later we are slamming the doors of the unit shut, Samantha beside me while we continue CPR. The second ambulance finally arrives as we are pulling out of the parking lot. They’ll have the job of cleaning up the scene and recovering all of our leftover medical gear and equipment.

Now we’re en route to the hospital.

One of the firemen is driving while Samantha communicates with the hospital, administering medication, reassessing the patient. I’m still just handling the chest compressions.

Tim is maintaining the BVM, squeezing occasionally, and oxygenating the body. He’s also making sure that the endotracheal tube is still in place.

And he is technically performing his job requirements, but he’s also in the throws of a major freak-out! I think Victor Charlie is taking pot shots at him right now, as he winces sporadically to unseen things.

And that’s when the patient’s stomach contents suddenly come up, spraying all over Tim. Luckily, Samantha’s tube keeps the patient from aspirating spoiled milk and Mad Dog 20/20—the kinds of cocktails that poor suicidal bastards drink before they pull the trigger.

I’ll be honest, I’m not sure what’s more kind, saving him, or letting him die. To wake-up back to the world he lived in, I’m not sure that isn’t cruel and inhumane.

Something seems to confuse Samantha while she’s on the radio, “Metro-five to St. John . . . ”

St. John . . . go ahead Metro-five.

“Metro-five to St. John, we’re currently inbound to your facility with a Priority-one trauma code. Twenty-two year old, male patient with a self-inflicted gunshot wound to the head . . . ” then she looks at the patient, squinting at something, “ . . . thirty-eight caliber.”

The fireman who’s driving, he says, “Hey, lady, it’s the other way around. He was thirty-eight, and the gun was a twenty-two caliber pistol.”

Samantha shook her head, toggling her radio, “ . . . gunshot wound to the head, we’re sure of that! Excessive bleeding.” She then informs the hospital that all ACLS (Advanced Cardiac Life Support) protocols are being followed. That’s important so that they know we did everything by the book.

“Our ETA is one minute!”

Thing is, we all know that the reality is that this patient, our Priority-1, he’s a corpse, now. But once we start CPR, they’re alive. Nobody dies in an ambulance. Ambulances are for the living.

Hearses are for the dead.

So, we can’t call death until the patient gets to the hospital, no matter how dead they really are. Doctors pronounce death, we announce it. These are the legalities of death.

And this . . . this is my first day.

Chapter 3

Slaughterhouse Rules

January 6th

Tuesday, 11:52 am . . .

Springfield Dispatch to Metro-EMS . . . we have a medical emergency at the Pennington Slaughter House. Caller says ‘broken leg’ and the man is conscious.

I’ve got half of my first bite of a delicious chicken sandwich in my mouth as my supervisor’s familiar scratchy voice graces the airwaves saying, “Metro-EMS to Springfield Dispatch . . . Metro-three is en route.

And now I’m spitting out my delicious, fresh chicken sandwich with lettuce and tomatoes and just the right amount of mayo. I’m doing this because Don has volunteered my unit’s services. See, Don knows where I like to eat lunch. He knows how fast I drive, and even the kind of music I enjoy listening to.

He knows everything.

As it turns out these days, I’m Metro-3. So this is our call. And it really sucks because I’ve been to the last three calls this morning, but my unit happens to be accidentally closer than anyone else’s, so I win the ambulance lottery. Or lose; it kind of depends on your perspective.

Sitting across the formica-covered table from me is Tim, eyeing his sandwich like it’s a cleverly disguised explosive device. It’s been over a year since I started working with Tim, and he’s still messed-up. Vietnam seems to be very much a part of his waking moments, haunting his days as well as his nights. I guess he eats to compensate. Well, he compensates a lot, because he’s fatter than ever. I feel like I’m gaining weight just being near the guy. His shadow weighs more than me.

“Tim!” I say as I stand, “that’s not the enemy.”

He looks up at me, then uses his knife to tap on the top of his sandwich bun a few times. Oddly, no ticking noises can be heard.

“We’ve got a call, Pennington Slaughter House,” I remind him.

“Shit,” he says as he scoots out of the booth, “that can’t be nice.” And as he removes himself from the friction between the plastic booth and the tabletop, I realize that our days as partners are growing short. It can’t last. He’s such a nervous, worthless piece of trash. He’s completely unreliable. He is not the guy you want jabbing a large-bore needle in your arm and administering drugs into your bloodstream.

We head out to the unit and I get in behind the wheel. I’m a crew chief these days. Turns out I’m pretty good at this type of work. I’m not as calm and collected as Medic-23. But I don’t crap in my pants and freak-out like Tim, either. I’m just the right mixture of neurotic and desensitized to be a good paramedic. Stuff still bothers me like the next guy, but I wait until the shift is over to consider it.

I legislate times for empathy and emotional catharsis. But that time is not during working hours.

We take off, and less than eight minutes later we are pulling up in front of the Pennington Slaughter House. This place smells like death from about two miles away. As we pull into the parking lot there is a large group of dirty old men wearing knee-high boots, cover-alls, plaid shirts, and those mostly plastic-billed caps with farm equipment company logos—you know, the basic redneck ensemble. And right now, they’re all waving their arms as if we might miss the place without their help.

“Shit,” Tim says under his breath.

Tim and I park and get out of the unit, following these men back to where they corral the cattle. It’s this dark, caged pit. And I don’t know how the whole system works, but I have this feeling that this area is the last place that animals enter alive. Off to the side, a young man is laying on his back in a mixture of straw and dirt and liquid cow manure. This is the most horribly dirty and disgusting place you can ever imagine being. To work in such a place . . . forget about it.

The guy on his back is moaning, his right leg bent 90 degrees the wrong way—kind of off to the side of his leg, against the proper motion of the knee joint. I kneel down, looking at what seems to be several large stomp marks. They’re all over his chest and body. So, in addition to the completely fractured lower head of the right femur, he has probably got other broken bones from where the cows did the Riverdance on him.

Behind me, this skinny guy with a few extra chromosomes says, “We tried to straighten it for ya’, but we ain’t no doctors. Besides, Billy wouldn’t let us touch it!”

Tim circles around the patient in order to hold in-line stabilization of the head, but on his way around he takes a bad step and rolls through the manure, sliding and crashing to a stop at the feet of some perplexed workers. And they must see people fall in this place all the time because they don’t even laugh.

I sigh, shaking my head as I look down at the man, “Billy, we’re here to help you out, okay? When my friend picks himself up he’s going to hold your head while I ask you a few questions. We have to make sure they didn’t hurt your neck.”

Billy looks to be in his early twenties, still young and without the signature wrinkled leathery face of a life spent working in a place like this. He looks scared and I’m trying to calm him down so that he doesn’t panic. I’m not worried about shock because that’s pretty much a phantom.

Let me explain. Shock is a failure of the circulatory system to supply sufficient blood to peripheral tissues to meet basic metabolic requirements for oxygen and nutrients, and the incomplete removal of metabolic wastes from the affected tissues.

Shock is usually caused by a hemorrhage or overwhelming infection and is characterized in most cases by a weak, rapid pulse; low blood pressure; and cold, sweaty skin. Depending on the cause, however, some or all of these symptoms may be missing in individual cases.

There are several varieties of shock: Physiological shock (from cardiovascular disease), Bacteremic shock (caused by various bacterium: Escherichia Coli, Proteus, Pseudomonas, or Klebsiella organisms), Anaphylactic shock (allergic reaction as the result of foreign material into the bloodstream), Cardiogenic shock (progressive decline after acute and severe cardiac damage), Neurogenic shock (autonomic nervous system shock cause by interruption of blood volume or nerve severance in lower body), Insulin shock (diabetics), etc.

And then there is Psychogenic shock. This is the kind that you see somebody crying “come back, come back!” in Hollywood movies. You know, the man is down, slowly dying in the final scene, and the attractive girl is kneeling beside him, screaming for him to keep his eyes open. This type of shock is the fainting kind.

We also refer to it as pussing out!

In a nutshell, blood pressure falls, the skin gets cold and sweaty, and the pulse rate increases. A decrease in the amount of blood flowing to the brain leads to light-headedness and loss of consciousness. But that doesn’t mean the person has been lost to some magical barrier from which death takes its final hold.

So, as a paramedic, I’m not worried about a guy fainting. I’m worried about the underlying cause. And in Billy’s case, he’s relatively aware. His pulse is strong. That makes it easier for me to ask him the kinds of questions that need asking in a situation like this.

What I am most concerned about is Hemorrhagic shock. See, if Billy has a severed femoral artery as a result of his fracture, then he could easily bleed internally. And quite quickly. Arteries are under serious pressure so they will forcefully squirt blood. Venous injuries are less serious because at that point the blood is coming back to the heart, and has much less pressure.

My first move, after Tim has gotten in-line stabilization, is to straighten the leg using a traction splint. I basically position it as straight as I can, getting Billy as comfortable as possible under the circumstances. Then what we do is called “packaging” the patient.

This involves putting him on a backboard. The first concern is the neck, which we stabilize with a C-collar. Then we place towel rolls on the sides of his head so that we can tape his forehead and the C-collar to the backboard itself.

The final touch is to secure the chest, the hips, and the legs of the patient with straps that look a lot like seatbelts by the way they clip and fasten on the sides.

While all of this is going on, I’m getting the explanation of what actually happened by a group of guys whose average IQ is probably in the lower to mid ’60s.

Apparently, Billy was in the caged area, trying to help along the traffic flow of the steers. He was urging them to a choke point where they line up single file to bid farewell to the land of the living, ending up on a burger plate at some point. As he was pushing one of the steers he got kicked in the nuts.

As you can imagine, a hoof from a steer will put any man down on the ground. Billy hit the floor only to be stomped repeatedly, and nearly trampled as the steers went wild.

A guy at the top of the shoot, who goes by the name Flea, saw Billy fall down. He yelled immediately for the others to move in and clear out all the steers. At some point, after the animals were gone, they realized that they couldn’t ‘pop’ Billy’s leg back into place, and somebody with a 3rd grade education called 911.

We lifted Billy carefully and placed him on a gurney, headed for the parking lot. As we rolled out to the unit, several men were walking with us, assuring Billy that everything was going to be alright.

“Don’t worry, Billy, we killed that steer that done this to you!”

“He’s dead, Billy,” another man assured him. “That some-bitch is dead!”

And I thought that was a curious way to emotionally comfort their fallen comrade, since all of those animals were just minutes away from being slaughtered anyway. I guess that’s society’s need for revenge or something. I’m no shrink, though.

As we loaded Billy up in to the unit, I decided to let Tim stay in the back with the patient. They both smelled like all flavors of crap, and I was on the verge of gagging.


“Metro-three to Springfield Dispatch . . . Metro-three transporting one,” I said, trying to only breathe through my mouth. That’s the key. Don’t use your nose. Because if you do, it’s like you’re eating whatever you smell.

I immediately rolled down all the windows, put the unit into drive, and we left the Pennington Slaughter House without lights or sirens—non-emergency—on our way to the hospital.

And I know, beyond any doubt, that I’m not going to get to eat lunch today. If by some chance I do, it certainly won’t be a burger.

Chapter 4

Concrete Proof

May 1st

Tuesday, 5:26 pm . . .

Springfield Dispatch to Metro-EMS . . . injury accident. Twenty-ninth and Range Line.

Tim and I just finished a non-emergency transfer. I grab the radio, “Medic-thirteen to Medic-twenty-three . . . we’re available at St. John’s.”

Copy that.”

Don answers quickly, “Metro-EMS to Springfield Dispatch . . . Metro-three and Metro-five are en route.

The reason he’s sending out two units is because 29th and Range Line is a high traffic area, and we imagine it’s going to be dangerous. It’s just on the other side of a railroad bridge and people have a tendency to come off of the bridge hauling major ass!

Tim is with me, bitching about not getting his promotion to crew chief. His hairpiece looks more artificial than ever, like a house cat stapled to his head, and he smells like disinfectant, again. It’s like some kind of cruel joke.

“Tim,” I say, “you failed your medic exam four times.” The guy’s not even fit to apply Band-Aids. Some kid watching ER could be a better service to the wounded than him.

“Well . . . ”

“Well, nothing!” I bark as I switch on the lights and sirens. “You shouldn’t even be a medic. Maybe this line of work isn’t for you. Maybe you should just do the dump-truck thing full-time.”

He doesn’t answer, but I can see he’s plenty angry. He’s fuming under his skin, his teeth clenched tight, his jaw muscles shifting from tensed to really tensed. I expect to see smoke come out of his ear canals any second.

He has a part-time job driving a dump truck. I’ve been pressuring him to take it up as a permanent career so that he doesn’t risk so many lives. He’s just a terrible medic, and a liability. To add insult to injury, he’s still resentful that I promoted past him for crew chief, a position for which he thought he deserved.

Turns out you have to be more than a warm body to promote. You actually have to be a capable paramedic, not just show up for work on time.

Let me tell you something else about my shell-shocked partner: He hates it when I drive. He is scared of speed. Absolutely, out-of-his-tits, scared shitless. And I drive like a bat out of hell each and every time he’s riding with me. I floor it every chance I get, and in my peripheral vision I can see him stabbing his foot into the floor, trying to hit some imaginary brake pedal, while his hands claw deeper and deeper into the seat cushions.

Every time I see him shiver or squirm as a result of my driving habits, I have this overwhelming urge to laugh maniacally, but I don’t succumb to it. I don’t want him to know it’s all by design. I’m basically trying to scare him into quitting.

This is an indirect form of playing Chicken.

So, right now, we’re at speeds that rival Mach 2, on our way to the accident scene.

As we arrive on the scene we see several police cars spread out, keeping the through traffic under control. There are also two fire trucks—a pumper and a rescue truck. The rescue truck has a fascinating bit of history attached to it. Ironically, it used to be a beer truck. The fire department purchased it, refurbished it to get rid of the beer smell, and voila.

The police have shut down two lanes of the four-lane highway. And one of the officers waves me off to the side. I notice our other unit—Metro-5—arriving from the other direction at almost the exact same time.

Once on a scene I have to gather information as quickly as possible. I have to determine whom I need to help first. The more serious the injury, the more in need of assistance they are.

And the story I get is this: A white Toyota pick-up came speeding over the bridge, toward a Southerland’s—home furnishings, lumber, etc.—at which the driver and passenger were employed. The problem came when a large cement truck occupied the entrance they intended to use. The Toyota was going Dukes of Hazard fast, and it met the cement truck at the rear quarter. You know, where all the cement is?

Toyota vs. Cement truck.

Winner: Cement truck.

Well, the guy in the cement truck barely even felt the accident. But the occupants of the Toyota were messed-up something serious. As I walked up to the passenger side firemen were extricating an unconscious man. He had on a C-collar, and he was big.

In the bed of the truck was the driver. He was so big he must have bounced forward and then rebounded backwards, exploding through the rear glass. His body somehow ended up in the bed of the pick-up. There were firemen holding in-line stabilization, waiting for us to get here.

A quick note on in-line stabilization. When you’re doing it, the act of carefully straightening the neck and head is accompanied by your inspection of Airway. And that’s the A of the ABCs (Airway, Breathing, Circulation.)

The fireman holding the passenger suddenly yells, “The passenger is coding! The passenger is coding!”

There was blood everywhere. Both of this guy’s legs are broken and twisted so much they looked like Jell-O. Like bags of chunky red sauce. His face was lunchmeat. Blood everywhere. Bits of bone and plastic and vinyl and glass and hair all mixed into a kind of accident soup.

No signs of life.

I know, for certain, that the passenger was not just coding! He was dead.

Dead dead.

In my assessment, the passenger is a goner. The guy in the bed might have a chance, so that’s who we need to focus our efforts on. It sounds cruel and heartless, but it’s the reality of the situation.

So Tim, in his brilliance, starts CPR on the passenger as I got to the driver. The driver was the only viable patient. That’s the sad truth.

But here’s the problem with what Tim has just done. Once you start CPR, you can’t stop until they get to the hospital and a doctor calls time-of-death. So what he has inadvertently done is commit us to the DRT (Dead Right There). And that means we’ve lost valuable time and resources that need to be dedicated to the only viable patient—the driver.

For reasons beyond my comprehension, the other ambulance crew took to helping Tim with the dead passenger. They might as well have been practicing on a mannequin. Maybe he called them over, or . . . I don’t know. But I’m working like crazy to keep the driver alive.

My patient was unconscious, with broken legs, a host of severe head injuries, not to mention all the stuff I can’t see beneath the blood. And there is blood all over the place. We have to package him up as quickly as possible, getting him out of the truck.

We get him quickly onto a backboard and lower him to the rolling cart. Within seconds we are racing him toward the unit where we can actually work on him. It’s just a fireman and I, both of us trying to do the same thing—keep this guy alive.

Once we get to the unit I get the patient intubated, hand off the BVM to the firefighter to continue breathing. I slap on two fast-patches and get the monitor up and running. He’s got a Sinus Tachycardia—that’s a really fast heartbeat. I start an IV and then glance around for my idiot partner, Tim.

“Goddammit, where’s Tim?” I gripe.

The fireman, who’s ready to drive me to the hospital, says, “He’s workin’ on the other patient. The DRT.”

We can’t wait. I glance up, “St. John’s . . . let’s go!”

I slammed the back doors shut and we’re out of there. As we start rolling we hear the radio, “Medic-thirteen . . . you’re partner is running behind your ambulance.

I grab my radio, keying-up, “You can keep him!”

Then, addressing dispatch, I say, “Metro-three to Springfield Dispatch . . . transporting one to St. John’s. We’ll be running hot!”

Metro-three to St. John’s . . . five thirty-six.

The fireman turns his head slightly in my direction, letting his foot off the gas, “What about your partner?”

“Who?” I reply as I study the monitor.

“You don’t want to pick him up?”

I point my thumb back through the small window in the back of the ambulance where my partner’s wobbly figure is shrinking and disappearing. As he’s running, the wind is picking up the front of his toupee, and he’s starting to wobble unsteadily.

Next thing I know he takes a tumble, rolling ass over elbows down to the pavement. What a retard. As far as I was concerned, he was dangerous. This guy routinely sticks endotracheal tubes down people’s esophagi. He inappropriately touches female patients when he’s alone with them in the back of the unit. He makes wrong drug calculations.

He’s useless.

The guy killed people, in my opinion. He is a sorry piece of garbage. Human trash. That’s the best thing I can say about him.

“That guy?” I say. “I don’t even know that guy. I don’t even know where he got the uniform.”

And with that the fireman laughs, guns the throttle, and we head to the hospital. Later, after it was all said and done, I heard that the passenger was in fact dead dead, on the scene. My patient, the driver, he eventually made a full recovery.

The city even put up a stoplight at the accident scene, just before that bridge. In this town, somebody has to die horribly before a stoplight gets put up. That’s Springfield’s version of evolution, I guess.

Chapter 5


May 16th

Friday night, 2 am . . .

Springfield Dispatch to Metro-EMS . . . we have a two-vehicle injury accident on Highway forty-four. Rural-fire is already en route.”

Medic-23, our supervisor, answers, “Metro-EMS to Springfield Dispatch . . . Metro-three is en route.

And this is the part where I sit up groggily, blinking several times to get the sleep out of my eyes. Metro-three, that’s us. I get up quickly, putting on my boots and jacket as I race out to the day room where I know my new partner, Ernie, will be.

Sure enough, he’s sitting at a table, completely prepared, finishing off his fifth bag of Peanut M&Ms. Ernie is big. He stands six-foot-three, weighing in at over 350 pounds. He’s got those big porky-pig cheeks, with thick round glasses and a mustache. He has a host of health problems because he is so big.

He’s the kind of guy that I figure we’ll have to eventually answer a call for. Ernie is always a breath away from a massive heart attack. Once he gets going, wheezing and puffing, you just know his days are numbered.

But then that’s just the physical side of Ernie. The thing about him is, he’s always ready for a call. He lives for it. He always has all of his gear prepared. He’s the most enthusiastic paramedic I’ve ever met. He wants to answer every single call that comes over the radio. And it’s tiring working with a partner like that because it means that we have to answer every call. Boring or not, he wants it. Morning, noon, or midnight, he’s game.

Most people say, “Ernie, he might be big, but he’s got more heart than any other paramedic alive.”

And no matter how close you are to the unit, once a call comes in, he’s there, raring to go. If he’s driving, the unit is always started and idling. If he’s the passenger, he’ll have his clipboard out, writing things down.

So we head out, flip on the lights and siren, scream through the town at breakneck speeds until we’re out of the city limits. The whole time that we’re driving, we’re hearing all sorts of radio traffic. It’s all just blackness and wigwags—the side-to-side strobing effect of the lights dancing off of pavement and trees.

I get on the radio, “Metro-three en route . . . please put LifeFlight on standby.”

An excited guy comes over the radio, “We have a ten-fifty, J-four!” Which translates to a motor vehicle accident, with fatalities.

I’m handling radio traffic as Ernie drives. I get a full description of the accident—numbers of patients and types of injuries sustained—and then I call for a back-up unit to respond, and I also make sure that LifeFlight is in the air.

See, any accident that involves a fatality instantly raises the threat level because anyone involved could be on the doorsteps of death themselves. They may look and seem okay, but since they were right next to a dead person, there is a very real chance they sustained similar physical damage.

About 10 minutes later we see a Christmas Tree—the assortment of different emergency lights and sirens of all colors—up ahead like a brilliant beacon in the otherwise pitch-blackness of the night. All traffic is stopped and the area is aglow with flares and emergency vehicles and bright strobe lights.

Off to the right there are guys out in the field, setting up an LZ (Landing Zone) for the LifeFlight medical transport helicopter.

And then we see the collision. It looks like two dark piles of twisted metal and broken glass. It’s difficult to imagine that it ever used to be two different vehicles. The moment I see this, my brain trying to make sense of it, my heart just sinks. I know, for sure, that there have to be dead people.

Lots of them.

Ernie and I jog over to the firemen who are trying desperately to extricate the patients. One man had self-extricated—ejected during the crash—and was laying nearly 50 feet away from the accident.

And this was the story: A vehicle with five passengers crossed the path of a vehicle with two passengers, coming in the opposite direction. A head-on collision ensued. There were beer cans in what was left of both vehicles, right along side the dead bodies.

In the car that had carried the five passengers, three of them were dead. All we could see was a bloody mangled arm, long black hair, and some fleshy bits—all of it encased in bent metal. This person, which we were looking at bits and pieces of, they were already dead, so there was no reason to worry about extricating them at this point.

Both vehicles were pouring out radiator fluid and oil from beneath, and the interiors were filled with blood. With the lights from all the vehicles, it might as well be daytime. There is too much detail. This is the wrong way to see death.

This is like looking at high-definition, Technicolor carnage. This madness represents a weird moment in time that doesn’t conform to the path these people were supposed to follow.

It’s one bad instant.

Less than a second from laughter to the abyss.

As the first medics on the scene, we take over scene management from the fire department that had created a makeshift triage center. The triage—a French word meaning ‘to sort’—is basically an area used to assess the different priority levels. These are: Priority-1 (immediate life threats), Priority-2 (potential/possible life threats, to be monitored closely), Priority-3 (walking wounded, can wait for medical treatment), and Priority-4 (dead, mass-casualty, imminent death, not to be treated).

One fireman was taking care of the man who had ejected from the vehicle.

Right now, everything is happening at the same time. We are making order out of chaos so that we can save somebody.

Of the three surviving patients, two were Priority-2s and one was a Priority-1. We immediately sent the Priority-1 to the LifeFlight that had landed within two minutes of our arrival on the scene.

We packaged the Priority-2s and loaded them into the unit. And let me describe the environment; there are people everywhere. There are tons of volunteers helping us move the patients to the unit. Both volunteer and full-time firefighters jogging back and forth.

Wreckage and smoke and lights and noise . . . and blood.

As we headed out, the volunteers stayed behind with the bodies—referred to as DRTs—until the coroner arrives. Their injuries were “incompatible with life”. These people weren’t almost dead or maybe dead. No, they were dead dead. Mutilated beyond any question or doubt. The only way to ask them questions now was to use a Ouija board.

One of the firemen was driving the unit while Ernie and I were in the back with the patients. We’re looking down at two teenage girls with their whole life ahead of them . . . maybe. Hopefully. Now they’re fighting for their futures while my partner and I follow our ATLS (Advanced Trauma Life Support) protocols.

They get the works: Large-bore IVs, EKG, high-flow Oxygen, and a full body assessment. We’re seeing them as machines that have to be repaired. Not as humans. Not as delicate young kids who were having a fun night out. There isn’t enough time to consider that this young woman in front of you is dying.

You have to go!

Fix the machine.

Fix the leak.

There are no mistakes in an ambulance. There can’t be. Even in this confined space, big Ernie is a professional. There are no missed IVs, or ooops, or I can’t find a vein. What’s taking over now is training and experience and adrenaline, and they’re all working together to make you more efficient. You don’t have to be God; you have to be better.

Then check it all again.

Because if we screw up, these kids are dead dead! And like I said, ambulances are for the living.

That kind of power and influence over the course of a human life is something that can attract you to this field, or destroy you. The emotional baggage and psychological pondering that usually follows, it’s saved for later. When the adrenaline is exhausted and the call is over, that’s when you’re left with your thoughts.

These girls, they’ll become human when we’re cleaning the clotted blood out of the back of the unit while the Rolling Stones are playing lazily in the background of the garage.

That’s when you reflect on the frailty of life and the ease at which death finds us. Luck and fate and all of that. Catharsis is the aftermath.

We got them to the hospital, dropped them off to the emergency room staff, and waited. Those three surviving kids . . . they lived. And I’d rather remind myself of that, than of the four kids that didn’t pull through.

My mind only has enough room for so many ghosts. And at some point you just have to start forgetting them. Old phantoms replaced by the younger, newer, more visceral images.


Chapter 6

Tramp Camp Riot

October 24th

Thursday, 3:26 pm . . .

Springfield Dispatch to Metro-EMS . . . we have a medical emergency. There’s been a stabbing under the Seventh Street Bridge, industrial area. Officers are on the scene.

Oh-no! I’m thinking as I grab my radio. Seventh Street Bridge can mean only one thing . . . the Tramp Camp!

I head to the closed bathroom door where Ernie is backing one out. He got a hold of some bad burritos earlier, and he’s been making us pay for it ever since. I hammer my fist against the door, “Pinch it off, Ernie. We’ve got a call to the Tramp Camp!”

I then lifted my radio and answered the call, “Metro-EMS to Springfield Dispatch . . . Metro-three is en route.”

I can hear him shuffling around, probably not making any attempt to wipe. His own radio keying-up as he struggles to pull his pants on. Everyone in the city can now hear Ernie pulling his pants up. I so hope he doesn’t comment on the damage his burritos have caused while he’s broadcasting live across the city frequency.

This kind of thing actually happens more than you’d think. People, especially heftier people, will accidentally toggle their citywide frequency without knowing it. And, of course, they start talking about things that they shouldn’t be.

Subjects like: who’s going to get fired, who’s sleeping with who, what doctors are sleeping with what nurses, how attractive that last overdose patient looked with her shirt off. You know, the kinds of discussions that are supposed to remain between partners. Last year a guy learned that his wife was cheating on him with another paramedic under similar circumstances. Anyway, no good can come of it.

Right now, Ernie is broadcasting the final throws of a turd to the entire city.

I have learned from experience to back away from the bathroom door when he’s in there because at any moment the 350-pound freight train is going to bust through there and haul ass to the unit. And trust me, you have to get out of his way when he’s coming through!

Nothing comes between Ernie and his ambulance.

Sure enough, he explodes through the door. As I run behind him I yell, “You’ve got an open mic, Ernie! All of Springfield just heard you take a dump.”

“Dang-it!” he barks as he makes his way to the driver’s side of the unit. Six seconds later the engine is purring as I pull myself up into the seat.

We light’em up—initiating all the bright spinning lights—and hit the sirens, and off we go!

The Tramp Camp is right around the corner, no more than four city blocks from our station, so we’re there almost instantly.

Long ago there were two large shipping and receiving warehouses with a large space between them through which railroad tracks ran. In this in-between area the trains used to be unloaded and loaded. It’s covered with a thin metal roof that extends between both buildings, probably 30 or 40 feet high. The companies have long since departed, the tracks no longer exist. When industry moved out, the bums moved in. But this creates what is affectionately known as the Tramp Camp.

Under the cover of the old metal roof, 25 or 30 homeless people have created a makeshift home. This was an open-air house, but it was a place where they could survive the elements.

In the center of this open space was a trashcan fireplace for cooking, hand warming, and whatever else it is they do to stave off hypothermia on a routine basis. It can get incredibly cold down here. The wind blows by with that howling chafe that makes you shiver just hearing it.

Surrounding the fireplace are decrepit old couches and end tables that seem to have been dragged out of a dumpster. They form a loose circle. This is the living room.

Beyond the living room were mattresses and more trashcan fireplaces. They really could use some drapes to brighten up the place. Oh, and everything is a shade of earthy brown. The color of things masked with soil and decay.

As we arrive on the scene, there are at least five police cars, one fire truck, and a bunch of scattered vagrants that looked plenty pissed that we were in their business. Ernie and I jump out right after the police assure us that the scene is secure. They lead us to the stab victim. Ernie pulls off to check out the other homeless guys, setting up a Tramp Camp triage.

The patient was laying on one of the garbage couches with his hands over his stomach. And almost instantly Billy Angel appears, letting everyone know that he understands how to handle the scene. He tells us not to worry, that he’s checked out the injury and that the guy only has a scratch.

“I’ll take care of it,” Billy Angel informs the rest of the bums.

We brushed off Billy and assessed the status of the victim. Looking at the guy we could tell he’s been beat on repeatedly. His ears and cheeks and eyes were all swollen and scratched. He looked like somebody had opened up a 12-pack of whoop-ass on him.

I look at this ball of clothes and bruises, and I ask him, “Sir, can you tell me where you’re hurt?”

All gruff and angry, he replies, “Can’t you see . . . it’s right here.” And then he removes his hands.

“Did you get stabbed, sir?” I ask, trying to figure out if this is the right guy. I notice, under the camouflage of a battered face, that this is Robert Salter. He’s not as infamous as Billy Angel, but he’s well known nonetheless.

He looks at me with this incredulous glare, “Are you stupid? Can’t you see the knife? It’s still in there.”

And sure enough, as his hands move and his body shifts a bit, I see the steak knife buried deep into his abdomen. The first and main concern in a stabbing of this nature is whether a hollow or solid organ has been punctured.

Since everything about the guy smelled like blood, feces, and ammonia (from old urine), I was worried that a solid organ such as the liver or spleen might be punctured. People that get drunk for a living have abnormally large livers. Thus, they become bigger targets for stolen steak knives.

Livers are extremely vascular, and blood loss due to a laceration is my main concern. We have to secure the knife in the abdomen for the hospital Emergency Department staff to remove at a later point. We do not remove the knife! Never pull out the implement that is stabbed into you! The knife or arrow or piece of glass or shard of metal might be the only thing preventing uncontrolled internal bleeding; or do more internal damage by cutting and lacerating on its way out. Leave it in place.

As we begin to use trauma dressings to secure the knife in place, the guy starts to crash. He stops talking to us, becomes rather incoherent, as his skin turns flush and clammy.

I yell to Ernie, “This one is a load-and-go!”

He can barely hear me because the bums are getting louder and more agitated, starting to scream at each other. This place is a homeless powder keg. Some old toothless hag is actually punching Ernie in the back, but he can’t even feel it through his rolls of fat.

Cops are running around doing nervous crowd control as things continue to escalate. The shouting gets louder and the bums seem to be turning violent. It’s time for us to get out of here.

We package him up as quickly as possible. C-collar, towel rolls, backboard in place, we hurry him to the safety offered by the back of the unit. Behind us the fighting has officially begun. It looks like a scene out of Gladiator, only with frantic police and withered old bums throwing the punches and kicks.

At any moment we should be able to taste the sting of mace in the air.

We have a fireman driving for us as I start to intubate. Ernie quickly starts the IVs—one in each arm due to the rapid loss of fluid. See, another thing about alcoholics is that they imbibe so much alcohol that their blood is thin and anemic—their blood doesn’t clot well, if at all.

So once they start bleeding, they just keep on leaking until they’re bleeding out Ringer’s Lactate (balanced salt solution, for fluid resuscitation). Ringer’s is a little better than normal saline; well, until you see it pouring out of your patient.

When they’re bleeding pink, you know you’ve given them enough.

I’ve got the defibrillator pads on Robert’s chest, watching the monitor closely. It looks like he’s got an SVT (Super-ventricular Tachycardia), which is an abnormally fast heart rate. Pretty much, the heart is getting ready to leap on out of his chest.

SVT usually precedes V-tach (Ventricular Tachycardia) and V-fib (Ventricular Fibrillation), which usually equals death. In V-tach the heart is just a quivering mess, not pumping any blood.

We’re tumbling down the road, bouncing all over the place. Firemen, as gifted as they are, aren’t the best of drivers. Luckily, the ceiling is padded because we’re hitting it repetitively with our heads and shoulders.

Ernie gets on the radio to the hospital while I manage the BVM squirting 100% oxygen into Robert’s lungs.

“Metro-three to Medical Control . . . we’re inbound to your facility with a Priority-one trauma. Fifty-six year old, male trauma patient. Stab wound in the upper left abdominal quadrant. Vitals are: thready, pulse over two hundred, blood pressure sixty by palpation, respiration’s assisted at eighteen-to-twenty a minute. The monitor shows SVT, rate of two-forty . . . ”

Ernie pauses for a half-second to catch his breath, swallowing, “We’ve stabilized the bleeding. Patient is intubated, breathing with BVM at one hundred percent O-two. Patient is fully immobilized. We have large-bore IVs, bilateral A.C.’s running at a KVO rate. We have an ETA of five minutes. Do you have any questions or orders?”

Negative, Metro-three . . . maintain ATLS protocols, we’ll see you in five.


After everything is said and done in the emergency room, old Robert Salter pulls through. Ernie and I are right outside the emergency room, at the ambulance entrance, cleaning out the clotted blood and biohazard medical waste. You don’t rush this part of the job.

We’re carefully pulling all the sharps (needles) out of the seat cushions where we stick them in the heat of a call. That’s better than dropping them to the floor to get stepped-on. There’s no telling what kind of horrible disease and rot is under the vinyl skin of these cushions.

When we finish cleaning the unit, we sit back and have a quiet cigarette. Right now, we’re just riding down the adrenaline rush. We’re listening and laughing to the radio traffic concerning what would later come to be known as the Tramp Camp Riots.

I turn to Ernie, “Did you know that old Robert in there is a retired firefighter?”


“Yeah,” I say, “from California.”

Ernie takes a long pull from his cigarette, the smoke drifting slowly out of his nose and mouth as he says, “You know, Danny, you and I . . . we’re just one or two paychecks away from being him.” He nods to nobody in particular, studying the blue smoke for sagely answers.

“ . . . just a paycheck away.”

Later on we learned that the Tramp Camp Riots started when our man Robert insulted the integrity of one of the local ladies—indistinguishable from the local men. That led to shouting, pushing, punching, probably a fair amount of spitting and slobbering, and eventually stabbing.

As things happen, a day later a dead body turned up. This lead to the city fencing off the entire area and making it off-limits to everyone. That left the bum community with only two choices: drink somewhere else, or stay sober and go to Soul’s Harbor.


Chapter 7

Water Hazard

Emergency Medical Services Appreciation Dinner.

Saturday evening . . .

Throughout the year we have different dinners, ceremonies, and get-togethers for the Emergency Medical field. The big one, however, is at the end of EMS Appreciation Week. There’s a large semi-formal dinner that brings us all together, usually sponsored by a local hospital. The hospitals throw these little shindigs to win favor among the EMS workers.

The theory behind this is that we have a choice of which hospital we’ll be bringing our broken patients to when we’re racing around trying to keep them alive. As if, with one hand on a gaping wound, and one fumbling for an IV we’re trying to figure out which hospital threw the better party, and therefor should get our patient.

Which is complete nonsense, because you don’t have time for all that. But as long as they keep an open bar, we’ll keep showing up to these events.

By semi-formal I mean that most of us dress quite appropriately in nice clothes. Key speakers might wear fancy suits. Rednecks would be wearing jeans and boots, with ridiculously large belt buckles, even though we all know they’ve never competed in a rodeo.

The audience consists of firemen, police officers, paramedics, doctors, and nurses . . . especially nurses. The dinners are usually a quiet evening in a large banquet hall with people receiving awards and commendations as we all picked apart whatever the overpriced meal was.

The spirits flowed quite freely, and you can imagine things deteriorating into a kind of controlled chaos. For the most part, though, people were on their best behavior. You see, you don’t want to make a scene at an event like this because anyone in the room might be your next chief, or supervisor, or rescuer.

The people in this room, if I ever keel over and have a heart attack, one of them is going to be getting the call. Another of them is going to arrive and secure the scene. Somebody else that might be sitting three seats away is going to be the girl that intubates me, putting a tube down my throat so that I can get oxygen.

So all of us are linked to each other, whether we realize it or not. Right now I’m sitting at a large round table with about 10 or 12 other people. Some guy named Art is at the podium right now giving a mind-numbing speech about a helicopter that crashed on the highway, or a car that crashed into a helicopter on the highway, or a highway built on top of a car that looks like a helicopter. Truth of it is, I can’t pay much attention. Art, he has a kind of monotone speaking voice, and I think I’m being lulled into a coma the more I listen.

Most of the people at this table are from our service, Metro-EMS. Ernie is to my left, barely fitting his legs under the table. His chair is pushed back about two feet farther than mine because his stomach is already butting up against the table.

Tim, my old shell-shocked, douche bag, partner is on my right, staring at somebody across the room that he swears is a sniper. Seriously, Tim is two winks away from a straightjacket. He’s one loud noise away from being a slobbering psychology experiment. He’ll lose his name and be given a number and that will be that. They’ll cart him off to the Stephens Unit. That’s where the Thorazine drip comes in. And once they give you that first shot, that’s it. You’re done. And I know that’s Tim’s future.

My supervisor—Don (Medic-23)—is beside Tim. Beside Ernie is the Metro-EMS director, Rick, with his wife Samantha. Yes, that’s the same hot Samantha that I trained with when I first came to work. She’s still hot, and Rick is still chubby and squinty and talks way too fast. Oh, and I think she’s sleeping around. Unfortunately, not with me. My suspicions are, to this point, unfounded. But I have one of those intuitive hunches that come with working around people for long enough to know when they’re trying to pull a fast one.

My dad always used to tell me not to dip my pen in the company ink. Don says it another way, “Don’t put your dick in the cash register.”

Either way, they’re both correct. It’s probably best, especially in this line of work, not to develop personal relationships that might lead to something physical with people you work just inches from. To say it’s frowned upon is putting it mildly. But then, almost everyone is doing it, so you just have to be really careful.

Anyway, when we first arrived, they were serving drinks and we were all just mingling, meeting people, stoking up old acquaintances. I ran into these two ER nurses that I had met several times at St. John’s Hospital.

Megan and Heather.

Megan had dark brown hair, big brown eyes and perfectly tanned skin that looked fresh out of an electric tanning bed. Heather had short blond hair and deep blue eyes, with thin perfect lips. They were both quite attractive, and I had been waiting for a chance to get either of them alone for quite some time.

Anyway, ever since I talked to them earlier I’ve been trying to figure out how to approach them. I’m timing my visits to the bar in the back with theirs. About every 17 minutes we meet, I grab a Jack & Coke, and they’re grabbing glasses of White Zinfandel.

We’ve met about four times now, and I’m thinking this is going to work out in my favor. I excuse myself from the table, barely escaping the gravity that Ernie exerts, and head to the bar. When I get there, Megan and Heather are talking to a guy I’ve met a few times, named Thomas.

Thomas works for Willard County Ambulance Service. And see, Willard County Ambulance and my company, Metro-EMS, we’re basically involved in a turf war, right now. So, this is the paramedic equivalent of a Crip and a Blood meeting on neutral territory. I kind of nod to Thomas, he kind of nods back. I think I could take him in a fight, not that it would ever come to that. But seriously, I could take him.

Megan takes a sip of wine, “Do you two know each other?”

We both nod again, Megan rolling her eyes. Boys.

Heather smiles, approaching me with this sinister sparkle in her eyes. I haven’t seen this side of her. Although, usually she’s covered in somebody else’s blood, so that would obviously cloud over any eye sparkling.

Heather licks her lips, “This is soooo boring.”

“I wish we could take this party somewhere else. Turn it up a notch,” Megan says. And it’s crazy how well girls can read my mind, because I was thinking the same thing.

But where?

“Hey,” Thomas says, stepping forward as he lowers his voice, “you know . . . I’ve got a hot tub at my place. It’s not far from here.”

I look at Megan, who glances at Heather, who winks at me, who turns and nods to Thomas. “That’s a good idea, Thomas. The best idea I’ve ever heard, tonight.”

15 minutes later . . .

I don’t know what Thomas was wearing, but I was in my birthday suit. The hot tub was on his back porch, and it was completely dark other than the light from the night’s sky. Heather and Megan are wearing their bras and panties, and the wonderful thing is that hot water and alcohol seem to make those garments nearly see-through.

So this is just wonderful by every account. I’m pretty sure I’m getting laid. What I am not so certain about is if it will be with Megan, or with Heather. Megan has been whispering all kinds of filthy things to me all night, so I think she’s good to go. But then, Heather has been giving me the eyewink and the tongue on the lips thing, so I might have a shot there, too.

What to do? What to do?

We smoked a little weed in the hot tub, and that seemed to push things along to the next level. Funny how weed will do that very thing. Right now I’m high as a kite, and hard as rock. The girls are primed for action. I can see erect nipples and tongues slowly gliding around mouths that are wanting of pleasure. This is the perfect environment for a life-changing event.

I decided to get things going. Megan slithers over to my right, starting to kiss my neck. Well, decision made. As she starts to kiss me I turn toward her, but I feel something strange. There are three hands on me. Wait . . . maybe four?

I suddenly notice Heather on my left. And her hands that I can’t see, are all over my body. This is like what might happen at a physical if porn stars were performing it.

I think Thomas must have gotten up to get some drinks or something because I lost track of him. And pretty soon it was a full on three-some! I’m on top of Megan, while Heather is kissing me, water splashing around, fluids being spread in every direction.

Those girls and I did things that would earn a Christian a permanent residence next to Satan’s throne. Those ER nurses, for all the horrible, traumatic things they deal with on an everyday basis, they’re just full of sexual energy and deviousness.

This will go down as one of the greater feats I had ever accomplished. And then, taken with the fact that it was in enemy territory, in front of a sworn foe . . . it was sheer gold. Well, pink, really, but you get the idea. And, come to think of it, Thomas never said another word to me. Ever.

The score was officially one to nothing. Well, two to nothing if you count the fact that I pissed in the water before leaving.


Chapter 8

Mutually-Assured Destruction

November 19th

Sunday, 7:08 pm . . .

Springfield Dispatch to available medical units . . . car pedestrian accident. Thirty-forth and Range Line.”

Ernie and I had just sat down at a Krispy Kreme. I was in desperate need of coffee that was strong enough to nurse a hangover. Ernie’s trying to gain weight, says it’s his ‘bulk’ phase or something. So I’m here for coffee, he’s here for obesity.

I responded almost immediately, “Metro-three en route!”

A few seconds later we hear, “ . . . Willard County unit-fifteen en route.

Ernie and I drop our coffee and donuts. Those bastards are trying to jump our call. We run to the unit, start it up, lights and sirens blazing!

Thirty-forth and Range Line is just about 10 or 11 blocks away. So we have to make up time here, or we’ll be beat. Again. Willard County unit-15 has been jumping—stealing—our calls all week. We can’t lose another. It would be too damaging to our morale.

I make sure that I’m behind the wheel for politics’ sake. See, Ernie’s Benedict Arnold-ass has been working part time at Willard County to support his new wife and inherited kids. Just talking about it makes me mad—his moonlighting, not the kids. He came to work this morning wearing one of their uniforms.

The nerve!

The reason we’re involved in this turf war with Willard County is simple: They’re a tax-based service. County taxes fund their payrolls. That doesn’t leave them with the necessary monies needed to pay for a full-time staff. And trust me, paramedics are 24-7. You always have at least six people, at the bare minimum, on the clock.

So, to offset this deficit in funding and supplement their income they have gone to taking calls in our service area. And that is a big, fat no-no! That’s like stomping on toes with a pair of lead boots.

That is the reason I’m breaking all kinds of land-speed records right now. It isn’t because of the money. It’s because of the principle. Those are our patients. Willard County needs to keep their asses in their own service area!

I race up to about 95 miles an hour, then skid my way back down to just under 10 miles an hour as I California-roll through the stoplights. No sense getting into an accident on the way to an emergency. 95, brake to 10, gas it to 95, brake back to 10—

. . . Willard County unit-fifteen is on the scene,” screeches over the radio.

My knuckles are white. “Son of a bitch!” I barked as I floored it.

“They did it, again!” Ernie says, surprised. Like he’s not in on it. Just some innocent bystander. I’m on to him.

As I’m burning through my seventh red light, I say, “Hey, Ernie, didn’t you work with Willard County-fifteen last night?”

Avoiding the question, Ernie says, “I’ll get the Trauma pack!”

We arrive on the scene moments later. One of the officers controlling the traffic talks to me through the window, “Car-pedestrian. He got his head split open. He’s in a bad way.” And then he looks at me funny, “Hey, how many ambulances are you going to need to transport this guy?”

I scowl at the cop, briefly glancing over at Ernie, “Just one, officer. Just one.”

We get out of the unit and jog over to the patient. He’s laying in the middle of the brown pavement. And the story is this. The guy was getting piss drunk at a wedding in a hotel on this side of the road. He then decided to walk across the street, in heavy traffic, to where the reception was being held. He found himself going too fast down the hill with no sidewalk for traction.

Being drunk he had limited control over his body and started to lose control. He couldn’t stop, and ended up running awkwardly out into the road where a car met his head at 45 miles per hour.

I kneel down. The patient is wearing a light grey shirt, black slacks, a snakeskin belt, and a giant gushing head wound.

So we’re dealing with another load-and-go, Priority-1 trauma. We can’t dick around at this scene. This guy needs an emergency room, now!

Ernie, being the consummate non-partisan diplomat, takes over as the experienced medic. He’s probably got more than five years of experience on these Willard County guys. All they’ve really done so far is to maintain in-line stabilization and try to stop some of the bleeding. Ernie does what he does best which is keeping people alive. They defer to him instantly.

Meanwhile, I grab a backboard and a gurney so that we can package-up the patient. And in the confusion, the Willard County guys didn’t notice as they loaded the patient onto the backboard. They had finished strapping him in before realizing that it was, in fact, ours.

By the time they figured out what I had done, we already had the patient rolling toward our ambulance.

“Wait, wait, wait!” one of them yelled as they ran up to us on our way across the grass to the unit. “What are you doing . . . with the patient?”

Ernie kept pushing the cot with the assistance of several firemen as I turned around to face the two bewildered Willard County paramedics. They’re standing there, mouths hanging open, their bloody gloves and shirts looking like they just came back from the front lines. Behind me the patient is disappearing into the back of our ambulance.

Ever so slowly, and with as much of a presentation as I could muster, I lifted the radio to just below my mouth, “Metro-three to Springfield Dispatch . . . transporting one to Medical Control. We’ll be running hot!”

Running hot means that we’re running emergency, and probably going to burn through a bunch of stop lights. Transporting one means that we just snatched back our patient. Call it a bamboozle.

As I lower the radio to my hip the guys from Willard County are lowering their heads. This right here, it’s priceless. This is the sweet nectar of victory.

I clear my throat and say, “Thanks for holding in-line stabilization for us, fellas.” And then I turn and run to the unit that is about to takeoff!

Ernie never does say anything about my petty swashbuckling as I jump in the back of the unit. He knows I’m right. And he’s about as opinionated as a wind-vane, anyway. Ernie’s just happy to be working on a trauma patient who’s bleeding profusely. For a guy like him, this is as good as it gets.

A fireman at the wheel, we light ’em up and take off! Ernie and I are working in the back. Victory is coursing through my veins, mixing with the adrenaline of the moment.

I love my job.

You have to understand, for a paramedic, it’s all about the trauma call. Not because somebody is going to make a bunch of money. Hell, we get paid by the hour, and not much at that. No, what we’re doing is changing the course of life on this planet.

Take this patient for example. Evolution—in the combination of an open bar, a steep hill, and a busy cross street—chose for this man to be taken out of the equation. He was finished.

But here we are, fighting back against the laws of nature, actually making a difference. See, paramedics, different from any other type of medical practitioners, actually affect the immediate outcome of life and death. Go to a hospital and what you have is extended care and medication and all kinds of treatments. But that’s just prolonging death. Stringing the grim reaper along.

Trauma is different. Trauma patients will either live or die in my hands. In the back of a dark, bumpy ambulance, traveling at 120 miles an hour. That is raw, undiluted power.

God doesn’t save trauma patients . . . we do.

Chapter 9

The Great Train Race

December 8th

Monday, 5:13 pm . . .

Rural Fire to Springfield Dispatch . . . we have a code blue at the Junction High School gymnasium. Please dispatch a medical unit.”

Ernie and I happened to be close to the high school at the moment, and we know we’re the only available unit. We had been at Ernie’s house where he was showing me his new shotgun. We got in to a discussion of why he needed a gun like that to shoot at squirrels. He didn’t have any kind of answer that would hold up in court.

In the middle of our conversation this English bulldog waddles in, and I just start laughing.

“What’s funny?” he had said to me.

The dog is fat and pudgy, and it looks exactly like Ernie. If Ernie got down on all fours and crawled around I’d have a hard time picking one from the other.

I know for a fact that we’re the only unit available to respond to the call. All the other Metro-EMS units are transporting patients or answering calls, so I pick up the radio.

“Metro-EMS to Springfield Dispatch . . . Metro-three copies direct. We’ll be responding to that call. Please put on standby.” And off we go.

Ernie gets behind the wheel and we haul ass. The radios are alive and excited with all sort of radio traffic from all directions.

As we approach the school, one of the first responders—volunteers—comes over the radio, saying, “Metro unit responding . . . we have a twelve-year-old cardiac arrest here at the basketball game. Bystanders started CPR. We’re continuing it.

I grab the radio immediately, “Metro-three to LifeFlight, please be en route. We’ll set-up an LZ (landing zone) outside Junction High School.”

LifeFlight copy.

Both luck and fate seemed to be conspiring against us as we neared the school. Here’s the problem. There are only two access points to this area, where the high school is located. Both of the entrances are separated by no less than five miles. There’s no in-between.

And looking at this entrance road, we see a train bearing down on us, about to cross our road. And it’s one of those long 15-minute trains that seem to last forever. The crossing gates have already lowered across the road, all kinds of blinking red lights and obnoxious bells are sounding.

And we’re on a real clock, here. This kid is in cardiac arrest. Brain death occurs in 4-6 minutes. So if we make a 10-mile detour—five to the other entrance, and five back to the school—this kid will be either a permanent vegetable, or outright dead.

We’re about a quarter of a mile away from the crossing, pedal to the metal, closing in on it at an intense velocity. Ernie asks, “What do you think, Danny? Detour, or . . . ” and then he glances at the tracks where the train is quickly approaching.

“It’s a twelve-year-old, Ernie,” I remind him.

He nods, tightening his grip on the steering wheel, lowering his huge shoulders, “Hold on, then!”

I make the sign of the cross and prepare for a collision.

Ernie, using a rare blend of skill and luck, manages to thread the gates at a ridiculous rate of speed, with the train honking its ear-shattering air horn at us. We are so damn close that we actually felt the thick cushion of air in the front of the train pushing us away from the tracks as we raced by.

If there had been contact, it would have been incredibly grisly. We would have exploded like a space shuttle. It would take CSI to find all of our bits and pieces.

One minute and forty-eight seconds later we are skidding to a stop in the Junction High School parking lot. We grab the Lifepack-10, Airway bag, drug box, and follow the first responders into the gymnasium where probably a thousand people are watching all of this unfold. The stadium was packed, every seat filled, but it was eerily quiet.

For most of these kids, this is the first time they’ve watched somebody they know die right in front of them.

Luckily for the kid, the woman doing the CPR was a nurse, so she was doing it properly. We take over the patient and I begin to intubate as the nurse explains what happened.

The 12-year-old in front of us fell like a sack of potatoes during a basketball game. People thought he had just tripped, but when he didn’t get up, people realized something else was wrong. Turns out he has a congenital heart defect.

He’s pale and clammy, with the color completely drained from his body. He’s wearing his yellow and blue uniform, and looks more like a mannequin than a human child. And I know he doesn’t have much time.

Ernie slaps the fast-patches—hand-sized defibrillator pads that are ultra sticky and incredibly conductive—on the boy’s lower left chest, and upper right chest. In the 1960s people used those paddles you see on television all the time, but they don’t get near the conduction. Also, the fast-patches are hooked-up to the monitor. That gives us all kinds of important information about the patient’s heart.

So, when we’re trying to jump-start somebody’s heart, we use the fast-patches.

By the time I get the intubation done, Ernie is yelling, “He’s in v-fib, everyone clear!” Think quivering, uncoordinated heart.

We all pull our hands up and he shocks the patient. The boy’s chest lifts off the floor as his muscles contract from the surge of electricity, and then back down to the hardwood floor.

I let a fireman breathe for him using a BVM while I start an IV. Meanwhile, Ernie is assessing the cardiac rhythm. Another fireman is doing the chest compressions.

And no sooner do I get the IV started that Ernie yells, “Everyone clear!”

We all pull our hands up, zap! The patient lifts, drops, and we’re back at it.

The fireman resumes breathing and chest compressions while I administer a bolus—large amount, dosage—of epinephrine. And by the time the plunger is pressing against the plastic, Ernie is ready to shock the patient again.

“Everyone clear!” he says, sweating and breathing hard. I’m really hoping that Ernie doesn’t fall over next to this kid clutching his heart. Because I’ll be in deep brown stuff then.

Everything we’re doing, Ernie and me and the firemen, it’s like a smoothly orchestrated cascade of events. It’s as if we’ve practiced together a thousand times for this one moment. But really we’ve learned from the dead and dying in our past. The ghosts in the back of our minds taught us what we now do as a matter of reaction.

Ernie shocks the boy a third time, and just as the firemen goes to start the chest compressions again, he yells, “Hold on, he’s got a rhythm! Check his pulse.”

I check the carotid artery on his neck and find a pulse. We then continue using the BVM to breathe for him. The fireman squeezes his hand, sending a fresh breath of 100% pure oxygen into the boy’s lungs.

I give him a shot of lidocaine to stabilize his cardiac rhythm, and we package him up carefully. We place him on the backboard, setting the oxygen bottle between his legs. Ernie throws the monitor over his shoulder by its strap so that he can continue to read the patient’s vital signs.

The boy is starting to look better with every passing second. He’s gaining color, looking less plastic and deathly. We lift him onto the gurney and head toward the gym door. And the moment we get there, the double doors being held open, I see the LifeFlight helicopter parked so close it’s almost surreal. It doesn’t look like it belongs here.

We race across the short stretch of parking lot and load him into the helicopter while I explain to the flight nurse all of the pertinent information. And before we know it the helicopter is taking off with the boy.

Seconds later they disappear into the darkening clouded sky, the rumble of the propeller fading quickly. And then . . . they’re gone. Vanished. It’s like none of it ever happened.

And you know what, that Goddamn train still hasn’t passed us, yet. Ernie and I gather up our gear and head out to our unit.

“Good job beating that train, Ernie,” I tell him, giving him a slap on the shoulder. “You saved that kid.”

He nodded, “We did, Danny. We did.”

That Ernie, he makes you want to be a better human. He’s so good-hearted that I want to call up ex-girlfriends and apologize for stuff I never even did. He gives me a glimpse of what decency really is. I like my big, fat, donut-guzzling, virgin partner.

I could tell you about the time he was cleaning one of his pistols and accidentally shot a hole in the center of his giant hand. I mean it was right through the dead center of his palm. You could look right through the hole, it was that big. And, luckily for him, it seemed to miss every bone and major vein and tendon. None of us could believe that he wasn’t badly hurt. We had no problem with the fact that he shot himself. That was almost a given. As if, when he purchased the gun it came with a special warning just for Ernie about what he should do when he shot himself.

But all of that, it doesn’t do anything to take away from how decent a person Ernie really is. His level of compassion is bigger than he and his portly bulldog put together. And there’s nobody I’d rather have picking me up off the pavement.

Chapter 10


May 5th

Wednesday, 6:43 pm . . .

Springfield Dispatch to Metro-EMS . . . we have a man found on the side of Fountain Road. Caller states that the man is requesting help and is covered in blood.

Ernie and I are walking down the middle of a Wal-Mart, looking for supplies for a dinner we’re going to cook back at the station. We’re at an impasse because he wants to get regular ground beef, but I want ground chuck—the good stuff. We already have a cart full of food, just ready to go. We have vegetables, buns, soda, and barbecue sauce. And the butcher is waiting for our argument to stop so that he can give us our meat.

Looking across the cart at each other, neither of us speaks. We’re waiting to see if anyone else is going to answer this call. We’ve spent the last 45 minutes shopping, filling up this cart, and if we have to go now, we’ll never eat. The night is going to be ruined, for sure.

Breaking the silence we hear our supervisor, Don, respond, “Metro-EMS to Springfield Dispatch . . .

And then we hold our breath.

. . . Metro-three will be responding.

Damn it!

We back away from the cart, maybe a little slower than we should have. “Come on, Ernie . . . they’ll be other meals.”

We turn and jog, Ernie talking under his breath. We don’t run. As a matter of fact, we never run, especially at a scene. You see, running at a scene causes panic. And panic spreads like wildfire. Maybe not in a Wal-Mart, but we still don’t run.

“Medic-twenty-three, this is Medic-thirteen . . . we copy that. We’re en route from Wal-Mart,” I say as we make our way out of the store.

We hop in the unit, light ’em up and head out.

As we begin our race to the patient we start to hear first responders on the scene describing what they believe happened. From what we’re hearing, it’s a bloody nightmare. There’s some guy, no vehicle in sight. He’s got blood and mud all over him. He’s incoherent, not responding well.

Ernie is psyched about this. He’s rubbing the belly of the Trauma Buddha, thanking him for such a wonderful gift. Because, the more these guys talk on the radio, the more horrible it all sounds.

Because it’s so far out, it takes us a relatively long time to get to the scene. When we finally arrive there are half a dozen first responders. They’ve started to bandage up the guy. There is just blood everywhere. Everybody’s rubber gloves are wet sticky red.

We’re thinking that this is a murder. Maybe somebody dropped him out of a car, or out of a plane. Something impossibly frightening. The kind of stuff urban legends are made of.

One of the early responders meet us as we’re getting out of the vehicle. “The guy says he’s from town and he came out here for work. Says there was an accident on the job site.”

As we approached we could smell the ammonia and the familiar spoiled milk smell that is Billy Angel. Both Ernie and I groan and sigh at the same time.

As soon as he sees us, Billy says, “There’s no need to have the fucking cops here. We don’t need no cops.”

“We’re not cops, Billy. We’re paramedics,” I say. The guy still doesn’t recognize us. I see the sorry bastard every shift and he treats each meeting like it’s our first.

As Ernie is cutting away at his blood-soaked pants, I start asking questions. “What did you do to yourself, Billy?”

To which he replies, “I didn’t do nuthin’. And it’s none of your business, anyway. Just fix my leg, cop.”

“We’re paramedics, Billy.”

“Fix . . . my . . . leg . . . pig!”

It’s obvious he’s lost a significant amount of blood and he’s going to need to go the hospital. He’s acting loopier than normal.

Ernie looks up at me, “There’s splinters of wood sticking out of his leg.”

“There’s one in my ass, too,” Billy adds. “And it hurts.”

We go about the business of packing him up. We give him the full trauma immobilization—C-collar, towel rolls, backboard, dressings over the gaping wounds. We start an IV because he’s definitely going to need blood when he gets to the hospital.

We thank the volunteers as we’re loading him up into the unit, congratulating them on a job well done. Since they don’t get paid, a thank you from a paramedic is a nice enough reward. They get to be part-time heroes, and they do save lives. Without them our jobs would be considerably more difficult.

This is a Priority-2, so I’m driving while Ernie tends to Billy in the back of the unit. I instantly roll the windows down because he smells so incredibly bad. The kind of wretched odor that makes you gag.

I yell back, “Ernie, see if you can find out what happened to him.”

You see, if he was assaulted we have to call the police. It becomes a criminal matter. But as it turns out, that’s not at all the case.

After a muffled discussion, Ernie gives me the short of it, “He says he was blowin’ stumps!”

By blowin’ stumps he means to say, using high-order explosives to remove tree stumps from the ground. This is a dangerous and technical skill, to be practiced only by licensed professionals. Unless you’re from our town. Then you find the most expendable person you can, and con him into doing it for drinking money.

During the long ride to the hospital, Ernie communicates with Billy. He has good bedside manner. He’s much more considerate and understanding of our patient’s emotional needs than I am. For me it’s a business. For Ernie, there’s much more to it. There’s a human component. He cares.

And so he precedes to establish rapport with Billy as we drive. In the back I can hear them talking while Ernie continues to stave off the bleeding.

And here’s what we learn along the way: Apparently, a tree-removal service had gotten a contract to clear a plot of land outside of town. They have machines that turn tree stumps into sawdust that are used for the majority of the clearing process. However, they occasionally run into trees that are too large for the machine. In those instances, they are forced to use explosives to uproot the stumps.

There was a group of particularly nasty tree stumps that they realized would be a dangerous affair to remove. Obviously, using explosives in the middle of nowhere is a dangerous undertaking. That’s when one of the contractors had the bright idea to hire some homeless guy to do the dirty work.

Billy Angel is a lot of things, but he’s no explosives expert. I’m not sure what kind of on-the-job training you get for blowing trees up, but it apparently wasn’t sufficient. When you mix Billy and dynamite, you just can’t have a happy ending. Really, when you mix Billy and just about anything it gets ugly.

But especially explosives.

What seems to have occurred is that he wasn’t at the minimum safe distance away from one of the stumps when he initiated the explosive charge. Jagged shards of the stump embedded themselves deep into his legs, arms, chest, and ass.

Yes . . . his ass.

The scary thing is, looking at his injuries, he must have done it more than once. That’s the only way to explain all the injuries. Billy’s got drive, I’ll give him that. When he says he’s going to do something, even if it will surely kill him, he’ll do it.

I grab the radio, “Metro-three to Medical control . . . we’re inbound with a Priority-two trauma patient.”

And I don’t want to tell them who this patient happens to be, but I have to, “ . . . it’s Billy Angel.”

I don’t hear anything for an awkward pregnant pause. And then, after a few seconds of static and barely audible sighing, I hear, “Copy that Metro-three . . . we’ll have his room ready.

I realize that I probably ruined a bunch of people’s night with that call, but I had to give them fair warning.

The Angel is coming.

Chapter 11

Freight Training

July 29th

Monday, 2:17 pm . . .

My pager starts screaming like a banshee! I lift myself up off the couch and reach for the wooden end table where my pager is shuffling around. I scoop it up and glance at the small screen,

‘On call . . . report to station!’

There goes my easy Friday. See, we get five on-call days per month. Usually it means that if there’s a serious emergency we’ll be called in to man the station while everyone else heads out in the units.

But not this time.

Not this call.

I slipped on my boots, flipped off the television, and jumped into my Ford Ranger. On a good day I can make it to the station from my apartment in just under 12 minutes. On a bad day, if the traffic is ugly, it might take me 25.

Today wasn’t a good day, but I still made it in 13 minutes. That should have been my first clue. The initial foreshadowing of what I was going to be dealing with. But you don’t think like that. At least, I don’t. No, 13 minutes is just four songs and a commercial. Just a stretch of lights and music.

I made my way into the station and it was a ghost town. Everybody was out on calls. My on-call partner walked in about 30 seconds behind me.

Samantha—the hot chick paramedic, and the director’s wife—was going to be sitting in the station with me for the next few hours. Normally this is the point where we grab a soda, kick back and relax, maybe get some paperwork done.

But that wasn’t the case.

Over the radio we kept hearing, “Metro-one . . . please advise if you’re at the station, yet.

Metro-one is the call sign for the station. That means, Metro-one is us—Samantha and me. We look at each other, knowing that we are going to have to go out on this one. Whatever it is, they don’t have enough help on the scene.

“Metro-one copies . . . on-call is at the station,” Samantha responds.

Metro-one . . . proceed to north Main at the train trestle. Respond immediately!

We race to the garage and jump into one of the units. Samantha is driving, I’m riding shotgun. She picks up the radio, “Metro unit-five en route.”

Six minutes later we find ourselves pulling onto an abandoned road, mostly covered in grass and small brush. About a 100 yards down the path we see tons of emergency vehicles. There are two ambulances, three police cars, and a fire truck, already on scene.

There’s an adult male, sitting on the ground, his knees pulled up to his chest. His head is down and he’s sobbing uncontrollably. Two police officers are near him, not really asking questions, just talking quietly.

We fast walk past him and he doesn’t even look up. This scene is disconcertingly quiet. Nobody is talking. There’s no yelling. Everyone is just solemnly walking back and forth.

The firemen wave us up to the top of the trestle. And I remember this place. Occasionally people will come out here to jump off of the trestle into the water down below. It’s only about 15 feet high. Just enough to get your heart racing, but low enough that you’re not going to die if you do a belly flop. You know, just a couple hours of summer fun.

On our way up a fireman walks by, his eyes hollow and vacant as if he’s seen something that he’s not supposed to be able to see. He’s witnessed something we’re not designed for. And in a barely audible voice he says, “That’s it . . . I’m done. That’s fuckin’ it.”

The problem with this location is that you have to jump from the train tracks that run across the top. There isn’t a lot of room up here on either side of the tracks.

We make our way up to the top of the trestle and we see blood and bits of bone and hair, everywhere. There are several body bags already. Two medics, assisted by several firemen, are working on a small child, who’s missing his left arm.

“We can’t find his arm,” one of the firefighters said, his face rather flush, his brow moist with sweat. “It’s got to be around here. It just has to.”

The child was right beside the tracks, completely pale. Totally unresponsive; which, under the circumstances was probably good. They were getting him packaged-up when we got there.

Not more then five feet away were the remains of a 4-year-old that had been chopped in half at the lower abdomen. The other bodies were even less put together. The firefighters were collecting tiny parts in different bags, trying to match the size of the arms and legs, with the torsos that were left.

And there isn’t much to work with. If I was to guess, I’d say there might be three different children, chopped into almost unrecognizable, stomach-turning pieces. And they were all DRTs.

Dead right there.

Samantha and I were instantly tasked with taking the small boy to the hospital before he bled out. And time was short for him. There was so much to see, and it was all so horrible, that my mind couldn’t compute it.

It didn’t make any sense.

This is probably why most paramedics suffer the long-term effects of post-traumatic stress disorder.

What was explained to us by the fireman that drove our ambulance was this: The family of six—the step-father that we had passed, and his five young children—had been taking turns jumping off of the train trestle into the water. Just having a relaxing summer afternoon together. The tracks that lead to the trestle take a sharp turn less than a hundred meters away, behind a thick mat of trees. Basically, the train had come out of nowhere when four of the five kids had been up on the trestle preparing to jump.

As the train rounded the corner the children were taken by surprise. Kids don’t stand much chance against a freight train. Three of the children—two girls and a boy, all under the age of 10—were smashed to pieces before they could even react.

The fourth child, that we were transporting, had only caught the edge of the train, tore his arm off halfway up the humorous. And he was leaking badly.

The only two to remain unharmed were the step-dad and one of the girls, who had just jumped into the water seconds earlier. Chances are, she was smiling and laughing, splashing down into the water while her brothers and sisters were being decimated.

The step-dad, he got to watch it all happen. Every gory second. Most likely, he’s finished. And not from a legal standpoint, but from a psychological one. With that kind of thing, and the amount of guilt and personal responsibility that comes with it, there’s no way he’ll ever be a full person again. That magnitude of tragedy, especially if you have any culpability—both real or imagined—spins your mind in directions that all the pharmaceuticals in the world can’t fix.

People can say what they want to comfort him. But he’ll know he killed them. Sure it was a train that came out of nowhere. Yes, people have been jumping off of the train trestle for 50 years. I’m sure he was a great dad.

But still, he killed them. That’s all he’ll ever remember.

We used a thick trauma dressing to cover the entire arm of the young boy in order to stave off the blood loss, and my lunch. We got him to the unit, and to the hospital in minutes.

When we finally delivered the child to the ER, Samantha looked at me, breathing deeply. She needed to get away from this. We drove to an empty parking lot where I left her alone in the cab while I went out and smoked a cigarette.

I’d been smoking a lot, lately. Maybe drinking a little more than I should have been, too. You can’t help it. Something has to take the edge off. Or you’ll just pop. Life in full color is too much. Especially when the color is red.

I was leaning against the back of the ambulance, smoking to calm my nerves. Puffing away at poison and nicotine so that I wouldn’t have to think about what I’d just been a part of. She was in the cab, sobbing because she was thinking about it.

She and I, we’ll both eventually end up at the same place. We’re just starting from different locations. This life of ours is a crooked line. I’m going to sit out here and smoke until somebody tells me otherwise . . . or I run out of cigarettes. Because, I don’t have the money for a good shrink.

Everything that you do as a paramedic to forget the horrible events we get to routinely experience, I’m pretty certain they’re the exact opposite of what are considered healthy psychological coping skills. At some point, you just stop looking at your fingernails because there’s so much dried blood underneath them.

Burnout . . . I figure that’s when you look down at your fingers and you can’t see the blood at all. I’m not there, yet.

The immediate effect of this was emotional wreckage. Everyone was damaged. We had a CISD (Critical Incident Stress Debriefing). That’s where all of the emergency workers can meet up and discuss what happened. There are all of these psychologists and other mental health professionals to help guys deal with post-traumatic stress, and any of the other kinds of emotional scarring.

This particular CISD was hosted at St. John’s, and I remember it distinctly because so many people broke down. It was like some kind of freaking nightmare. Lots of people quit working over that. Seasoned firefighters, nurses, paramedics, and even a doctor. Like that firefighter that had passed us on the way to the trestle. . .

. . . they were done.

Chapter 12

A Perfect Angel

October 12th

Saturday night, 11:24 pm . . .

Springfield Dispatch to Metro-EMS . . . medical call, sexual assault. Ninth and Main, in the alley.

I lift my radio, “Metro-three en route. Please have officers respond.” I lower the radio to my side, nodding to Ernie. We just finished cleaning the unit, so we were only two feet away. I didn’t even have my radio back on my hip when I was shutting the passenger door.

Ernie lit ’em up, hit the sirens, and we squealed out of the bay on our way to the call. And we’re there almost instantly because it’s only a couple of blocks from the station.

When we get there the police are on the scene, and one of the officers waves me over to warn, “Just so you know . . . it’s Billy Angel.”

We walk around to discover our dear friend Mr. Angel laying on his back in the alley. He looks as old and disgusting as ever, but with an added bonus. His musty old pants are down to his ankles. As we approach I notice a new bottle of Wild Turkey in his left hand. His right hand is balled into an angry fist. He looks madder than a sack full of cats.

The first thing I say to him is, “Damn it, Billy . . . I spend more time with you than I do my own family.”

“Fuck you, you . . . you don’t know what I go through. It’s horrible! Keep those faggots off of me. Did you catch them?”

Catch who, Billy?

He sits halfway up, “The queers, man! Did you catch the queers, yet? Look what they done.”

“Slow down, Billy,” I said. “Just take a breath and relax.”

Nobody, no matter who they are, should have to be sexually abused. Rape isn’t funny, even if Billy occasionally is. The strong aren’t supposed to prey on the weak. This is the uglier side of humanity. The side of life that nobody should ever have to witness.

I glance over at Ernie and his eyes are almost watering. He’s taking this differently than I am. Ernie’s kind of an empath. What we try and do now is retain what dignity Billy has left.

And I’ll be honest, I actually feel pretty bad for this guy. We cover him in a thick blanket, carefully load him onto the cot and take him to the unit. In the kindest gesture I’ve ever made, I go back and gather up all of his trash and belongings, throwing them in the back of the unit.

I tell the officers to follow us to the hospital so that they can make an official report and a rape kit—semen samples, fingerprints, DNA. The whole nine yards. Billy’s body is a crime scene until the investigation is complete. This is why it’s so important to get rape victims to the hospital as quickly as possible. Evidence starts to disappear almost from the second of the crime. If you wait hours, it might be too late.

I wish . . . I wish that just once I could help this guy. For good. I wish there was a way to give this guy a shot and inoculate him against all the pain and suffering he must feel on a daily basis. In the cold space of the universe, there is no morality. No right and wrong, or fair and unfair. But here, in the unforgiving streets that we all take for granted, guys like Billy are victimized by the rest of us. Like it or not, we made him.

He’s our dad.

Our brother.

Our kid.

When I go to take his pulse, at his wrist, I notice his clenched hand again. “Billy . . . what’s in your hand?”

He kind of shrugs and looks away. But he won’t open his hand.

“I need to check your pulse, so you need to relax your hand.”

I can see the tendons tightening down on the underside of his wrist.

“Billy,” I order him, “open your hand, now!”

He glares at me, his eyes just two little slits.

I sigh, “Billy, please open your hand. It’s alright. I’m not going to hurt you. I need to take your pulse.”

He snorts through his nose, and shakes his head. Slowly his hand opens up to reveal two crinkled 50-dollar bills.

Oh, crap. I close my eyes, looking up to the ambulance’s ceiling. I should have seen this coming. You allow yourself an ounce of emotional investment, and you get cheated quicker than a Vegas slot machine.

I shake my head sadly, “You didn’t get raped, did you?”

He opens his mouth to reply, but all that comes out is a half breath, barely enough to be audible.

I turn my head up, yelling toward the front of the unit, “Save your tears, Ernie. This one’s a workin’ girl!”

But Ernie is such a virgin, completely inept when it comes to things like this, that he doesn’t understand what I’m talking about. “Huh?” he replies.

“He was whoring himself out,” I explain. “Our man is a man-whore.”

And then I look down at Billy, “So . . . you care to explain this before the cops start asking you questions you can’t possibly answer?”

“I needed the money, man,” he says. “Everything was fine until the guy pulls out somethin’ meant to split me into two pieces.”

I’m noticeably cringing, trying to delete any imagery relating to Billy Angel having violent gay sex for money. So I try and change the subject, “Hey, uh, I notice you’re healing-up pretty well from the stump blowing incident.”

He nods, “Yeah, they took the cast off last week. Still got the staples, though. That dynamite is a bitch, huh!” And then the weirdest smile makes his face crooked for a moment. Then it’s gone.

I look down at his staples, “Those look kind of rusted.”

“Yeah, they were supposed to take them out a while ago. Couple weeks, I think.”

Billy absolutely cannot take care of himself. Every day he wakes up is another middle finger at evolution. He’s continually taunting fate. Each step he takes, somewhere a statistic is being rewritten.

I guess I should have expected each and every part of this God-awful story.

I pick up my radio, taking in a deep breath and groaning, “Metro-three to Medical control . . . we have a fifty-year-old sexual assault. Patient is stable and in a comfortable position. We’ll be at your facility in five minutes.”

We take him to the hospital and deliver him to the emergency room staff. Recognizing him instantly, they then direct us to Billy’s usual room. Ernie and I go to rid the ambulance of all smells that remind us of Billy.

After I finish my requisite cigarette, I take his belongings up to his room. At this point I’m just ambling down the hall, wanting to wash my hands and take a shower. I feel dirty. Disgusting. Maybe I need to go to confession at the local church, who knows.

As I get out of the elevator I notice one of the nurses dashing frantically out of his room, her hands covering her mouth, as she cuts a direct path to the employee bathrooms. I go to drop off his stuff in the room and I overhear one of the doctors asking him,

“ . . . Billy . . . how long have you had maggots in your ass?”

Mr. Angel—since he’s in the hospital he’s a Mr. now—really doesn’t have an answer for this question. He’s not his usual charismatic self.

The doctor shrugs, turning to me, “Well, they probably kept him clean. They eat the bacteria, you know.”

In my entire life I’ve never felt sorrier for maggots than right now. The horrors they must have suffered living in Billy’s ass. It gives me a full-body quiver. I have all sorts of unnerving questions bouncing around in my mind, but I know that I won’t ever be able to eat again if I get the answers.

I drop the bag full of Billy’s trash, turn on my heel, and head out into the hall. A pair of nurses fast-walk by murmuring something about, “ . . . had actual live maggots in his . . . ”

I’m heading outside, now, where I can have a few more cigarettes. When I finally get to the unit, Ernie is sitting on the back, with the rear doors open, staring numbly at the pavement. He looks distraught, saddened deeply by this. He doesn’t get this depressed after a multiple fatality with a chainsaw. But there’s something about Billy that really gets to Ernie.

“What’s up, Ernie?” I ask delicately.

He slowly lifts his head, his eyes red, “There’s just no hope for some people, huh?”

I pull a cigarette out, lighting it with a cheap blue lighter. I take a long, slow drag, and offer one to Ernie. He lifts his big, meaty arm and takes one. The cigarettes look like matchsticks in his huge hands.

I reach over and light it for him and we just sit there, letting our thoughts evaporate with the soft grey smoke as it dissipates above us.

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Soul’s Harbor: True Adventures of Medic-13

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