Authors: Courtney Moreno
With the IV line established, Vick pushes fifty millileters of dextrose through one of the ports and flushes it with saline. He’s able to achieve this only because four grown men are practically sitting on top of his patient.
Teddy’s eyes open and focus on the room around him. “Oh, hey guys,” he says.
“Teddy!” Carl says. He and the others climb off. On my last shift, Carl told me combative patients are his favorite type of workout.
Our patient sits up, blinking. He looks at his arm, the crisscross of skewed tape holding the IV catheter in place. “Did my sugar get low again?” He manages a weak smile as he rubs his leg in the spot where Carl’s knee had pressed him.
I wait for someone to explain to him his close call with death, or advise him to monitor his sugar more often. No one does. If anything, the vibe as we leave is casual.
See you next time
“Piper, you have to jump in more,” Ruth says as we climb back into the ambulance. “I give everyone a pass on their first day of training, but this is your second. Which means starting now, every single moment of every single call you should be figuring out what you can do to help.”
But she’s not talking about helping the patient, she’s talking about helping the firefighters. “Does that guy know he almost died back there?” I ask.
“Teddy isn’t the brightest star in the galaxy.”
“Maybe because he’s gone into severe hypoglycemia too many times.”
The ambulance slows from Ruth’s usually leaden foot. “Maybe it is,” she says. “I don’t think you should be changing the subject right now. We’re talking about you, and how you can be a better EMT. Not Ted and how he can be a better diabetic.”
“I only meant—”
“No, you listen. Don’t make excuses. Don’t change the subject. If I tell you that you need to get better at the job, it means you need to get better at the job.”
“You’re right,” I manage to say.
Carl and I wash the ambulance in the parking lot of Station 710, which faces Normandie Avenue and borders a nightclub. The club’s unlit neon sign, hanging over the entrance, reads
, but everyone at A & O Ambulance calls the joint “Dy-
.” Ruth is inside the station, having her monthly meeting with the district supervisor, and as we soap up the rig
walls I think about the girl at Sustainable Living, imagining the day when she will choke on a piece of gum or a speared slice of honey crisp apple, and I will rush to save her—I will do perfectly executed abdominal thrusts—and she will collapse into my arms and stare soulfully into my eyes.
“Ruth and I have a bet going about you,” Carl says, interrupting my reverie. “About whether you’re going to be a badge bunny.” He cocks his head and studies me. “Personally, I don’t think so. Not sure what it is about you, but I just don’t see it.”
“What does Ruth think?” I’m careful to keep my voice casual, as if the answer won’t matter to me.
“Ruth hates other girl EMTs. Most of them are husband-hunting or looking for uniforms to hook up with.”
I wiggle my toes, feeling the hard plate in my steel-toed boots, and try to fight off my disappointment. Here I’ve had so much respect for her, and she’s making bets with her partner about how many firefighters I’ll sleep with.
Carl gazes at the suds-filled bucket. “I can’t wait to be FD. I’m going to collect badge bunnies like baseball cards.”
As I hose down the rig, Carl lectures me on how to endear myself to my training officer. When he tells me to steer clear of lady killer Vick, I grunt in frustration, but then he tells me that the real way to kiss ass is to start calling Ruth “ma’am.”
“That’s ridiculous. I’m older than her!”
“Not in EMS you’re not.”
“I’m not calling her ma’am.”
“Fine, don’t take my advice. But keep talking back like you have been, and you’re going to get yourself spanked.”
We hang the wet towels on the low brick wall to dry them in the sun. I pour out the soapy water and we watch it spread, coating the parking lot, seeping into its cracks and potholes, pooling around the weeds.
“Want to see something?” Carl asks. I wonder if he ever doesn’t have
that smirk on his face, the lopsided one that makes his right ear and right eyebrow lift higher than the other side. It’s impossible to hate him.
He pulls out his phone and shows me a picture from a call he had last year. On the little screen, a dead woman lies on her side on a couch. At first glance it looks like she just slumped over and never sat back up, but then I notice that half of her face is gone. So much skin and muscle have been removed that one eye looks normal while the other stares out from the orbital of her skull. Perched above her, sitting on the couch’s backrest, is a small, fluffy white dog whose black eyes and pink tongue turn up toward the person taking the picture. But the cute face thrusts forward guiltily; the flat-eared expression belongs to an animal expecting punishment.
I look up with a growing feeling of horror. “Did the dog…?”
He nods, gleeful. “Her neighbors hadn’t seen her for a week, so someone called 911. We broke apart the door with an ax and went in there. She’d been down a while. Little Fluffy must have gotten hungry at some point.”
I look back down at the phone. The woman looks withered and crumpled, a small pile of bones folded into a flower-patterned dress. Carl shouldn’t have this on his phone. Health care professionals aren’t supposed to share any information about patients, much less take pictures of them. “That’s a HIPAA violation,” I say. “You’re not allowed to do that.”
Carl nods, his face mocking. “See, I knew I’d win that bet. You’re a pretty big nerd, Piper Gallagher.”
The man reaches for me, lets his arm collapse back onto the gurney. I look around for Ruth; she’s near the front of the ambulance, craning her head to talk to Carl as he drives.
“Baby girl,” my patient says. “Baby girl, I’m not okay.” He can barely keep his eyes open but he’s trying; his eyebrows are pulled up like ship sails trying to catch a breeze.
When we pulled him out of the bushes near the neon signs of Hollywood Park Casino, he was alone, with no wallet or ID, utterly incapable of answering any questions. A comical, towering six-foot-five that spilled over both ends of the gurney. Now, on the way to the hospital, the largest rag doll I’ve ever seen is coming to life.
I awkwardly pat his shoulder. It seems the thing to do. “What happened, sir?”
He shudders and grows still, his eyebrows relaxing, eyelids drifting shut. “I lost all my money,” he says. “I gambled it away.”
I nod even though he can’t see me. “What did you take?”
He tries to remember. Definitely he drank, maybe even for twelve hours straight, and then he recalls taking about seven pills given to him throughout the night. One or two of the pills was Ecstasy, but other than that he can’t remember a thing. Which, it sounds like, was the point.
“Baby girl,” he says again. His low tone is intimate, and there’s something about those two words and the way he keeps saying them that’s getting to me. He fumbles for my hand, and as he grasps it I blush, amused and caught off guard by my own vulnerability. Ruth’s attention is still on Carl, but I hate to think how she would react if she turned and saw this. His warm, drug-addled hand wraps around mine with the tenderness of a lover.
My patient rolls his head to look at me; it’s a fluid, slippery motion only drunks are capable of, and for a moment it looks like his head will keep rolling right off the gurney. With supreme effort he keeps his eyes open and peers at me, solemn as a priest.
“Baby girl, I’m sorry.”
At the end of my shift, Ruth lets out a groan when she sees my paperwork. Slamming one of my forms down on the table, she points out mistakes.
“How old is she? How do you spell diaphoretic? Why is there a number
from her zip code?”
I’d been doing so well. I’d jumped to holding C-spine for a patient who slipped in the bathroom, recognized sepsis in a frequent flyer, restocked the ambulance in between calls without any reminders, and gave a report to a triage nurse for the first time. But our last patient was a middle-aged car thief who was covered in Taser barbs from her escape attempt from the cops. She cussed loudly and creatively the entire way to the hospital (“mama-pissing-pig-bitch-butt-wrench”), and seemed to be under the firm impression that her own mother was the one who had outed her to the police. The way she struggled against the restraints shifted the silver-cylindered barbs, and as I watched the folds of her jowls turn raw and pink from the points of puncture, and as she proceeded to call me every name she could think of, I had felt, strangely, a swell of excitement, a sudden self-assurance that I would be able to handle the job, and this assurance echoed old choices—my previous escapes from the ordinary—and an almost-forgotten version of myself, which is to say that I got so overwhelmed with a rush of simultaneous emotions that all I accomplished in the back of the ambulance was staring at her.
Ruth presses her palm to her face, and I watch as her fingertips drum against her forehead. Finally she says, “Listen, Piper, you have four days off before we see you again. I suggest you make the most of them.”
“I’ll get better,” I tell her. “I absolutely will.”
By now you’re starting to realize the simplicity with which it’s all possible. If you want to memorize something, turn it into a mnemonic device. Rhymes help, as do melodies; throw in visualization and associations for good measure. To memorize that the normal range for an adult pulse rate is 60 to 100
beats per minute, picture a snake curled up next to a bucket in one room, a skinny man blowing smoke rings in another.
The ability of your neurons to remap themselves, to change their strength and connection, is thought to be the reason you can form and retrieve memories or learn new behaviors. You’re constantly creating pathways that can get triggered, recalling information voluntarily or at random.
For paperwork purposes, you memorize hospital, treatment, and medication codes. You learn the fire station numbers and addresses for five battalions, as well as all the freeways, major streets, and zip codes in your district. You memorize your rig, assignment, and employee number.
“Okay, ma’am,” you say.
Height, age, weight, date of birth, phone number, social security number, address, zip code, medical insurance number, phone number of an emergency contact. What your patient rattles off by rote is just the beginning of our memory vaults. These digits are nestled in with those of bank accounts, passwords, pin numbers, and credit cards. This little computer chip sits alongside old addresses and phone numbers, security questions and answers, email addresses, and mothers’ maiden names.
“Please sign here.”
Roughly translated, the average patient looks like this: (323) 467-8792, 555-66-9827, 5′7″, 42 y/o, 145 lbs, 01/13/1968, 34689 103
Ave, 90044, 555-66-9827A, (818) 227-6900.
When you’re giving the report at the hospital, your partner wanders over in the middle of it. He’s been standing next to your gurney-riding patient in the ER hallway, using the portable vitals monitor to collect “a fresh set of numbers.”
“Ready for her?” he asks, and you nod, pen ready. “She’s 156/90 on the blood pressure, 102 beats per minute, about 18 breaths per minute, a temp of 98.6, pain scale is 7 out of 10, and 99 percent oxygen saturation on room air. Hospital medical record number is M110462890.”
Consider a neuron, its cell body a spiderweb suspended in brain matter, its axon sending signals to one or several of one hundred billion other nerve cells. A conduit for the electricity running through your body, the translator for how to make electrical signals meaningful, a neuron’s physical structure fortifies with each memory stored. One pluck of the spiderweb’s string and all the neurons involved in a single memory light up. They reconstruct the visual—the shape of the numbers on a page, or on the card in your wallet—and they reconstruct the action. With kinesthetic sensibility, your tongue gallops across the roof of your mouth for “twenty-two”; your lower lip sweeps against your upper teeth for each “forty-five.”
You watch the memory traces come alive in another human being and you want to believe it’s enough, these numbers; you want to believe there’s something meaningful, even altruistic, behind the reduction. You look at your patient, rolling the pen between your callused fingers. She looks blankly back at you.
323-467-8792 555-66-9827 5′7″ 42 145 01-13-1968 34689 103 90044 555-66-9827A 818-227-6900 156/90 102 18 98.6 7/10 99 M110462890…
You suddenly want to tell her: “Ma’am,” you’ll say. “You are an abacus. A license plate. A chi square. You are an exponential equation, a rosary, an irrational number, a fundamental theorem. You are singular simply because you represent a combination of numbers not represented by anybody else.”
You are unique only because the possibilities are endless.
As soon as the glass double doors slide shut between me and the night air, I spot her: she’s in the bulk section, refilling plastic numbered vaults with grain and flour. To do this, she hefts large barrels onto her shoulder from a skinny metal cart and pours from them into the propped openings. She
makes it look easy but it isn’t. The sound of heavy barrels slamming against the metal cart attests to their weight.