Zen and the Art of Tying Knots

I was only four months into EMT school the first time I was attacked by a patient.

Looking back on it, EMT school was really just a warm-up for the fourteen-month-long paramedic course, the place where pre-hospital care advances from mere first aid to actual medicine. But at the time, as someone uninitiated into the world of public safety, it seemed to me an entree into a very strange and exciting world. We were taught to recognize imminent life-threats like strokes and heart attacks and given a crash course in anatomy and physiology. We learned CPR, the Heimlich, how to immobilize patients with possible spinal fractures, and how to apply tourniquets and pressure dressings.

In fact, after hour upon hour of practicing skills and studying books, we could, in those early months, recognize and respond to any number of critical situations...so long as the victims were mannequins.

That’s an odd disclaimer to place upon a group about to enter the world with the purpose of saving or at least preserving human life but none of us had yet laid eyes on a single living patient. The longer class went on and the closer we got to finishing and heading out into the real world to treat real people, the more this began to weigh on my mind. The word trauma was absolutely terrifying and conjured up images of flashing lights and motorists dying on the side of a highway. Yes, I knew the buzzwords and the techniques but I had no idea if I’d be able to translate that information into the practical skills that actually save lives.

All that changed one day when our instructor walked into the classroom and rather cavalierly informed us that before finishing the course and being released to take the National Registry Exam – passing which allows you to work as an EMT anywhere in America – we had to ride on an actual ambulance. And see actual patients.

This was as thrilling as it was nerve-wracking. Our instructor had arranged for us to ride with Grady EMS, the 911 provider for the City of Atlanta. Grady EMS is part of Grady Hospital, one of the largest public hospitals in the southeast and a place known the world over for having first-rate trauma care. A reputation, of course, that was earned the hard way.

Grady Memorial Hospital looms large in Atlanta’s consciousness. It is a place of horror stories and ghost stories, of lawless halls seen only by the poor, the crazy and the critically ill. My first view of it came in the dark of a November morning as I awaited the start of a 4am third ride. The giant lighted cross atop the 16-story building glowed red in the dark sky, and steam from a pair of smoke stacks slowly rolled out like a blanket of fog, softening the orange glow of the street lights.

The original hospital still stands, as do a handful of other nineteenth century buildings and between the fog from the steam plant and the crumbling, century-old buildings, a large moon in the otherwise empty sky, the whole thing resembled to my wide eyes a scene from Jack the Ripper’s London. Somewhere in the distance a lonely siren wailed.

The knowledge that at any second, without warning, you will be called upon to deal with an emergency creates an anxiety which, if you stick with this long enough, is eventually reduced to a low-grade form of nervous anticipation. But in the beginning, for me, the thought was all-consuming. Waiting for the crew I’d been assigned to, I paced back and forth, wondering what I’d see, what I’d be asked to do and how I’d respond. Once they arrived things began to move very quickly and before I knew it, before I was ready, I was sitting in the back of an ambulance rumbling through the heart of a sleeping city.

All ambulances carry the same smell, a dizzying cocktail of disinfectant, plastic and diesel fuel tempered by the menagerie of scents leaking in from the outside world. But there’s something else, a smell you can’t quite put your finger on and, in truth, doesn’t even exist. It comes not from any physical source but from the knowledge that people have sweated, bled and died in there. This knowledge that so much has happened in so small a space will immediately dispel the notion that those who die in violent or sudden circumstances forever haunt the site of their demise. An ambulance, at its most spacious, is a ten-square-foot rolling memorial to the suddenly and tragically dead. How many have slipped away in any one of them is simply unknowable and yet not one story exists of lonely and angry specters rattling chains or whispering threats to frightened paramedics.

That said, the crew I was assigned to that day were specters in their own right and had Charles Dickens been there he may well have called them the ghosts of EMS Past. The job has changed a good deal over the years and Pike and Wooten came up in the brawling Wild West days when Atlanta was the murder capital and surviving the daily parade of shootings and stabbings required a hard-bitten and ruthless approach. Pike was a wiry, rangy guy with a thick goatee straight out of the Civil War who chain-smoked cigarettes, pounded coffee from a beat-up silver thermos and had the manic energy of a guy who never slept. Wooten was silent and bitter, his thickness a testament to the poor diet so common among public safety workers. While Wooten sat silently in the passenger’s seat, Pike drove like a madman, talking without stop, without prompting. “This whole area, everything you see,” he said, waving his arm indiscriminately at everything we passed, “fucking shit hole. I hope they raze it all.”

The shithole he was referring to was an area known locally as The Bluff – five square miles of drug houses, flop houses, abandoned buildings co-opted by the homeless, drugs, violence, desperation and the constant woop-woop of sirens. The Bluff is Atlanta’s answer to Compton, to Chicago’s Southside and to the Heartland’s countless and nameless meth-riddled trailer parks. It is where all of Atlanta’s heroin is sold and most of its crack is consumed. People here live in aging projects or derelict bungalows and, Pike said, when they weren’t getting into trouble they were calling 911.

“And for no damn reason at all,” Pike said, stomping on the gas and tearing open the air with a long, loud burst of siren. “Wake up, motherfuckers!”

My father-in-law spent a year of his life in Vietnam, an experience that has affected him deeply and about which he is generally tight-lipped. There are some topics, however, he is willing to discuss, one of them being the futile efforts of the 1960s-era Army to prepare its conscripts for jungle warfare. For instance, he loves to tell you how he trained with an M-14, never even laying hands on an M-16 – the weapon with which he was expected to win a war – until after he was already in Southeast Asia. And he’ll laugh as he describes the WWII-style combat tactics taught to him by his drill instructors, men who’d never seen a jungle and who never once addressed the unique difficulties and strategies of jungle warfare. Any skills he’d eventually acquire for keeping himself and his friends alive would come from the war-weary nineteen-year-old kids who’d gotten there a week or two before him.

EMS training is nowhere near so inadequate but the very nature of practicing medicine in streets or bathrooms or living rooms or elevators or construction sites, renders obsolete many of the rigid procedures drilled into our heads during school.

That first morning, while Wooten napped in the ambulance, Pike chain-smoked cigarettes and rattled off a list of techniques learned in school that were not only poorly-suited for the streets but could, in some cases, get me or my partner hurt. As he spoke, flicking ashes and pacing back and forth, I felt like Charlie Sheen in Platoon – a crumpled and useless FNG watching Willem Defoe dig through my backpack and discard all the items I didn’t need and which would only slow me down.

“Backboarding,” he said, referring to the practice of strapping patients with suspected spinal injuries to a long, hard board. “Do it like they show you, straps running crosswise over their body? Fuckers’ll slide right out.”

“Slide out?”

“What happens when you got them strapped like that and you try carrying them down stairs?”

“They slide out?”

“They fucking slide out.” A heavy drag, a long, languorous exhale. “Run those straps between their legs and crisscross them over their chest. Fuckers aren’t going anywhere.”

On and on it went, my head spinning as I tried to collect and organize all of the advice into its appropriate mental folder.

“When it comes to fighting patients you—”

“Wait, what?”

“What?”

“Fighting? You said fighting?”

He laughed. “You think all these fuckers are glad to see you? That they’re gonna hop on out to the ambulance for a quiet ride to the hospital? Think again. Four, maybe five times a year I end up in full-on brawls.”

I asked what would cause someone who, presumably, had called for my help in the first place to attack me upon arrival. Pike shook his head as though I was almost too dumb to help then ticked off a list that included seizure patients, drug overdoses, violent psychs, drunks, head injuries, pissed off family members and those who, for no good reason, were simply pissed off at the world and to whom I represented a great place to start exacting revenge. It was all how I approached them, Pike said, the way I asserted my authority – a tricky blend of rigidity and leniency – where I drew the line and what I did the moment they crossed it that would determine the direction these calls would take. “Handle it properly and you’ll be fine. Fuck it up and you’re in for a long afternoon.” He grabbed a pack of patient restraints and asked if I knew the proper way to restrain a patient. I shook my head and just as he was opening the pack we caught our first call.

“We’ll deal with that later,” he said, tossing the restraints back on the shelf.

People often wonder how it is that we deal with the sight of critically injured patients, how we are able to move beyond the grotesque and set our minds to the task before us. The answer I give is that it’s one thing to see someone hit by a car and have to watch, helplessly, as they bleed on the sidewalk. It’s another thing altogether to show up in an ambulance with the equipment, experience and knowledge to get that person help. There is also a time-space thing at work, where empty-handed witnesses have nothing to do but focus on the horrific details. We, by contrast, can occupy our minds with the long list of tasks that need tending to prior to our arrival at the hospital. Typically it isn’t until the whole thing’s over and the patient is in the hospital and out of our care that we even begin to consider what had just happened. The result of this is that things move much more quickly for us and twenty minutes pass by like two, while for the bystander each second ticks loud in their head, time moving excruciatingly slow.

These factors combine into a defense mechanism of sorts and allow us to finish a call and head straight for lunch. On that first morning, as I watched from the close and inescapable confines of an ambulance, my inexperience put me in the unique position of being both frightened observer and busy rescuer. It also made me utterly useless. There are countless reasons why work in an ambulance, no matter how critical the patient, is almost always a two-person job, not least of which being there simply isn’t room for a third person. Toss in that extra body and you get in each other’s way and, more importantly, on one another’s nerves. Attach, then, to this third wheel a complete ignorance of what he should be doing and you see why most medics hate third riders. I’m not sure Wooten even knew I was alive but Pike’s willingness to deal with me certainly began to fade as the day wore on.

For my part, I was mesmerized. We picked up a child with a fever, dropped off a woman with abdominal pain and bandaged a man who’d been sliced open by his girlfriend during a domestic dispute. Twice. The first time we dropped him off at Grady he stayed long enough for them to stitch half of his wound before leaving. Naturally, he headed straight home and resumed beating his girlfriend. The second time he was transported by the police and as I bandaged his still-bleeding arm, his girlfriend poked her head out of the back window of a police car and pledged her undying love for all to hear.

The day continued like this, calls going out in projects and high-rises and on the litter-strewn shoulder of I-85 until mid-afternoon, when we finally got some downtime. There are no breaks in EMS, no lunch hours or nap times and when it’s busy there’s scarcely a spare moment to use the bathroom. So you eat what you can when you can. That afternoon we ate greasy chicken from a fast food restaurant whose health rating couldn’t have been higher than 80 and then immediately fell into a stupor. The cool morning air had finally warmed up and we all became sleepy and content and as I sat alone in the back of the parked ambulance I drifted off to sleep. I was floating somewhere in that half-dream, half-awake state where the real-life sounds around you become part of your dream when the ambulance suddenly started moving.

“We got a call,” Pike yelled.

I hadn’t yet shaken off the fog of grease when the ambulance jerked to a halt and, for the first time that day, I heard Wooten’s voice.

“Holy fucking shit.”

There are strange things that happen in the world and one of them happened that afternoon. A man none of us had ever seen before and would never see again had spent the previous night binging on an interesting cocktail of drugs known as a speedball. A speedball is a mixture of cocaine and heroin – one drug to cut the trail for you, another to send you down it. Heroin being what it is, calms while the cocaine fuels.

The problem is that the heroin has a shorter lifespan than cocaine and so, out of nowhere, BAM! Your smooth and mellow, yet inspiringly vivid, high suddenly becomes all sweat and frustration and grinding teeth. Generally speaking, heavy users don’t deal well with this transition. Our patient certainly fell into this category and, after his buzz turned sour, he spent the afternoon homicidally racing his car through the streets before running down a ravine and crashing into a tree.

He’d hopped out before our arrival and so we found him, confused and combative, running around the street. The sight of a big, sweaty, drugged out lunatic running through traffic wasn’t what caused Wooten to finally speak, however. For a medic who’d been on the street for a decade, that alone would’ve been somewhat routine. What stood out immediately as cause for, if not concern then at least his first verbal reaction of the day, was that the man had broken both of his legs below the knees. Badly. Your lower legs are made of two bones. The larger of the two, the tibia, is essentially what holds you up below the knee. The fibula is smaller, runs parallel to the tibia and is what you feel when you reach down and grab what’s referred to as the shin bone. It’s not all that uncommon for these bones to break but it is uncommon for those thus inflicted to walk, let alone run. Our patient, strung out on the souring effects of a speedball binge, didn’t seem to notice his legs were broken. Hence the running.

And it was this running, or rather the resulting injuries, that caused Wooten to shout. When the man had gotten out of the car, the broken bone ends immediately poked through the skin so that now, with each step, the upper and lower sections were jutting out in a grotesque sort of crisscross pattern. I stood next to Pike and Wooten in front of the ambulance – heart-pounding, pupils dilated – partially horrified, partially hypnotized and totally unsure of what to do. Wooten swore under his breath. Pike spat in the street. A passing car honked. And then it was on.

Pike hopped up in the ambulance and grabbed our box of narcotics and a syringe. As I watched, he drew up five milligrams of versed and another five milligrams of haldol, a potent mixture of sedatives that rarely misses its mark. With me following close behind, they slowly approached our patient in much the same way a zookeeper might approach an unruly bear. When the guy saw us coming he turned and ran back into traffic and the world was instantly drowned in a flood of squealing rubber and blaring car horns. With nowhere to go, he turned back toward us. For an instant we froze. In that tiny space of time, certainly less than a second, he sized us up like a cornered bull and decided we presented the path of least resistance. Pike and Wooten quickly recognized what was happening. I was a little slow in arriving to the party.

They both jumped out of the way. Not me. I stood frozen as the patient – wild eyes, hulking mass, broken and scissoring leg bones – charged me. I’d like to say it all happened in slow motion but it didn’t. It happened so fast I never reacted. Steps before the guy plowed me over, Wooten, much more agile than his rumpled largesse suggested, appeared out of nowhere and knocked him down. Pike piled on top. I stood watching as the three of them rolled around until Pike screamed out in pain, wailed the guy with a wild elbow and yelled, “Grab the needle!” Somehow in the tussle he’d dropped the sedative and it was now out of his reach. This, finally, snapped me out of my daze and I grabbed the syringe, popped off the top and, with Pike’s direction, jabbed it into the man’s ass.

Then I backed up. Pike and Wooten slowly untangled themselves from the patient and watched as the drugs worked their magic. Within seconds the patient, still flat on his back in the middle of the street, was snoring. Pike grabbed the stretcher and the three of us snatched him up and loaded him into the ambulance. Once the doors were closed, Pike and Wooten exchanged a wary glance and laughed. It had been ugly but they’d gotten the job done. Wooten took out a pair of scissors and cut off the man’s pants to get a look at how much damage he’d done to his lower legs while Pike and I set to work on tying restraints.

Tying someone’s hands and feet to a stretcher with soft restraints is as much art as science, with special consideration needed for different patients. If they’re strong, for instance, you want to restrain one arm at their waist and the other above their head, thus separating their major muscle groups and making it that much harder to break out. You also need to be careful about what type of knots you tie.

To this day I know very little about knots other than that the type I tied that day should never be used to tie a patient’s hands. But, as is so often the case with acquired knowledge, this is something I had to learn the hard way.

Back in the ambulance we had the patient’s legs stabilized and bandaged, his vitals checked, IV lines running and – we thought – the restraints securely fashioned, so we started for the hospital. Pike was behind the wheel and Wooten and I sat in the back observing that awkward silence usually reserved for perfect strangers in an elevator. One thing about sedatives is they affect each patient differently and you never know how yours will act until after you’ve sedated him. If, for instance, a patient has been given that particular combination of drugs before he’ll have built up a tolerance and they’ll either last a shorter period or simply sedate him to a lesser extent. Other complicating factors exist, of course, including what else your patient has in his system. Large amounts of certain drugs, cocaine being among them, simply make it hard for sedation to truly set in. And so, after a few minutes on the road, our patient began to stir.

In reality, this isn’t all that uncommon and generally it’s not much of a concern if your patient has been properly restrained which, as I’ve alluded to, ours wasn’t. So I sat on the bench seat and watched this rather herky-jerky reanimation process with a pit in the bottom of my stomach. It was the very same feeling I got as a child while helping my step-father in the garage. He’d be underneath the car when suddenly oil would begin pouring out and in his fury he’d scream for me to hand him something in a voice so garbled by the car and the excitement that I wouldn’t be able to understand him. I’d freeze knowing that at any second, madder than ever, the problem worse than before, he’d poke his head out only to find me standing there empty-handed.

“Uh…he’s coming around,” I said after the patient opened his eyes.

Wooten shrugged. “He’s tied down.”

My hands began to sweat as the patient twitched, then jerked, a wild animal caught in a snare. He turned to me and shook his head in fury, then flopped back, sat up, kicked his legs and blew out a lungful of hot anger. Breathing heavily, he lifted his head and pulled against the restraints. His right hand, the one Pike had tied to the stretcher near the patient’s right ear, didn’t budge but the left hand, the left hand was clearly a problem. Already it was loosening and when he ran his fingers over the shoelace-style knot I’d tied it was clear all he’d have to do is tug on the right strand and it’d unspool. The patient and I locked eyes, both of us coming to the same realization at the same time, and I swear he smiled. Maybe he did, maybe he didn’t, but before I knew it he was untying the knot.

I yelled for Wooten but it was too late. Before either of us could react, the patient had freed his left hand and was reaching for the right. Wooten, again surprising me with his feline quickness, grabbed a sheet and yanked it hard over the patient’s face, if not fully restraining him then at least blinding him. Feeling useless following my knot-tying failure, I jumped up and tried to grab his free arm when a paralyzing pain shot right through me – the patient, half-restrained, partially-sedated, a little bit blind and totally out of his mind – reached up and grabbed my nuts.

It’d be nice to say I reacted firmly. That I endured the pain, swatted away his hand and set to work on regaining control of the situation. That would be nice but the scream I let out – terrified and desperate and too high-pitched to be mine – says otherwise. I don’t remember Pike stopping the ambulance. I don’t remember him getting in the back and properly restraining the patient. I hardly remember the trip to the hospital. What I do remember is a blinding, searing pain and my long, quiet period of huddled convalescence.

At some point we dropped the patient off. At some point we went back out and ran more calls. At some point the day ended and I went home and whatever I told my wife or my classmates of that first day was, in all likelihood, edited for content. Did I claim to be a hero? No. But did I own up to the scream? I doubt it.

Of course, there were other third-rides, more classroom hours. More quizzes and, in December, the national registry exam. I did fine on my rides, took the quizzes and passed the exam. I received my EMT certification in the mail and was prepared to begin my career. But I did all of those things with the knowledge that knots are knots, patients can turn on you and when all hell breaks loose, I’ll get the job done – but I’ll scream like a girl as I do it.

The Innocent Don't Run

Strange things go through your mind when you watch someone get shot. Matters of life, death, vengeance, punishment, redemption and mercy all swirl around in the blurry stew that is your sub-conscious mind.

For instance, you will recall in those first dizzying moments the old saying that there's no such thing as an innocent victim. That somewhere between crime and punishment reside certain truths, wrapped as they are in mystery. The lone man – whatever his intentions – who runs into trouble on the wrong side of town knows this all too well.

But it's not until it's all over – when the dust has settled and the blood has dried – that your thoughts turn to the aggressor. You will wonder, perhaps for the first time in your life, if, just maybe, the victim got what he deserved.

Bearing witness to violence raises a lot of questions and I’m not sure I have any answers. What I do have is a story.

It all started in a K-Mart parking lot. Understand, the store in question isn’t as classy as your typical K-Mart. And I say that with all the reverence of a man whose first job was running a cash register at one of these fine places. Trust me when I say you haven’t properly rung in the Fourth of July until you’ve had a monstrously fat woman hand you a soggy twenty that had spent the afternoon wedged between her bra and left breast.

Anyway, I was sitting in the parking lot eye-balling whores. One hundred percent true. The K-Mart on Cleveland Avenue resides between the interstate and a worn-out crack motel called the Palace Inn. Believe me, I have been to some places. Dirty and dangerous, rank with the stench of death and desperation, but I have rarely been somewhere as bad as the Palace Inn. But still, the whores there had a good deal. Situated as it was near the highway, all they had to do was wander around the parking lot and wait for the depraved, and a smattering of truckers, to come calling.

And they did. Day and night these skinny, worn-out white women would wobble down the hill, pick up a John, lead him up to the Palace Inn and then return, thirty minutes later, for another round. I couldn’t get enough. I’ve spent hours watching this parade of second-hand sex march on by, all honking horns and dancing clowns, happy as can be.

The downside to whores, of course, is that they attract the unsavory.

Drugs, drugs dealers, drug users and those who understand that, just as smoke precedes fire, money precedes drugs.

So I was sitting in the parking lot feeding stray dogs and bearing witness to the decline of an entire segment of the population when two men began arguing. I’d been vaguely aware that someone in overalls was standing about twenty yards to our right but paid him little mind.

I paid him even less when the argument started. Mainly because arguments, or at least the injuries they create, make up a huge part of our day. Say two guys are remodeling a house. Neither is making much money, both have marital problems, drinking problems, drug problems and one guy drops his end of the piece of plywood they’re carrying. An argument ensues and one of them pulls out a box cutter and slashes the other across the chest.

Or, perhaps, it’s two drunks hanging out at a liquor store. Best friends, known each other all their lives, when an argument starts over a lotto ticket or a half-finished pint of gin and before anyone knows it someone’s been slapped over the head with a hunk of concrete.

In both cases the loser will throw up his arms, his face streaked with tears, and claim to be an innocent victim. Will I help him? Naturally. Will I feel terrible for him? Probably not.

And anyway, it’s best to keep clear of arguments in-progress. Tammy and Darryl taught us that. So, my partner and I were talking when we heard a soft, harmless POP. Movies have given you the wrong impression. Guns, with the exception of really big ones, do not sound as though they’re firing a chunk of molten lead capable of ruining or even taking your life. They sound, well, harmless. So much so that even though I saw it, I still turned to my partner and said, ‘Did he just shoot that guy?’

The answer to that question, by the way, was yes. The guy in overalls, the one who’d been standing not twenty yards to our right, had shot the second man. Right in the throat. There was a brief pause as I, my partner, the victim, hell even the damn shooter, all froze as though trying to process what had just happened.

Finally the moment passed and the victim, in a funny, hobbled sort of way, started running. I turned to my partner. ‘Where’s he going? He got shot. Where’s he going?’

You would think, given that we’re an ambulance and probably exactly the sort of help he was hoping for that he’d be running our way. Nope. He was running sort of willy-nilly across the parking lot. Left hand over his throat, right hand flailing out to his side, he darted past the exhausted whores and the horny Johns, totally unnoticed by everyone except the stray dogs who in their weird animal kingdom way knew something was definitely wrong.

I knew, obviously, that we should be helping this man but our status as witnesses to the crime opened up a whole new world of possibilities. Mainly, would the shooter try to shoot us? I have a friend who worked for years on an ambulance in Compton. Of all places. Compton, home to Snoop Dogg and Ice Cube, birthplace of gangster rap – which, I’d like to say for the record is far superior to the Puff Daddy-inspired sample-happy crap that came around in the mid-90s. Compton, even real estate agents admit, is a bad place.

Anyway, my friend said one night he and his partner were driving around when they stumbled upon a guy who’d been shot. Being paramedics, they hopped out and were getting ready to start working the guy when a voice from the shadows said, ‘Y’all best let that motherfucker die.’ They quickly hopped back in the ambulance, drove off and radioed dispatch to have the police come and investigate a murder.

I myself have spent tense moments barricaded inside an apartment while an angry boyfriend pounds on the door trying to get in and finish the beating his girlfriend so rudely interrupted when she cracked him with a pan and fled to a friend’s place to call 911.

As we watched the victim flee, it was my partner who first raised the question.

‘Why do you think he did it?’
I laughed. ‘Hell, I’d run too.’
He shook his head. ‘The shooter, I mean.’

Quite frankly, until that moment I hadn’t even considered motives. There are, I’m sure, a million reasons to shoot someone but it seemed to me at the time there were more pressing questions – just how far our future patient was going to run pretty much topping my list. Not so for my partner.

‘Strange.’
It was all strange me to me. ‘Which part?’
‘Look at him. He’s not even running.’

By ‘him’ he meant the shooter and sure enough, he wasn’t running. He simply tucked his little .25 back into the bib pocket of his overalls and took a seat on the back bumper of his van. This, if you’re keeping score, is the cue we needed that our intervention wasn’t likely to draw any fire so we put the truck in gear and eased across the parking lot.

As we pulled up alongside the patient I unrolled the window and entered into one of the strangest conversations I’ve ever had.

‘Hey buddy. How, uh, how you doing?’ Come on, what do you say to a guy who’s been shot in the throat and is running for all he’s worth across a parking lot packed end-to-end with scrawny crack whores and jittery sex-starved truckers?

Evidently, you say nothing because he gave me a single glance – sort of a cross between thirsty man in a desert and cornered possum – and kept on running. I turned to my partner who just shrugged. I leaned out a little further.

‘How far do you plan on running because I’m really thinking we should get you in here and get you some help. Maybe even take you to the hospital. You know, being shot and all.’

He turned to me now as though seeing me for the first time and finally stopped. I’ve never knowingly been in the crosshairs of a rifle but I can imagine what it’s like. There was a strange tingle at the base of my neck as I stepped out and grabbed the patient’s arm. Somewhere not far behind us was the man who’d shot this guy and for all I knew he was presently drawing down with his .25 – a gun if not exactly feared for its earth-shattering firepower, known the world-over for being woefully inaccurate.

We quickly hustled him into the back of the ambulance and began conducting what you’d call triage. Basically all that means is you give the guy a once-over, identity life threats and determine which one poses the biggest threat. His wound being straight in the throat and an open and working airway being the most important part of maintaining a living patient, we didn’t have to do much triage. After a little poking around I learned the bullet had passed through his throat, just below and to the left of his Adam’s Apple and exited through his right shoulder blade.

‘Do you feel you can breathe alright?’
He nodded.
‘Can you talk?’
Another nod.
‘Can you do it? Just so I can see?’
‘Yeah.’ A little breathless, maybe a little desperate but he had been shot in the throat.
‘You hurting anywhere else?’
‘No.’
‘Okay. What happened?’
‘Fucker shot me.’

Seriously? That’s what you’re gonna say? I think, of all the variables, that part we got.

‘I know but…why?’
‘No fucking reason. Shit, I was askin’ him if he needed some help and next thing I know he shoots me in the neck.’

Perhaps not the most plausible explanation but people have done worse for less. Years ago I was called out to a house late at night. Since people tend to get squeamish when talking about injuries to children I’ll spare you the details but I will say that when it was all over I walked out of the children’s hospital to find my partner – a man with over a decade of EMS experience – standing quietly in the parking lot. He was staring off to the east, smoking and watching the first blue streaks of dawn creep into the sky. After a minute, he flicked his cigarette across the lot, turned to me and said, ‘There are some brutal motherfuckers out there.’

Though our patient was breathing and talking and appeared to be, all things considered, the luckiest person alive, I figured it best to get him to the hospital sooner than later. My partner nodded and soon we were rumbling down the highway, weaving around the afternoon traffic with the sirens blasting as I cut off his shirt, checked for other holes, listened to his breath sounds and started an IV.

A few minutes later we were in the trauma bay where chest x-rays proved what we had already suspected – despite being fired into our patient’s throat at pointblank range the bullet had somehow missed not only the numerous vessels running up and down his neck but also his rather large and incredibly important trachea.

Medically speaking, the questions had been answered. Practically speaking, nothing had been answered.

Who was he and what was he doing there? Did he live in the motel? Was he a pimp, a John, an addict or was he just a guy who showed up at K-Mart hoping to grab something on blue light special only to get shot in the neck?

Why was he shot? Who shot him? And did he really not see the ambulance?

I was unsatisfied.

As we headed outside I saw a cop car pull up near the ambulance bay. The cop got out and wandered over, casual as can be, and said ‘You guys just bring in a shooting from the, uh, you know, K-Mart?’ Yup. He started to ask if the guy was gonna live, what his name was. Blah, blah, blah. I wasn’t having any of that.

‘Did you catch the guy who shot him?’
‘I’m not sure catch is the right word. He was sitting there waiting for us.’
‘Seriously?’

But the cop was just as impatient to get answers to his questions as I was and continued on. I followed him.

‘What happened?’
‘Guy says he was standing by his van when your friend came wandering down from the Palace Inn and tried to rob him with a screwdriver.’
‘A screwdriver?’
‘Yeah. So he shot him.’
‘Yeah that part I got. Did he say what he was doing there?’
‘Nope.’
‘Say why he didn’t run?’

At this the cop finally stopped walking. He turned to me with a look that suggested I was perhaps too dumb to understand, but he was willing to try anyway.

He said, ‘You don’t run if you’re innocent.’

After that he disappeared. No doubt he headed straight into the trauma bay and slapped a pair of handcuffs on our patient.

My partner and I got into our ambulance and drove off but the whole thing kept swirling around in my brain. The whores, the shooting, the victim running away while the perpetrator casually tucked his gun away and awaited the arrival of the police. The stray dogs who from the very start had identified the victim as the guilty party.

I’ll never know why that man was at the K-Mart. Maybe it doesn’t matter. Someone tried to rob him and he did what so many of us have wanted to do so many times – he took the law into his own hands.

Was he guilty? I don’t know. But he sure as hell didn’t run.

Deliverance

Sweating beneath a knee-length plastic gown, goggles fogging up, rubber gloves slick with goo, the high-pitched screams of a natural child birth drowning out the sound of my own voice, I reached between the woman’s legs and grabbed her baby’s head, which, to my horror, immediately exploded.

There are a number of reasons people get into EMS. Some are called by a desire to help others. Some see it as an entrée into the world of medicine – which would make sense if a high-stress, work-all-hours-of-the-night, throw-your-back-out-while-carrying-fatties job that offers mediocre pay is your idea of a good way to dip your toe into the raging sea that is emergency medicine. Others are answering the adrenaline call of the sirens, blood and guts types who yearn to be characters in those horribly misleading television shows like Trauma.

Some, like me, are tourists. I simply want to observe the truly strange up-close. Much in the same way normal people go the zoo and stare into the gorilla enclosure, I hop on an ambulance and stare – popcorn in hand – at the weirdoes among us.

There are other reasons for pursuing a career in EMS of course including, I hate to admit, that a young man wakes one morning to find a GED and a clean driving record are his only marketable qualities. But fear not. Turds like this are weeded out after a bungled call or two which, I guess, when you really think about, is reason to fear.

Drive carefully.

Whatever path led us to this odd little world, it’s safe to say a desire to deliver babies in stairwells and cars and cluttered little bedrooms was not one of them. For all the time I spent in training – six months for EMT and another fourteen when I upgraded to paramedic – very little of it was dedicated to the slippery skill of delivering babies.

Perhaps as justification, my EMT instructor said some of us would never have the privilege of bringing another life into this world and to those who would he offered this: ‘You don’t deliver babies. Mothers do. You simply help.’

Rather flippant, I thought at the time. What happens when the baby comes out not breathing? Or when a blue arm pops out first? This, I thought, was something we should spend a great deal more time on. After all, delivering babies is a specialty. Whole hospitals are dedicated to the enterprise. But, like so many other aspects of EMS, it is yet another skill we would be expected to master with little training or experience.

So I set out in the hopes of being one of the lucky medics never called upon in such moments. My hopes were quickly dashed. In my first day on the job my partner and I were dispatched to a motel for a woman with abdominal pain. We walked through the door to find ourselves staring down a howling, sweating expectant mother, stripped bare at the waist.

Strange things happen to the human body during child birth. Even stranger things come out of it. Noises and liquids and pungent, alien smells – and all this before the child even considers sneaking out.

That particular child shot out like a greased watermelon and, before ever arriving at a hospital, had been suctioned, stimulated, cleaned, snipped free of his umbilical cord, wrapped in warm blankets and named. All this (with the exception of the last part, honestly I would never send a child out into the world with a name like Que’Shawn) by two young men armed with little more than their wits and a scalpel.

In the years since I have been present for a good many deliveries. Most of them have been easy, a few totally bewildering and one or two tragic to the point of criminality. That a mother can deliver a child in three feet of water and leave him submerged for six minutes because ‘he’s been breathing in water for the last nine months’ without spending the rest of her life in jail is truly mind-blowing. But it happens.

Today I’m experienced enough that should a woman ever find herself in the unfortunate position of delivering a child in my house I would be able to provide excellent, if not ecstatic, assistance. But it wasn’t always so, which brings us to the aforementioned exploding head.

Way, way back. Years ago, actually, when I was a brand new EMT I spent a few months under the tutelage of an experienced but rather burned-out medic. My own partner had recently shipped out to Saudi Arabia and his replacement was…how to say it?

He was good at his job. Honestly, if everyone approached their job with the same fervor as this man the world would be a better place. The problem was he had the expensive habit of getting tangled up with loose women. Though this may sound fun, the day inevitably comes when she asks you to take on a second job. ‘To buy a house,’ she says. Of course, buy a house is code for ‘I need time to bang another man,’ and so begins your misery.

For my partner it meant taking on a second EMS job. Since both of his jobs followed the one day on, two days off schedule, he worked two days in a row and was home only every third day. Think about that. You work forty-eight hours straight, go home for twenty-four and then return to work for anther forty-eight. And on and on for eternity.

So he was tired. And burned-out. But he got lucky in that I was in paramedic school, which meant not only was I desperate to get wrist-deep in every call but that he, technically, could allow it. So long as he was there to supervise. Which he was, in his own sleepy, grumpy way.

And so on a blistering hot August day we were bouncing down the road en route to a woman in labor. For the record, every call we get involving a pregnant woman comes out as ‘Woman in labor’ or ‘Imminent delivery’ or ‘Contractions less than one minute apart.’

Of course, we usually arrive to find a girl sitting quietly and happily on the couch, in no noticeable distress who felt ‘a little pain about twenty minutes ago.’ So when my partner offered to let me run the show if this was the real thing, I quickly agreed but did so without much hope of it being the real thing.

All that changed the second I walked through the door.

Two steps beyond the threshold and a horrible scream like someone being disemboweled came from an upstairs – Upstairs! Naturally! – bedroom. We hustled up, gear in hand, and were met at the top step by a rather strange and squirrely figure.

I’m not sure if he was the father of the child, the father of the woman in labor, a neighbor, friend or some combination thereof but he refused to give us any information. At all. In fact, during the entire time we were there the only thing he ever said was ‘Man, I need to go.’ Which he repeated every thirty seconds.

But he met us at the top step and motioned toward the bedroom. There were, of course, no lights. If you’ve been keeping score, you’ll notice that most of these stories take place in houses missing at least one of the basic utilities. Could be chance, but I doubt it.

By now my partner and I were joined by not only the patient and the Mystery Man but also by four firefighters. As a general rule firefighters abstain from touching women in labor. Probably some sort of fire rule they have; a code perhaps that dictates they stand as far as possible from the offending orifice and stare, mouths open, any time someone asks for their assistance.

If that is indeed so, these guys were doing a fantastic job. But of course, I was new and inexperienced and eager – a dangerous combination – and I wasn’t looking for help. I was looking to make things happen.

I turned to the Mystery Man and asked how long this had been going on, got no answer, then asked the same thing of the patient and received only a howl. She was clearly quite pregnant and evidently in distress of some sort so I asked her if she could make it downstairs with our help?

She howled and shook her head.

‘What if we carry you?’

Another headshake, much to the relief of the firefighters.

‘Man, I need to go,’ the Mystery Man said, though he didn’t.

I turned to my partner, who suggested we deliver here. Of course he also didn’t move, making it clear ‘us’ meant ‘me.’

So I opened our bag and yanked out the OB kit. I slipped on the plastic gown, put on the goggles and slid my hand into the rubber gloves which, unlike our regular gloves, extended halfway up the forearm.

I guess I was prepared, I was certainly hot, but I didn’t really know what to do next. A thousand things were swirling around in my mind. Things I’d learned in class, things I’d seen in movies, stories I’d heard about the birth of family and friends. But I’d never been in charge before. Where do you start?

Best, I decided, to start at the beginning.

‘So, uh, can I take a peek?’

That’s probably not the most medically sound way of telling a woman deep into a long and painful natural childbirth that your next move is to see if the baby is crowning but it worked. She grunted, howled and, with a violent heave, tossed the sheet on the floor.

All eyes turned to me as I silently cursed every medical text book I’d ever read. All the drawings and pictures and descriptions, the cocky reassurance of my EMT instructor that I’d simply be a spectator, all proved useless as I stared at the enormous tangle of undergrowth.

I couldn’t see a child, but then again I couldn’t see the entrance from which said child would emerge. In my head I pictured a machete-wielding Michael Douglas chopping his way through the Columbian jungle in Romancing the Stone.

I looked to my partner for guidance and received none. I looked to the firefighters for help but they were retreating faster than the Mystery Man who was mumbling, yet again, that he had to get the hell out of there. I cleared my throat, wholly unsure of what to do when the woman screamed, bucked up on the bed and flung her legs out.

There was simply no time to think so I didn’t. I stepped forward and called for someone to grab her right leg. Miraculously, someone did. I called out again and someone else grabbed the left leg. The woman was screaming now, her eyes bulging out, mouth open, neck veins about to burst.

‘Push!’ I yelled.

She pushed.

‘Keep pushing!’

She kept pushing.

‘Maybe a little more of the pushing…’

Yes, that one was a little flat but I was running out of things to say.

Suddenly, there it was. A head. Or, at least, a bulge. Movement, anyway. Once again my mind swirled with contingencies. Suction, a voice in my head screamed. Start with the mouth, then the nose. Check for meconium, don’t drop him, stimulate him if he’s not breathing, put him on the mother’s belly, cut the cord but make sure you do it at the right distances. Do you remember when to start CPR and how fast to do it?

A thousand steps, each committed to memory months and in some cases years before, rushed through my head in the seconds following that first sighting of what maybe, perhaps, was a head.

Of course, as I was thinking I was also doing. The bulge continued to emerge and I slid my hands down, like a catcher, curved just so, prepared to usher this young man into the world.

I’ll stop here to say, again, that this was a long time ago. As I’ve said, since this day I’ve helped deliver a number of babies and many of those doubts careering through my mind that day have since found purchase on the solid ground of experience. Things you should look for, prepare for. What to expect and, also, what to ask.

Simple questions, but important all the same. Like has your water broken yet?

But of course, I didn’t know these things then and so, when the bulge – disguised, as I’ve noted, by an inhuman amount of hair – emerged I reached for it.

My partner saw what I was about to do and tried to stop me. The firefighters closed their eyes. The Mystery Man, from his vantage point across the room, reiterated his need to leave.

But, surging with adrenaline, I reached for what I took to be the child’s head and grabbed it. And it exploded. I remember a moment of confusion as hot liquid blasted into my hands, rushed up my arms and splashed onto the plastic gown.

Somewhere deep inside I wondered what in hell had just happened.

But the outside world, the real world, had already figured it out. The delicate but quite full sack of fluid had slipped out during a push and rather than allowing it to break on its own I had ruptured it with an ill-advised reach-in. And it exploded.

Seriously.

I immediately jumped back, peeled off the soaked gloves, tossed the speckled goggles away and yanked off the soaked gown. As I recovered my senses and frantically checked for any fluid infiltration, my partner stepped in and rather effortlessly delivered the child.

Imagine. There I was cowering in the corner while the baby – the real one this time – crowned and then squeaked out. Requiring no assistance whatsoever, he simply opened his eyes and started crying. Before I could even put on another pair of gloves he’d been dried and the cord cut.

It was to be my first delivery and I’d missed it.

We packaged mother and child for transport and took off, leaving behind the firefighters and a suddenly-content-to-be-at-home Mystery Man.

Immediately thereafter, anytime water was spilled my co-workers would laugh and shout ‘Look out, Hazzard!’ Or ‘Go get your goggles!’

To make the world smile is itself a gift, right?

Since that day whenever I have a patient in labor I think back to my EMT instructor. His comments, suddenly not so flippant, accompany the realization that we do not deliver babies. We’re just along for the ride. And for an EMS tourist like me, that’s not such a bad thing.

The Tricky Art of Raising the Dead

I knelt on the dead woman’s bed, my weight pressing down on the mattress until her cold and lifeless body rolled into me. Then I lifted her wig, leaned in close and whispered, ‘Open your eyes.’

Every year twenty million Americans commit suicide. Actually, I have no idea if that’s true. I just made the number up. But this being the age of Google you can probably find out yourself. More than likely the number is high. A good bit lower than twenty million perhaps, but high nonetheless.

Anyhow, when it comes to suicide several things have always fascinated me. Chief among them being the deceased’s method of choice. If Groundhog Day taught us anything it’s that there is, literally, no limit to the number of ways you can off yourself. After all, one of Bill Murray’s final deaths comes at the hands of a groundhog with road rage. The possibilities are endless.

Which raises a lot of questions. Such as why would you choose something long and slow and painful in a world in which the means of self-inflicted death are so limitless and hilarious? (Come on, death by road-raging groundhog is funny)

Personally, I’m a jumper. Mind you, not the middle-of-rush-hour-stop-traffic-all-day kind of jumper, but a jumper all the same. And if you’re concerned about the mental state of a person who’s already chosen his preferred means of self-removal, worry not. I just happen to have seen a few. And at some point even the most sound among us are forced to step back, hands on hips, and say ‘That is not the way I would’ve done it.’

My other point of fascination when it comes to suicide is the large number of non-committals. Someone once said ‘You know it’s time to kill yourself when you fuck up suicide.’ Which, of course, brings us back to the woman I raised from the dead just a few paragraphs ago.

It was a dark and stormy night. Seriously. It truly was a crappy night and anyone who’s ever worked in EMS can tell you how horrible it is to do our job in the rain. So I was just thrilled to be skidding through town for reports of a ‘suicide attempt, breathing status unknown.’

By this point in my life I had seen a number of these: some were true emergencies and others, well, not so much. Every time I catch one of these calls it brings me back to the first suicide I ever ran. It was a middle-aged woman who had passed the long dark night in the company of a dozen kitchen utensils (I still can’t look at a corkscrew the same way). What we found on arrival was straight out of Stephen King.

Imagine red pudding. Everywhere. Stunningly, the woman was very much alive. Walking around, crying, narrating her strange night as I followed her with a handful of four-by-four bandages and rolls of cotton cling. The despondent are a very strange lot.

But at least she lived alone. Unlike the lost soul we were being called out to help right now. As soon as we pulled up to the curb a teenage girl in curlers darted across the law, hands waving wildly in the air. We hopped out, grabbed our gear and sloshed through the rain to the frantic cadence of sixteen-year-old in hysterics.

Inside we were met by five more girls (Yes, FIVE. All between twenty and ten. Seriously, where do these people find the time?) who were at various stages of agitation. We were quickly ushered down a set of steps and into a very small hallway. An old woman, not a day under ninety, appeared from nowhere and, with a single look, sent the crowd of cackling girls back upstairs.

Truly enthralled, my partner and I stood in this very tiny hallway with this very old woman. And waited.

Finally she spat a stream of tobacco juice into a plastic cup and said, ‘I’m so tired of this nonsense.’ I nodded. ‘Who’s not?’

I’m not sure if that was the right thing to say in that particular circumstance but the old woman turned and opened a door covered in old stickers and magic marker scribbles. ‘She’s in there.’

When I was a kid, if left to my own devices, my room would get messy. Most people can say the same. However, the state of the room we had just entered into wasn’t messy. It was…it was the product of a lifestyle choice. One that said, ‘You do what you want. Me, I wanna be a turd.’

At the far end of the room, flopped out in the middle of a sheetless queen-sized bed, was our patient. The old woman shot out another stream of tobacco juice. ‘She’s gone and killed herself again.’

That struck me as an interesting choice of words.

It probably goes without saying that I’ve seen the dead. Natural causes, violent causes. Those who have been dead for weeks, those whose last breaths I was there to witness. These people, the dead, they have a certain…lifelessness to them. It’s very easy to see, not so easy to duplicate. Not that people don’t try.

One of my old partners and I walked in on a family so tricked by their loved one's fake death we had to physically stop them from doing well-intentioned but piss-poor CPR. Then we gave the deceased a quick whiff of ammonia and she perked right up. Hand of God, reached right down and saved her. Not that she was grateful.

So suffice it to say I can spot a faker and the woman flopped out on the bed before us? She did not look dead. Still, my partner stepped in to take a closer look and I turned to the old woman. Before I could say a word she summed up our patient’s life-story as a series of bad decisions punctuated by the occasional suicide. I cannot tell you, at that moment, how much I liked this little old woman. She was like a wig-wearing, tobacco-spitting Buddha.

By now my partner had assessed our non-dead patient. Her blood pressure, heart rate, respiratory rate, blood sugar and oxygen levels were all perfect. There was no sign of trauma and her skin was warm and dry. Our attention could now be turned to the tricky art of raising the dead.

There are a number of ways to do this, none of them medical. Sometimes you can shame them. Take for example the underappreciated woman who went limp during Thanksgiving dinner, slithered out of her chair and, rather ceremoniously, died under the table. I saved her from the flames of hell by saying she had sent her grandmother into a state of shock from which the poor woman may never recover.

You can also flick their eyelids–the undead tend to blink—or squeeze their fingertips between your thumb and a pen. The pain causes them to draw back, a reflex not commonly found among the dead. Sliding an airway device into their right nostril has the tendency to wake them in dramatic fashion—think Uma Thurman in Pulp Fiction.

I usually start with a little conversation. Ask them nicely to open their eyes and talk because the next step, I tell them, is for me to stick you with needles, shock you with electricity and shove a tube down your throat. And you don’t want that.

In the years I’ve been doing this I’ve heard people heap a lot of accolades on the EMS profession. But with all the soothsaying, the voodoo, the smoke and mirrors, I like to think of us as Witch Doctors.

Just as I was about to begin my séance the old woman, ever full of wonder, shot a stream of tobacco juice through her front teeth and said, ‘She usually leaves a suicide note.’

If ever a single sentence has delighted me more I couldn’t tell you what it was. I scanned the dresser, the night stand, the floor. I found a lot of things, many of them with no business in someone’s bedroom, but no sign of any note. I was about to give up when my gaze fell upon our patient.

She was sprawled out in the bed, eyes closed, mouth open. Her left arm was extended at an unnatural angle and pointing, more or less, toward her headboard. It was one of those strange beds where the headboard doubles as a shelf and there, on the top shelf was the note. My hands trembled.

It’s very rare to find out what led someone to their make-believe suicide. True, actual suicides tend to be a little tight-lipped but typically when you out a faker they’re either bitter or embarrassed and either way in no mood to talk. That other woman I mentioned? The one my partner woke up with ammonia? She was so mad she peed in the ambulance…while staring my too-stunned-to-respond partner in the eye. People are strange.

Anyway, standing on the edge of the bed, letter in hand, I began to read. Aloud. Let me stop here and say I don’t plan to kill myself. As a kid I couldn’t even pull my own teeth. I’d make my mom do it. So I’m a little iffy about hurting myself. Add to that the whole ‘leaving loved ones behind in the wake of your own selfishness’ thing and I just, it’s not my thing.

But, were I to do it—AND leave a suicide note—I’d make damn sure the thing was legendary. At the very least I’d make sure the spelling was passable. Our patient did no such thing. Misspelled words were just the beginning. There were run-on sentences, half-finished sentences, non-sentences. Seriously, how do you graduate from high school with the belief that ‘Ain’t no reason be look again’ means anything, let alone something you need to express with the final three hundred words you’ll ever compile.

I soldiered on. It should be said I did so with a great deal of decorum. The old woman, after all, was a relation of some sort. Granted, a relation at the end of her rope and whose straight-forward take on life and fake death made her an instant favorite of mine, but she was a relation nonetheless.

Finally I got to the How of our letter. In bold script that included a large arrow pointing toward the shelf, the note read ‘And so I swallowed these bullets and them pills.’

I instantly scrambled across the bed and there, propped up on the top shelf for our viewing pleasure were four Tylenol and three 22 caliber bullets. It should be mentioned that a twenty-two does not shoot large bullets. We aren’t talking fifty cal or shotgun shells. The dreaded twenty-two fires a bullet the size of the little red eraser on the end of a pencil. Even with the shell casing it’s still smaller than a cashew. Granted they can do a great deal of harm should they enter your body by means of, say, a gun. But when swallowed? Not so much.

I fought hard not to laugh. I bit my tongue, my lip. I hid behind the suicide note as a smile crept across my face. Just as I was sure I could hold it no longer a snicker rose up behind me. It was the old lady. Have I said how much I love this woman?

But there was real work at hand now. Tylenol seems like a very innocent drug. We take it all the time without issue, so it’s a common choice for young girls looking to punish a boyfriend or a parent. ‘I’ll just take a few of these,’ the girl says to herself as she swallows twenty Tylenol, ‘and then they’ll be sorry.’ And someone will be sorry, alright.

Tylenol, when taken in even medium-sized quantities kills the liver. Slowly. And painfully. The ones lucky enough to be found quickly can look forward to hours of a rather painful and brutal process called a stomach lavage. The others can look forward to a slow and unnecessary death.

I quickly located and dumped out the bottle. The pill count printed on the label was twenty five and I found eighteen. That’s right. Including the four already removed for demonstrative purposes, our patient had taken three tablets. Now we all laughed.

Still our patient feigned death. I read on. More finger-pointing, accompanied by more snickering from the old lady—seriously, who related to this woman wouldn’t want to extend their life by decades simply to increase the amount of time spent in her presence?

At the bottom our patient had signed her name—illegible—and had been courteous enough to include a PS.

This addendum really piqued my curiosity. I wondered what kind of insight, what tiny piece of wisdom was so important it had to be included in the suicide note, but was trivial enough to be excluded from the main text? This I had to know. I read on.

‘PS. Nook Nook will always be in my heart.’

I lowered the note. ‘Who the hell is Nook Nook?’

The old woman shot out a stream of tobacco juice. ‘Jackass who used to live down the street.’ Before I could ask how he passed, she said, ‘And he didn’t even die. He moved to Charlotte.’

And there you have it. The wisdom of our age knows no bounds. I tossed the note and crawled across the bed. I reached out, lifted the dead woman’s wig and told her we’d had enough. That you can’t die from swallowing bullets or by taking three Tylenol. I said her family was very concerned—here the old woman tittered—and would certainly be delighted to hear she was fine.

The game is up, I said, we all know you’re alive.

‘Besides, Nook Nook not only resides permanently in your heart but also a mere four hours north. Open your eyes. Now.’

And she did.

A Curse Wrapped in a Prayer

Weaving my way through darkened halls stinking of mold and filthy bodies, boots sticking to the floor with each step, I tell myself, as if I needed reminding, this is not how I wanted to start the day.

On the stairwell, weighted down with forty, fifty pounds of equipment I pass a ghost – bone-thin and wearing ragged clothes – who shakes his head and says, ‘Motherfucker don’t look good at all.’ Have I said it? Do I even need to say it?

I tell myself the anticipation is usually the most dramatic part of a call but when we reach the basement this theory is shot to hell. Sprawled on the floor and surrounded by a crowd of gawkers and medical theorizers – ‘I seen that shit before. That shit right there AIDS’ – is our violently convulsing patient.

‘This is not how I wanted to start the day.’

It’s less a statement than a whisper, a curse wrapped in a prayer. My partner grunts and leans over the patient.

If someone had asked me twenty minutes ago how the day should start I would’ve said a desperate asthmatic, an interesting 48, perhaps a sweet old lady with chronic hip pain. But no one asked me. And so we’re here. In the basement of a homeless shelter.

All-in, Atlanta has a dozen or more homeless shelters. They vary in size, population, mission, cleanliness and effectiveness. In northwest Atlanta there’s a women’s shelter crammed wall-to-wall with laughing children, their mothers sullenly sorting out the details of their collapsing lives.

One of the downtown shelters occupies the old city jail, which is a whole lot more ironic than anything mentioned in that stupid Alanis Morissette song. Once you’ve been in a jail there’s no mistaking the architecture: the severity of its design, the pervading philosophy of containment and control. Not surprisingly the residents live like inmates, each floor its own cell block, each room its own cell. The steel doors are still attached, the locks ready to be thrown as though fate, unsure of what to do with either the building or the men, has left its options open.

The battered women’s shelter resides in secrecy.

And squatting in the shadow of the Capitol is a shelter for the mentally ill. In my experience a large number of the homeless fall into this category, either through some unlucky twist of genetics or, just as likely, the mind-cooking effects of illicit drug use. Whitney Houston was right: Crack is whack. There’s an old woman living in the psych shelter, Rory, who has unnaturally thick, white hair and speaks in shrill, staccato bursts. Last time I picked her up she refused to leave her room until I went in there, alone, and shared an imaginary lunch with her. Picture me at three a.m.: locked in with Rory, two hundred and fifty cockroaches and enough rusted cutlery to give tetanus to half of Asia. As I nibbled a make-believe sandwich it occurred to me that my wife and dog were happily asleep on the far side of town.

Each of these places, even on their worst day, is a far cry better than the hell hole my partner and I are headed for. A massive structure in the middle of town, this particular shelter seems to specialize in loitering. Morning, noon and night hundreds of men crowd the surrounding blocks, arguing, fighting, pissing, getting high, getting arrested. It’s so out of control a local bar owner made national news for designing the Bumbot: a water-squirting robot that chases off the homeless like they were naughty cats.

Today, like every day, the surrounding block is crowded. As I step out of the ambulance a man leaning against the wall takes a long drag on his cigarette and says, ‘Guy’s inside.’ Where inside, I ask. He rolls his head on his shoulders like I’m really putting him out and says he’s gonna lead us back. Another drag on his cigarette. I ask when.

‘Huh?’
‘We going now or we gonna sit out here and smoke for a while?’
‘Sheeit.’ He angrily stubs his cigarette out and disappears through the front door.

Behind our slow-moving but conscientious guide we pass through the sleeping areas for both temporary and permanent residents. That’s right. Permanent residents. In a homeless shelter. There are truths in this universe so confounding they were never meant to be revealed because doing so would undermine the very laws of nature. How a man becomes a permanent resident of a homeless shelter – is he still homeless? – is one of them. So I don’t ask.

As we pass the showers I sense a growing unease. Our guide has no idea where he's going. He radios to someone else who advises him the patient is downstairs. In a huff he leads us down into the dayroom, a gathering space where hundreds more men sleep in chairs, play cards, talk to themselves, fight, piss and steal prescription drugs. In the building’s original incarnation it was probably a delivery bay. Two large overhead doors open onto the street. The lighting is dim and the floors, walls and ceiling are made of crumbling concrete. The air is heavy with stink and activity. We can hardly see to pick our way through.

Every few feet someone yells, ‘Here go your patient!’ to the delight of his friends. Others shuffle up alongside us, ghosts in the musty air, and ask us to look at boils and cuts, abscessed teeth and gangrenous fingers. We push on into the dark, past the yelling, laughing, cussing and horrible tubercular coughing. We push past the makeshift alter, occupied at the moment by a chubby preacher whose voice carries over the noise. ‘And you must say onto Him, “Lord Jesus I give myself over to you for thou art King!”’

And then the descent. Step by step into the black nothing that, far from empty, is filled with chaotic voices. At the bottom, bathed in orange light, is our patient, surrounded by his faithful contingent of gawkers. These men, half-drugged and quite possibly insane, are down here for a variety of reasons. Boredom and curiosity, for starters. There’s also a lunatic fringe convinced they can help and a strange minority actually pushed the edge of tears for a man they do not know.

A man, as I’ve said, who’s convulsing violently on the floor. My partner squats, afraid if he sets the bag down it’ll adhere to the floor, and pulls out a needle and syringe. Seizures are common. Incredibly so. The thought of how many seizure patients are driving up and down are streets right now is sobering. Dangerous and horrible as they seem, however, they’re quite easy to stop.

I reach into the drug bag, also suspended from the sticky floor, and pull out a vial of versed. My partner grabs it, pokes the needle in, forces a cc of air into the vial and quickly draws out an equal amount of seizure-stopping benzodiazepine. Clamping the syringe between his teeth like a modern day pirate, he rolls up the patient’s sleeve and jabs him with the needle. Medicine in, seizure out.

The hand of God has just touched this filthy basement and a hush settles on the men around us. ‘Sheeit, that right there is some heavy shit. Heavy fucking shit.’

We quickly begin a series of questions and tests, each designed to confirm what we hope to be true: this man has a history of seizures, has not been taking his medicine – probably in favor of drugs or alcohol – which explains today’s issue. But nobody knows him. Not enough to confirm or deny anything.

With a back cramp developing I shift my weight. My left foot, planted less than a minute, is already stuck to the floor. I tug and it pops loose the way your jaw does after you bite down on a Jolly Rancher. My partner looks around and says, ‘What the hell are we standing in?’ What the hell are we standing in? Theoretically it’s just concrete. But it’s covered with black ooze as dark as pitch and the texture of a movie theatre floor...That is, if instead of soda what covered the floor beneath your seat was decades’ worth of old urine. Nobody answers. Nobody wants to know, really. I take out a flashlight, hand it to my partner and clear my throat. ‘So long as there’s no trauma let’s get him up and get the hell outta here.’

He shines the light and instantly everything changes. A puddle of blood extends across the floor beyond the man’s head. A quick survey of his skull reveals a huge cut and a slight indention. ‘Could be old,’ I say.

As if in response the man begins seizing again, more violently than the first time. The group of gawkers jumps back. I prepare more versed, yelling above the gathering noise that I need to know what happened.

Someone thinks he fell. Someone else thinks he was pushed. Maybe he’s been here since last night. Maybe not.

‘Not how I wanted to start the day,’ I say just as a stream of vomit shoots across the room. The gawkers immediately clear out. My partner gets on the radio to request help but we’re in the basement of a large brick building. No reception. We’re on our own.

For the next ten minutes we struggle to get the man immobilized, to suction out his mouth, to get him on oxygen and, painfully, to get him up the stairs. Carrying all of our gear plus an unconscious and volcanically spewing patient up steep stairs in the dark isn’t as easy as it sounds. But time is working against us so we push on.

Upstairs we have light but things don't get any easier. The hundreds of loiterers crowd around us. They push and yell, some trying to clear a path, others intentionally stopping progress. They scream at each other, at us. Some ignore the man and ask what we can do for a stomach ache. The preacher fights his way through the crowd, steps in front of us and lays a hand on the man’s chest. He begins to convulse again. ‘This man needs prayer,’ he says. I ram the stretcher into the preacher’s gut. ‘I already prayed. God told me to get his ass to the hospital.’

And just like that we’re gone. Hurtling down the street. He seizes twice more en route. There are more medicines, IV lines, suction. The entire world smells like vomit and urine. At the hospital we wheel him into the trauma bay where a half-dozen doctors and nurses set upon him, their hands expertly moving over him with the practiced skill of people who do this every day.

He is alive when we leave but how long he’ll stay that way is impossible to know.

Later that day we go back to the shelter. Something little this time. Nothing’s changed. The same loitering and arguing, the same smells. The preacher calling out from his tiny homemade pulpit. ‘Whosoever will come let him!’

And then it’s over. We clean the ambulance, return our equipment and head home. I unlace my boots on the porch. My wife opens the door, a smile on her face.

‘You leaving those out here?’
‘Yup.’
‘Why?’
‘You really wanna know?’

After a long, hot shower I pour myself a drink and sit down. At some point during my shift an email went out about tonight. Dinner at our favorite Mexican place. Drinks outside in the spring air. Friends. ‘Sound good?’ my wife asks. It does. We hop in the car, windows down, sunroof open, trees passing overhead in a lush green blur. I turn on the radio and my wife asks how my day was.

Started out pretty poorly, I say. But it’s looking up.

There Has Been a Jailbreak

Some things are hard to explain. Sometimes questions like ‘What were you thinking?’ are better left unanswered. Sometimes you should just keep your mouth shut and see what happens.

Back in my sophomore year at The Citadel I knew a Jordanian whose alarm clock played the Muslim call to prayer. On a hot afternoon I snuck into the guard tower, activated the campus-wide PA system and turned on my friend’s clock. Know what happens when several thousand young men looking for an excuse to rebel are suddenly blasted with a recording of an Arab singing his praises to Allah? I do.

Twenty minutes later, following a brief but memorable riot, I found myself face-to-face with a general whose three tours in Vietnam had left him slightly unhinged. I learned two things that day. The first being ‘Because I thought it’d be funny’ is not a good answer to ‘What in hell were you thinking?’ The second of course is that some things, in hindsight, are hard to explain.

And so it was that nearly ten years later I found myself staring at the Director of EMS Operations (that’d be the boss of my boss’ boss) being asked a now-familiar question. And really, what had I been thinking? I still wasn't sure so I said nothing. This silence, awkward as it was, lasted a long time which was kinda funny when you consider how much had been said to or about me over the last twenty four hours. Words like practical joker, dumbass, punishment and suspension. Hell even reckless endangerment and termination had been making the rounds.

But of all the things that had been said one word stuck out. Sure, if you wanna be technical, the offending phrase consisted of exactly eighteen words but really only one mattered. The word that had roused an unsuspecting if overzealous neighborhood association president from his bed. The word that led to the awkward silence presently making me squirm. The very same word, in fact, from which my entire career presently hung.

That word was jailbreak.

Some background.

EMS, as you’ve probably surmised, is not like your job. For lots of reasons. Sure, we get sent out to car wrecks and shootings and over-heated joggers. And yes you could say our odd habit of roaming the streets hoping not only for carnage but an opportunity to fix it makes us appear, among other things, like the product of an unnatural liaison between Mother Theresa and Geraldo Rivera.

But it’s different in other, more subtle, ways as well. We work strange hours. In fact we work all hours. And we are truly a feast or famine occupation, sometimes hip deep in bloody messes and trivial complaints and other times not so much. And when it’s slow you wait.

And wait.

They say idle hands are the devil’s workshop. What they don’t say is when it comes time to explain yourself the devil’s never around to help.

If the devil had been there that afternoon, this is probably what he would’ve said.

See, I had picked up an overtime shift. An easy one. An eight-hour Sunday shift that started at 7 a.m. They don’t get much easier than that. Sundays are usually quiet but that day was quieter than most and so when we put ourselves in-service we were sent to the very edge of the city…to a post not far from the Federal Penitentiary.

Working in Atlanta for an EMS service that runs over a hundred thousand calls a year doesn’t allow all that much downtime. But, as I’ve said, that day was particularly quiet. My partner and I talked for a while but how long can you really talk to one person before you get bored? We turned on the radio but it wasn’t working. I tried to buy a newspaper but the gas station had none.

What we did have, in perfect working order, was a PA. Ambulances have all kinds of gadgets. Suction units, cardiac monitors, drugs, sirens, flashing lights. But the thing that always catches my attention is the PA. Now, you might say this fascination suggests I didn’t learn my lesson all those years ago but I like to think it’s because they’re the only thing we never use. I’m not sure why we even have them. But we do.

And so there we were on a quiet Sunday morning, on a quiet side street and, well, I keyed up the PA.

‘Helllloooooo. Can you hear me? This is your toilet talking.’

My partner also keyed up the mic, introduced himself as the third cousin of Bob Marley and then we set it down. But you know how it goes. There’s always a voice in the back of you head whispering that no harm could possibly come from pushing it one step farther.

And so I grabbed the mic again. Did I mention we were two blocks away from the Federal Penitentiary, a massive prison with a maximum security block?

‘May I have your attention please. There has been a jailbreak. I repeat there has been a jailbreak.’

For a few seconds it seemed I was right in thinking we were too far from the houses for anyone to have heard us. Well, that all changed pretty fast.

Suddenly a door flew open and a skinny little hipster bolted out onto his porch. At first I didn’t pay him any mind. It was eight in the morning, we were in a bad neighborhood and this guy had a pirate flag hanging from his house. Did he really expect to be taken seriously?

I can tell you now the answer to that question is yes.

He darted down the steps and started stomping his way across the street.

‘He coming over here?’
Trying not to make eye contact with him, my partner said, ‘Looks like it.’
‘Well this should be fun.’

The guy stomped right up to the driver’s side window and started yelling. My partner, God bless him, smiled through the glass. ‘I can’t hear you.’

This infuriated the little guy so much that, I swear on my life, his feet came off the ground.

‘Unroll it, then!’

My partner reached up and tapped the window button, slowly lowering the window with a loud, rubbery squuuueeeeaaaaakkkk.

He smiled. ‘What’s up?’

For the next five minutes the little guy railed on, mostly about us waking him up at eight on a Sunday morning but with a heavy emphasis on ‘people live here, you know. People live here.’ And so, when he finally ran out of breath, we apologized and he stomped back into his house, turning to glare at us every few steps.

You know how some people get more worked up the more they think about something? The little guy fits into that category. Two hours later we got a call from one of our supervisors. We needed to get back to Grady. Now.

What followed was a long and surreal series of conversations (every few minutes the little guy would call back and up his demands) in which we were progressively warned. Turns out what started as ‘They woke me up’ turned into ‘They were rude as hell,’ then later morphed into ‘I want them fired’ and finally came to rest on ‘I want them arrested.’

‘Arrested for what?’

Our supervisor shook his head. According to this guy our close proximity to the federal pen made saying the word ‘jailbreak’ akin to shouting ‘Fire!’ in a crowded theatre. He wanted us arrested on reckless endangerment charges.

Which is what brought me, first thing the next morning, into the Director of Operations’ office. She clearly had better things to do, as did I, but she dutifully looked over the complaint and then settled into the awkward silence we presently occupied.

Just as I was sure something bad was going to happen to me I noticed, the bottom corner of her mouth twitch. That was followed by another twitch, then another and soon her entire mouth broke out into a huge grin. She closed her eyes and tried to look serious the way parents do when their child gets into trouble but looks cute doing it.

‘Did you really say that?’
‘Yeah.’
Another smile. ‘You know you’re an idiot, right?’
‘That’s what my wife says.’
‘Get back to work. I’ll take care of this guy.’
‘Thank you.’
Then, as I was leaving, ‘Mr. Hazzard?’
‘Yes?’
‘No more PA. Okay?’
‘Done.’

I’m not sure what she did to calm the little guy down but it worked because I never heard another word about it until…

Two weeks later I’m at a bar and who do I see across the room, watching soccer and screaming at the TV? The little guy. I looked at my friends, my wife.

‘That’s him.’
‘You sure?’
‘He wanted me arrested. I’m sure.’ Pause to think. ‘Should I buy him a drink?’

Seconds later I find myself at the bar ordering a shot. And it all comes back to me. The quiet morning, the broken radio, the allure of the PA, the federal pen, the pirate flag, a jailbreak, the long, loud squeak of the window as it unrolled. I think about his tirade, our (evidently) inadequate apology, the escalating threats to my livelihood – did he really want to have us arrested? And, of course, I think of my boss’ boss’ boss smiling at my non-explanation.

I take the shot, walk over, clear my throat.

You might wonder why I would provoke a guy I’d once pissed off so badly he tried not only to get me fired but tossed in the clink. You might even wonder what I was thinking.

Well, some things are hard to explain.

Ten Seconds til Midnight

Albert carefully opens his notebook and smoothes out the pages with his enormous hand. He plucks a pen from an afro bristling with lint and sticks, and then stares up with his giant doe eyes.

‘Can you repeat that, please?’

My partner clears his throat. ‘Big Gulps, huh?’

Albert focuses on the pen and carefully writes ‘BigGulpsHuh’ at the bottom left hand corner of the page, capping off his long list of psychiatric meds with a quote from Dumb and Dumber.

My partner leans back on his heels as a huge smile spreads across his face. This has become his favorite game.

You see, one night last year my partner convinced Albert Brass Monkey wasn’t just a Beastie Boys song but an anti-psychotic medication. Skeptical at first, Albert thought his way through it, let it roll around on his tongue for a minute and after careful consideration he agreed.

‘I need to write that one down,’ he said, taking out his pen. ‘I think I’m supposed to be taking that one, too.’

Ever since that night my partner has been slowly adding phantom meds to Albert’s list. At last check BringOutTheGimp, CharlieDontSurf and BigLebowski have been entered into the US Pharmacopeia. BigGulpsHuh has just made the list.

It’s a harmless joke but as Albert jabs his pen back into his afro and shifts his considerable weight, his bull shoulders blocking out the light behind him, it occurs to me that someday Albert is going to snap. And considering genetics have hung four hundred pounds on his six-foot-ten frame the question of how I would go about dealing with him ceases to be academic.

Not to mention he’s a schizophrenic. Rule number one with mental patients is never turn your back. Even the ones who take their meds have bad days and clearly Albert has an incredibly loose sense of what defines a medication.

Once Albert has tucked away his notebook I ask him what I can do for him.

‘I gotta go to thirteen,’ he says.

Thirteen is Grady’s psych ward.

I may be sarcastic and cynical but I will readily tell you there are signs that all has not been lost. That the psychiatric facility at Georgia’s largest public hospital occupies the entirety of the building’s thirteenth floor is one of them.

That’s right. The thirteenth floor. You can’t help but laugh. You can’t help but wonder if it was an oversight. I hope to God it wasn’t.

In today’s era of public apologies and oppressive political correctness, housing psych patients on the Thirteenth floor is an all-too-rare but gloriously unrepentant prank.

It has always stricken me as something George Orwell, Joseph Heller or Kurt Vonnegut would have dreamt up: Not so much a dig at the nuts confined within its padded walls as a cosmic joke played out on those of us who must venture up to its paranoid halls in the name of patient care.

As I start my paperwork I ask Albert why now. Why at twenty past eleven in a driving rain has he decided he has to go up to Thirteen?

‘It’s twenty-six past eleven,’ he says.

Fine. Twenty-six, forty-six, a hundred and six. Why now?

‘I can’t listen to them anymore.’

‘You’re hearing voices?’

He nods and bobs his shoulders and the ambulance rocks like a small boat.

‘What are they saying?’

‘Bad things. Mean things. Telling me I ain’t worth nothing.’

‘They telling you to hurt yourself?’

He nods his head and the ambulance crests another wave.

‘They telling you to hurt other people?’

Albert looks away; a nervous child caught lying to his parents.

‘Albert. Are they telling you to hurt other people?’

‘They want me to purge myself. I’m rotting inside and I have to be ripped open so the foul can come out. I have to be relieved of this burden.’

There’s just not a whole lot you can say to that.

‘Huh.’

‘But they want me to wait. To do it at ten seconds ‘til midnight.’

I check my watch. 11:28.

‘You’ll probably still be here then,’ he says. ‘You’ll probably try to stop me. I’ll probably have to kill you.’

The next fifteen seconds pass in silence. Albert, of course, does not sense my unease. That I have picked him up dozens of times in the last several years, that we have talked and joked and extended to one another a certain degree of mutual respect does not, in his mind, preclude sudden senseless violence.

At least he’s given me a warning.

All too many times we pick up psych patients who calmly walk to the ambulance, buckle themselves into the bench seat and ride happily for ten minutes before deciding to listen to the advice of an entity created by their particular chemical imbalance. Get out, the voice tells them. Now. And all hell breaks loose.

My partner clears his throat and says ‘Five and five and a four-point?’

What he’s asking is if I wanna sedate Albert with five milligrams of versed, five milligrams of haldol and then tie him down by his wrists and ankles.

I tell him I think we’re good but I don’t really believe it. In reality, the task of trying to sedate a gargantuan man with doses made for regular people is difficult. Not to mention Albert’s tolerance.

Haldol works wonders the first few times it’s used on someone but after that you might as well be blowing kisses. Some of them get it so often they remember it by name.

Useful tip: if you’re ever in an ambulance with someone you think might be crazy ask him if he’s allergic to haldol. Anyone who answers yes not only has needed it in the past but should be considered a high risk to need it again.

The true elephant in the room of course is that brawling with Albert might simply be more than we’d like to bite off. As I said he’s four hundred pounds. Jumping him, holding him down, sedating and then tying him to our stretcher would be neither easy nor fun.

‘Let’s just get rolling.’

My partner nods and hops behind the wheel, cranks up the ambulance and off we go.

It’s 11:29. We have thirty one minutes.

Once we start moving Albert settles in, crossing his legs so the untied size nineteen on his left foot dangles in midair.

‘There’s gum on your shoe.’

He knows this already. He also knows about the hole. He doesn’t remove the gum or fix the hole because he doesn’t want to destroy the evidence.

‘Evidence of what?’

‘They’re putting gasoline into my body. Every night. It goes in through that hole.’

‘And the gum?’

He smiles. ‘It’s not gum. It’s a plug. Remove it and you can see all the way to my brain.’

‘So if I removed the gum...’

‘Bad things could happen.’

11:33. Twenty seven minutes and counting.

Somewhere a few miles from Grady we hit a red light. The ambulance eases to a stop and the constant noise – the rumbling diesel engine and the air snapping through the passenger compartment’s cheap plastic windows – stops.

And the voices immediately come back.

‘I don’t care what you say,’ Albert says. Not to me of course, just an offering to the ether. ‘No, we already agreed. Stop bothering me.’

11:35. Twenty five minutes.

Thankfully the light turns green and the rumbling resumes. But just as I’m about to relax, my phone rings. Albert jolts forward.

‘Who is that? I said no one back here but us!’

Albert reaches for his seatbelt and my stomach plunges. I yank the phone out.

‘Look! Its’ my phone. Just a phone. It’s just us.’

He stares at my phone while I tighten my grip on the heavy laptop in my hands.

Breathe in, If he attacks me, breathe out, I’ll raise this computer, breathe in, and smash him over the head.

Albert nods and settles back into his seat.

Breathe out.

Time keeps ticking and 11:36 slowly melts into 11:37. Twenty three minutes.

At 11:40 the back-up alarm sounds as my partner eases us into a parking space on the Grady ramp. One hurdle crossed. Twenty minutes to go.

Albert unbuckles his belt, gathers up his stuff and hops out like a child hustling into McDonald’s for a happy meal.

I tell my partner we’re good and follow Albert in alone.

We hit the brightly lit emergency room and find it quiet and calm. This is good. That Albert gets worked up by stimulation should come as no surprise. And this being not only a large public hospital in the middle of one of America’s largest cities but also the only major trauma center around, it tends to be hectic.

In fact it’s not uncommon to walk through the door and find a mouthy drunk cackling at his nurse, an overdosing teen flopping like a fish on his stretcher, a badly injured shooting victim leaving a trail of blood all the way to the trauma bay and a quiet old lady calmly vomiting into a basin.

But not tonight. Tonight we breeze through without a hitch. When we hit the elevators it’s 11:42.

Eighteen minutes.

The elevators, of course, are quiet. And so Albert begins to wind himself up again, standing in the corner and grumbling under his breath. Three people have hopped in here with us and now as they press the second, fourth and sixth floor they’re beginning to realize their mistake.

I smile at them and they give me the look of terrified spectators. Any hopes I had for a quick and easy trip disappear as riders hop on at each floor, pushing buttons, stopping progress.

At one point conversation begins to build until Albert shifts his weight and rocks the car. Suddenly you can hear a pin drop.

At 11:44 the doors open and we step out onto Thirteen.

The interesting thing about Thirteen is that you never know who you’re looking at. Some of these people are easy to mark as patients but some aren’t. And then you have family members, friends, visiting health care workers and the odd wanderer who simply got off on the wrong floor.

Whoever they are, they all get the same welcome. A security checkpoint immediately outside the elevator doors.

It’s manned by a single guard sitting behind a desk plopped down next to a metal detector. The procedure is for everyone’s belongings to be searched. Thoroughly.

Tonight there are four people in front of us. Two of them have bags.

‘How you doing, buddy?’

No response. Albert rocks back and forth like a fighter staring down his opponent.

‘Okay. Well, you just be cool and they’ll get to us soon.’

The next six minutes pass in a terrifying, frustrating, clock-watching blur.

It’s a thousand degrees up here and everyone is sweating and irritable. Every few seconds the elevator doors ping, causing Albert to jerk. There’s a patient just beyond the secured area who keeps knocking on the locked double doors begging to be let out so she can smoke a cigarette.

And the people in front of us? All patients. All in need of help.

The guard is harangued constantly as he checks their bags, sorting through old perfume bottles, CDs, cell phone chargers, crumpled bus maps, bits of cigarettes, lighters, butter knives, old lottery tickets, broken sunglasses and dirty underwear.

‘Take everything out,’ he says over and over. ‘Your pockets too. I have to see everything.’

They fuss and grumble, accuse him of stealing their stuff.

‘Last time I lost my paperclips.’

‘Last time you smoked my cigarettes.’

‘Last time that fat bitch stole my bra.’

All the while the patient behind the doors keeps knocking, keeps asking to get out. And the elevators ping and the patients argue and the room gets hotter and the clock ticks.

It’s beyond loud now, it’s riotous and I keep waiting for all four hundred of Albert’s psychotic, unmedicated pounds to explode in a wild rage.

‘Next!’

It’s our turn. I hustle Albert to the desk. We only have ten minutes.

This part, thankfully, goes quickly. Albert really doesn’t have much besides his notebook and some clothes. His notebook. Shit. The pen in his afro.

The guard misses it but it sets off the metal detector. I hold my breath. Nine minutes and counting.

Albert hands over his pen and we proceed through the doors. As we pass the Cigarette Lady she begs to be let out, begs for just one smoke break. I keep a hand on Albert’s elbow and we pass her by.

Grady does a wonderful job of keeping this area as calm and normal as possible but there’s only so much you can do. It smells like dirty socks and is filled wall-to-wall with men and women who, for one reason or another, need immediate psychiatric help.

When we reach the triage area I’m hoping the nurse will be there to receive us but of course she’s nowhere to be found.

Albert’s nervous now, pacing.

‘What time is it?’

I tell him we have time. All the time in the world. He just shakes his head. It’s getting close and he knows it.

If he was anxious before the crowd in here has brought him to a whole new level.

There’s a woman wrapped in blankets spread out across three chairs, a man covered in grass and mud no one wants to sit next to, a furious-looking teenager talking to himself and a couple, completely cracked out, pretending they don’t need to be here.

The man looks at me and shakes his head as though to say ‘Can you believe these people?’ I can’t, I think to myself. Then again, I can’t believe your girlfriend thought that t-shirt was a dress.

There’s also a man wandering around wearing a hat with CIA printed across the front in big yellow letters. He eases up next to me and leans in close.

‘You see any documents? I lost all my documents. My mints too.’

And of course there are the Combatants. If you blindfolded two angry psych patients and dropped them off in Tiananmen Square they’d find each other in less than a minute.

Our contenders tonight stare, make threats, pace, stand up, sit down, get in each other’s faces and then pace some more. They’ve probably been carrying on like this for hours and will continue to do so until one of them gets distracted.

Despite all this, it would be tolerable in here tonight if it weren’t for the Screamer. There’s always a Screamer and when the Screamer gets going the rest of them join in.

The Screamer’s always mad, though about what it’s difficult to say. Our contestant tonight is a woman. She’s wearing a dirty sweater and no pants, though someone has been kind enough to wrap a sheet around her waist. She might be only half-naked but she is fully pissed.

‘What the fuck you lookin’ at? Huh? Tryin’ to get my booty?’

She goes from person to person, making accusations and threats, swinging her barely concealed ass around like a wrecking ball. She punches the air and giggles and spits on the floor.

All of this has distracted me from my main purpose, which is trying to keep Albert calm. It’s less than two minutes to blast off and he’s getting worked up.

He is sweating now and refuses to acknowledge me. He tears at his shirt, his hair, scratches his nails down his arms and digs them into his stomach.

He throws a shoulder into the wall, shakes his head at some ethereal accusation and stares at me with red, wild eyes.

‘I can’t take this anymore,’ he stammers as sweat runs down his face. ‘I have to be opened, I have to be relieved.’

‘Be cool. We got time.’

‘No. No, we’re out of time.’

I throw open the doors, dash into an area marked Staff Only and bang on the first door I come to.

A slow-moving sleepy-eyed woman answers.

‘Look, you have a patient in triage who’s threatening to kill himself and anyone who tries to stop him.’

If she senses the urgency it doesn’t register on her face. She tells me flatly the nurse will be with us in a moment.

I look down at my watch and the last twenty seconds of the countdown have begun. I hustle back down the hall and, shouting through the double doors like the Cigarette
Lady, tell the security guard there’s about to be some trouble.

As he makes his way to the triage area I grab his arm.

‘You might wanna call for help.’

‘What for?’

In that instant someone screams and there’s a crashing sound like breaking chairs.

We rush in to find the Screamer standing on top of a table, sheet off, shaking her ass like a stripper. Everyone is gathered around her laughing and hooting, even the combatants have called a truce to watch the show.

In fact everyone is enjoying it except the CIA man, who’s still on the hunt for his mints.

As the guard tries to break-up the show I notice Albert isn’t here. Could he have slipped out behind me, snuck into some hidden part of the ward to disembowel himself?

The guard has his hands full with a half-dozen howling patients and one naked Screamer.

I’m on my own. I spin around, looking for the most likely hiding place. And there it is: The bathroom. I rush over, grab the handle, deep breath and try the door...

It’s locked.

A calm voice echoes from beyond the door. ‘Who’s there?’

‘Albert?’

‘I’m relieving myself.’

‘You’re what?’

‘Relieving myself.’

I laugh. My back is covered with nervous sweat and I lean my head against the wood.

‘I haven’t had a good movement in a week. The gasoline, it binds me up. And this is the only place they can’t infiltrate.’

‘So that’s what you...Good. Good. That’s really good news, Albert.’

‘Can I have some privacy?’

‘Sure. Anything you need.’

Across the room the guard has gotten too close to the Screamer and she’s wrapped her left leg around his neck. His back-up is trying to free him but they can’t break through the line of spectators tossing cigarettes and crumpled ones onto the table.

The nurse arrives, followed by four more guards and I leave Albert in their capable hands. He’s no longer a threat and, besides, his enormous presence is completely overshadowed by all the yelling and cheering and the Screamer’s gyrating ass.

Outside I take a minute to relax and enjoy the cool midnight air. Sirens wail in the distance. As we drive away I see a figure lumbering down the sidewalk like a battleship with an engine out.

It’s Albert. In the chaos someone left the doors open. The Cigarette Lady is probably out here too.

After a few seconds he disappears around the corner, munching CharlieDontSurf pills and shouting at the heavens.

He’ll be back of course but tonight he is free of gasoline.

Tonight Albert has been relieved.