Thursday, April 22, 2010

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.

‘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?’
‘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.

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