Bad Call

First day on the job and so far, so good. I’ve been on another couple of calls before—ride-alongs with Pete, the boss, and Jim, one of the drivers. A man with D.T.’s and an elderly woman who died in her sleep, in that order. But today, it’s a full twelve-hour shift, and I’m on for real. I’ve been on since 5:30 a.m., and we haven’t had a single call.

Maybe this won’t be as bad as I thought.

It’s lunchtime now, and we’re dining in the ambulance and we get a radio call in Sunnyside. It’s a possible DOA. I’m told DOAs always come through like that—as possible. Even when we go there and see the corpse for ourselves, we can only write down Apparent DOA on the pink sheets we use to document calls. Only a licensed MD can officially pronounce someone dead.

I’m told they once got a possible DOA that was a skeleton in a closet in a building being razed on Welfare Island.

I am partnered up with Big Al. I’ve actually known him for a couple of years already, as a customer at Dad’s gas station. He and I are double-parked in the running ambulance near Roosevelt Avenue behind a public school, right up against a Sabrett’s hot-dog cart. Al is running a weenie tab. The hot-dog man is handing them through the open window to Al as fast as he can snuggle them into their warm buns. No sauerkraut, no mustard, nothing that could slow the flow. As far as Big Al is concerned, these dogs are so good they don’t need any enhancements. I agree.

Al is passing me one Sabrett’s for every three he eats, usually in two bites. Al is enormous. Easily over three hundred. I don’t have the nerve to ask him his weight outright. His entire football-shaped torso is hard as a rock, but not in a good way. I often think he wears some sort of support garment, like a corset, that firms him up like that.

Al likes to intimate that he’s connected at a low level—the kind of unmade man that sells watches out of car trunks and other stuff that falls off the trucks. The final link in the wise-guy marketing chain: direct to consumer. Sometimes I wonder if his underlayment might be a bulletproof vest.

The lenses in his specs are as thick as the proverbial Coke-bottle bottoms, and there is almost always the stub of a Palumbo or Di Napoli cigar, made from grade C or D tobacco, sticking out of the corner of his mouth. The kind Clint Eastwood smokes in the spaghetti westerns. They stink like hell when they’re lit—hence the nickname Guinea Stinkers. I smoke a lot—at least two packs a day—but I’m not eager to try one of those, just yet.

Anyway, Big Al’s girth and the glasses and the cigar, not to mention the fact that he can be as funny as anybody I’ve ever met, combine to give him a sort of zany Merry Mafioso persona.

On a more sobering note, he did tell me once that if I ever wanted anyone taken care of to just let him know. Sure will, Al.

By the time we saddle up and hit the lights, he has inhaled twelve Sabrett’s hot dogs. I have no doubt he could eat twelve more and perhaps twelve more after that. But we have to get going.

We stop near some train tracks. There’s a Long Island Railroad work crew and several patrol cars and some cops and a couple of plainclothes. It’s hot and I’m starting to regret the four hot dogs I’ve eaten. I’m sweating profusely.

We make our way to a clump of police standing over the possible decedent. I squeeze through to take a look. It’s a young black male, semi-recumbent, head cocked back over a small canvas bag, mouth and eyes wide open, the latter pointed right at the sun. He and his clothes are drenched in perspiration. He’s apparently dead. I enter that information on my pink sheet.

What happened is a mystery. His lunch is beside him: a substantial meatball hero and a large bottle of Coca-Cola. He had only eaten a few bites of the hero and barely touched the Coke. Did he choke. Have a heart attack. Whatever it was, it was something. Pretty sure he wasn’t done in. Even more sure we’ll never know what it was.

A couple of the LIRR guys come by and say this was the guy’s first (and last, one volunteers with a snicker) day on the job, and he seemed like an okay guy and everyone just thought he was taking a brief lunchtime lie-down until he didn’t get up. Well. First day on the job for both of us.

I hope I have better luck than he’s had.

Idle chitchat ensues, cop and ambulance shoptalk: What’s your favorite precinct; Jeez, it’s hot; Nice shoes. Nice shoes goes like this: Nice shoes. Where’d you get ’em. To which the answer is inevitably, DOA.

Big Al volunteers that if we want shoes, he can get us anything we want.

Al tells me we’re waiting for the crime-scene guys and the ME’s—medical examiner’s—truck. But it turns out we don’t really have to wait. We’re clear to go. Ambulances are for the living. Besides which, with a suspicious death in a public place, they almost never take away a body—that’s for the ME guys.

But we don’t have a call on deck, and the inertia of a really hot day plus a Sabrett’s overload is upon us, so we just kind of hang around. I’m staring blankly at the body when I notice something. One by one, the fattest, brightest bluebottle flies I’ve ever seen are landing on the dead guy’s face and then hopping into his mouth and disappearing down his throat.

This is startling and fascinating—and I guess it more or less proves he didn’t choke. Where are these flies headed. I had expected this, seeing flies (and their wriggly babies) on the dead, but I’m looking at this scene and I’m surprised by the bluebottle flies. I’ve been told that most of the flies one sees on bodies are houseflies, and they like to congregate around the eyes or open wounds to lay their eggs and maybe have a bite or poop and then take off.

I’m standing here, and I find myself counting the blue-green beauties going into the man’s mouth. Not one is coming out. I am up to thirty, and there are still more taking the plunge. I have no idea how many went down before I got here or started counting. There may well be more than fifty flies in his stomach and esophagus. Maybe even more than that. A hundred. Who knows.

As I stand here in the sun, my mind is beginning to wander. I’m trying to picture what the flashy, chubby flies are up to in there. Are they all the way into his stomach. How can they all fit. Each one is nearly the size of a peanut. What’s the volume of fifty flies compared with four Sabrett’s. How can they breathe in there. Are they past the stomach. Why aren’t any coming out. Are they going to keep going until they come out his rear end. Yuck.

I’ve stopped counting to make room to think about the flies’ itinerary. Now I’m getting a notion that maybe I should get out of the sun, because I’ve got this deranged urge to poke this young man’s stomach to see if flies come buzzing out—like poking a hornet’s nest with a stick. Like some kind of real-life Looney Tunes scenario.

What would it sound like, I wonder, if I rhythmically pressed on his abdomen. Could I make some sort of buzzing-fly music. Would it be like CPR, except that he would exhale flies instead of carbon dioxide.

I’ve begun to think I am hallucinating until I am startled out of my lunatic fantasies by a firm poke in the back. Big Al says, Let’s go.

He’s ready for his afternoon feeding.

I’ve been at St. John’s several weeks now and have spent some of that time working with Jim, one of the nicest people you’d ever want to meet. When I haven’t been working with Jim, I’ve been working with Pete, the boss. If this job were a salad, Jim would be the extra-virgin olive oil, and Pete would be the bargain-priced, horribly astringent red-wine vinegar.

I went on my second call with Jim—an unpaid ride-along before I started full-time. My call with Jim was a DOA. It was an extremely old woman who had died overnight, in her own bed, in a house she shared with her grown son and his wife.

Until then, I had only seen two dead people. That was on Thirty-Ninth Avenue, in Bayside, on my way to the deli for my mother. I was seven. It was a very bad accident, very bloody. Two old people had hit a tree. The driver, a man, had been decapitated. A woman was dead beside him. What I remember most is there were no other people around—it was very quiet—and I had no emotional reaction.

That first call with Jim was a little bit like that. It was very quiet and I had no reaction. The dead woman had that grotesque dead-person look on her face: mouth wide open, head back, eyes slightly open. Her dentures were in a glass by the bed. Their absence turned her gape into a macabre abyss.

I was just there to look and learn. Jim really had it down, what to say and do. He was asking her family questions.

How old was she. She was ninety-eight.

Bless her heart, said Jim. God bless her.

He was smiling and moving his head slowly from side to side as if to underline his blessing with Don’t we all wish we could go like her, at ninety-eight, in our sleep. I watched the family. They smiled, too. It was all very calming. I know it made them feel good. It made me feel good, too, and I wasn’t even part of the family.

I learned a lot about patter from Jim. I feel almost certain he must have kissed the Blarney Stone at some point in his life. He is very Irish, in the very best sense. There’s a lilt to his voice when he speaks. He’s what the Irish call a darlin’ man. Genuinely friendly and totally imperturbable.

Jim is actually working two jobs. The ambulance is one, and in his spare time, he’s an electrician. He must be making a small fortune.

I would like to work only with Jim, but he can’t always work. He has a bad back problem, which hits him without warning. Sometimes when he bends over, his back locks, leaving him in excruciating pain and unable to straighten out. If this happens on the job, St. John’s sends out the other ambulance to pick him up.

Why they keep him on or why he wants to stay at St. John’s is a mystery to me. Having a bad back on this job is like being a blind umpire. You really should consider doing something else.

Anyway, I’d like to work with Jim most of the time, but he just isn’t around enough. Besides, he always works weekdays, and I have to work nights and weekends or anytime they need me, which looks like it’s going to be just about all the time.

It’s a nice day today, not too hot. Summer’s just getting into full swing. Still not the Fourth of July, but it’s coming up in a couple of weeks. Jim and I get a call. It’s a cop down. This could mean anything from a gunshot to getting hit in traffic, Jim says.

No matter what, officer down calls are always a rush. Last week, we were all outside the emergency room smoking and joking when the heavy double doors literally exploded outward, missing me by inches. Two cops burst through, on their way to an officer down, all units respond call.

I guess if you want to see the doughnuts fly, that’s the call that will do it.

This call is behind a private house in Maspeth, right up Fifty-Seventh Avenue, not even as far as the gas tanks. It will only take us a couple of minutes to get there. And here we are. And so are the cops. Three cars.

Come around back, beckons one of the policemen. I’m expecting to see a man down, blood spurting from a gunshot wound. It’s never what you think you’re going to see.

Instead, a very calm man in shorts and a T-shirt is sitting on the grass with his legs splayed apart in an odd way. He’s sitting in front of a charcoal grill. The coals are lit. He’s obviously in distress, but he’s in control. He’s okay enough to tell us what happened. It’s pretty simple if a bit unbelievable.

He was squirting charcoal lighter on the coals, and the can blew up, dousing his legs in burning fluid. That’s it. So this can actually happen. They tell you not to do this on the can. I’ve done it many times.

Not no more.

He really doesn’t look that bad. His legs aren’t even red. But they don’t look right. They look very white, almost like they’re made of alabaster or something. I know what it is. They look like the fat you see on uncooked steak. Thick, opaque white fat. On the side of each leg there’s a thin red line of blood, marking where the epidermis was burned back.

Jim sees me looking and takes me aside so the patient won’t hear. Those are third-degree burns. I am surprised. Not at all what I expected, not having seen third-degree burns yet. What did I expect. Yes, blackened charred flesh. Jim continues, The tissue is dead, there’s no blood. The burns are deep. These are serious burns, he goes on. It’s about the rule of nines. I know about this but haven’t memorized it. Jim gives me the Cliff’s Notes.

When they give a burn victim’s condition as having a certain percentage of burns over his body, it’s totaled up by units of 9 percent. For example, each whole leg is 18 percent. The front of each leg would be 9 percent. Our patient has the front of both legs burned, so he has third-degree burns on 18 percent of his body.

That doesn’t sound like much to me, but Jim is concerned. He gets very quiet when he’s concerned, and the blarney stops cold. Apparently this percentage is very serious when the burns are third degree. Nothing to do but get this poor guy back to St. John’s. Straight shot down Fifty-Seventh and right on Queens Boulevard, and we’re there.

We don’t usually expect any closure on calls. We get so many, there’s no way to keep track. Plus we don’t really want to know most of the time. And, of course, patient information is supposed to be confidential, unless you’re a member of the family. But sometimes we find out anyway.

Word comes down the next day that our policeman patient has died. With third-degree burns that didn’t look like anything, over just 18 percent of his body. It’s so hard to believe. Maybe he died from a heart attack or some other complication. It doesn’t make sense—18 percent is just a number. It just doesn’t seem like that much.

But I guess it was enough.

I can’t say for sure exactly where we are, except that we’re way up in Astoria. We got this call: woman down. What does that mean. Down. Could mean anything, really.

What is this place. Looks like an old apartment building. Obviously, it was an apartment house, but it’s been converted into some kind of rooming house. The doors to the rooms are all open. The people inside the rooms are elderly, and they look sick. Some are in bed. Some are sitting by their beds, next to walkers.

Nobody seems surprised to see us going down the hall with our stretcher. Most don’t even look up as we go by. It’s not a nursing home in the conventional sense. Not like any I’ve seen. Almost certainly unlicensed. Looks like a homemade nursing home for poor people. A neighborhood co-op nursing home, like a neighborhood garden.

It strikes me that it’s kind of nice that something like this exists. The need was there, and somebody made it happen. The building is clean and the heat is on, even though it’s summer. It is cool outside, but it’s not that cool. Old sick people are always cold. Somebody cares.

I bet it’s a walk-up again. Of course it is. A woman leads us upstairs. She’s not wearing a uniform, but she’s obviously in charge. It’s Sunday. She’s the weekend shift. Probably not an RN or even an LPN. Just keeping an eye on things. I suppose she’s the one who made the call. Good for her. A lot of looking the other way goes on in places like this.

Up we go, three, four floors. There’s a noise, but I can’t place it. We’re going down the hall in the direction of the room where it’s coming from. It sounds like it’s coming from an animal being abused in some way. Jesus. Take a deep breath; in we go.

It’s difficult to describe what we’re seeing; appalling seems barely adequate. There is an obese black woman half out of the bed. She’s making the animal noises. No words. No screams. Just roars and groans and snarly gurgles. Her eyes are wide open, but I don’t think she can see anything. They’re darting back and forth really fast. The whites are the color of yellow mustard, and the pupils are dilated all the way. Her head and upper body are wedged between the bed and one of those huge old ornate radiators they call Napoleons. After the pastry or the emperor, I wonder. Have to remember to look that up. This one was full of steam. These are much hotter than the hot-water kind. Burn-you-to-death-hot.

The parts of her head and upper body wedged against the radiator have turned white. The rest is her natural color. No one knows how long she’s been like this. Didn’t anybody hear the noises. Everyone here is old, so maybe not. She looks pregnant. Pretty sure of that. All her weight seems concentrated in her abdomen. Her limbs look relatively normal in size. She’s young enough to be pregnant. I’d say in her late twenties at most. Why is she here with all these old sick people.

Big Al says she isn’t pregnant. He says she’s in the last stages of cirrhosis, and that’s why her abdomen is so distended. Now we’re guessing she was near the end when she fell and got stuck between the bed and the radiator and was too weak to get free, so she got slowly cooked.

What a break. Dying from cirrhosis plus burned alive by a goddamned radiator.

It’s very hard to get her unstuck, and we have to be careful not to get burned ourselves. The Napoleon is still searingly hot, and no one seems to be able to shut it off.

She isn’t struggling, but she isn’t cooperating, either. She is very heavy, completely inert, and really in there. By the time we get her unstuck and onto the stretcher, she’s not making noises anymore. Her eyes are still darting back and forth.

Does she see me. I don’t think so. I’m talking to her and telling her it’s going to be okay. I tell her we’re taking her to the hospital, and she’s going to be all right—this being one of our more useful lies. I’m thinking what could she possibly understand at this point. And if she can understand me, is it any comfort. Sometimes, I think it is.

I don’t think it matters much this time.

We get her to Elmhurst General, alive, and brief the staff on what we think we’ve brought them. They don’t say anything, but we know they’re dismissive of our cirrhosis diagnosis. That’s okay with me. I know we’re not doctors. We’re just telling them what we were told at the scene. They can see the rest of what’s happened for themselves. They can see it. Who can say if they believe it.

I wonder if she’s going to make it. God forgive me, but I hope she doesn’t.

A Chevy Bel Air has smashed into a tree on a nice street in Forest Hills. The lone driver is the only casualty. He has submarined under the wheel, and he’s stuck in there pretty well. No seat belts in the car. I’m talking to him. He’s conscious but very bloody, obviously in a lot of distress but handling the pain well. He’s being as tough-guy as his situation allows.

He’s a big man. A lot of us say big when we really mean hugely fat. Big, then, is our standard euphemism for obese. So okay, this man is really, really fat. I am thinking that this fatness probably saved his life when he hit the steering wheel.