FICTION | Exhaust
I hate my job. I save people’s lives for a living.
My partner’s tachypnic. We just transferred a combative hypoglycemic patient who knocked my partner’s head into the glass case we use for storing the NPAs. His nose isn’t swollen, but he keeps touching it softly like it is.
There’s no one more dangerous than someone lacking sugar.
If you’re ever arguing with a loved one, my advice is: eat. Food calms. It massages. More people need grapes, not Xanax.
This is our fault, his sore nasal bone. We should have used restraints. But you tend not to use those on patients who aren’t psych. But, truth be told, all patients are psych patients.
My elbow bleeds from rushing in back to help. I actually did help, too; the patient saw the gash on my arm and instantly got quiet. The ambulance floor has red freckles. Some people can’t stand the sight of blood. Others, like me, are paid to stand in it. The good thing about our BGL kits is they’re always filled with alcohol swabs and Band-Aids. I also personally carry the greatest hemostatic drug of all—Super Glue.
So I patch myself up with the kit that was supposed to be used for the patient, gluing myself together.
I’m an alcoholic.
I should clarify; I don’t drink.
Seeing people die quickly from drunk-driving homicides and die slowly from cirrhosis where their ears and nose and eyes bleed simultaneously tends to make you a total teetotaler. What I actually mean is that I have a borderline addiction to alcohol swabs. I love the smell of alcohol swabs at night. It smells like defeat. I get paid when people get hurt and lose and fail and fall. And when we get hurt on the job, it just proves to all the judges in dispatch and H.R. that we’re EMS lifers.
When I used to work at the Domino’s in Brutus, there were times I’d take the call, make the pizza to their specific strange combination of requests (Fiery Hawaiian with extra sliced ham, smoked bacon on only a quarter, no hot sauce, triple the jalapenos, mozzarella on half), and then deliver it to their unmarked dirt-road three-story house; after all that, they’d still stiff me for the tip.
Fast-forward to now where I have patients who don’t speak a syllable of English, then we have to lift over three hundred pounds to get them on the gurney, get them on the ambulance, get them off the ambulance, and get them in bed again, transport their personal possessions, and the whole time fight to get a b.p. on their arms that seem to have no pulse. I’m their translator, mover, chauffeur, and nurse and not only do I not get a thank you, but they often insult me.
They make fun of my phone.
They make fun of my hair.
They make fun of my wage.
They make fun of my uniform.
They make fun of my lack of humor.
It’s hard to laugh when you can’t find someone’s pulse. Even if they tell you they’re fine. Patients will tell you they’re feeling perfect and then die on you. No one is fine; otherwise they wouldn’t be patients.
Once we’ve dropped them off we’re allowed to have a sense of humor. My partner and I make fun of their valuables and accent and pulse and lack of pulse and penchant for insulting us when we’re at our most hectic. We laugh and feel horrible and sit in the silence of Detroit’s deserted weedy gas stations waiting for the next call.
It’s true though. I do have a bad phone. I have cowlicks, Alfalfa head, hair boners. I’m paid just above minimum wage; I eat appetizers for meals, can only ever order water to drink. My uniform makes me look like a bad security guard. I have the world’s worst Jay Leno impression.
Our pager goes off. We’ve set it to play “Jingle Bells.” It’s March. Christmas died three months ago.
I read what it says.
My partner asks, “So?”
As a bad Bill Cosby, I say, “Baker Act.”
“Christ,” he says.
My partner hates the suicidal. He only likes to do medical calls. We have a deal. I do the psych patients. He does all the other patients. I do this because I’m worried what he’ll say or do to someone who’s already on the edge of swallowing every pill known to man. It’s like he wants to encourage it to happen. I know he’s worried about over-population, but he goes too far. He’s from Mumbai and Milwaukee and Butte and New York, said that in India they leave the windows open on the top floor of buildings. There, if people want to commit suicide, it’s easy as going upstairs. He said in Colaba he’s never seen a suicide, but he’s heard one. He said that in Japan, suicide is honorable; in India, it’s quotidian; but here, he said, it’s laziness. He talks like this. He talks a lot. But usually without saying anything substantial. I don’t know who his mother is. I don’t know his father. I know the bones of his body. Because he knows every bone in the human body. He knows the pisiform and capitate. He knows the medial cuneiform and the sesamoid. And now I know them too because he quizzes me every shift.
The way the EMS world works, you get your partner and then you have to stick with them through thick and thin, through the thick femur and the thin fibula. If you ask to switch partners, dispatch hates that. They’ll cut your hours; they send you to LBS calls; they’ll give you a patient fifteen minutes before your shift is about to end; they’ll give you a call when you’re already on a call; they’ll make you run with the worst ambulance the company owns; they’ll take the emesis bags off your rig without telling you. There’s a lot dispatch can do if they want to drive you to insanity. So I shut my mouth and act like I don’t mind working with Mark.
Mark’s name is Marcus and he hates when you call him Mark because ‘mark,’ apparently, means someone who is a target for your standard three-card Monte scam. Marcus is your average ordinary Bronx-Wisconsin-Montana-Indian guy who speaks fluent Bengali and Italian. He learned the latter as a hobby. On the odd occasion that we actually get an Italian-speaking patient, Mark suddenly becomes the best medic on the face of the earth.
And if there is a face to the earth, Detroit is its left nostril. In case you didn’t know, the right nostril tends to be the biggest one. We hardly even breathe through the left nostril. That’s the type of crap you learn being an EMT.
I’m going to fast-forward at this point to the end of the call.
The Baker Act was also an overdose. And Mark really hates overdoses because he’s as anti-drug as Nancy Reagan’s pastor. And because overdoses are the most unpredictable patients of all. The problem is that aspirin tends not to kill you. It tends, instead, to kill your kidneys. It kills your hearing. It kills your balance. I’ve never seen it kill a patient. In the end, they’re just left with dialysis and a heightened possibility of recurring seizures and a brain that’s just received the equivalent of a donkey kick to the cranium without any skull protection. Failed suicide attempts tend to make people even more suicidal. It’s an ugly cycle to be caught in. And Mark feels like he’s the gerbil trapped on it, because, for the patients, they may not see the inside of a psych ward for another three years, but for Mark, it’s going to happen tomorrow. And the next day. And the next. And next. And next. Because from what I’m seeing as far as trends, medicine is all about two things—diabetes and mental health. That’s over ninety percent of our calls. So, really, Mark has become a diabetes medic and I’m a psych ward EMT. That’s the paperwork I do over and over and over and over and over and over and over and over. And that’s what I’m doing now when Mark says he wants to kill himself.
You heard that right.
Now, he shouldn’t be telling me this, because he knows I’m obligated to report it, so I call dispatch and he asks what I’m doing and I walk away, talking low.
I watch Mark while I’m on the phone. His uniform tucked in, shoes actually shined, he looks good. Most medics do. They haul patients all day. We literally lift a ton every shift. And even with that, even with our destroyed lumbars, we still make it to the gym while off-duty. The funny thing is I’ve never hauled a suicidal fat patient. The suicidal tend to be good-looking. They tend to be perfectionists. If they only saw themselves as I see them—beautiful and intense—they’d snap their brain into a whole different set of chemicals firing inside.
I hang up because I see Mark walking away and that’s not good.
I’ve had my moment to process. I keep pace with him and ask how he wants to kill himself. I remember this being a question you’re supposed to ask. If they say they’re going to shoot themselves, the next question is, “Where’s the gun?” It’s simple. First: how are you going to do it? Second: is that available to you now?
He says he’s going to run into traffic. Hospitals tend to be near traffic, heavy traffic. They tend to be just off freeways and highways, thrown into some ex-field where the land was available at a steal and where there’s the possibility of building what really is a warehouse for the sick and dying. They can throw as much Disney horticulture and fancy lights as they want around a hospital, but all I see is a human storage unit.
Right now, Mark walks a bit like the walking dead.
The reality is that sleep deprivation, bad pay, horrible treatment by nurses and doctors, the brain-numbing repetition of the job, the insults of the patients, the freaky hours where we spend Travis Bickle nights with the prostitutes in thongs and snow boots and the drug dealers with their U of M ball caps, and the most depressing thing of all—the whole of Detroit.
I mean, of all the places to work, we work in Detroit. Where I was born and raised. Just like the Journey song that ended The Sopranos—“born and raised in south Detroit.” Except there is no south Detroit. South Detroit would be the Detroit River. South Detroit is Windsor, Canada. I’m north Detroit. Where it’s even colder than south Detroit.
And anyone who lives in north Detroit with its sun-deprived pregnancy of a nine-month winter and isn’t at least a tad bit suicidal is a flat-out liar.
Except Mark isn’t being a tad suicidal. He’s full suicidal. I can tell. I’ve seen enough patients to know when someone is. He’s cracked. You can practically see the shadows in his skull.
I know, from experience, that all he needs is sleep, some uncontaminated Chipotle, and an hour of mind-numbing TV and he would feel like a whole new almost-man. The guy’s twenty-two. He’s a freaking medic at twenty-two. His brain hasn’t even fully developed yet. He’s got at least three more years until that has happened. Maybe more. Hell, in the EMS world, we tend to be community-college dropouts and epinephrine junkies.
But Mark wants this repetition of hauling suicidal people to psych wards to end. And so he goes for the hospital’s main exit and I am looking for security, but security tends to either be sleeping or flirting or peeing or wandering. For security to be where security is supposed to be in a hospital takes a hell of a lot of miraculous cosmology and that’s not in the cards tonight. My partner goes out into the night and I have this feeling that I’m going to be driving shitty ambulances and not getting overtime hours and will get scheduled for every holiday from now to eternity if my partner dies tonight.
We’ve only had one medic killed in the history of our company and it wasn’t a medic; it was an EMT. And it wasn’t an EMT; it was two EMTs. Two EMTs who got electrocuted. That’s how mythology works; the story keeps changing. Except this one really happened. The night shift dispatcher told me it went like this: it was an MVA on a drizzling night in Bloomfield Township with its six-figure incomes and privacy trees and a power line was down and the first EMT got out of her ambulance, walked towards a vehicle involved in the collision, and just dropped down into a puddle. The second EMT walked over to help the first EMT and he dropped face-first into the puddle as soon as he stepped into it. They both had a half million volts shocked through their systems in front of a darkened mansion with its marble baths and bluestone patio nearby overlooking it all. That’s the way it was told to me and that’s the way I believe it. But however you look at it, now we don’t get out of the ambulance if there are any downed power lines. We leave the scene, call the electric company, and wait. Sometimes it takes people dying to learn.
And my partner is heading towards death.
Death is M-8, the Davison Freeway. The name reminds me of M-80, the powerful firecrackers. I’ve seen a ton of explosions on M-8 in my day. I’ve seen trucks turned into avant-garde artwork. I’ve seen cars where the bumper sticker is in the front seat. I’ve seen motorcycles disintegrated. I can’t imagine what would happen to a body stepping from that wide left shoulder out into the apocalypse of traffic.
I have about two blocks to convince him to go back. Or I can try to tackle an all-state honors wrestler and struggle to get him in some kind of MMA chokehold that I don’t even know how to do. Or maybe security will somehow emerge from the great herpetic mouth of the hospital.
From working with a hundred psych patients, I’ve learned that aggression heightens aggression. I’ve also learned that when tension happens, there are two basic choices—anger or sadness. And when I’ve given into anger, the Baker Acts always respond badly. I’ve learned that sadness is the best way to go. It’s not hard for me to get teary when I think a patient might try to kill me. Or at least hurt me badly. And when they see me get teary, they get teary. It’s infectious. Like a yawn. And then once the patient gets teary, they often start to let go and just full-out begin crying. And usually this is followed by collapse. Into a chair or onto the floor or back into their bed where they rest, quiet. And then I can reason with them.
Except now the patient is my partner and he’s one block away from semis going eighty miles per hour and it’s too dark for him to see if I can even manage to get my eyes wet anyway.
He stops, thinking.
Now’s my opportunity. Except I realize there’s nothing to say.
I mean, there’s nothing to say in terms of what I would normally say to a patient.
I can’t repeat all of the endless clichés we reiterate.
If I have to hear my partner say “couple bumps” the next time we go over a pothole when we’re driving, I’m going to scream myself.
If I have to hear my partner say “it’s a good hospital we’re going to” when I know he’s never been to the place because it’s the first time he’s headed this far southwest, I’m going to swallow an entire bottle of Coke.
If I have to hear him say “watch your head” when the next patient’s relative steps into the ambulance, I’m going to blow my brains out with a water pistol.
I don’t want to die.
I just want more than minimum wage. And I can’t make more than minimum wage, because I don’t know how.
My parents made minimum wage and they give me minimum wage advice and they know minimum wage people who can get me other minimum wage jobs in minimum wage towns similar to minimum wage Detroit.
Détruit, in French, means ‘destroyed.’
I realize I have to talk to him and it has to come from my guts. From my digestive organ. It has to come from my fundus and cardial notch and pyloric antrum and duodenum. I have to secrete acids and enzymes of truth.
And the truth is I don’t know him.
We’ve worked together for almost a year and I know he likes big booty girls and likes foosball and hates Geico and hates Floyd Mayweather because he’s too safe of a boxer and I know my partner knows the sternum and the false ribs and the synovial joints.
When I think about it, we’re two floating ribs in this world.
We’re surrounded by the amniotic fluid of night.
I’ve just about lost the ability to see things in any metaphor that’s not medical. I think because the medical world can be so predictable. Because the body is so predictable. It’s so simple to stop bleeding. There’s direct pressure and elevating. There are pressure points and sterile dressings.
Right now, for him, I need a psychological tourniquet.
We’re less than a half block from the freeway. I hear the warning noise of diesel. On our ambulance, someone scratched out the SEL on the DIESEL marking for the gas cap so that now it just reads DIE. I imagine my partner seeing that every dawn when he fills up at the end of shift. It has to sink in.
He says, “I killed a patient last week.”
He never told me this. I don’t believe him. I believe him. I listen. I hear a siren in the distance.
“We were doing CPR,” he says.
“And I forgot I put a line in her. Every compression I was doing on her chest, blood was pouring out of her arm onto the floor. I didn’t notice. I didn’t notice until we got to the E.R. and when we went to move her there was so much blood that I was like a—it was like—”
He waits for me to say something, but I’m editing the hell out of myself. I’m bad with patients. I’m bad with job interviews. I put my foot in my mouth and my ankle in my mouth and my leg and my penis and torso and throat until there’s no body left because it’s all in my mouth. The only reason why I got this job is because there was no job interview. They were desperate. I was desperate. They took me. They took him. They’ll take anybody. The job’s not rocket science. Hell, it’s not even science. It’s driving. It’s driving the bleeding.
I say, “I’ve never killed anyone. Yet.”
It’s the wrong thing to say. And the right thing. It’s a thing. I said it.
The siren fades. It wasn’t a cop. It was one of us. An ambulance. Going lights and sirens. Which is bad. Patients ask us to put on the lights sometimes; they want us to put on the sirens. They want to feel what it’s like to be a patient who might die. That’s who gets lights and sirens. It signifies someone who might be in Heaven or Hell by tomorrow night. People want to know what that feels like, to be close to Purgatory.
Mark knows right now. He’s hovering on a precipice. Actually it’s a curb. But it’s a curb not far from freeway. And freeway is all speed and velocity. Freeways are physics and physics tend to kill people.
“I want to kick one,” he says.
I have to scratch my balls right now. This happens. Stupid timing. I’ve had a patient who was telling me about the death of her daughter one time and all I could think about was how much I needed to go number two. Our days are spent eating the worst food with little time for bathroom breaks. It’s amazing how often patients talk to me and my bladder is all I am listening to.
“I want to kick a truck,” he says, “One going seventy miles an hour. I want it to take my leg off.”
Without censoring myself, I say, “I want to kick a truck too” and I don’t know how come my tongue is made out of eels. My brain is a terrorist. I don’t know how to communicate with people in the real world. That’s why I’m in medicine. Medicine takes anyone. We’re anyone. I’m anyone. And so I keep talking. “Let’s kick the ambulance,” I say, “It’s a truck.”
It’s like God gave me a moment to be normal, to say something that makes sense, that works. I had a five-year-old in the back of the ambulance one time and I started telling her a story about a fifteen-year-old boy eaten by an alligator. I went into detail, looking down at the floor and when I looked up I realized that horror exists much more intensely for children. I realized sometimes I need to keep my mouth shut. This wasn’t that time. Mark loved the idea. Why take the world out on his own body when we had an ambulance that had filled our lungs with so much exhaust that we both had permanent intermittent coughs? Patients frequently ask us if we’re all right. We always say no, we’re not.
Mark looks back in the direction of the hospital. The ambulance is just sitting there waiting for butterfly kicks and roundhouse punches. The types of punches that Mayweather would never throw.
And that’s where we go. And I can’t even wait myself. And when we get there, I start kicking. I kick where the dents are so that we won’t get in trouble. I’m kicking what’s already destroyed. And Mark kicks too. We beat the hell out of the ambulance. Hell drains out of it. All of the ghosts in there from dead patients run out, flying away.
We end up sitting on two nearby rocks, hyperventilating, looking at the big stupid new sore ambulance.
Mark asks when the cops are coming. He says he doesn’t want to be Baker Acted. I didn’t tell dispatch shit. Because dispatch is shit. I tell Marcus when I called dispatch I said that we were ‘delayed.’ It’s a word that gives you more time. We don’t have to say what we’re delayed about, because the implication is it’s due to some issue of patient confidentiality. I didn’t tell them my partner was suicidal because my partner isn’t suicidal; he’s human.
I say, “If you kill yourself in the next ten years, it’s going to be on me. And if you kill yourself, then I’m going to have to kill myself and then you’re definitely not getting into Heaven.”
He says, “I don’t believe in Heaven.”
We watch the hospital E.R. doors open and close. No one came in or out. Maybe ghosts went inside. That happens. E.R. doors have their own minds.
“But I promise.”
“Good,” I say.
A cat walks by us, stares at our faces, and continues down the street, as if all that asphalt and cement were made specifically for her to wander at night.
“Stray,” he says.
I hand my partner a piece of gum. Twenty-nine calories, but it’s something; you can almost pretend you’re eating for as long as you have it in your mouth.
For Detroit, the night feels magically hot.
We get up and call ‘available’ on the radio, no idea what the next call will be, and feeling like we’re closer to each other now, so rare in this world.
Ron Riekki wrote U.P.: a novel (Great Michigan Read nominated) and edited The Way North: Collected Upper Peninsula New Works (2014 Michigan Notable Book from the Library of Michigan), Here: Women Writing on Michigan's Upper Peninsula (2016 Independent Publisher Book Award Gold Medal Great Lakes—Best Regional Fiction), and And Here: 100 Years of Upper Peninsula Writing, 1917-2017 (Michigan State University Press, 2017).
Photo by Daniel Lu.