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Help Is on the Way: Tales of an Ambulance Driver

Owen Freeman

Potential Space

My partner takes a long drag on his cigarette and scratches the back of his head. I stand with hands in pockets, my head cocked to one side. We are silent. We are staring. We face the object in front of us almost as if we are at an altar praying, so deep is our reverie.

The rig is new. New! Crisp, clean walls with our company’s logo and colors painted on both sides, bordered by gleaming chrome and perched on tires with fresh tread. No scratches, no dents, no scrapes. Shining like an egg in the sun. The sirens and brakes haven’t yet experienced Code-3 driving; the inside compartments, newly stocked, have not heard screaming, gasping, puking, crying; the gurney hasn’t yet been contaminated with Code Yellow or Code Brown; and blood has not yet dripped onto the floor.

My eyes slowly scan the rig from top to bottom, soaking in every detail. I feel, strangely, a little sick to my stomach. Is this sparkling new ambulance mocking us? I don’t want to be reminded of what our last rig went through. I don’t want to think about what this one is about to go through. I don’t want to remember the particularly bloody trauma call two months ago, and how my partner had complained for weeks because blood had seeped between the metal floor plates that lock the gurney in place. I don’t want to think of the smells I occasionally noticed in the back — old, lingering smells. We survived all that, the rig, my partner and I. We got through it together. Now, here’s this ridiculous rookie rig, all clean and eager and unaware.

The station phone rings, the loudspeaker blaring right behind us. In the old days I would have jumped, panicked, bolted for the passenger seat, grabbed the radio and my map book, stared at my pager for the address and type of call. But these are not the old days, so says the fresh ambulance in front of us. I toss the keys to my partner, who drops his cigarette, crushes it. I let out a long sigh. Then we slowly walk to the doors and get in.

First call of the day. It begins.

 

Help Is on the Way

You are young, eager, a rookie, and you don’t yet know that this job does not mean saving lives. You haven’t yet figured out that 90 percent of all 911 calls are B.S., so every time you hear dispatch say your rig number over the radio, your heart does a front flip into your mouth, all that extra weight just sitting on your parched tongue. You scramble with the Thomas Guide; you aren’t good at mapping yet, your partner may or may not hate you, and the firefighters all but roll their eyes at you as you fumble, fumble, fumble.

Your first call, the first real call, is a two-vehicle accident and an overturned truck whose wheels are still spinning as you arrive first on scene. Your partner checks the truck while you squat next to the crinkled, folded car. Your patient sits slightly dazed amid the chaotic mess. Your patient asks for water, asks if he can call his fiancée, asks if he can go home. But you don’t answer his questions or say much, because as soon as your eyes connect with his against the backdrop of What He Just Went Through.

There’s light behind him

Every bit of medical information you ever had flies out of your head. You used to know the difference between pleural effusion and pericardial tamponade, but at the moment you don’t know your own name, much less how to make an assessment. Your eyes are locked with his, he seems calmer than you feel, despite the blood on his face and arms, the pieces of glass still stuck to him.

Does he know can he feel

Your brush jacket is too big and the helmet keeps slipping down over your eyes. You feel like a little kid playing dress-up, and it doesn’t help that you could swear you see something that doesn’t make any sense.

I swear I can see I swear I can see

Already you know you are too sensitive for this job, not tough enough, too trusting. You’ve been laughed at before for dutifully taking the blood pressure of a patient obviously faking an illness. But patients appreciate that you are all sympathy and that you actually listen to what they’re saying. What you need to learn is how to focus on what needs to be done in the short time you have.

I can see does he know

And it’s frustrating because you know you have potential, you know you could be good at this job but you just can’t put the pieces together fast enough.

I can see his

Or detach yourself like you know you need to.

There’s so much light

Because in this job to help someone you kind of need to ignore them, don’t you.

I can see so much

The fire truck and the paramedic squad are pulling up lights and sirens and you open your mouth to tell him that he can’t have water because it’s an airway compromise, that he has to go to the hospital because he may have sustained serious internal injuries, that the paramedics are here to help him. But what comes out instead is,

“I can see your guardian angel. You’re going to be fine.”

 

Half-Mast

“Baby girl,” he says. He is unable to keep his eyes open, but he’s trying; his eyebrows are pulled up like ship sails trying to catch a breeze. “Baby girl, I’m not okay.” I nod sympathetically, fighting the twitch his words induce in my stomach, and the flush in my cheeks. It’s not that he’s so good-looking, necessarily, but his low tone is personal and intimate, and there’s something about those two words and the way he says them that is getting to me. If he had called me baby, babe, sweetheart, chick, darling, lady, queen, hot stuff, foxy — I’ve heard them all — I would’ve rolled my eyes, stiffened and put on my tough-girl act, but his soft, sad crooning is making me wish I had someone to go home to at the end of this shift.

I awkwardly pat his shoulder. “What happened, sir?”

When we pulled him out of the bushes 20 minutes earlier he was alone, had no wallet or ID, and was utterly incapable of answering any questions, this comical, towering 6 feet 3 inches, which spilled over both ends of the gurney. Now in the hospital, the largest rag doll I’ve ever seen is coming to life.

He shudders slightly and his eyebrows relax, eyelids drifting shut.

“I lost all my money,” he says sadly. “I gambled it away.”

I nod even though he can’t see. “What did you take?”

He tries to remember. He’d been drinking for 12 hours straight, and took seven pills given to him by friends throughout the night. One or two of the pills were Ecstasy, but other than that, he can’t remember a thing. Which, it sounds like, was the point.

“Baby girl,” he says again. He is fumbling for my hand now, and as he grasps it I really am blushing, amused and caught off-guard by my vulnerability. He rolls his head to look at me; it’s a fluid, slippery motion only drunks are capable of, and for a minute it looks like his head will keep rolling right off the gurney. With supreme effort he keeps his eyes open, and then peers at me solemnly.

“Baby girl, I’m sorry.”

 

GSW

The only time I’ve ever dreamed about a patient, I held the potent images in for as long as I could and was scared to share them. Some things are precious. The patient was a GSW, which stands for gunshot wound. The patient was found lying face-down in the street, with a river of blood coming out of his head. The patient was about 25 years old; the patient was a heavily tattooed John Doe; the patient was presumably a gang member.

Police were on scene long before we were, and they didn’t bother to call it in because they assumed he was dead. They staged out the area, put up the caution tape, and started hunting for clues, witnesses, the killer and the weapon. At some point someone noticed that blood bubbles were popping out of his mouth, that he was still breathing.

For those of you who want to know, it looks exactly like the movies. I had trouble watching graphic movies before I drove an ambulance, and I can’t watch them now. I guess that’s what they call irony, since most people can’t do this kind of work but can watch those movies without a problem.

We descended on him eagerly — a true case of trauma is a rare and coveted event — and the police officers watched with bemused interest. One even got a notebook ready in case the guy regained enough consciousness to reveal his or his assailant’s name. It was my first GSW and I was very much a rookie at the time, but even I could’ve told the cop to put his notebook away.

The bullet had gone through the patient’s occipital lobe, and the larger exit wound showed that it had shot out of his left temporal lobe. The part of his brain that controlled his breathing remained, amazingly, intact. Once we had treated, packaged and begun our transport to a trauma center, there was nothing to do but sit and watch him breathe. I matched his respirations with the bag-valve mask to help push extra O2 in. His vitals were fine, but we all knew we were looking at a dying man, or a comatose one. His body had yet to admit the obvious.

When we went over a bump in the road, the trauma dressing slipped from his forehead, and a large geyser of blood and brain gushed from the exit wound. I yanked my left hand out of the way and slid my foot away from the new pool of blood. My right hand continued to bag him with oxygen as I reached for a new multitrauma dressing. I saw brain, I kept thinking.

I had the strangest feeling while watching him. His body was still warm and strong; his clothes had been cut off and he lay there oozing with life, impossibly alive. Somebody loved him, I thought. His mother, his girlfriend, his brother, his friend. Somebody thought he was invincible. He had thought he was invincible, clearly. The muscle memory in his body reeked of it.

Later, when it was over, when I had changed into a fresh uniform and finished my report, I took a nap in the ambulance, my arms crossed over my chest, my sunglasses on. I looked tougher than I felt: I was shaken to my boots. He died amidst the tools, machinery and impersonal language of the ER. All that yelling across his body, but nothing anybody did seemed related to him. And where was he in the midst of it all? Forgotten. A John Doe, dead. A policeman’s empty notebook page.

My partner didn’t think he was worth saving. His opinion was that all gang members were a cancer on society, and they should be rounded up and allowed to kill each other, so the rest of us could be free of them. He had two years’ experience on me and ordered me around constantly. That day I was too numb and exhausted to tell him what I was convinced of: that it wasn’t our job to decide who lived or died. That I didn’t ever want it to be my job to decide. If a person lay dying in front of me, I would try to help.

I didn’t think I’d be able to fall asleep sitting in the rig, but in the end I did. I slept and I dreamed. In my dream there was a clean white room: white walls, tile floor. John Doe was lying on the floor, still naked but cleaned up: no sign of blood or brain or even the wound for that matter, and his skin and tattoos were gleaming. His eyes were closed, he wasn’t yet dead but not alive either, and whatever life existed in him was in the form of a kind of coiled-up and angry tension: Some part of him refused to let go.

I got underneath him very carefully. Curled up in a ball, my head lowered, my breathing labored, I inched his torso into a sitting position by leaning my body weight into his back and pushing the ground away. It was slow, meticulous work and he was unnaturally heavy. His arms were relaxed at his side and his head was tilted back resting on my serpentine spine. His mouth was ajar and through the open channel of his throat came a kind of smoke or light. Every time I nudged him, his body relaxed a little more, and that strange substance slid out, curling up into the air around him.

That smoke, that light was grateful to be going. It was grateful to be going, and the more it left him, the lighter and more relaxed his body became. No tension, no ugliness, no holding on. Just a body on a tile floor, with smoke and light in the air around it, and me crouched underneath.

I want to be that grateful when I go.

 

Our Phantom Limbs

We drive her home in the middle of the night, but she can’t remember her ZIP Code or any cross streets. The hospital face sheet only has a numeric address, and there are so many streets with that name in the Thomas Guide, running east, west, north, south and diagonal — what side of the city did she live on? Then I have the bright idea to call someone who knows her. I pull over on the big vacuous street, a half-mile from the hospital, and set my hazards blinking. Once in a while a car zooms by and the rig slowly rocks from side to side. My partner in the back is digging through the patient’s purse and finds a tattered piece of paper with a phone number on it; I dial it on my phone, forgetting that it’s the middle of the night, not recognizing the New York area code, and wake the woman up. Her voice, brittle and paper-thin over the bad connection, grows with warmth and volume as the conversation progresses; she didn’t know her sister was in the hospital. She helps me out with the address, then, with a choke in her voice, says, “Tell her to call me when she gets home. Please?”

I assure her, hang up, put the paper slip back. I drive again, my hands at a perfect 10 and 2 on the wheel. I know where I’m headed, easy does it, this is a simple transfer, I’m just tired, no problem, but before I know it, one tear rolls down, and then another. Ridiculous, I say out loud. I wipe my face and say it again, softer and under my breath. Ridiculous. I hope my partner doesn’t see or hear me being a fool up front, but then I stop caring about that and give myself over to it. The tears flow steadily now; I have no idea where they’re coming from or why. Something about that concerned voice on the phone, and the empty, dark streets, and the sad, lonely character in back, the one who doesn’t remember where she lives, who didn’t tell her sister about her medical problems, who is now a double amputee.

When we get to the house and struggle to fit her through the narrow, cluttered hallways in her new wheelchair, she tells us to lock the door on our way out; there are seven dead bolts and nothing inside worth stealing. I remind her, with a sense of responsibility and my own familial guilt: Call your sister, okay? She looks at me, nods reluctantly, and, just before we squeeze ourselves out and into the night, gasping for fresh air, I see her pick up the old rotary receiver and stare at it.

 

WeThemUs

We eat fried chicken, potato chips, burritos, pizza. We microwave a frozen dinner and follow it with ice cream; we drink coffee, soda, energy drinks, liquid crack. If caffeine via IV were available, we would jab it into our veins; if filling meals existed cheaper than $5, we would consume them unapologetically. We smoke cigarettes right outside the hospital, chew tobacco and spit it into cups, careful not to stain our uniforms. We get scattered sleep but have perfected catnaps: We know how to park the rig in the shade, lean the seat back, and even in our sleep, we can filter noises from the radio, only waking when Dispatch calls our rig number. We fry our brains on television and video games during the day at station; we sleep as hard as we can for as long as we can, knowing we will never make it through the night, knowing there will always be at least one call. We know how to stumble out to the rig with a half-buttoned shirt, peer sleepy-eyed at the map book, flip on lights and sirens, drive relentlessly fast, and get on scene within time. Get there and have the shirt tucked in, gloves on, equipment ready. Get there and be alert, helpful, polite. Stumble back to sleep when it is done. In the morning there is coffee. In the morning there are bags under our eyes. In the morning we have dry skin, wrinkled uniforms, our first cigarettes. Meanwhile, the firefighters are switching out crews and the fresh ER hospital staff are just arriving, pouring coffee, hearing stories of the night before.

Our patients have diabetes, heart problems, chronic respiratory disease, renal failure, hypertension. Often they have spent years killing themselves slowly with their vices; their lists of medicines are long, their trips to the doctor often. Their pain scares them, wakes them in the night, and their fear of dying lives under their skin like a parasite. They feel it is unfair, their poor quality of life. But they remember to bring their cigarettes to the hospital even when their ambulance ride is spent wheezing. They sit and watch TV on tiny beds, complaining of nonfatty, compartmentalized food, even as their feet grow bluer from pooling, noncirculating blood; they stare blankly at the doctor when he advises them to exercise.

And we, the emergency medicine providers, the first responders, the paper pushers and gurney loaders, we hand off these patients to caffeine-ridden nurses, stressed-out and sleep-deprived doctors, overweight administrators. We hand them over and we roll our eyes and cluck our tongues: Here we go again, this frequent flyer is back, same chief complaint of chest pain. They survived this time, but we know one day they won’t. One day we will be pulling them through hospital doors in a flurry of action: chest compressions, ventilations, IV bag in tow, the paramedic pushing atropine and epinephrine through the narrow tube. If it is someone we like, we will feel frustrated, sad, helpless. Come back, come back, we lost you this time, your heart finally up and quit. We told you, we tried to tell you, now there is nothing we can do.

All the same, we refuse to think of our own mortality.

Somehow it feels like the only way we can survive this job is to have these same vices as an outlet, as if the cigarettes and caffeine and cheap fast food are just as necessary as the gloves and uniform and gear. As if being able to choose what we put in our body makes our poor choices irrelevant. We think our youth will save us, but we are only throwing useful artillery to the enemy, only turning a blind eye to the shrinking distance between us and our patients.

Come back, come back!

 

Chief Complaint

The patient I am treating has myriad infectious diseases and is spouting off a narcissistic soapbox tangent about what’s wrong with her life, her health, my clumsy efforts to help. Meanwhile, the rig is lurching because my partner is tired and resents this patient’s intrusion on his sleep cycle. It is 3 a.m. on a Monday night, Tuesday morning, whatever. I peer out the back of the rig at the streams of light. The police car is probably still behind us — should I have insisted that an officer ride in back with me? A moment ago, she’d been crawling up my arm, literally, demanding to see my pen and wanting to know what I’d done with her children — why had I killed them, why was I taking her to the graveyard, when she just wanted to go home. I pictured the pen being driven into my throat, so I gulped away my sleepiness and threw my forearm into her sternum with my weight behind it to sit her back on the gurney. I looked at her with an icy strength I didn’t feel and said in my best warning voice: “Hey, be nice to me and I’ll be nice to you. I promise not to take you to the graveyard. Now relax.”

My paperwork is sprawled about the rig. I’d take wrestling a psych patient over filling out paperwork any day. Name, birthdate, Social Security number, medical-insurance ID, height, weight, age, medical history, allergies, meds ... on and on. She’s changed her mind three times about her home address, not to mention having given six digits for her phone number, so I give up. The most important part of the paperwork, medically speaking, has yet to be filled out. In a few minutes I will give a report to the triage nurse, explaining who the patient is and what’s wrong with her, and I still don’t know what I’ll say. She’s violent, diseased, angry, but there is no apparent drug use; she’s probably a psych patient who is noncompliant with her meds. ...

Does it hurt anywhere? I ask loudly, interrupting her rant. Where is your pain? “Fuck you. Where are my kids, you bitch ...” and off she goes. Okay. Chief complaint: pissed off. Chief complaint: Threatened an officer outside a 7-Eleven, then insisted she had severe pain that has now vanished. Chief complaint: Probably doesn’t have a home, so the hospital is as good a place as any. Chief complaint: bilateral full-bodied “fuck you” pain with good circulation, sensory and motor.

I’m going to die this way, I think suddenly. I’m going to catch Hep C from a patient, or tuberculosis, or, at the very least, MRSA. I will get slammed in an ambulance crash, crushed by a burning building, shot by a gangbanger, blown up by a terrorist, exposed to a hazmat leak. I make minimum wage, risk my life in a war zone, and for what?

I’m almost tearing up, I’m so self-involved. The car lights are getting blurry and the paperwork is forgotten. I look back at her to find her quietly studying me. I have treated her before, I realize with a start, when I first started doing this. I have a painful, blindingly self-aware moment: Here I sit, another burnt-out EMT, with a wrinkled uniform and scuffed boots. My boots! When was the last time I polished them? Her eyes are momentarily clear and lucid and she smiles. “You’re very pretty,” she says.

Thanks. The rig stops and my partner ambles around the side to open the backdoor. His face is miserable as he puts on a fresh pair of gloves.

We’re here, I say.

 

No Complaints

Let me tell you a secret: In our job, it’s better when there are things to do. The worst kind of patient is the one we can’t help. Want to know the most infuriating chief complaint out there? Abdominal pain. We hate treating abdominal pain in the field. When someone has abdominal pain, whether it’s mild indigestion or a life-threatening aortic aneurysm, the treatment is the same: Drive to the hospital. That’s it. They could have an ulcer, blood in their GI tract, kidney stones, a bladder infection, appendicitis; they could have internal bleeding from a bruised solid organ or the swollen infection of a hollow one. They could be throwing up bright-red blood or vomiting “coffee grounds” — digested blood. This could have been going on for weeks or hours. The most you can do on your way to the hospital is get an accurate description of where in the body the pain is occurring, signs and symptoms, and severity. The triage nurse takes it from there, but God forbid you finish your assessment on the rig and still have even one minute to go on your ride to the ER. That’s one more minute of sitting there, listening to someone scream their head off, ask for pain medicine, tell you they’re going to throw up. You can sympathize with their pain, hand them a basin, tell them no pain medicine is allowed until some tests are performed at the hospital, but what it feels like you’re saying is: I’m useless, I can’t help you; just sit tight in this overrated taxi and we’ll get you there.

At least, that’s what I thought.

I get a call for an unconscious male outside a shopping mall. That description, of a “man down,” is the vaguest one out there; it can mean anything from a medical cause (syncopal episode, seizure, low- or high-blood-sugar diabetic, stroke, heart attack, drunk, or drug overdose) to a traumatic one (assault, stabbing, gunshot wound). He could be sleeping or he could be dead.

This patient is none of the above. When asked what hurts the most, where his pain is, what his reason was for calling 911, he says the same thing over and over.

“I can’t function.”

We walk him to the rig and sit him on the gurney inside and the paramedic and I climb in the back. The barrage of questions begins. Pain in your head, chest, abdomen? Difficulty breathing? Is there ringing in your ears, is it difficult to see, can you squeeze my fingers and wiggle your toes? Do you have heart problems or diabetes, do you feel confused, weak, dizzy? Have you fallen, been hit or bruised, can you describe how you’re feeling, do you have any pain, and has this happened to you before? What have you had to eat or drink, what medications are you taking, what kind of medical problems do you have? Drugs, alcohol? Anxiety, stress, panic attacks?

“I can’t function.”

He’s alert and oriented, knows where he is/what day it is/his name, but to every other question he says the same thing. He can’t function. He’s not taking meds, he ate lunch not that long ago, he feels “warm” from having been sitting in the sun, he doesn’t want to hurt himself or anyone else, and one more thing: He can’t function.

At first it’s kind of funny, then it’s annoying, then it’s sad. The paramedic sits there, asking, asking, going through his store of medical information, the mental checklist. Interrupting, I report the guy’s vitals one by one: His breathing, pulse and blood pressure are fine; his lungs are clear bilaterally. His blood is fully oxygenated and traveling to the farthest reaches of his body. His pupils are PERL (pupils equal, round and reactive to light), his skin signs are normal, he’s not altered in any way, and his blood sugar is perfect.

There is a moment of silence and we all sit there. If there were a clock, we would have heard its ticking. The paramedic is frustrated, but I am somewhat in awe. This man walked out of a shopping mall on a Thursday afternoon. He didn’t make a purchase. He probably walked toward his parked car, or the bus stop, and then just stopped dead in his tracks, not knowing if he wanted to go home, stay put, or return to the mall to buy something. Not knowing if he was hungry, thirsty, tired, lonely, restless, anxious, sick or crazy. He only knew he didn’t know. It’s not a medical complaint, and there isn’t a thing we or the hospital can do, but all the same, he can’t function. What do you do when you can’t function? You call 911. Who else are you going to call?

Something criminal happens, and 911 sends the police; if there is a fire, the fire trucks arrive; he has a medical problem and here are the paramedics and EMTs; and when things are real bad, you get all of the above. But when someone’s mind starts to go, there is no system in place. If you can’t function in this society, you’d better have friends and family, because otherwise, you are shit out of luck.

In the end we take him to the hospital. I sit in the back and don’t say a word. I keep thinking of a clock for some reason, the one that would be ticking because it is so quiet. The one we don’t have.

 

Eyes

You avoid looking at your patient, you have learned this much on the job at least: Patient is 95, female, complains of chest pain. The live-at-home nurse called 911 because she wasn’t sure how severe the old woman’s condition had become. They both speak Russian, you half-listen to the firefighters struggle with the language barrier while you hook up the 12-lead EKG. Move the 95-year-old breast out of the way, line up V4 with the midclavicular line, line up V6 with the midaxillary line, the rest is easy. Ma’am, we’re going to take a picture of your heart, you say, knowing that she’s not listening. Hold still for us, okay?

She is strong and angry; you feel it coming off her in waves. Feel it but don’t see it; you still won’t look at her. She is not the boss of the scene, the lead paramedic is, so you turn to him with the first copy of the EKG readout, which you wish you understood better but don’t. He looks at it, nods; you start to put her on oxygen but he shakes his head. Thumbs over his shoulder. Do that on the rig, we’re going to load her up and go.

Ah. Sack-of-potatoes time, you were waiting for this. She is old and weak, with light bones; there is a fairly easy path from the bed to the gurney waiting in the hall. You nod to your partner: We’ll G.S. her, you say. You still don’t know what G.S. stands for, but you get behind her, put your arms through her armpits, and grab her wrists. Your partner scoops up her legs: one, two, three, lift. The whole time, she is complaining loudly in Russian, and then before you can get to the gurney the 95-year-old flesh-and-bones package wrapped in your arms starts writhing and her complaints grow louder. All of it too fierce for that frail frame.

Almost there, but the paramedic stops you. There has been a shift in the air, but you missed the turning point. You were busy negotiating with the carpeted stairs, the thick table legs, the vase your partner almost elbowed. The paramedic’s face and voice have softened. Put her back, he says. You blink at him, feel the thin layer of sweat under your uniform, and start the shuffle back. She has slipped down and it’s increasingly awkward. You hear the paramedic talking to the nurse while the firefighters pack up their gear and you strain to make out the words.

Okay. It’s her choice. If she wants to die in her home, that’s her choice.

Strangely elated, with respect, you place her on the bed. You know you can look at her now, so you do. She is propped up on frilly pillows, hands clasped, coal-black eyes burning fiercely into yours, white hair in a tight bun. Reserved, dignified, powerful. Go away, her eyes say. I am the boss of me.

Beautiful, you think. Thank you, you almost say, but stop yourself. You slip the image of her gorgeous face into your pocket along with the second copy of the EKG printout you’ll study later, and almost skip out the door.

 

Honey, I’m ...

I am standing in the doorway of my apartment and my brain is empty. My bags are still on my shoulders. I could go anywhere right now, because loaded on my person is the following: bedding, a Thomas Guide, a shopping bag full of nonrefrigerated foods, and a travel bag full of toiletries, clean underwear and socks. I could go anywhere, but I’m here. I’m home.

It’s still dark outside, but the sun is coming up and my apartment is a muted gray. I keep standing there. I don’t know if I should wake up or rest, if I want coffee or sleep, and I can’t even bring myself to put my bags down because I can’t remember what goes where. Nothing makes sense.

Maybe I should call 911. That’s the new joke, these days. So many people call 911 for things I’d never dreamed of: for a headache, a stubbed toe, a runny nose. Maybe they were feeling anxious. Or they needed a ride to the hospital. Or they just wanted attention. No one has ever actually admitted that they’d called 911 for attention, but I wish someone would. There is one woman who calls every week; she has freshly made pies waiting for the firefighters, her bags are packed and ready by the door, and her makeup is perfectly done.

My weight is slowly shifting back and forth as I rock on my feet, and it’s a while before I even realize I’m doing it. I still haven’t put my bags down. Were there any good calls this last shift? The past 24 hours are a blur, and the answer to that question has become the new way to define my time, my job and myself. Did I have any good calls?

No, I can’t recall a single one.

I feel like a snail with a house on its back: What I am clutching feels more familiar than the yawning opening in front of me. I’ve been so, well, tired lately. Tired through and through. My voice-mail box is full, there are unopened bills on the counter and I’m scared to open my e-mail. I wash the ambulance I drive every day, and I always tell myself I will wash my car while I am at the station, but then I never do, so two months of bird shit and dirt have built up. My car is also a muted gray.

The lady who calls every week, the one with the pies, is what we call a seeker. There are many types of frequent flyers, but a seeker is hooked on pain meds. Calling 911 to get ambulance transport to the hospital is just additional abuse of the system. The funny thing about seekers is they complain ferociously about going to the hospital and they are very particular about how you handle them, how you lift them, how they are treated at the hospital. It’s as if going to the hospital was your idea, not theirs.

This woman complains of the same back pain, and has for years. Even though she shows no discomfort, talks normally and can walk but won’t, she always rates her pain at a 10 on the severity scale. We have to carry her down the stairs and hoist her onto the gurney, remember to bring her bags, and I will admit that while I am busy lifting her, I have a childish jealousy of the pies the firefighters will eat later. At the hospital she rattles off her medical-insurance numbers with ease and opens her mouth for the thermometer before I ever mention needing her temp.

You are wasting our time, I always think. Somewhere someone is having a heart attack or a stroke, ingesting poison, having a baby, bleeding out from a stabbing, or experiencing something somewhere that falls under the category of “emergency,” and here I am, hauling around a body that can move think breathe beat live all on its own.

One of my favorite things about being an EMT is (or used to be) showing up at a home or a restaurant or a car wreck or a street corner and being able to say the following words: “We are here to help.”

It’s glorious to say that and really mean it. But dealing with B.S. calls like the seeker’s is actually more exhausting and numbing than the adrenaline up-and-down swing of working real emergencies, and it’s hard to say those words and mean them when someone is lying to you.

“I’m here to help,” I call out to my apartment as I finally shuffle forward from the doorway, shrug my shoulders and relax my hands. Bam. Everything hits the ground at once. I slowly head upstairs and tip myself over into bed; I’m asleep before my head hits the pillow. My dreams are a muted gray.