Flatline: NYC

The End, Maybe

We found her writhing on the kitchen floor.

I leaned over and peered down at her face. "Hey," I yelled. "What's going on?"

She laid there, silent for a moment, then lifted her head and muttered something unitelligible.

"Yeah," I said, looking around. "I see." 

By Bronx standards, the apartment was decent.  Light from an airshaft filtered through a dirty window onto green linoleum.  Not too many cockroaches, I thought, not too much trash either. 

Her sister was there, or maybe a cousin. Can't remember. "She swallowed the whole thing," she said, handing me an orange pill bottle. It was empty. The label read: 

"AMITRIPTYLINE 50mg. Take one a day. Pill Count: 30."

"Uh hu," I nodded, glancing at Jose. He nodded back.

Jose bent down to grab her knees; I put my arms around her chest. She flopped into the chair with a thump. 

Head dangling backwards, she snored. A moment later, she lifted her arms and flailed about, uttering gibberish. "Yo kid, that's is some zombie shit right there," Jose giggled. "Like Night of the Living Dead or some shit like that."

As her sister stood beside me, I laughed. "Alright dude, let's bounce."

As we wheeled her to the ambulance, her sister explained the story. The woman was in her late-40's and her son had just moved out of the house. She was very distraught, he sister said, but she'd never tried suicide before.

First time for everything, I thought.

Inside the bus, she started to thrash and twist. We bound her hands and feet. Digging my knee into her upper arm, I started an IV inside her elbow. She pulled away to no avail. 

Once at the hospital, she was sedated and paralyzed. Doctors rushed to pump her stomach. 

I thought of my parents and wondered: Did they miss me? Were they sad when I moved out? 

Whatever. They're still alive.

But it sucks to be alone.

 

Haunted, Part 1

Rick asked me if I was mad. I said no and polished off the rest of beer #2. He asked me what was up.

"I'm trying to get this woman's screams out of my head," I said, staring blankly at his knee. "I want to drink enough so that I stop hearing her voice."

Rick looked around at the other people in the room and muttered, "O...Oh, Okay."

We had started the morning with back-to-back cardiac arrests.

The first one was on the 16th floor of a luxury apartment building for the faculty of a local university. On the ground was a one-legged man, surrounded by fire fighters actually doing CPR. It was both surprising and impressive.

I ripped off the fire dept's automated defibrillator pads and replaced them with my own. "Don't touch!" I said, pointing to the man. i waited for the monitor to show a perfect, uninterrupted flatline, then hit the print button

"Ok, continue CPR," I nodded.

My partner got out the IV setup as I pulled out the tube kit.

The intubation was no problem., but my partner was having a hard time with the IV.

We put the first round of drugs down the tube. And then the second. And then the third.

By now, the tube was overflowing with liquid, a frothy mix of blood, mucus, and Epi. My partner prepared the stretcher, implying that we would take the man to the hospital. I shook my head vigorously and reached into the medication bag for a small, twenty-two gauge needle. I found a small vein on the inside of the man's right wrist. I hit it on my first shot.

"Get me an Epi, would ya?" I asked my partner, smiling triumphantly.

As I finished pushing an amalgam of medications to no avail, my partner looked at me. "I'm gonna get on the phone," he said.

I nodded. The phone meant Bicarb, and Bicarb meant the end was near. He walked into an adjoining room with the phone to his ear.

I rechecked the monitor and took off my gloves. Nada. I wiped my hands like Pontius Pilate and started picking up trash. Dirty needles were the biggest worry, and after that it was the used medication vials. A fire fighter followed me around with a red trash bag.

"Well, it's been fun," I laughed, patting him on the shoulder.

Just then, the man's sister arrived. She fell to the floor next to him, screaming. "C'mon you bastard, get up! Get up!" she pounded her fists on the floor. "Live...live you bastard!"

Needless to say, her arrival was a major buzzkill.

My partner returned rubbing his hands together like a boy at Christmas. "Two Bicarb and call him back in five minutes," he announced.

His smile disappeared when he saw the woman on the floor.

"You bastard!" she howled. "You can't die! You can't leave without me! You bastard, you can't die! Live you bastard. Live!" Her cries gradually morphed into an incomprehensible jumble of sobs and injunctions.

The EMT continued with chest compressions and our student kept bagging. I continued to gather our things, which had been scattered about in the initial rush to save the man's life. No one would make eye contact with woman who now had her brother's hand in her own and was caressing it vigorously. We pretended to ignore her and the result was a bizarre, stiltled normalcy. The EMT pushed down on the man's chest and the student squeezed the BVM and the woman sobbed. And sobbed. And sobbed.

My partner returned. "The time is 1036," he said.

The EMT stopped CPR and I hit the print button one last time. Our student kept squeezing the BVM--a glossed-over look had overtaken her face. I pulled the EKG wires off the man with a single yank.

"What's going on?" asked the woman, bewildered.

"He's dead," I said, eyeballing our student. The fire fighter with the red trash bag approached her and she looked up at me, still squeezing the BVM. I nodded. Slowly and seemingly in disbelief, she disconnected the dirty BVM and placed it in the bag.

The woman threw herself on top of her brother, clutching his lifeless body. "You lived a good life, goddamnit. You bastard, you left without me! You left me all alone! You left me, you bastard!" She grabbed her brother by his shoulders and shook him as she said this. "Do you hear me? You bastard, you can't be dead. You can't."

I picked up the monitor and left like I was fleeing the scene of a crime. No double-checking to make sure I had everything. No goodbye. No "Sorry for your loss." I just wanted out of that room, out of that apartment, out of that sadness. I wanted fresh air and fresh clothes. I wanted to be somewhere else. I wanted a drink, a laugh. Something to get her voice, her screams out of my head, out of my mind, out of me.

To be continued...

Sammy

I've been avoiding this post for at least a week.

There's this guy that I've been picking up lately. His name is Sammy. The first time I had him it came accross as a Cardiac Arrest. We almost took out a cop car on our way there.

And there he was, walking in the street like an idiot, his mouth wide open, breathing exagerrated as though he was gasping for air. My partner had had him before many, many times. "I need oxygen! I can't breathe!" he would yell between breaths.

Lungs clear and equal. Oxygen saturation 100%. Diagnonsis: EDP (Emotionally Disturbed Person). That's shop talk for "Lunatic," in case you didn't know.

The funny thing about being in EMS is that you see enough EDP's that you learn to recognize them on site. The moment a person opens his or her mouth––and sometimes it doesn't even take that much––the diagnosis becomes clear.

I always have a hard time with EDP's. I just, I don't have any compassion for them when they call 911. I just don't care. They are a waste of my fucking time. Sometimes, a person wigs out cuz something bad happens and that's understandable. But the drunken lunatic that calls 911 twice a day––well, I really don't care if he gets run over by a truck. Really, I mean it. I just don't even view them as human beings.

The irony behind all this, of course, is that my mom would be one of them if things in her life had turned out differently. She is officially an EDP. Certifiable. But she is also a good person with a big heart.

But growing up with my mom prepared me--hell, predisposed me--to this job, to this line of work. Being a paramedic is about managing chaos well, and my childhood was, well, mostly chaos. Mom flipping out, breaking things around the house. Screaming at 3am and waking the neighbors. Crying inconsolably. You get the drill.

But that childhood made me who I am today. Now I thrive in chaos. It suits me well––it makes me comfortable.

But there are the EDP's themselves. I can't bring myself to look them in the eye as though they were human. I just, I can't do it. It would bother me too much. I'd rather hate them than let that happen. Nothing is worth that price.

Really, Sammy just needs a place to live where people will take care of him. He is not fit or meant for society, at least not when I see him. He is straight EDP––so far gone from the realm of the normal that there's no mistaking him. Everyone, even the neighbors, know he's crazy.

He was asking for oxygen, saying he was having an asthma attack. We had a student and she was preparing an albuterol treament.

"Hold it there kiddo," I said. "What's this guy's chief complaint? What's wrong with this guy?"

The student looked at me, slightly confused. "Shortness of breath," she said, nodding her head, "he says he can't breathe."

"Okay," I retorted, rolling my eyes, "but what do you see, what do you really think is wrong with him?"

"What do you mean?" she said, still lost.

My partner hopped into the mix, trying to talk her down from the ledge off which respectable, street-wise medics like us hope never to fall. "What's really wrong with him?" he asked, trying to rephrase things somehow. The whole exercise last five minutes and went nowhere. Finally, I lost it.

"The guy's a fucking EDP!" I shouted. "He's a fucking lunatic, and oxygen does not fix crazy people."

Meanwhile, Sammy started crying. "I need oxygen, please!"

I refused to make eye contact with him.

"Let me put it this way," I explained rather flatly, "what's going on my paperwork? Am I gonna write this up as a Diff Breather? Or as an EDP?" My student nodded as I said 'EDP.' I paused for dramatic effect. "So if he's an EDP then why the fuck are we giving oxygen!"

"But there's no contraindications for oxygen," she replied. I cut her off.

"We're feeding into this fucker's little game. He calls 911 because he wants attention, and every idiot who gives him oxygen and a nebulizer treatment is encouraging this shit. Remember, we dispense treatment because we think something's wrong with the patient, not because they ask for it. We run the show––not the patients, remember that."

We took Sammy to the city hospital. On the way, our student put an oxygen mask on him on the way there. I glared into the rear-view mirror with disapproval.

We walked him into the ER from the ambulance and made him carry the unplugged oxygen mask in his hand.

As we stepped inside, an EMT looked at us sidelong. "Okay, which one of you was it?" she said "Which one of you gave Sammy O2?"

I shook my head and pointed at the student. The EMT laughed. "And you guys let her?" she asked.

I looked away feeling slightly embittered. At the same time, the triage nurse pointed him to a seat and told him to sit down. He was going straight up to the psych ward, which made us and him happy.

That's all I wanted: Sammy away somewhere. I didn't care if it was in a psychiatric ward or a shallow grave. I just wanted him gone--and right now I'm tired and honest enough to say that I didn't care where it was.

the Save

We saved someone today. To be honest, it was kind of a joke. I was working BLS on the overnight, and an hour before six, our official off time, they dispatched a cardiac arrest ten blocks away. We buffed the job. It was at a nursing home. The man had a tracheostomy and was a vegetable at baseline.

The nurse, to my surprise, was actually doing CPR when we arrived. I attached the AED and it said, "No shock advised." The man was swollen with CHF and Liver Failure. Even his chest was edematous. I continued with CPR as my partner gathered information.

The medics showed up a few minutes later. One of them, a middle aged black woman, touched the man's leg. It was cold.

"C'mon guys," she scolded harshly. "What are you thinking?" implying that we should have pronounced him DOA.

I rolled my eyes. The paramedic patch on my shoulder was out of her view. The man wasn't pronouncable. Staff said he was breathing fast as they were bathing him and then seized before arresting. No rigor mortis. His torso was still warm.

They put the man on the monitor. He had a slow paced rythmn from an internal pacemaker. His pulse was incredibly hard to palpate, but he had a distinct heartbeat upon auscultation.

The irony was not lost on me.

"How about we get a blood pressure," I asked, bearing a shit-eating grin.

Vitals were: BP 52/18, Pulse 38, Respirations 4 & agonal

"You know what we should do," I said, thinking nothing of it, "we should pace this guy."

With the edema, the medics didn't seem too eager to start an IV. I figured we'd just transport and gathered our gear.

The second medic was forty-year old white guy with tatoos poking from under his sleeve. He had a cool, I've-been-doing-this-forever vibe. As I made ready to leave, he stopped me. "No," he said, speaking softly, "wait. We're gonna do what you said. We're gonna pace this guy."

Some discussion ensued about how to use the pacemaker.

Lo and behold, it worked. We got the man's pulse up to 80.

As we stepped into the ambulance, the black woman pulled out an ACLS manual. I shook my head and suggested they try starting an IV in the man's scalp. He had a big one just calling our name. No takers.

The man lived.

About My Recent Absence

It's been a while since my last post and while I don't want to totally give myself away, I thought I'd let you guys know that I won a couple national writing awards for work totally unrelated to Flatline. There's been a some hoopla surrounding one of the awards, and I've been busy with the ceremony and related stuff.

Thanks for the understanding.

-Tyson

The Toaster Fire

Smoke was pouring out of the house. White smoke. But still, what the hell were we doing going in? Whatever. I grabbed the bags and stepped past several firemen. The fire was in the kitchen--some overdone casserole. The woman was in the back, on the floor of her bedroom. Two EMTs were doing CPR and a fireman was fiddling with an automatic defibrillator. Clothes and food wrappers littered the floor. My partner, the Old Man, setup the defibrillator. I pulled out the intubation kit.

No one had seen her for an hour. She was asystole on the monitor--the heart's electrical silence. Her head was in a corner with little room for me to lay down or sit. I instructed a fireman to drag her legs toward the door to give me some room. She was fat, and fat people always make for difficult intubations. It took four tries and someone shoving a pillow under her shoulders for me to actually intubate the woman. Her throat was a bloody mess by the time I was done with it.

It was impossible to figure out the woman's history as the smoke, now lightened by wafts of fresh air, and the clutter made finding anything impossible. After 3 rounds of Epi/Atropine and a round of Dextrose & Narcan, I was surprised to hear the Old Man suggest that we take the woman to the hospital. Normally, we don't transport dead people. And believe me, someone who's in asystole after 3 rounds of drugs is fucking dead. He figured that because of the fire there was a chance it was related, therefore maybe the hospital could do something we couldn't. Let me tell ya, they can't and they didn't.

But that doesn't mean we didn't have some fun zooming to the hospital. For the first time in a while, I got to perform CPR. Normally, that's someone else's job. But in the back to the bus, it was just me and the Old Man. He was busy pushing drugs and well, doing something, so it was up to me to do CPR. As we zipped through traffic, I did CPR with one hand and squeezed the BVM with another. Just in case this is confusing, a BVM is the thing that you use to blow air into a person's lungs. We call it "bagging."

In all the confusion, the EMTs drove past the nearest hospital and ended up going to a more distant one. "This is a long fucking five minutes," I shouted to the driver as my arms grew tired. He responded with a paniced mumble.

I shook my head.

At the ER, we all felt like stars. People were standing outside, mouth-open, gawking. An EMT hopped onto the stretcher and began performing CPR.

"Where's the camera's?" he laughed.

The ER staff was sitting casually at their desks, looking bored. We had achieved complete surprise.

"Is this a cardiac arrest?" asked a flabbergasted doctor.

"No," I said, holding onto the ET tube. "It's an ankle fracture, we're just doing this to get you riled."

The ER spun into motion. Doctors shouted orders. I called out my report: "75 year old female, Cardiac Arrest. Last seen an hour ago. We've got 5 Epi's, 3 Atropine's, 2 amps of BiCarb and Narcan-D50 on board. There was a small fire in her kitchen and she's been asystolic this whole time."

They hooked her into a variety of machines. The automated CPR machine was my favorite. It made a loud noise that filled the ER: Whapa, Whapa, Whapa. And thus the last sound of her legal life was the sound of people clucking and machines chattering. She was pronounced dead a few minutes later.

"Well, earned our money today, Old Man," I said, "didn't we?"

He nodded and we both laughed.

For Compassion, an Elegy

We found him sitting on the curb, crying, drunk, and surrounded by firemen.

"They kicked me!" he howled, "like I'm not even a person."

I looked at him and thought, well, you are a drunk...

The fire department lieutenant looked at me and smirked. "Yeah," he said, "one of my guys gave him a little shot in the ribs to, you know, make sure he was still alive and everything. We found him passed out on the sidewalk...Now he's saying something about having chest pain."

I nodded and motioned for the man to stand up. I find that with drunks it is easiest to grab them with two hands, one on the belt, another on the collar. You can control their movement that way. Especially if they're really hammered, you can kind of throw them onto the stretcher and prevent them from falling. I grabbed him and helped him into the bus.

"Twenty years ago," he sniveled indignantly, "no one would have ever dared to kick me."

Oh yeah, right, back in the good ol' days, I thought.

I had never picked the man up before, which is something of a rarity with drunks, especially homeless ones. The man was Puerto Rican, named Jose, and the 14th of 14 children. He had served as a Marine in the Vietnam War and been a Corrections Officer for most of his life. I was moved by this, but not surprised. I had met two retired Corrections Officers--that is, prison guards--on the job, and they were both trainwrecks.

A lot of EMTs want to be cops, and sometimes it's easier to get a job as a prison guard than a regular cop. I beg them with my eyes not to take the job, not to volunteer for prison duty. Prison engulfs you, it cages your soul and estranges you from the world outside. It's not just a place but a state of mind, and come-and-go as you might, your mind stays there, trapped.

Jose keeps crying and whining about being treated like a dog. I ask him if he had ever kicked anyone while he was in prison. No, he said, he would never do that. I was dubious, and looked away.

At the hospital, he thanked me profusely for being so kind, as drunks tend to do. He offered me his hand, but I didn't want to touch it. I was afraid it was dirty, that maybe he had wiped his ass with it or jerked off in the morning. That's what I told myself at least.

I shook his hand nonetheless, and wanted to wash it immediately. It really wasn't the grime that bothered me so much as his humanity. By touching his hand and accepting his thanks, I had to recognize him as a person, not just a drunk. I didn't care about him, really, or at least I didn't want to. He was just another fucking drunk with a story. I hate fucking drunks. Kick 'em all you want, FDNY, it's fine with me. But in touching his hand and meeting his eyes, I couldn't help but feel a little sorry for the guy. He had worked at an honorable, if thankless, job his whole life; he had served in the military and gotten shot in the knee; and now, here he was, drunk and homeless in New York City.

I felt uncomfortable, perhaps a little guilty.

A long time ago, when I was 18 and I had just become an EMT, I thought I was gonna save the world. I remember one day I went over to People's Park, where all the homeless slept, and offered them whatever medical assistance I could.

Jesus, I think to myself now, what was I doing.

Medicine--EMS--has changed me, made me less sympathetic to the world. I try to remember how I thought about the world and about people before I was in EMS, and I can barely remember it. That person that I was seems so foreign, so distant from who I am today.

When I first started working as an EMT, I would tell my friends how much the job makes me appreciate the fragility of my own life and how much it compels me to adopt a Carpe Diem outlook on life.

Yeah, that phase is over. Don't get me wrong, I still love my job, but I'm not a bright eyed kid anymore. I look at patients with one eye and another fixed on the cold calculus of self-preservation. I could care about you, but that would mean giving some of me to you, and I don't have that much of myself to go around. Empathy is dangerous--it can get inside you, remind you of the you you might become. It can make you imagine your father's heart attack or your sister's suicide. It can make you feel like you might be a patient, and that's all well and good when you're a kid with heart and love to spare. But I ain't that kid anymore. And here, today, on my stretcher, you're just another fucking drunk and I don't have time for your bullshit.

I know this post isn't as polished or dramatic as my usual writing, but it's the straight shit, it's how I feel, unedited, and the thing is, I want to be a good person and I still want to make the world a better place. But sometimes, I don't. Maybe I'm a bad person for feeling this way and thinking these things, but surely, I'm not alone.

Easter Sunday

A cop was running frantically around a grey minivan. Children sat inside, still buckled in, their Sunday dresses fluffed into clouds of lace and satin.

"Where's the baby?" I asked.

"Mommy took him away in a car," the youngest girl answered.

It was almost one those calls. Those calls that stay with you forever.

We were basking in the Easter sun when the radio crackled: "Six-Kilo and Ten-Zebra for the arrest..."

I looked over at my partner. Umm, okay, I thought, giving it about a 50/50 chance that it was a legitimate cardiac arrest. We stretched out our arms and yawned before reading the text in onboard computer message. It read:

"CARDIAC ARREST....2 YO BABY IN THE STREET... "

Without saying anything, I put the ambulance into gear.

I had been on a cardiac arrest involving a baby before and the memory has never left me.

When we pulled up, I was expecting someone to come running at us with a dead, floppy baby. But instead there were just three little girls, a thirty-something year old man, and a similarly aged woman, apparently their aunt.

A lone cop was on scene, trying to get the full story. He said the mom had left in a taxicab doing CPR on her two year-old baby. Word was that they had gone to Jacobi hospital, miles away, bypassing several closer hospitals. God, please tell me they didn't go to Jacobi, I thought.

But what had happened--it was still a mystery.

Then we saw it: a single, dime-sized bullet hole in the side-door of the mini-van. Someone had shot the kid.

If I had believed in god, I would have told him to go fuck himself.

"Hey, let's get these kids checked out, make sure none of them are injured," suggested the cop.

Good idea, I thought. "Okay, girlies," I said, "we're gonna take you over to the ambulance and check you out and make sure you're not hurt, okay?"

They nodded in unison.

Just then, another ambulance pulled up. My partner explained the story and pointed at the bullet hole.

"That's so funny," the EMT said, ""we heard a bunch of gunfire earlier and I said, 'someone's gonna get shot.' I just never thought it would be a little kid."

I sat the girls in the back of the ambulance, checking them for hidden gunshot wounds.

"What happened?" I asked.

The middle one, who had been crying, started talking and bumbling. "Stop, let me explain," interrupted the older one, her hair held up by a pink ribbon. "Or else they won't understand."

"We were driving down the street," she continued, her voice high and girlish, "and there were gunshots and one of them hit my baby brother right here [she lifted up her left arm and placed a hand over the left side of her chest]."

"Uh huh," I nodded, "and then what happened?"

"And then my baby brother stopped talking," she said.

Tears crested in my eyes when she said this, her voice so innocent. I stopped for a moment, then walked them back to their aunt as she sobbed in the street.

"Okay," I said to my partner, "let's get out of here."

We drove in silence down the street. I held back tears as I imagined how it might have been if the woman and the baby had still been there.

The sun was still high in the sky, and outside people laughed and barbecued in their Sunday finest. Everywhere, people were happy.

At the hospital, we found a dead baby, a grieving mother, and a newsvan.

"The baby's dead, they cracked his chest open and everything," a friend in the ER told my partner and I. "The bullet took out one of the valves of his heart. But don't say anything, the mom doesn't know yet."

Family members gathered around the door to the ER, pushing each other out of the way to peer inside.

The woman, nicely dressed, rocked herself back and forth as she sobbed. I took one look at her and shook my head.

It was a holiday, I thought. I need to get some air.

dying

He was dying, victim of a slow suicide.

Gasp. Gulp. Gasp.

"Umm, sir." I asked, squinting my eyes. "What's wrong with you?"

He did not respond.

Angry Black Man followed his "brother" into the other room.

i look him over. In the dark of the basement, he appeared near death. His arms were covered in bandages, hiding gigantic scabs and pus-filled blisters. His chest was gaunt and sunken, nothing more than ribs and skin.

I asked him when was the last time he used heroin, thinking he might be in heroin withdrawal. Last night, he saidm, still gasping. Hmm, there goes that theory.

ABM returned, approaching me. He whispered in my ear, "His brother said he's High Five, Hep C, TB, fucking everything." High Five is our code word for HIV, and Hep C & TB are classic dirtbag diseases gotten from sharing needles and living in third world type conditions.

I looked the man over again, searching for a spot to place an IV. Nothing. He had shot up so much that there was no hope for him. He was all scabs and sickness and death. We threw him on some oxygen and carried him out to the ambulance.

At the hospital, as we waited for a nurse, the man started shaking and jerking about.

"What's his problem?" asked one of the EMTs.

"Status Dirtbagus" I said, laughing sarcastically.

After a while, the muscle jerks and trembling became uncontrollable and the man unbuckled the straps holding him down.

I approached him. "Dude," I said, "What's wrong with you? What should I tell the doctor?" It was a longshot, I knew, but what the hell, it never hurts to ask.

"Cocaine...overdose," said, gasping for air.

"No shit?" I nodded, suddenly putting it all together.

"I think..." he continued, "I'm having a heart attack."

Telemetry: Orders from Above

He was autistic, muscular, and in the bouts of a serious asthma attack. Walking into the room, I noticed the sweat glistening from his brow in large, irridescant drops.

Aww shit, this is gonna be a bad one, I thought.

We had a student with us, who listened to his lungs. "He's tight," he said, reffering to the severity of his wheezing.

Instantly, I reached for a nebulizer setup. Screw the hand-held thing, this kid needed a mask strapped to his face.

As my partner got vitals and my student got more of a history, I setup an IV and thought about what I'd ask for on the phone. Ahh, the phone. As paramedics, we can do a lot, but at some point, to do some things, we must call and confer with a doctor. The doctor, of course, is sitting somewhere cozy and quiet and far from our chaotic little scene. The good doctors cut us some slack when we need it, the bad ones just don't understand how things work in the chaotic field environment.

There was as issue with the kid. He was 19, a big, strong boy, and he didn't like us putting things in his face. The air hunger was making him frantic and combatitive, exacerbating the strain of being exposed to strangers. Autism is a hard disease to deal with. You must be patient, very patient, a quality rarely attributed to Paramedics. We practice medicine hard and fast. If you don't like what we're doing, we really don't care. Most people don't like what we're doing, and after a while, it makes you numb and impatient to people's varying sensitivities and complaints. I'm not saying it's a good thing, but it's reality, it's life on the streets, and god knows it's a far cry from utopia.

The kid didn't want the albuterol, by mask or any other way. Albuterol, though, is the first line treatment. It's that misty stuff they give you when you have asthma, and it works wonders, sometimes.

I got on the phone. Ok, I wanted Solu-Medrol--a steroid to decrease inflammation--and Magnesium Sulfate--a muscle relaxant used in moderate to severe asthma. Wait, it was Doctor Silverman, #80249. Damnit.

I told him the story.

"Unless you have an IV established right now, you need to stop what you're doing and initiate transport," he responded.

Jesus. This wasn't going well. We were on the 5th floor of a walkup apartment building with a narrow staircase. If we didn't stabilize this kid and get him to cooperate now, he might have to stop breathing or die before we could move him.

"Sir," I said, "this patient is autistic and extremely uncooperative. There's no way we're going to transport him unless we stabilize him first."

"I want you to start transporting immediately," he said, growing annoyed.

I glanced into the other room. The kid's uncle had convinced him to accept the albuterol treatment, an important success. Our student was struggling with the IV.

"Look, well, how about this," I suggested, rolling my eyes. "What if we start transporting right now and get an IV en route, can we then go ahead with some Mag and Solu-Medrol?"

"Well," he paused. "Okay, just as long as you start transporting right away."

Ahh, relief.

I stepped back into the living room, where my partner, my student, and the family stood huddled around the boy. He was looking better. The albuterol was working, thank god.

"It wasn't easy," I proclaimed, "but I got us Mag and Solu-Medrol...Oh, and Doctor Silverman wants us to transport right away."

My partner shot me a dirty look. "Yeah. Well, Doctor Silverman can wait," he said.

The boy was mostly calm by the time we finally go the IV. We decided to hold off on the big gun--the Mag--because the albuterol had worked so well. The Solu-Medrol would help prevent recurrence, at least for a day or so.

It was still a bitch to carry the kid down the stairs. He felt like dead weight, something that was intensified by the strange forward leaning position in which he sat. We carried him down five flights. Man, if he he had been fighting us, it would never have happened. Maybe he would have died, who knows, but we did out job, despite the ill-conceived orders from above.