Population 485 (22 page)

My brother John made a call, he came busting in the kitchen, and the first thing that hit him was a palpable wave of cigarette smoke and bacon grease. A man was spilled backward on the floor, his chair upended. His plate was mounded with half-finished eggs and sausage links. His cigarettes had slipped from his shirt pocket. His white belly protruded like risen dough. And his wife looked at my brother, and she said, “I don’t understand…he’s never been sick a day in his life.”

And John says he remembers his first thought was, Well, he’s sick now.

Alone in the van, I have a ball in my gut. I can already feel the eyes that will turn to me as I step through the door. The eyes will be stricken and hopeful, and I will throw myself into doing what I’ve been trained to do, not so much out of hope as a means of avoiding those eyes, because I know the man who lives here, and I know his health is poor, and I have a terribly accurate idea of the likelihood of my doing him any good. I step through the patio doors and one woman is tearful in the kitchen, pointing down to the end of the trailer, and in the bedroom, the man is flat on the floor and another woman is doing CPR, and as soon as I enter the bedroom she stands, backs away from the man, and bursts into tears. The bed has been pushed aside. A half-eaten muffin rests on the windowsill.

I strip my stethoscope out of the pack now and listen for a heartbeat. In the midst of the mess and panic, you plug the earpieces in, press the bell against the still chest, and listen. You are hoping to hear audible hydraulics from a fist’s worth of muscle. You are scanning for life’s backbeat. The
lup-dup
groove. A little heavier on the
dup
. That most ineffable iamb.

Nothing. I place an oral airway. It is a simple plastic device that keeps the tongue from the back of the throat, allows air to pass through the mouth. I resume CPR. Headlights sweep the window, and shortly my mother is kneeling beside me. She has a defibrillator and a Combitube. We attach the defib pads and fire up the machine. The line that should be bouncing across the screen is flat, flat, flat. Doing chest compressions with one hand, I grab my radio from the floor and call Chetek 245, to give them an update. When they answer, I can hear their siren in the background.

“This is two-forty-five, go ahead, New Auburn first responders.” I recognize the voice as Karen, an EMT I’ve taken shifts with for years.

“Two-forty-five, be advised we have an elderly adult male patient who suffered an unwitnessed cardiac arrest…. CPR was inprogress…at this time the patient is…is…” And then I lock up. For some reason, when I try to come up with the term we use in these situations—PNB, for “pulseless nonbreather”—I draw a complete blank. The only term I can summon is “Nebraska sign,” the old EMS chestnut equating the patient’s EKG tracing to the topography of the Cornhusker state. Not the sort of line you want to use over the airwaves or in front of family. I blurt out the next thing that comes to mind.

“…ahh…this patient is a
flat-liner
.”

After a little pause, Karen 10-4s me. There is a grin in her voice. It seems inappropriate, and unlike her. Later, she says when they heard that “flat-liner” business, they got the giggles in spite of the situation, because they wanted to know exactly what TV show was it I thought I was on?

Back in the trailer, my mother and I are working on the man, and I can feel the family behind me, watching. When the ambulance arrives, we hustle equipment in and out, get the man loaded on the cot and on the way. I have a moment then to speak with the family, and I tell them gently that it doesn’t look good. It is the only way, I think. I don’t go for false hope. I ask if there is anything I can do, or if they need someone to lock the place up. It is one more poignant facet of small-town volunteering. Someone calls for help, and it turns out the best you can do is make sure their windows are all shut, or that they get a ride to the hospital.

What a profound thing it is to call for help. How astounding, the number of people fate allows to float through this life never once confronting their own mortality. One of the benefits of the fire and rescue business, if you will have it, is a near-constant sense of vulnerability. A recognition that at the cellular level, or the speeding freight train level, we are but a particle removed from chaos. I have carried my kit in to find tattooed tavern-clearing monsters weeping in bed, hairless from radiation, leaking soupy feces from a colostomy, skin like mottled paté, and on the walls beer mirrors and bellicose biker tchotchkes, and I think, how do we ever forget this sort of possibility? How do we lapse into what you might call
ignortality
? In part, I guess, because you simply can’t function if you are always feeling the scythe pressed to your neck. I have knelt beside a wrecked car, seen a burly forty-year-old shaking with pain and fear, and realized the last time I saw him he was steaming under the bright lights of the hometown football field, running his body like a weapon. I superimpose the image in my head over the image before me, and try to keep the new one from displacing the old one, so that later I can ponder the contrast and see what it might teach me. The lesson never concludes, but I’m getting parts of it. I understand that what you’re doing when you dial 911—it sounds so perfunctory—is announcing to strangers that you are losing the battle. I no longer have the strength, I no longer have the answer, the trouble is winning, and won’t you please come help?

We have our frequent flyers. People only too willing to dial us up. The little old lady with heart trouble who meets us on the porch, all buttoned up and smiling, suitcase packed and set beside her. The woman with the flu who makes us wait until she gets her makeup right. The round man on the floor who calls because he has fallen and can’t get up, and as soon as we hoist him to his feet, he says thanks and toddles off to watch TV. “Tip-ups,” we call those.

One day, back before the 911 system, back in the phone-bar days, I was pulling weeds when I heard the steady jangle of the fire phone beside my bed. I banged through the doors, thundered up the stairs, vaulted the bed, and yanked the receiver from its cradle. “Fire department!” I said, heart pounding, chest heaving. An elderly man was on the other end, his voice placid. “Just checking my automatic dial,” he said, and hung up.

When our victims can’t call for help, others do it for them. “In here! In here!” screams a wife through the screen window, her husband pale and sweating on the floor. “She’s on the couch,” rasps an old man, waving the cherry of his cigarette in the direction of the living room. “There’s some guy bleeding on the road in front of the café,” says the farmer on my porch. We are hailed by relatives waving their arms at the end of driveways, or neighbors swinging a flashlight beside the mailbox. An old man whose wife was having trouble with her blood sugar flicked his porch lights when we rounded the corner. “It’s my mother again,” says a woman who has called many times before. In the middle of an all-night writing jag, I come downstairs to boil water for tea. I am capping the thermos when I hear noise in the street. I kill the lights and peer out through the porch. A van careens to the curb. A man leaps out, runs up the sidewalk, and pounds on my door. I let him knock a while, until I’ve had chance to study him in the streetlight glow. When I do step out on the porch, I keep the heavy steel thermos in hand and keep the door closed between us. A little paranoia, for safety’s sake. He hollers at me through the glass. “Is there a cop in this town?”

“Not tonight.”

“There’s a car in the ditch out on SS! With a guy in it! The car’s still runnin’ and he don’t answer! We seen your light on, so we thought we’d try to get help.”

“I’ll call,” I say. He runs back to the van, and the tires spit snow as it peels away from the curb. I write the license number in the window frost, in case this turns into something weird. Then I call the fire number and dispatch myself.

We find the car just beyond the village limits, eased nose first into the ditch, deep in the snow. A car idling in snow is potentially lethal. Back in the late ’60s, a couple went parking on Springer Lane and were overcome when they backed their tailpipe into the snow and the car filled with carbon monoxide. I remember my mother telling this story when I was a child, and I’m sure it was on her mind the night of my first date. She stopped me on my way out the door. “If you decide to go parking,” she said, “please come home and do it in the yard. We won’t bother you, and otherwise, I’ll just worry.” I knew her too well to think this implied carnal carte blanche, but to hear such straight talk from this churchly woman with her hair up in a meek bun—you could have knocked me over with a peck on the cheek. As it turned out, the girl in question only kissed me twice, both times under a pine tree in the open air, and she dropped me in less than two weeks. But the image of that young couple—I always imagine them in a ’50s vintage car—stuck in my head. Even after studying the effects of carbon monoxide poisoning, about how the carbon monoxide sucks up oxygen’s spot on hemoglobin and lulls you to sleep before it chokes you, even after studying the chemistry and the symptoms, the first thing I always think of when I see a car stuck in the snow and running, is my mother’s story. And so it is tonight when I see the body slumped in the front seat of the little red car.

It’s a young man. He’s pink-faced and unresponsive. Pink skin is a classic—but not so reliable—sign of carbon monoxide poisoning. I see his chest rise, feel for a pulse. Rapid. Ninety-six beats per minute. Feeling my hand on his wrist, the man rouses. His eyes peel open, slowly, and turn toward me. His sclera are bloodshot, and I can smell alcohol. I try to give him oxygen, try to take his blood pressure, all without luck. He pushes me away, slowly. Occasionally he raises his head and fixes me with a stare—a stare I’ve seen before on the psych ward and on detox calls, the one you get right before a previously complacent patient suddenly decides to go off at you. When I try to pull the keys from the ignition, he tugs them from my hand and stuffs them in his pocket. He gives me the glare again. “I think,” he says, slowly, ponderously, as if with great thought, “I’m gonna do something stupid.”

I back out of the car just as he takes a poke at me and lurches from his seat. He stands on the roadside for a moment, listing from side to side. Then, at a slow walk, he begins to leave the scene. He walks south, out of the headlights, following the centerline. It isn’t our responsibility to physically confront or restrain a guy like this, but it’s vicious cold out. If we lose track of him and he freezes in a snowbank, or he gets hit walking on the road, it won’t look good. We are hung up between the very real legal issues of assault and abandonment. Jack and I follow him. He looks back, starts to run. We fall in behind him, staying about five yards back. “Man, don’t do this,” I plead. “You can run from here to Bloomer and every time you look back, I’m gonna be right over your shoulder.” I run five or six times a week, and I’m in pretty good shape. Better shape than a drunk man at three
A.M
., I figure. Even in my fireman suit. He cuts to the right, heading for the ditch, which is filled in level with snow. He steps off into it and pitches face-first, punching through the crust with his bare hands. He flails around, gets his feet, half-swims, half-crawls to the other side, and takes off south again, into a patch of trees. Jack and I get across the ditch and fall back in stride. It’s a clear night, and there is enough moonlight to keep track of the guy, but not enough to see all the face-slapping underbrush, so I tuck right in behind him, like I’ve got the ball and he’s my lead blocker. We keep zigzagging through the brush, and I’m on the handheld, radioing a sort of directional play-by-play so that when the cops get here they can maybe cut us off somewhere. It had to be entertaining, listening to me trying to talk on the run, puffing and stumbling through the snow. Later my mom told me she was in bed following the whole thing on the scanner. Worrying, of course, because after all, her boy was chasing some drunk through the woods in the dark.

He stops finally, and starts fiddling with his pants. “Gotta pee,” he says. He looks over his shoulder. “S’pose yer gonna jump me now.”

“Nope,” I say. “We don’t get paid to fight.” It’s quiet out there in the woods. Still and cold. Just the sound of one man tinkling. Jack and I stand by. The man finishes, puts himself away, zips, turns, and stares at us. Then he shrugs, and takes off again. I radio our new direction of travel and resume the jog. It must have been a sight, the three of us in a line, one barehanded guy in a light coat and street shoes, dogged by two fully turned-out firefighters. I was fine with the running but I was wearing rubber gloves, and my hands were going numb. Rubber gloves have a built-in wind-chill factor. It was all I could do to key the radio mic. It looked like we were headed for a clearing over behind the natural gas station, so I updated the chief. We could see blue lights through the trees. Cops. We broke into the moonlit clearing and the man stopped. There were flashlights bobbing toward us, about seventy-five yards out. The three of us stood in a cluster, our breath steam-puffing across the moon. My hands were dead numb. Jack handed me his helmet. During the last leg of the run, he ran a stick in his eye. Messed it up for a week. When the guy was cuffed and in the squad, I asked Jack what the deal was with handing me his helmet. “When I got stuck in the eye, I had it,” he said. “If he’d of took off again, I’da coldcocked that sonofabitch.”

There is no standard call. The second you get your dispatch information, you commence to forming this picture in your head, drawing on all the calls you’ve made before, and when you get there, the picture never really matches up. “Person having difficulty breathing,” says the dispatcher, you get to the northbound rest area and the guy is a full-blown code. Not four hours later, I get dispatched again. “Difficulty breathing,” says the dispatcher, and this time it’s a cheerleader with a mild case of hyperventilation. Dispatchers have a tough gig. They function as interlocutor between two parties occupying various states of panic. They sort it out the best they can. It’s fascinating to think of them wherever they are, with their phone, their microphone, their maps, playing such a critical role in a drama where they never meet the other players. The dispatcher is hip-deep and detached, all at once. Think of a football coach locked in an office during the game, calling plays and relaying them to the quarterback based on reports given to him by a fan on a cell phone. The dispatchers gather what they can get and pass it on. Their voices float to us over the air, and we try to act accordingly. “This would be a larger male person,” says the dispatcher one night, and I figure, Well, that’s something to go on.