A Thousand Naked Strangers (6 page)

I clear my throat. “Don said something about insurance fraud?”

He waves his empty cup at the waitress and smiles. He explains it like this: “We charge more for transporting a patient in an ambulance—one who can't sit up or who needs the special care of EMS during transport. And so long as we can prove the necessity for an ambulance and not, say, a much cheaper wheelchair van, Medicare will pay the higher cost.” He stabs his fork into a pile of hash browns. “So, we simply document the medical necessity of transporting the patient by ambulance. Sometimes it's true and sometimes . . .” He laughs. “You're new,” he says. “Trust me. You're gonna see all kinds of things.”

Our Nextel chirps and he grabs it. “Yeah?”

Sherry's voice crackles over the diner. “Got one for you.”

•  •  •

Crestview Nursing Home is perched atop a sloping hill and rises from the clay like a tombstone memorializing its uncounted and uncountable dead. To the east lies a forgotten cemetery where, during the 1996 Olympics, police found several murdered hookers but not their killer. To the west its neighbors are a strip club and an abandoned apartment complex, remembered—by those who remember it at all—as the spot where a toddler was killed by a stray bullet that passed through his bedroom wall. To the rear sits a long brick building that is rumored to have served as a dormitory for chain gangs working in South Atlanta. Other than that, there is the highway and nothing else.

Crestview is monstrous. How many thousands have slowly slipped down the drain of life with bellies full of Crestview Jell-O is impossible to say. Most of the home's residents live and die anonymously; they are the toothless faces of Georgia's poor and infirm.

Jonathan and I step off the elevator. I'm immediately assaulted by the air, heavy with the stink of dirty diapers, reheated food, and unwashed bodies. We squeeze around a resident who stares but doesn't move. He's nothing but an open mouth, a vacant face. A geriatric still life in dirty pajamas. Down the hall, it only gets worse. Fish-eyed men in bathrobes stand frozen in corners; legless women roll around in squeaky wheelchairs. At every turn, more appear. The blind, deaf, demented, and forgotten shuffle toward us with pained yet purposeful movement, propelled, zombie-like, by the scent of real-life humans.

We press on toward the nursing station and find the place in total chaos. Files teetering on top of food trays, threatening to topple over. Nurses, a half-dozen, at least, cackle in the island dialect found in nearly all of Atlanta's long-term care facilities.
Somewhere—be it Jamaica, Barbados, the Dominican Republic, or Trinidad—someone is recruiting nurses, tons of them, making it hard to find a single nursing home not echoing with the distinctively lyrical and unrushed accent.

Of course, they ignore us. Jonathan casually reaches for a file marked 22b and asks what the problem is. The nurses stop talking, annoyed by the intrusion. Without turning toward us, one of them says, “It's rum nine, bid twennnty-twooo-bee. Din't eat nooo breakfuss this marnin'.”

They continue on with their conversation. Jonathan interrupts them again. “That normal?”

“Wit youuuu tink?”

“Don't know. Don't know him. Or is it a she?”

We obviously aren't going to take the patient and disappear. The nurse sighs and snatches the chart. We follow her to room nine, where she stops at the foot of bed 22b and starts thumbing through the paperwork. The man in the bed, Mr. Perry, does not look good, even to my untrained eyes. His black skin is shiny and packed tight like spoiled sausage, swollen to the point of bursting. His dry lips are cracked, eyes yellow and sunken, breathing heavy and fast. He's so febrile that I can feel the heat rising from the bed. His limbs are shriveled and contracted, his belly bloated as if he's swallowed a frozen turkey. A feeding tube pokes out of his gut just below his ribs and runs to a bag of the brown liquidy stuff eaten by people on feeding tubes.

Jonathan points at the line. “So, if he's on a feeding tube, how did he not eat breakfast? Because it seems to me all you'd have to do to get him to eat breakfast is turn it on. Did you forget to turn it on?”

The nurse thrusts the chart toward him. “Din't you reeed dis?”

“Nope.”

“Line is clogged. No floooow.”

“I see.”

“And hee's gut a feeeever.”

“For how long?”

“Staaaarted las' night. Night staff don't tell us nutin'.”

Jonathan and the nurse stare at each other. There's no way that his fever, his distended abdomen, his clogged feeding tube, or even his dirty diaper are new as of the last twelve hours, but there are some things not worth arguing over. We take Mr. Perry and his chart and leave. Outside, it's like we've been released from prison. Or a coffin. We wheel him to the ambulance and load the stretcher. As I climb in to get a set of vital signs, the doors slam shut behind me. I freeze.

Certainly Jonathan isn't going to leave me, an EMT with under two hours of experience, alone in the back of an ambulance with a man whose list of complicating medical factors exceeds my own medical vocabulary. Certainly this is a joke. Then I hear the front door open, and the ambulance sways under Jonathan's weight. The engine fires up. I poke my head through the window connecting the front of the ambulance to the back. “What the fuck are you doing?”

Jonathan smiles. “Going to the hospital. Don't worry. You'll be fine.”

“I'm not worried about me. I'm worried about him.”

“He'll be fine. Or not. Dude's literally on his deathbed. What's the worst thing you could possibly do?”

I look at Mr. Perry, a feverish, bloated, heavy-breathing bag of slowly dying humanity. “You gotta get back here. Seriously.”

The ambulance starts to move.

“This isn't funny, Jonathan. It's incredibly far from funny.”

“You're right. This isn't funny. This is your job.”

I grab the blood pressure cuff and check Mr. Perry's pressure. If he has one, I can't tell what it is. I've pushed my fingers into his neck to count his thready pulse when, without warning, he opens his mouth and shoots a geyser of dark brown blood straight up into the air.

I scream for help, but Jonathan keeps driving. There's nothing to do but roll Mr. Perry onto his side and let him soak the cabinets, the equipment, the sheets, everything, with partially digested blood. A Stephen King novel has nothing on this. I am scared and furious, and even after we get to the hospital, I ignore Jonathan. When we've dropped the patient off, Jonathan shakes his head as he surveys the damage in the ambulance. “This is gonna be an expensive cleanup.”

Five minutes later, we're standing behind FirstMed's ramshackle offices, haggling for a better price. Jonathan has ten dollars in his hand. Richard, a local homeless guy, shakes his head.

“Come on,” Jonathan says. “It's a pretty straightforward job. All I have is this ten-dollar bill.”

“That's not a ten,” Richard says. “That's a bunch of ones.”

“Ten ones. Same fucking thing.” Jonathan slaps the bills against his hand. “So?”

To my astonishment, Richard hops in and starts cleaning. Without so much as a pair of gloves. He hoses out the back, disinfects the ceiling, stretcher, and floor, then replaces all the dirtied items from the cabinets. Jonathan sits back, pointing out little gobs of blood Richard has left behind. “Missed a spot right there, man. No. There. Under the seat.”

When Richard's done, he hops out, snatches the stack of
ones, and shambles off. “Call me any time,” he yells as he disappears into the liquor store. “Any time.”

And none of this is an aberration. Everything I've seen since laying eyes on a FirstMed ambulance has been perfectly normal to everyone around me. Nobody finds it strange that I was hired without providing any proof that I'm an actual EMT. Though we are ostensibly an ambulance service, no one cares that people occasionally drink on the job. When I tell people about Jonathan's stunt with Richard, everyone keeps waiting for the twist that justifies my revulsion. But no twist ever comes. The revulsion is mine alone.

The place is a misfit circus, a sort of way station for EMS cast-offs. It's owned and operated by an incredibly kind couple about whom it is hard to say anything negative. At one time or another, nearly every medic and EMT in Atlanta has worked at FirstMed. Anyone in need of extra cash, who's been fired, or who is fresh out of jail or rehab can walk through FirstMed's squeaky front door and find a spot on an ambulance. Or a place to live.

I quickly learn that Richard isn't merely one of the homeless men wandering the streets but that he lives, quite happily, in an abandoned tractor-trailer behind the FirstMed office. He runs an extension cord from the offices to the truck, which he uses to power a fan, a lamp, a hot plate, and a thirteen-inch black-and-white TV. Then you have Mike and Linda. Mike is a skinny white guy with stringy hair; Linda is a skinny black woman with stringy hair; neither looks even slightly trustworthy. Mike is an occasional crack addict who was fired for his addiction, and Linda is a dispatcher who was fired for being Mike's dealer. In the span of a single week, each shows up—clean and sober—and
is greeted with open arms. “Give it a month,” Jonathan whispers. “They'll be back at it.”

One night a medic named Lyle—tall with a shaved head and the droopy-eyed look of a man who knows it's his lot in life to be perpetually on the clock—disappears with an ambulance. Nobody notices he's gone until the cops call to say they've caught him getting a ten-dollar blow job from a man wearing high heels. The manager bails him out but insists Lyle do the disinfecting himself.

Did I say the place is a circus?

•  •  •

Sabrina is standing at the open driver's door, shaking her head. “I can't drive an ambulance.”

Jonathan is undeterred. “Of course you can. Just put it in gear and drive.”

“No,” Sabrina says. “I mean I can't. It's illegal.”

“So?”

Sabrina looks at me. I tell her it's a bad idea but not the worst idea. I'm wrong, of course, but if you spend enough time around lunatics, their normal slowly becomes your normal.

Two minutes later, we're rumbling down the road. It's a slow Saturday, and Sabrina thought she was just meeting us for lunch. Now this. It doesn't seem so bad until Jonathan flips the sirens on. Sabrina's head snaps over. “What are you doing?”

“Just drive.”

“I can't. Not like this. Turn those off.”

“Too late. Drive.”

So she drives. An ambulance. With the lights on. Down a crowded city street. She isn't supposed to be here, not in the
back, not anywhere. And yet here she is. Driving. She runs a few lights and eventually makes her way back to the car. She's a little shaken but giggling, and when I ask if she liked it, she nods and says, “I kinda did.”

•  •  •

In May I finally escape. I'm standing outside a dialysis clinic, there to pick up yet another legless patient and carry her back to yet another run-down nursing home, when my phone rings. It's the recruiter from Rural/Metro, the company with Fulton County's 911 contract. My heart pounds as she tells me they're about to start a new-hire class. “Are you interested?”

“Very.”

“Can you start next week?”

“I can start right now.”

She laughs and then launches into a disclaimer: The opening is in South Fulton County. North Fulton, she says, is much more popular because it's affluent and safe and people don't call as often for toothaches and headaches and babies with a fever. South Fulton, by contrast, is all run-down apartments and poverty and roach-infested ghetto.

She pauses, clearly expecting me to hang up. And then, with hope in her voice, she asks, “Are you ready for this?”

P
icture a lawn mower blade. Heavy and dulled by the constant thwack of sticks and rocks. Rusted steel and motor oil covered in a fuzzy green layer of minced grass. It spins on a bent axis, the bolt loose and the blade wobbling ever so slightly as it goes. It's early morning, the grass wet with dew. A foot slips and disappears under the mower's bruised metal frame. The blade, more belligerent than precise, hacks through leather, rubber, and cotton, right on down to sweaty black flesh and crooked bones. A single scream rises in the air, joining the pungent cloud of oil smoke from the two-stroke engine. The mower stops. Three toes, starting with the big one and working inward, are hacked off and scattered in the grass. Never to be found, just gone.

“Gone. Sheeeit.” Our patient looks at me, his pained expression replaced for a moment by a horrible realization—his toes are gone. He'll never walk right, never run. Never go barefoot. He shakes his head. “Sheeit.” He's sweating on the stretcher, shedding diced-up bits of grass. He smells like blood and gasoline. “Sheeit.”

This is my first call at Rural/Metro, my first call on a 911 ambulance, and I'm happy. Glad to be here, to be the one to catch this call, glad he cut his toes off. Somewhere there's a doctor
who'll tell him there's nothing to be done, that she can sew him up but the toes are a memory. “Get a cane,” she'll say. These words will break his heart but not his spirit, and he'll get over it and get better—eventually, he'll get back to work. But I'm not here for the diagnosis or the cure. I'm here for the blurry and frantic moments right after the injury. My partner, a medic named Jerry, has been around a few years, so a man with three missing toes barely commands his attention. But me? On my first day? It's magic. We drop him off and run more calls.

We end the shift with a woman who's spent the night in the company of a dozen steak knives and an ever growing puddle of congealed blood. Jerry and I wander the house, collecting knives and looking for the second victim—no one has this much blood. But it's just our patient and her demons, and though she won't tell us what she's done, she says it's bad, too bad to tell anyone, and that she just wishes she could die. There's a cleaver on the kitchen floor, bloody and rusted. Next to it sits a bent knife, the skinny kind used to filet fish. She kicks it dismissively, derisively, says it's useless. No good for cutting through human flesh at all.