gotta go,” he says.
He hangs up. I hold my breath. Jonathan is a light-skinned black guy, easily six-four, probably 230. Every time he shifts his weight, the entire ambulance rocks with him. “We got everything?”
“Well, I grabbed what Sherry told me to get, but I’m not sure if it’s everything. This is my fir—”
“Good. Let’s get breakfast. I’m starving.”
• • •
A long line of eggs crackles on the griddle at Waffle House. Jonathan dumps sugar into his coffee. He dips his spoon in, stirs, nods to me. “You work yesterday?”
“Actually, this is my first day.”
“Off all weekend, huh?”
“No. First day first day.”
“Oh. Cool. How long you been doing this?”
“First day first day. First day.”
He stops stirring. Regards me closely for the first time. “Like your first day on an ambulance? As in never worked before? Ever?”
“Yup.”
“Why didn’t you say something?”
His demeanor changes and suddenly he is talkative, smiling. He grabs his phone and calls the office, tells Sherry I’m a baby EMT, fresh out of the package. Give us any call that comes in. When the food comes, he talks with his mouth full. He claims, improbably, to be a med school dropout, a former cop, and an ex–marine reservist. EMS is the only thing that ever really suited him, he says, so here he is. He smiles. “Job sinks down into your bones,” he says. “You’ll see.”
I ask him what exactly it is that FirstMed does, and he explains there are two types of ambulances. Obviously there are the 911 ambulances, but there are also the others: private ambulances whose sole purpose is to take the infirm to and from appointments. That’s us. To work for a private service is to spend your professional life wandering through dialysis clinics and nursing homes, neither of which is pleasant. Dialysis clinics are sterile white rooms filled with the tang of bleach and the soft whirring of machines that slowly drain your blood like calibrated vampires so it can be scrubbed and then pumped back in. Nursing homes are nursing homes—slow death in an industrial setting. I ask him why we have so much equipment if all we do is take patients to appointments, and he explains that dialysis is complicated and taxing on the body. Sometimes those patients simply die.
But there’s something else, too, which is that nursing homes sometimes fudge their math. Think of it this way, Jonathan says. A nursing home patient slips and falls. If the staff calls 911, this suggests an emergency—something, anything, they can’t handle on their own, which raises questions they’d rather not answer. If they call a private service, a non-emergency service, it suggests a small but concerning problem, something caught and handled early. He shoves food in his mouth and says: It’s sleight of hand, but it works. And it happens every day.
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