and discolored mannequin missing his left leg—but for purposes of this class, it could be anyone, man, woman, or child. Sometimes the patient can talk, other times we get information from a bystander. Often the patient is unconscious, occasionally he doesn’t speak English.
We ask questions: What’s your name? . . . What’s the problem? . . . Can you breathe? Alan provides answers: John, I think he’s dead, dónde está la biblioteca. But it’s not enough for us to know what questions to ask and what the answers mean. We must prioritize them by what will kill the patient first. Start with the airway, move to breathing, then worry about circulation. In that order. Even if my patient’s guts are tumbling out, I have to make sure he has an open and clear airway and he’s adequately breathing before I can worry that he’s been disemboweled.
Tonight I quickly move through the early stages of the scenario without finding any problems. So far so good, but this is where it gets tricky. Were this patient actually a patient and not merely a dummy, the problem would probably be obvious. But it is a dummy, and I’m standing in front of my class. Alan taps his watch. Tick-tock, tick-tock. I launch into a battery of questions: What have you been doing, are we inside or outside, do I notice anything strange?
Alan sits up. “Where?”
“On, uh, on . . . her skin?”
“Bingo. She’s got a rash on her foot, spreading up her leg. In fact, now you notice an EpiPen on the table.”
“Is she allergic to anything?”
“Yes!” Alan yells, ecstatic. “She is. But before she can say to what, she collapses.”
I quickly recheck that her airway is open, and for not immediately panicking, I’m rewarded with the following: “Outside the window, you see a lawn mower surrounded by a cloud of angry bees.” Allergic reaction. I launch into the treatment of anaphylaxis—at least, the portions of the treatment an EMT can provide. The studying, the notecards, they’re paying off. For me, at least. Despite my near-perfect assessment and my early and aggressive intervention, the patient dies.
Alan tells me not to worry about it. This is medicine, not TV. Sometimes mannequins die.
4
Living and Breathing Dead People
It doesn’t even occur to us that we haven’t placed our partially trained hands on an actual human until Alan walks in and tapes three pieces of paper to the chalkboard. “Sign-up sheets,” he says. “Time for your ride-alongs.”
We’re five months in at this point, three months until we finish the course. After the course, we’ll take the National Registry exam. Passing it allows a person to work as an EMT anywhere in America. But before we get to all that, we have to do our ride-alongs. A ride-along is exactly what it sounds like: a daylong apprenticeship in the back of an ambulance, shadowing medics and EMTs. Someone asks what service we’ll be riding with.
You can hear a pin drop when Alan says Grady.
Grady Memorial Hospital looms large in Atlanta’s consciousness. To many, it’s a place of horror stories and ghost stories, of lawless halls teeming with the poor, the crazy, and the critically ill. My first close view of it comes in the dark of a June morning as I await the start of a four A.M. ride-along. The giant lighted cross atop the hospital glows red in the dark sky, and steam from a pair of smokestacks slowly rolls out like a blanket of fog. There is a large moon in the otherwise empty sky. Somewhere in the distance, a lonely siren wails.
I’m here early, and there’s nothing to do but wait. I pace, I overthink, I worry—about what I’ll see, what I’ll be asked to do, how I’ll respond. I wonder what these guys will think of me. Grady EMS is the 911 provider for the city of Atlanta. The phones ring off the hook, and Grady medics are busy to the point of exhaustion. They’re broken in, tested, and competent. They’re the standard by which all medics around Atlanta are measured. They prowl the city’s worst streets, wander housing projects at night, and frequent jails and crack motels. Years of working in these conditions have taught them to sniff out the signs of illicit drug use and recognize when a situation is about to go wrong, almost instinctively. Grady medics are experts in treating their patients, calming their patients, and occasionally fighting their patients. They’re cocky and untucked and stand in stark contrast to