The thing of it was: Troy’s diabetic episodes were almost entirely preventable. We all need sugar to survive. A diabetic lacks insulin that breaks the sugar down and transports it to the cells. Troy gave himself daily shots of insulin and carefully monitored his blood glucose level. He tried to keep his in the 80-120 range -- on the low end. 80-120 is fine, except some sudden bursts of energy and you could go down to 50, and 50 was where Troy started to loose control. At 40, he was cold and diaphoretic. At 35 he was unconscious. Other diabetics kept their level higher in the 120-160 area. The higher the sugar level, the less likely you were to be affected by missing a meal or a sudden rush of energy. But the higher you maintained it, the sooner the disease would advance its nasty handiwork. Troy wanted his low because the lower he kept it, the better for his long-term health.
“I’m really looking forward to the day my first toe falls off,” he said, as he pricked his finger with a lancet. “Then my foot, then the leg up to my knee, then I’ll go blind, I’ll need dialysis. I’ll get killer bed sores, open seeping pus filled wounds. You’re in such good shape, you’ll still be here to cart me around, pick me up at Trinity Hill three times a week.”
“You’re crazy,” I said.
He squeezed a drop of blood onto the test strip. “Yeah, I’ll have orderlies wiping my butt. Then my heart will fail, and they’ll find me cold in bed. You’ll be working with Linda, and after a quick initial exam of my corpse, she’ll tell you to go back to the ambulance to get a crow bar.”
“A crow bar?”
“Yeah, because after I’m gone, even though my toes and fingers have fallen off, they’ll still need the crow bar to beat my dick to death.”
“You’re demented.”
“Sugar’s 53. Better give me one of those Baby Ruth’s.”
I already had it in my hand.
“Walking the thin line,” he said.
“Eat your bar.”
Troy always played it close to the wire. That might have been all right if he took better care of himself, but that wasn’t his style.
“That man does two things,” Victor Sanchez told me. “He works and he parties. Him and his buddy Pat Brothers -- the dynamic duo. Those two, they don’t go down to the corner for beers, they drive to Atlantic City or catch a plane to New Orleans for the Mardi Gras or Miami Beach or wherever the action is.
“Three years ago they ran with the bulls in Pamplona. New Year’s -- they’re at Times Square. Once they went down to Jamaica for some reggae festival. They come back and Pat’s got a picture of them smoking foot long spliffs, hanging out with Rastafarians. Troy’s got his hair in miniature dreadlocks. Last year they went to the X-games -- you know the ones on ESPN. Troy comes back with his wrist in a cast and a medal. It’s not a gold or bronze or silver. It just says “Participant” on it. Still it was a medal. He was very proud. He entered the skateboard competition. Finished next to last, but he still participated. They’ve surfed the pipeline in Hawaii, gone scuba diving with sharks off the Great Barrier Reef, and hunted mountain goat in the Rockies. Most years they go to the Super Bowl.
“One time one of our medics Kim Dylan was vacationing at Caesar’s in Las Vegas with her sister and her kids. The casino’s hosting an Elvis karaoke contest. She looks up at the stage and there’s an Elvis look-a-like dressed in a white leather jacket, with a scarf around his neck, down on one knee, singing “You Gave Me a Mountain.” She looks at him closer. She can’t believe it. It’s Troy. Not only is it him, but he wins. She runs into him again that night. He and Pat and two busty showgirls are at a craps table. He’s still in his Elvis suit along with his fake sideburns. They’ve parlayed the $500 he’d won in the karaoke contest into over $25,000, every penny of which they lose, but not until they enjoyed two days of comped suites, shows and ringside seats at a heavyweight title fight. They even got Kim’s rooms comped for her and got her tickets to Siegfried and Roy.”
“That’s funny. Troy as Elvis. I can see it.”
“Living large. The two of them can pack away the liquor, too, though Pat has tapered off lately now he’s got a steady girl. I drink it goes right here on my belly. They stay lean; still it’s got to take a toll. You reach an age, well, you know, how’s that song Nestor is always singing go? ‘Hangovers hurt more than they used to.’”
Thursday mornings when our shift started, Troy always looked pale and haggard. He was a giant white candle, his eyes the burnt wicks.
“You ever thought about maybe going a little easier,” I finally said one day after driving behind the Mobil Station on Washington Street so Troy could puke for the third time that morning.
He wiped his mouth as he leaned against the dumpster, then said, “Go to hell. Okay?”
“What could I have been thinking?” I said.
If he wanted to party and drink for days, it was his life. He knew what the disease was all about. He knew the complications and its inevitable course. We saw its handiwork nearly everyday.
The address was a single-family home in the city’s South end across from a public housing complex. The white paint on the house was dull and peeling. The side boards were rotting. The front gutter had fallen off and lay in the tall grass next to the garage. The cement walk that led to the front door was buckled and uneven, and made a rough ride for the stretcher. A sign by the door said “The Smiths.” A neatly dressed woman in her sixties met us at the door. “He’s in the den,” she said. “I don’t know if you’ve been here before. He’s a diabetic. I came home early and found him.”
We could hear him snoring as we walked down the hall. He sat in an arm chair with torn upholstery. He was cold and diaphoretic to the touch. I repositioned his head so his tongue wasn’t partially obstructing his airway, while Troy pulled out his IV kit. The man had one leg missing at the knee; half his other foot was gone. On the floor was a pair of thick-lensed glasses with tape around the frames. There were several Old Milwaukee beer cans scattered on the floor and TV tray. On an old TV set with a wire coat hanger attached to the antenna John Wayne’s battleship took heavy fire from the Japanese Navy.
I spiked a bag of Normal Saline and got out the glucometer. Troy handed me the needle in exchange for the IV line. I put a drop of blood from the needle on the glucometer strip, then handed Troy the bristo jet of D50 after he’d taped down the IV. He already started pushing it when the reading came up. “21,” I announced.
“Oh, dear,” the wife said. “I should never have left. I knew this would happen.”
“Do you think he did it on purpose?”
“He just doesn’t care anymore,” she said. “I have to watch him.”
The man opened his eyes and saw Troy. He looked disgusted.
“Your sugar didn’t register,” Troy said. “You were barely breathing.”
“What time is it?”
“It’s six-thirty,” his wife said. “I wasn’t going to come back till later tonight, but you wouldn’t answer the phone, so I came back early.”
“You should have stayed away,” he said.
He stared grimly at Troy’s hat. “A Yankee fan, huh? Wouldn’t you know it?”
“You don’t like the Yankees?”
“What are you a comedian? You wouldn’t know the Red Sox score would you?”
“They lost,” I said. “5-4”
“And I’m not dead yet.”
“You’re still here,” Troy said.
“I thought for a moment I’d be spending my time with him.” He nodded grimly at Troy.
“It’s not our time yet,” Troy said.
The man laughed without humor. “Fucking Yankees.” He said to his wife again, “You should have stayed away. Let a man have his peace. This is no kind of life.”
“You want us to take you to the hospital?” I asked.
Troy gave me a glare.
“No, I’ve been that route before,” the man said. “No thanks.”
“Just sign here,” Troy said, producing a run form and drawing an X for the man’s signature on the refusal line.
“You sure you don’t want to get looked at?” I said.
“The man said no,” Troy said. “His sugar should be back to normal.”
“Where do I sign?” the man asked. “I don’t see so well.”
“I’ll make certain he eats,” his wife said to me. “And call if I have too. Thank you for coming.”
As we wheeled the stretcher back to the rig, I said to Troy, “Maybe we should have had him committed. Don’t you think he needs a psychiatric evaluation?”
“He’s not crazy,” Troy said.
“You don’t think he was trying to kill himself?”
“He’s just trying to live the way he wants. If he wants to die, fine. If I get there in time, I’ll save his life. If not, well then at least he’s at peace.”
Annie Moore was thirty years old, but she looked forty. She was skinny with long stringing hair, lines around her eyes and mouth, and brown teeth, but her green eyes still could shine when she cracked a smile, when she was trying to get money out of you.
We were parked outside Dunkin’ Doughnuts at Capitol and Broad. Annie came up to Troy’s side of the ambulance. “Got five bucks so I can buy a lottery ticket? I’m feeling lucky. I win, I’ll split it with you.”
“Now, there’s a deal. What kind are you going to buy?” I asked.
She hesitated. “The $5 kind.”
Troy laughed. “Here’s a fiver. Put it on Old English.”
“You’re all right,” she said. “You’re a generous man.”
“Old English?” I said.
She was gone before I could convince him to take it back.
“You’re just enabling her,” I said.
“To have a good time and enjoy herself before she kicks.”
She’d been on the street for eight years, according to Troy. Capitol Ambulance picked her up nearly everyday. We’d find her passed out behind the High Street Liquor Store, or in a doorway off Broad Street, or standing against a telephone pole on Capitol Ave. She wasn’t always drunk. Sometimes she was beat up. Troy had to intubate her a couple times she was so unresponsive. Every now and then Troy said he’d run into her when she was sober after a long hospital stay, and she could be quite pleasant. She knew she had a disease and she knew it was going to kill her. That fact didn’t keep her from trying to go straight. It just helped her to savor being sober when she was. Sometimes I gave her food to eat, a package of crackers, half a sandwich. If she wanted money for coffee, I went in and bought her the coffee and a sometimes a doughnut too. Troy only gave her money.
Some EMTs would yell at drunks and treat them roughly. They resented their stink, their vomit, their very existence that at times made the EMTs seem like human garbage men. When they were having a crappy day, it was easy to feel no compassion for someone who had brought their own troubles on themselves. Troy wasn’t like that. He seemed to have an affinity for those crushed by alcohol, or mental illness. He never lectured anyone on mending their ways. While others often quickly resorted to restraints to control troublesome patients, leave Troy alone with a psych or a drunk and more often than not, he could get them to come along peacefully. “He speaks their language,” David Nestor said. And maybe he did. He let them smoke before getting in the ambulance, and then again at the hospital outside the ER doors before taking them in to the psych ward. Same thing with drunks. What others might turn into a physical confrontation, Troy defused. With Troy it was like Troy and the patient were sitting next to each other on bar stools commiserating about women, work and the weather. I’d drive to the hospital listening to Troy singing duets with them on country songs like “Blue Eyes Crying in the Rain” or “I Got to Get Drunk.”
The only thing Troy had a low tolerance for was bullshit, and working in the city, we saw plenty of it. In Hartford, as often as not, people used the ambulance as a taxi service. Difficulty breathing turned out to be a four-year-old with a runny nose for two weeks. Abdominal pain was just stomach cramps from too much beer and greasy chicken. Someone would go to the ER, get a prescription, and then call back the ambulance the next day because they still weren’t feeling better. You have to take the full seven-day course of medicine, we’d say. It doesn’t work after one pill. We’d go to motor vehicle accidents and find people claiming neck and back pain who hadn’t even been in the car. It tended to put a cynical edge on you.
It was a busy day. We were flat-out nonstop, racing back and forth across the city, all for bullshit. We cleared Saint Fran after bringing in an earache and were sent priority one across town to Wethersfield Avenue for a woman passed out.
“Oh, great,” Troy said as we pulled up to a funeral parlor. “An I-I-I.”
“Maybe it will be legitimate.”
“Dream on.”
A line of mourners wound out the door and back through the parking lot. Denny Creer met us outside and said, “It’s BS. You know that kid who got shot on Spring Street two days ago. It’s his funeral. His girlfriend pulled a fainting fit. They’re all gathered around her, paying homage right now.” He led us to a parlor where the boy’s girlfriend and mother of one of his two children lay on a couch. Anxious family members surrounded the girl, who wore a black sun dress. An older man held a wet towel on her forehead.
“She saw the casket and she fainted. Now she can’t speak and her eyes roll back in her head,” the man said.
Troy held her hand up over her head and let go. The hand moved and fell harmlessly to the side. He opened her eyelids, and she rolled her eyes back. He felt her pulse. “This is bullshit,” he muttered.
“What’s wrong?” the man said. I could see the veins in his neck fill with blood.
“Nothing is wrong. She’s fine,” Troy said. He rubbed his knuckles into her chest. She moved against his hand, but kept her eyes closed. “See, she reacts.”
“You’re hurting her,” the man said.
“This is not a medical problem,” Troy said.
I was cut off from Troy by several on-lookers. I tried to get to him in time.
“What do you mean? Can’t you do anything? Can you take her to the hospital?”
“She’s faking. There is nothing wrong with her. She wants attention.”
“Can’t you do anything? Look at her.”
“She just needs a good slap.”
“What?”
“Not too hard. You don’t want to hurt her -- just bring her back to reality.”
“Excuse me,” I said, stepping between them. “That’s enough, Troy.” I shoved a candy bar in his hand. “Go back to the car.” I pushed him backwards.
“No, Lee, this is bullshit. People have to learn.” He shouted at the woman. “Get up! Nap time is over!”
“Get out of here. Go sit in the car.”
“Easy, Troy,” Denny Creer said, grasping his arm.
“Fine, you deal with it,” Troy said angrily. “It’s BS and you know it.”
“Go,” I said.
“What do you say we get you something to eat?” Denny said, walking Troy away.
“I’m not hungry. I’m just pissed.”
I turned to the man. “I’m sorry, sir. He means well,” I said, and then using a phrase I had come to rely on said, “He’s having a bad day.”
“Bad day. He shouldn’t be doing this job.”
“He just lost his best friend in a car accident. He’s out of his mind, but we can’t get him to take time off. I apologize profusely”
I got him to sign a refusal, then went back down to the car, praying that Creer had taken care of Troy, that I wouldn’t find Troy passed out, beat up, or running around naked in the garden.
He sat in the passenger seat reading the paper, eating the candy bar. He said nothing to me when I got in.
“You didn’t have to go at her like that,” I said as we drove away. “That was pretty rude. You’re lucky her brothers didn’t beat the crap out of you.”
“Like you wouldn’t have helped me.”
“You know your sugar isn’t an excuse for treating people that way.”
“Your Red Sox lost again,” he said.
“Thanks for the reminder.”
“Yankees up by seven.”
“Remind me to get a new partner.”
“482, take 23 Dorothy Drive in Bloomfield, Apt G for the unconscious diabetic. Visiting nurse on scene.”
“Shapiro,” Troy said. “Great.”
Alan Shapiro was a bloated fifty-year old diabetic with pasty white skin. He’d gotten gangrene from an infection on his foot, and had slowly lost half the leg to progressive amputation. He never wore more than his boxers and a white sleeveless tee shirt. He never left his apartment.
“Same old story,” the visiting nurse said when we arrived. “You’ve been here before.”
We found him in the bedroom, sprawled across his bed. The room was dusty and cluttered with girlie magazines and adult videos. As Troy made a half-hearted look for a vein, I opened up his med kit and took out a vial of glucagon powder, a vial of sterile water and a syringe. Shapiro was a bitch to get an IV into; his veins were all used up. The three previous times we’d been there Troy had to give him intramuscular glucagon instead. An injection of glucagon right into the muscle enabled the body to convert the glycogen stores in the liver into a temporary sugar supply. It took a little longer to work – sometimes up to twenty minutes -- and was always a second choice because if you used glucagon one day it would be several more before the body could build back up the body’s supply of glycogen so it limited your choices if his sugar were to drop again. Troy unsnapped the tourniquet from the man’s arm, and picked up the syringe and vials I’d laid out next to him. He stuck the syringe in the sterile water vial and pulled back loading the syringe. He then injected the fluid into the vial with the powder, shook it up, and then again, pulled back on the plunger, loading the now reconstituted drug. He wiped Shapiro’s thigh with an alcohol wipe, then stuck in the syringe and injected the glucagon.
While we waited for Shapiro to come around, I looked at the photos on the wall. A young man with a crewcut stood bare-chested in army fatigue pants in front of a bunker, dog tags around his neck. With long hair and mustache, dressed in a 70’s suit, he looked sheepish as a girl with glasses kissed his cheek in front of a wedding cake. He stood with the same woman and two young girls in Mickey Mouse shirts, the Magic Kingdom in the background. There were no pictures more recent. He complained to us once bitterly about his wife’s lawyer.
“Check this out,” Troy said, holding up a prescription bottle he’d found by the bedside. “Viagra.”
Troy stared at the label. I wondered if maybe he wasn’t having a vision of himself sitting there thirty years from now with his own bottle and girly magazines. He set the bottle back down without saying anything more to me. He looked glum.
