David Nestor was one of the city’s original paramedics. Now at forty-eight, he weighed over three hundred pounds. He’d been taken off the road due to his arthritic hips and cardiac problems, not helped by his three pack a day cigarette habit. Others said the hospital had quietly yanked his medical control to practice because he had been unable to adapt to changing protocols and techniques. His job now was to read through the previous day’s run forms, sort them by number, and make certain all the signatures and insurance numbers were in place before the forms were sent on to the billing department. He often came to work unshaven. His uniform no longer fit. His prodigious gut hung over his belt. He looked like a broken tusked walrus. Instead of sitting at the desk in the back office, he sat on two chairs at a table in the crew room where he liked to hold court.
“Melnick, how can you wear that medic patch on your sleeve?” Nestor said. “I’m looking at this form. You write this guy had rales and you didn’t give him lasix? Didn’t they teach you anything in school?”
“I thought he might have pneumonia.”
“You can’t tell the difference? Didn’t they teach you assessment?”
“Yeah, but you need an x-ray.”
“An X-ray? Bullshit. All a medic needs is a good head on his shoulders and a twenty-dollar stethoscope. A medic doesn’t need an x-ray to see the patient’s in failure. Just reading the form, it’s clear he’s in failure. He’s got JVD, no fever, pedal edema, rales, Bp’s up, he’s tachycardic, Sat’s in the low 90’s despite your non-rebreather.”
“He’s got a pneumonia history. He wasn’t that bad, I didn’t want to take a chance and dehydrate him.”
“Are you a paramedic? You gave him nitro, go ahead and give the lasix. He’s on 60 a day, give him 120 and hand him a urinal. Case closed.”
He turned to see what everyone else in the room was looking at.
Troy, sweat on his brow, stood in the doorway with that demon gleam in his eye. “Nestor, you worthless slug,” he said.
Nestor narrowed his eyes suspiciously like he wasn’t sure whether Troy was serious or just toying with him.
“Nestor, I wouldn’t let you get within ten feet of me with a placebo.”
One moment the EMTs in the crew room had been checking their equipment and strapping on their bulletproof vests. The next they were silent, watching, waiting.
Nestor looked confused and irritated.
“You old paramedics don’t know half what the newest medic coming out of school today knows,” Troy continued. “There’s a new breed on the street. Fifty dollars says Melnick knows all his pediatric doses off the top of his head, and that you would only know them by pulling out your field guide unsticking its pages and putting on your bifocals.”
“Listen to you,” Nestor said to Troy. “Go take your medication.”
“That’s right, Melnick,” Troy said to the young medic. “It would do you some good to take some lessons from a real paramedic, not some washed up old dinosaur like Nestor who has killed more people than Son of Sam.”
“You wouldn’t know a medic if you saw one,” Nestor said. “When I first worked the city medics were special -- they were giants of the street. You had to earn the patch. Now days all you need is a pulse and you get hired. Medics are a dime a dozen, but they’re not worth the paper their card is printed on. Shake and Bake medics. Chia Pet medics. No wonder no one respects us anymore.”
“You make a good case for the giant part. The size certainly attests that they were exceedingly large, but like the stegosaurus they had tiny brains and made large shits wherever they went. When’s the last time you took a bath?”
“Psycho,” Nestor mumbled. He looked down at his run forms.
The EMTs in the room smiled like jackals and grinned at Troy, like they’d just crowned him lion king. Nestor was red-faced.
“Atropine .02 milligrams per kilogram,” Melnick said. “Epi...”
“Shut up Melnick,” Troy said.
I went out to the car. Troy might have been a phenomenal paramedic, but he grated me. We all traveled our own roads and took our own hard lessons. I guessed his were ahead of him.
“482, You available to sign on yet?”
“Just about,” I answered. “Give us a couple minutes. Troy’s in a meeting.”
“Tell me once he’s finished his paperwork, I need you to sign on and cover Newington.”
“Understood,” I said.
I went back into the crew room. “Have you seen Troy?” I asked Nestor.
He shook his head without looking up from his run forms. “I’m not his keeper.”
I looked in the bathroom, but no one was there. I glanced in the supply room. I saw no one. Then I did a quick double take. Troy lay on the floor in the corner of the room, half hidden by several stacked crates of IV fluids. He wasn’t moving. When I approached I saw his eyes were glassy. His skin was gray and beaded with sweat. I shook his shoulder. “Are you all right?”
He was unconscious, his skin cool to the touch.
I turned for help just as a tall broad-shouldered medic came in the door. He was about Troy’s age, blonde and fair-complected, wearing a Boston Red Sox hat. He went right for Troy. “Yo, bro!” He rubbed his knuckles into Troy’s sternum.
Still no response.
“Don’t worry,” he said to me. “He does this all the time. It’s his sugar. Now go close the door.”
I knew Troy was a diabetic. I’d seen him checking his sugar with his pocket glucometer, pricking his finger to produce a drop of blood for the test strip, but certainly I hadn’t expected to see Troy Johnson like this. The medic talked gently to Troy as he put a tourniquet around his arm. “Sometimes he resists, so you have to be careful. He’s being good today.” He took an alcohol wipe and rubbed it over a large vein in the crook of Troy’s arm. He stuck a needle in. I saw the blood flash back. “Get me some D50 from the shelf.”
I handed him the blue box. He took out a large bristo jet and a glass ampule of Dextrose, screwed them together, and then stuck the Bristo jet needle in the rubber port of the IV line. He pushed the ampule deeper into the jet, pushing the sugar water into Troy’s vein.
Troy’s eyes were still closed, but his skin was less diaphoretic.
“Shit,” he said, groggily. He looked up at us. “Gimme some gauze."
“You know you have to eat,” the medic said.
“I got a headache. Don’t push it so fast, you know that.” Troy grabbed the four by four dressing I offered, placed it against the IV site, then ripped the line out of his arm, and bent his elbow. “That hurts.” He got to his feet. “What’d you use? A sixteen?” He walked out of the closet and went into the bathroom across the hall.
“Nothing better than a grateful friend,” the medic said. “I’m Pat Brothers.”
“Lee Jones.” We shook.
“I’ve heard about you. I guess no one gave you the spiel on Troy. I’ve been on vacation or I would have.”
“I’ve got part of it. Not this part.”
“He’s a brittle diabetic, and you’ve got to watch him constantly. As long as his sugar stays above 70, he’s got your back. It dips below; you have to have his. Are you any good at IVs?”
“I’m not IV certified.”
“That’s all right. I’ll teach you.
“This happens frequently?”
“Yes, it does, though it runs in spurts. He can be fine for months, and then it’ll happen every day for a week. The company knows he has a problem, but not to the degree it happens. There isn’t a medic here that hasn’t had to sit on him once or twice or five times to get some sugar in him. If you’re going to work with him, you’re going to have to learn how to do IVs.”
I could have answered that I wasn’t an IV tech, but from looking at the light blue of the EMT rocker on my shoulder he already knew that. I saw how things were, and I’ve done worse deeds than look out for a co-worker.
Pat grabbed two EMTs out of the break room, and despite their protests, had them roll up their sleeves. He gave me a quick course. I stuck each of them twice, and Pat three times, getting veins in the crook of the elbow, the forearm, wrist and hand. “Excellent, you’re a natural,” he said. “You’re all set.”
Troy came out of the bathroom ten minutes later, looking hung over, his hair out of place. He put on his Yankees cap and walked right past Nestor like nothing had happened between them.
“A pity the young are so frail,” Nestor said.
I thought Troy would go home for the day, but he sat in the ambulance, and we went out on the road. He said nothing about the incident.
“You’ll learn to see it coming on,” Pat said to me that day. “He starts doing crazy things. Make him eat. Don’t take anything he says personally. He just needs a little sweetening from time to time.”
