OMG

 

Two weeks ago, it was Black Jack. This week it is OMG. Oh, My G**.

The woman lays on a parking lot sidewalk behind the school. Her face is blue and she is only breathing one or two times a minute. She is wearing tight spandex and bright pink tank top. She has tattoos on both arms.  I am guessing she is in her thirties. Our response is routine. A shake to see if we can get her respiratory rate up.  It increases to 6. She briefly opens her eyes, then goes back out. We lift her up and put her on the stretcher, and get her into the back of the ambulance. Her ETCO2 is 70. Without stimulation, her breathing is agonal. We give her 0.25 of Narcan IN up each nare (We continue to experiment with dosing. How little can we give and still get the response we need.).  My partner puts in an IV and we take out a 100 cc bag of saline that we put 0.5 mg of Narcan in. By the time she has received 20 cc (0.1 mg) her ETCO2 is down to 35 and her eyes open on prodding.  We shut the drip off.

She wants to know what happened. We tell her where we found her. She doesn't live in the neighborhood, but it not unfamiliar with it.  She admits sniffing some heroin. She says she doesn't do it often. She finds it hard to believe she was barely breathing.  I ask her how she got started, and she says it was just around and she used it with others. She says she isn't a true addict. I ask her what markings were on the bag she bought.  She says there was green on it, but she can't recall what it was called.  She just wanted some. Fair enough. She thanks us for helping her. She says she will be more careful. You can never tell what is in the heroin anyway and one slip and you are dead. We get her in her ED room. I am making the stretcher up when the nurse calls me back in the room. The patient wants to know again where she was when we found her. I tell her and she thanks me again. She is very polite, very grateful. She thanks us for saving her life.

Later, the nurse tells us our "lovely patient" left AMA after stealing half a tray of IV supplies.

My partner and I have identified a number of spots in the city where people are known to shoot up. We go early in the morning and do a census of the wrappers. I feel like an archaeologist as we record the names and numbers of each. We find Comptons-- a minimalist bag with the word Compton stamped in red on it. We found some of these last week, but no quite so abundant as we are now finding).  We find a new one called Emerald City-- a colorful green and black preprinted bag. But far and away the freshest most plentiful bags are OMG, Oh MY G**, another multicolored bag.  We find only a few Black Jacks and they appear old. Fleeting Glory.

Two days later we get a call for an unconscious in a car. Based on the address, we are pretty sure it will be another heroin OD. It is in a parking lot on a street I have done many OD s on.  The customers buy the drugs off Park Street, and then find a place to shoot up before they get back to the suburbs -- at least those who can't wait do. The Fire Department is banging on the car door.  The man inside looks at them, but seems to be in a bit of a stupor. There is a lot of shouting. They open the door. You're not in trouble, we just need to check you out, my partner says. You're crazy sweaty. A young man in a bright white t-shirt with a thin cut Mohawk is finally persuaded to step out, but then he suddenly makes a move back inside to grab something -- a syringe. There is a short wrestling match and shouting.  The man is thrown up against the car.  A police officer retrieves the one cc syringe. It has .5 cc of a water with a ribbon of blood in it. The needle is bent. I dispose of the syringe while my partner gets the man on the stretcher. He is trembling and very diaphoretic. On each arm is a tattoo of a dragon. With the police officer, I do a quick look in the car for additional information. We find ten empty heroin bags in the console.  A bundle. All OMG.

Our patient is tachycardic at 140. He says he has not used in four days. His pupils are pinpoint. Sweat is beaded on his forehead. He is bleeding slightly from a vein in his hand. I am guessing he nodded off halfway through his hit with the syringe still in his hand vein. He didn't get enough to get rid of the sickness. He won't get Narcan from us, even though he nods off at times during the transport. We give him fluid and Zofran. He tells us he hurt his shoulder lifting weights and was put on Percocet. He got hooked. He has been to rehab several times. He tells me he called a beeper number, and then met his contact by the bakery on Park (There are several bakeries on Park). He too is grateful to us. He tells us how thankful he is for us helping him. He says he wants to get back into rehab.

He shakes our hands at the hospital once we him to his ED room. I write on a piece of paper the address where his car is parked. My partner gets him a pillow for his head.

Later that afternoon we are driving down Park Street. I do a double take. I see a familiar young man in a white tee-shirt standing in a doorway of a boarded up store, talking on a cellphone. He has a distinctive Mohawk and tattoos on this forearms.

OMG.

***

 

Black Jack

I did three heroin ODs on one shift last week. Another medic did four in a shift the day before. Lots of OD calls going out. All three of these ODs used the same brand. Black Jack. For years, dealers in the Northeast have been branding their supply, stamping or printing it on the glassine envelopes the heroin is sold in. While many areas of the country get their heroin in small balloons made from the tips of latex gloves or torn off shopping bags, in Hartford (which is supplied from the New York I-95 route) it is almost always sold in the small glassine bags. One bag $5. A bundle of ten bags - $50. Black Jack is evidently pretty strong as there seems to be a big demand for it, and it is knocking people down. The more deadly, the greater the appeal. That is why many of the brands promote the idea of danger.

Big dealers take a kilo of heroin and cut it down, mixing it 50/50 with baking soda. It is enough to fill 25,000 glassine envelopes, which are usually prestamped with the brand, before being distributed along the chain.

I have heard that dealers make the first batch extra strong to create a demand, and then slowly cut its strength. When I was in medic school there was brand on the streets called Tango and Cash, named after the Sylvester Stallone/Kurt Russell movie cop duo. It was laced with Fentanyl and caused enough death and furor on the Hartford streets to earn mention in the New York Times.

Toxic Heroin Has Killed 12, Officials Say

Lacing heroin with Fentanyl seems to en vogue again, as it is mentioned in most articles that deal with upswings in ODs. On one scene, a bystander noted that the heroin must have had Fentanyl in it as his buddy was an experienced user, and was not normally felled by such a small amount.

One of the overdoses was a woman who does a $100 dollars worth of heroin a day. Two bundles. She Oded in the bathroom of a doctor's office where she had brought her mother for an appointment. They were able to wake her with stimulation, though she would nod back off if you left her alone. She decided to clean out her pocketbook while we checked her out. She tossed a crack pipe and several empty Black Jack envelopes, one of which she gave to me. She wore a skimpy top for such a large woman. She had numerous tattoos on her arms. Her pocketbook was filled with condoms. She told me she had gotten into heroin five years ago when she found out her boyfriend was cheating on her. She was very sad she said and wanted escape.

Looking at the Black Jack stamping on the envelope, I had an idea to collect empty heroin bags as a sort of an urban art collection. I thought of all the brand names I had heard over the years. Atom Bomb. 9/11. Empire. New World. Isis. Obama Care. I could drive around Hartford, attempting not to buy heroin, but the empty bags. No, no, I don't want the heroin, please pour it out, or sniff it yourself, I just want the empty bag. Gotta any Monkey Man? No, I don't need 357, I have that one. I Goggled the topic and found I had been beaten to the punch. Graham MacIndoe, an ex-junkie included photos of heroin bags in All In, Buying In to the Drug Trade, his memoir of addiction. Then there is Dequincey Jynxie ( a pseudonym), who at one point had a collection of over 3,000 bags before she threw them out. For awhile, she was the go to expert on heroin bag labeling. She even ran a web site Jynxie's Natural Habitat where she had posted photographs of various branded bags and rated them them in three categories, Rush (Strength of Drug) Legs (How Long it Lasts) and Count (How much You get for the Price).

I went to the blog, and looked at the stamps and read some of the reviews. Here is what a reader wrote about Ace of Hearts.

'Best product I have come across in the neighborhood in a while! This connect was formerly slingin' something called Public Enemy #1 for some time which wasn't terrible, but this is far superior. No name or letter on the bag, just an image of an Ace of Hearts (which I suspect is preprinted (ie not stamped). A bit pricey at $100/bun, but a very consistent product nonetheless."

When I went to the blog site, the first thing that caught my eye was an entry titled The Future of Jynxie.

As many of you have already guessed, I've decided it is no longer feasible to continue this blog. This is because with Jynxies death I am permanently logged out of the main administrative account, meaning I can only post myself, can't invite authors, and can't change the format or administer this blog in the way it needs to keep it running smoothly.

The post was by Eve, who often co-posted with Jynxie, and had taken over maintenance of the blog as Jynxie went through recovery and tried to move on to something different in her life. I assumed Jynxie must have died of an overdose, but with a little more digging I found out she did not die of a heroin overdose, but had left the market several months before and moved to Oklahoma to work in her boyfriend's family business. There, she and her boyfriend were murdered, and their house set on fire with their bodies in it in an as yet unsolved homicide. It also turns out she was an IVY League graduate and artist, who had once had her work displayed at the Museum of Modern Art. She was also a designer for Old Navy.

Check out some of these names listed on her blog: DOA, Just Do it with the Nike label, Jim Jones.Little Debbie, Versaci, True Blood, America's Most Wanted, Double Dragon, Dark Night, Walking Dead, Level 9, Overdose, Godzilla, Rihanna, Dead End, Zombie, Four of a Kind, BioShock, Life Support, Powerball, Medusa, OMG, Lights Out, 007, Kill Bill, Breaking Bad, 24K, Got Milk?, Lacoste Knockout, Ace of Hearts, Happy Hour, Red Butterfly, Hell Boy, Toy Story, Oblivion, War Horse, Venom, Bring A Friend, No Parking, 9mm, Bada Bing.

I read a recent article on the net about how drug dealers in Philadelphia put NBA MVP Stephen Curry's picture on their heroin bags. If you were a sports memorabilia collector, how much would you pay for Kobe Bryant's first NBA basketball card? How much would you pay for a limited edition empty heroin bag with his picture on it?

Philadelphia drug dealers stamping image of NBA star Steph Curry on heroin bags

When the actor Phillip Seymour Hoffman was found dead, there were empty glassine envelopes near his body stamped with the Ace of Hearts and Ace of Spades. Intrepid reporters found Jynxie's Heroin blog and reported on the reviews for the batch, which I mentioned above.

The woman who gave me the empty Black Jack bag, nodded off again in the ambulance. We put an ETCO2 cannula on her and watched her ETCO2 slowly rise to the 70s. We ended up giving her 0.02 Narcan IV. Yes, 0.02, not 0.2. The deal with Narcan is you only want to give enough to keep them from hypoventilating, but not necessarily wake them up. That is often a hard line to walk. Often if you wake them up with vigorous stimulation, they will fall back asleep and once asleep, they start hypoventilating. This woman was very nice and did not want to upset her dose at the same time, I did not want her to hypoventilate, and I knew while I could keep her roused all the way to the hospital, I would likely get tired of constantly hitting her in the triage line to keep her breathing nor would I feel comfortable leaving her in a room to fall back into hypoventilation once we left her. The 0.02 Narcan given as two 0.01 pushed five minutes apart seemed to do the trick. I delivered it by putting 0.1 mg in a 10 cc flush. Next time I think I will put 1 mg in a 100 cc bag and just run a slow as needed drip. This is the type of dosing that is traditionally used in hospitals for patients who hypoventilate post sedation.

The other two Black Jack patients that day were both men. One in his 40's who had a new heart valve(within the last month) and said he was just using for the first time again after his operation and this was just as a one-time deal. We hear that alot. Before we got to him, his buddy gave him the city's home remedy, ice in the pants. He needed IN Narcan from us as his respirations were 1-2 a minute. Again, we experimented. Giving 0.5 mg in each nare with a plan to wait five minutes while bagging before giving him the rest. This is the Maine guideline. It worked great and he was breathing and talking to us in about four minutes with no signs of withdrawal. He agreed to come with us to the hospital. While on scene, I made sure to teach his friend how to do IN Narcan, and he promised he would go down to the health clinic and get one of the kits they handed out. What about the ice in the pants? he asked. You don't need to do that, I said. Just give Narcan. Okay, he said, I'm going to go down there this afternoon.

The last victim drove his car into a parked car, and was so out of it, the police had to break the window out with a window punch to pull him out of the car. He was pale as can be when we got there, but talking. We got him in the ambulance and he said he did not want to go to the hospital. He wanted to drive home. We explained his car was totaled but he did not believe us. He was in his twenties. The cop came over and gave him a stern lecture on how the streets would eat up a skinny white kid like him from the suburbs. He told the cop this was the first time he had used heroin. On the way to the hospital, he admitted to us, he had been using for ten years. He started recreationally using stolen pain pills from his friend's parents when he was 15. We didn't have to give him narcan, but we talked to him about the drug. He said he carried a Narcan kit in his glove compartment.

I have a set of questions I ask all heroin users (if they will answer. Post Narcan patients tend to be very quiet and withdrawn). How did they get started? How many times have they been to rehab? Do they have Narcan handy or do their friends and families? I think now I will start asking them what their top five brands of heroin are of all-time?

Just playing around, if I was a heroin distributor, here are some of the brands I might think about starting:

OJ, Ebola, Double-Barrell, Roulette, 911,Tombstone, Smackdown. Zika, DNR.

Yesterday, during a downtime between calls, my partners and I decided we would drive to a park near drug area and see if we could find any empty bags with labels on them. Here's what we found in a little over 15 minutes of looking along the edge of the parking lot:

Black Jack, Call of Duty, Focus, Adidas, El Chapo, Worldstar, Chief, Headphones(just a design), Compton, Avengers, Money Bags, Avatar. We also found one with a weird red design and a few that were indistinguishable. Only Black Jack was multi-colored, several had fancy designs, others just a stamped name. It had rained hard that morning, so the bags were damp and some muddy. There were also lots of unlabeled bags. We found some that were colored pink, others light blue. In some cases we found the same brand clustered together. I don't know how long the bags had been there, some -- the clustered ones were likely fresh (an addict does a quick bundle and tosses the wrappers out the car window). Some of the others could have been there for months. It was hard to go two feet without finding an empty bag of one kind or another. Some people hunt Pokemon. We hunted empty heroin bags.

Later we drove by a few other areas and within moments found more brands, including Louis Vitton.

But everywhere we went we found Black Jack.

My Addiction, Through My Eyes Self-portraits by Graham MacIndoe.

RIP Jynxies Natural Habitat

The Hidden Story of Middle-Class Heroin in Brooklyn and Beyond

Shelby Hughes Obituary 

Three Lives

 The heroin epidemic continues unabated in Hartford. I called the time on two fatal overdoses in a recent week. Both men were in their 40's. One was in a low-rate motel. He sat by the window in his breeze-less room, the curtains pulled just enough so he could see the cars rolling past on the highway. His head had rolled back, his mouth open when he died. He was riggored in his chair, surrounded by half unpacked moving cartons that held his tattered belongings. The room was dirty. The TV showed footage of the Dallas shootings. The ashtrays overflowed with butts. There were scattered glassine envelopes with a monkey stamped on them. The other man was in the guest bedroom of a small apartment where he was staying with his sister and her four year old son. He lay back on the neatly made bed, his feet on the floor, his eyes staring at the ceiling, his skin cold and grayish blue. On the bureau was his prescription for Buprenorphine. His sister said he had been clean for three months. She and her son had spent the night at her mother's and returned in the morning to find him there.

The next day, I did a third overdose. A man spotted down an embankment in the bushes of a city park, across the street from a shopping area where I have treated multiple overdoses in the past. The fire department carried him up through the thickets to the sidewalk path, where we worked on him. He was apneic, but still had a pulse. 2 mgs up Narcan up the nares. While we waited for him to begin breathing on his own again, I bagged him. As I held a tight seal, and steadily squeezed the bag, I looked down on the park and could see the public swimming pool. It is one of the rare fifty yard pools in the country. It was in the 90's that day and the blue water was very inviting. Sometimes in the summer, I take my lunch break from my coordinator job and go to that same pool and swim laps. The water is cold and clear as I glide through it. When I am done, I lie for a few minutes on a towel and feel the sun on my skin and gaze up at the robin egg blue sky. Sometimes a community group comes and they splash and play under the eyes of the councilors and the city lifeguards. When I was a child I lived at the pool in the summer. Most of the mothers of my friends were stay home moms like mine, their job to ferry the kids around. My childhood was idyllic. While I have had my share of sorrow and heartbreaks in life, I have never had a feeling that no cared about me. The three lives I mentioned, one white, one black, one Hispanic could have come from any background. I don't know if they were rich or poor, from broken childhood home or not. All I know if that at some point they lost their way. Whether they got into the drug by getting hooked on prescription opiates following an injury, or through recreational use or to escape sadness, it does not matter. A highway motel. A guest bedroom. A city park. I do not believe that no one loved them, that there was not the possibility of renewal ahead for them. The one survivor denied that he used heroin when he finally came around. A firefighter told him to be honest with us. He had been near death and had his life saved. Had someone not seen him, and the firefighters not gone down into the thickets on ground with scattered human feces, and carried him up where we gave him narcan and breathed for him until he could breathe again on his own, he would have died. The man bowed his head and said nothing. I saw him staring at his swollen and pocked AC in the crook of left elbow. Most of his veins were pristine. He was new to the struggle.

Cat Burglar

One of my greatest joys on the job is the opportunity to play cat burglar. By this I do not mean the opportunity to break into homes to steal jewelry and works of art. I am talking about the chance to break into homes to rescue people (with police permission).

The person has fallen and can’t get up or, perhaps, it is a medical alarm, and no one knows if there is a person in distress or merely a false activation. We arrive on scene. All the doors are locked and there is no key under the flowerpot (almost as good as doing a second story entry is being the guy who finds the key under the flowerpot. Brilliant!).

I have broken into dozens of homes over the years. I consider myself a top tier cat burglar second story man. My three advantages are: 1) my height(and thinness), 2) my ability to lift myself up with my arms, and 3) my quickness to volunteer. After a boost from my partner or a police officer, I usually go in head first, my legs high in the air, providing a chuckle for the earth bound. I hit with arms extended to soften the landing, do a wheelbarrow crawl until my legs are in, then stand and commence the search. As Mighty Mouse used to sing: Here I Come to Save the Day!!!!

Many times no one is home. Often the person is on the ground by the bed. Occasionally, they are dead. Once I thought a man was dead. He was in a chair, his back to me as he watched TV, completely motionlessness and heedless of my call and all the banging and knocking that had preceded the window entry. Turns out he was just hard of hearing.

I have landed near a Scottish terrier and a dachshund. Fortunately, I have never landed in the same room as a rottweiler -- one of the hazards of being a second story man. I was on scene once where a police officer insisted he go in first. He landed on a sleeping cat, who awoke with a screech. Better him than me. It also turned out we were at the wrong house. The correct address was across the street. Whoops.

Ten years ago in a blog post,The Juice, I wrote:

My cold is still lingering, although I might say I am feeling a little better. Still after three back to back calls yesterday, I was getting tired of lugging my gear and lifting people. Everything seems heavier than it should be when you aren’t feeling 100%. I hate standing at the top of the stairs feeling my heart pound, my breathing quicker.

On our last call, when we got there the cops were still trying to get into the house. I saw that a window screen was just barely open, so I climbed out on a ledge and jimmied it open, then I passed the flower pots that were on the window sill to a police officer and had called for my partner to boost me just a touch so I could get my arms into the window enough to pull myself up and in up. I love being a second story cat burglar man, but even as I was preparing to do it, I was thinking I was crazy. Maybe when I was feeling better, I could try it. Here I was with two fit police officers in the late twenties, and me a forty-seven year old man, getting ready to go head first through a high window. I think I was trying to prove something to myself. Fortunately, someone finally came to the door, just as I was getting boosted up. The patient had soiled herself during a syncopal episode, so her daughter was cleaning her up in the shower and hadn't heard the knocks on the door.

I have been reading this book about Barry Bonds and steroids called Game of Shadows. It is a pretty amazing book about more than just Bonds. It meticulously details the drugs Bonds and other athletes, not just baseball players, but world class track and field athletes –were taking. They’d be over the hill, their careers on a downward slide, and then they’d get on this drug regime and start setting world records. They were taking up to 50 pills a day, but the main ones were undetectable steroids and human growth hormone. They’d also take insulin, clomid, a female fertility drug, and some stuff to make lean muscle in cattle.

I’m reading this book and thinking, you know I’ve been feeling run down and over the hill, maybe I could use this stuff. Let’s look at the public good here. Barry Bonds takes steroids to hit home runs, Marion Jones takes steroids to run fast, I would be taking steroids to help people. And I could go for a world record, too. Instead of hitting 73 home runs, I could carry 73 millions pounds of patients and equipment in a year. And steroids would prolong my career. Of course, I wouldn’t want to swallow all the pills, rub all the creme on, and stick myself with all the syringes Bonds used. Forget about the female fertility and the cow stuff, just give me the Clear and the Cream and HGB, along with the legal supplement ZMA — zinc and magnesium.

Worry about getting caught? No, the state doesn’t test medics for steroids. Not yet anyway. But, you know, I might be a standup guy anyway. What bugs me the most about these athletes is not that they took steroids, but that they lie about it. They deny what anyone with eyes can see. I wouldn’t be like that. If someone asks me how I lifted that 400-pounder all by myself, I’ll say, “It’s the juice! man. It’s the juice!”

Anyway, tomorrow I start taking my daily vitamins again.

***
Today I am fifty seven and not nearly as spry as I was at 47. Three years ago, I was quite fit. I ran in a Rugged Maniac, Warrior Dash, Spartan Race, Down and Dirty, Fitathlon, and the penultimate, a Tough Mudder. It was all the result of a year of purposeful training. I ran hills and trails and went to the playground with my daughter and climbed everything on the playscape. The one skill you have to master for those races is the ability to run and jump up a wall, getting your hands on the top, pull yourself up, and then swing your leg over. You do that all the time in these races. I was pretty decent at it. Unfortunately, the last Spartan race I have witnessed this year was on TV, while I sat with poor posture on my couch eating from a bag of Utz Sour Cream and Onion Ridged Potato Chips.

After my adventure race year, I developed plantar fasciitis, which made even walking quite painful so I abandoned mud runs and half marathons and have since been a dedicated swimmer, swimming in meets and open water swims. I swim very fast for my age, but my fitness beyond swimming has deteriorated significantly. The last two years I feel I have been in physical decline. My hearing is shot, I need glasses not just for 24s IVs, but for 20’s, intubations and to read the label on the Alleve package. I take thyroid medication every morning now, and once or twice a year I am afflicted with the gout (the sadness of the gout is I get it after only 1-2 beers on top of a couple days of red meat and bacon eating. I used to love beer drinking. But during my last gout attack (which comes on rapidly and at night, causing excruciating pain even at the feel of the wind on my big toe) I called out for Heroin. I called for it even knowing that if I tried it just once, I would likely begin a life spiral that would lead to the loss of my job, family, home and any vestige of self-regard. I would die alone and be buried in a potter’s field. That’s how bad the pain of gout is. It is tiny shards of glass in your swollen joint. Fortunately, no one heard my call and after a couple zillion years of agony, aided by the exhaustion of my tears, and a Benadryl, I was able to finally sleep for a few hours till the alarm awoke me, calling me back to the work. I picked up my shovel and using it as a crutch, I limped to my 2002 Honda and drove to the EMS mine. Another day older -- and no beer to look forward to at the end of the shift. Normally six to eight times a day, I am asked “How tall are you?” When I get the gout, instead I am asked, “Why are you walking so slow? Is your foot okay?” My answer instead of “six eight and a half -- I used to be six nine and a half, but my partner Jerry has beaten me down,” I say, “I’ve got the gout.”

My partner, Jerry, who has more silver in his hair than I do (mainly because he has more hair) enjoys putting a "Fall Risk" bracelet on my wrist every opportunity he gets while we wait at triage for our number to be called. He gets as big a kick out of it the eighth and ninth times as he did it as he did the first time. Oh, well, I did promise his mother I would look after him.

Which brings us all to today and my impetus for this post. No, I did not break into home to rescue a person -- it has been awhile since I have done that. We responded to an apartment building in the north end for a woman who couldn't walk. Her daughter met us at the door, and held it open so we could go up the stairs and into the apartment building. There a woman with a swollen knee for a month was requesting transportation to the hospital. While my partner and my preceptee put the patient in the stair chair, I carried the gear back out to the ambulance. When I returned, the outside door was locked. This apartment building had balconies that were about five feet off the ground. I raised my eyebrows, measuring just what I would have to do. I tried to reach my foot up to the balcony floor, and it was a tight stretch, and I just made it, then grabbing two of the the balcony railings I pulled myself up. Then I tried to swing my leg up to get over the top railing, but my leg wouldn’t stretch that far. I rested a moment, then tried again, swinging my leg against my stiff joints. Success. I swung my other leg up and over. There I was up on the balcony lickedy-split. I entered the room through the billowing curtains. “Walla,” I said. My partner, my preceptee, our patient and her daughter all looked up at me oddly like what was I doing there and what was I talking about, and then they resumed their conversation. I wanted to say “Walla” again to call the deserved attention to my Batman act, but instead, i just celebrated silently, realizing my feat had more meaning to me than to them.

This afternoon, I had my partner drive me to the playground off Oakwood Street, where I practiced some climbing.

I am not ready to retire the self-title of cat burglar second story man extraordinaire. 

Sinners and Saints

 As each of us will ultimately find ourselves before our god, many will find themselves before their paramedic. But unlike their god, their paramedic does not sit in judgement. We treat all of our patients the same. That is the creed. The man in the Mercedes Benz gets the same care as the man pushing the shopping cart full of cans. The model gets the same priority as the toothless crack whore, the All-American the same careful assessment as the bed sore ridden amputee, the police officer the same professionalism as the thief.

Most of my patients are anonymous. But sometimes they are not. I have cared for famous politicians, athletes, entertainers, scholars, businessmen and criminals. Sometimes I like to talk to my patients. I ask them about their lives, how they ended up here on my stretcher, what lessons or regrets do they have from their journeys. When my patient’s public history is known to me, and I suspect my letting on that I know who they are will make them uncomfortable, I try not to let on that I know. I am just the paramedic and they are just the patient. I don’t ask the real questions I am thinking.

Some of these patients are old and jaundiced, their heart and organs are failing, their lungs filling up with water, their minds moving toward dementia. They are likely not the same people they were in their primes. There are pressing questions I would like to, but do not ask -- questions I am interested in their reflections about. What was it like to change your position on an issue that had meant so much to you, just so you could advance your political career. Did your “move to the center” feel like you had sold your soul and everything that had gotten you into helping people in the first place just for that short burst of fame. How did it feel to buy that historic company, then close down the local factory and layoff all those people while you made millions? Was that miracle season where you seemed to strike batters out at will your greatest memory, or was it the time you spent with your family before the drugs found purchase in your soul? Did you really sleep with your young secretary while your wife lay in bed at home cancer-ridden? What was in your heart that late night when you raised your rifle and squeezed the trigger? Did you lament the bloodied lives you left on that killing floor?

I wonder up in heaven, if God has people who help prepare the new arrivals for their meeting with him -- the meeting that determines whether they get a seat in the clouds or the trapdoor opens beneath them. If there are, I bet those assistants are much like us, professional and kind, treating sinner and saint the same, leaving the judging to the higher ups.