The Ride-Along

Night Shift

Chapter 11: The Ride-Along

The ambulance was Unit 47 out of Station 31 on Shelby Drive, three blocks from Delia's apartment, the station a building she drove past five nights a week on the way to the center and that she had never entered because the station was not her building, the station was the other end of the system, the end where the dispatching became the responding, the end where the voice became the hands, the end where the call's information was received and converted into the action that the information required — the driving and the arriving and the entering and the treating and the transporting — the action that Delia initiated from Console 7 and that the paramedics performed at the addresses, the addresses that were dots on Delia's map and were doorways to the paramedics, doorways that led to rooms and hallways and kitchens and sidewalks where the emergencies waited for the help that Delia's voice had promised.

Department policy required each dispatcher to complete one ride-along per year — one shift spent in the field with a responding unit, the policy designed to bridge the gap between the dispatch floor and the street, between the voice and the hands, between the person who sent the help and the people who were the help. The policy recognized what the dispatchers knew and what the paramedics knew and what anyone who worked in a system with multiple components knew: that the components functioned better when the components understood each other, when the dispatcher understood what happened after the dispatch, when the paramedic understood what happened before the arrival, the understanding a bridge, the bridge a tool, the tool the thing that improved the system's performance by connecting its parts.

Delia had done five ride-alongs in her six years — one per year, as required, always with EMS, always on a night shift, the night shift her shift, the night hours her hours, the hours she understood, the hours whose calls she knew, the calls that came between 10 PM and 6 AM the calls she dispatched, the calls she would now see, see from the other end, see from inside the ambulance rather than from inside the headset.

She reported to Station 31 at 9:30 PM on a Wednesday in October, the third week of the month. She parked in the station's lot, beside the ambulances, the ambulances large and white with the orange and blue stripes of the Memphis Fire Department's EMS division, the ambulances the vehicles she tracked on her mapping screen as green icons, the icons that she moved with her dispatches, the dispatches that sent the ambulances to the addresses, the ambulances that she had only ever seen as icons and was now seeing as vehicles, large vehicles, the vehicles parked and waiting and real in a way that the icons were not, the vehicles three-dimensional and physical and heavy, the vehicles not data but metal, not pixels but paint, not information but the actual things that drove to the emergencies she dispatched.

The crew was two: Davis and Shakira. Paramedic William Davis, twelve years on EMS, a man in his forties with the build of a person who had spent twelve years lifting patients and equipment and stretchers, the build not muscular in the gym sense but functional in the labor sense, the body shaped by the work the way all bodies are shaped by the work they do, Davis's body shaped by the lifting and the carrying and the kneeling beside patients on floors and sidewalks and staircases. EMT Shakira Webb, four years on EMS, twenty-eight, a woman whose competence was visible in the economy of her movements, the way she prepared the ambulance for the shift — checking the supplies, testing the equipment, logging the inventory — the movements efficient, practiced, the body knowing where everything was without looking, the hands finding the gauze and the IV kits and the splints in the compartments that the hands had opened a thousand times.

Davis shook Delia's hand. The handshake was the greeting of a person who had met many dispatchers on many ride-alongs and who understood the ride-along's purpose and who accommodated it without ceremony, the accommodation professional, the handshake the entire welcome.

"You're the one on the radio," Davis said. "Console 7."

"That's me."

"I know your voice. I've been hearing your voice for — how long have you been on nights?"

"Six years."

"Six years of your voice in my ear. Strange to see the face that goes with it."

The strangeness was mutual. Delia had heard Davis's voice — or rather, she had heard the voice of the EMS units she dispatched, the voices on the radio that acknowledged her dispatches and reported their arrivals and provided the scene updates, the voices that were professional and brief and that she processed as data, as status reports, as the information that updated the CAD and the map. She had heard Unit 47 acknowledge her dispatches dozens of times — "EMS 47, copy" — the two words the unit's voice, the voice that she now connected to a face, to a person, to a man in his forties with a handshake and a name.

The connection was the ride-along's first lesson, the lesson that arrived before the ambulance left the station: the voices on the radio were people. The units on the map were people. The icons that moved through the digital Memphis were ambulances with people inside them, people who drove and treated and lifted and transported, people whose night shift was not the headset but the street, not the console but the scene, not the voice but the hands.

Shakira handed Delia a reflective vest. "You stay behind us," Shakira said. "You observe. You don't touch patients, you don't touch equipment, you don't get between us and the scene. If we say move, you move. If we say stay in the truck, you stay in the truck."

"Understood."

"Good. Welcome to the other end."

The other end. The phrase was the phrase that the paramedics used for the dispatchers, the way the dispatchers used the phrase for the paramedics — each side the other's other end, each side the part of the system that the other side could not see, the two ends connected by the radio and the CAD and the dispatch that traveled from one end to the other, the dispatch the signal that activated the response, the response the thing that happened at the other end.

The first call came at 10:17 PM. The radio — the ambulance's radio, mounted on the dashboard, the sound different from the headset's radio, louder, more present, the radio filling the cab rather than filling the ear, the radio's sound shared by the three people in the vehicle rather than delivered privately to the dispatcher's headset — the radio crackled with the dispatch.

"EMS 47, respond to 3215 Faxon Avenue, medical emergency, male patient, chest pains, conscious and breathing. Code 3."

Davis acknowledged. Shakira drove. The ambulance moved — the lights activating, the siren engaging, the vehicle accelerating through the Memphis streets with the urgency that Code 3 prescribed, the urgency that Delia had dispatched a thousand times and had never experienced from inside the vehicle, the urgency different from the inside, the urgency physical, the urgency felt in the body as the vehicle moved through the intersections and the turns and the acceleration, the body pushed by the motion, the body experiencing the dispatch not as data on a screen but as force, as speed, as the physical reality of an ambulance responding to an emergency at 10:17 PM.

Delia sat in the back of the ambulance, on the bench seat beside the stretcher and the equipment. The equipment was the thing — the thing that she had never seen, the thing that existed at the other end of her dispatches, the thing that the paramedics brought to the addresses that Delia sent them to. The cardiac monitor. The defibrillator. The IV kits. The medication bags. The airway equipment — the intubation kit, the bag-valve mask, the suction unit. The cervical collars. The splints. The bandages and the gauze and the tape and the tourniquets. The equipment organized in compartments and bags and mounted on the walls of the ambulance's patient compartment, the compartment a mobile emergency room, the room that traveled to the patient rather than the patient traveling to the room, the room that contained the tools that the paramedics used to do the things that Delia's voice could not do, the things that required presence, physical presence, the presence of hands and equipment at the scene.

They arrived. The ambulance stopped. The address was a house on Faxon Avenue in the Orange Mound neighborhood — a single-story house, brick, the porch light on, the front door open, a woman standing in the doorway waving them in, the waving the universal signal of the person waiting for the ambulance, the person who had called 911 and had been told that help was on the way and was now seeing the help arrive.

Davis and Shakira moved with the efficiency that twelve years and four years had produced, the efficiency that Delia recognized because the efficiency was the field version of the economy she recognized at the console — Marcus's economy, the economy of experience, the movements stripped to the minimum necessary, the minimum producing the maximum, the body knowing what to do without the mind deliberating.

Davis carried the cardiac monitor and the medication bag. Shakira carried the airway kit and the IV kit. They walked — not ran, walked quickly but walked, the walking deliberate, the deliberation the training, the training that said: do not run. Running increases errors. Running creates urgency that the scene may not require. Walk quickly. Arrive composed. Assess the scene with the composure that the patient needs to see, because the patient who sees composed paramedics feels safer than the patient who sees running paramedics, and the feeling of safety is the first treatment, the feeling of safety the first intervention, the feeling of safety the thing that lowers the heart rate and reduces the adrenaline and begins the calming before the medical calming begins.

Delia followed. She followed into the house, through the doorway, past the woman (the wife, the person who had called 911, the person whose voice Delia might have heard if the call had come to Console 7, the voice that Delia had heard a hundred versions of — the spouse's voice, the partner's voice, the voice of the person who loved the person on the floor), and into the kitchen where a man sat in a chair, his hand on his chest, his face the color of ash, the color that the dispatchers never saw, the color that lived at the other end.

The color. The color was the ride-along's second lesson. At the console, there was no color. At the console, there was the voice and the data and the protocol and the codes, the codes that translated the emergency into the language of the system — Charlie-level response, chest pain with cardiac history, difficulty breathing — the codes that were precise and clinical and that did not include color, did not include the particular gray of a man's face when the blood was not reaching the skin because the heart was not pumping correctly, the gray that was not data but was information, was the visual information that the paramedics received and the dispatchers did not, the visual information that changed the emergency from an abstraction to a presence, from a call on a screen to a man in a chair with a gray face and a hand on his chest.

Delia stood against the wall. She stood where Shakira had told her to stand — out of the way, behind the paramedics, in the observer's position, the position that allowed her to see without being in the way, to witness without participating, to be present without being involved. She stood and she watched Davis assess the patient — the blood pressure cuff, the pulse oximeter on the finger, the electrodes attached to the chest for the cardiac monitor, the twelve-lead ECG that Davis performed with the practiced motion of a man who had attached electrodes to a thousand chests, the attaching automatic, the hands knowing the positions the way Delia's hands knew the keyboard.

She watched and she made the connection — the connection between the voice she would have heard at Console 7 ("my husband is having chest pains") and the scene she was now witnessing (the husband in the chair, the wife standing behind him, the kitchen with the dinner dishes still on the table, the dinner interrupted by the pain, the pain interrupting the ordinary, the ordinary the dinner and the dishes and the kitchen and the evening, the ordinary the thing that the emergency disrupted, the disruption the reason for the call, the call the thing that Delia would have received and processed and dispatched, the dispatching sending these people — Davis and Shakira — to this kitchen, to this man, to this pain).

The connection was the seeing. The seeing was the thing that changed the hearing. Because after the ride-along, after the seeing, the hearing would be different — the hearing at Console 7 would carry the images that the seeing had provided, the caller's voice no longer producing only the protocol's data but also the scene's picture, the picture that the ride-along had painted, the picture of the kitchen and the gray face and the dinner dishes and the wife standing behind the chair and the paramedics kneeling beside the patient, the picture that the dispatcher now carried alongside the codes, alongside the data, alongside the voice.

The man was stable. Davis administered aspirin and nitroglycerin. Shakira started an IV. The monitor showed sinus tachycardia — fast but regular, the heart pumping quickly, the pumping the heart's response to the pain or to the underlying condition that the hospital would diagnose. They loaded the man onto the stretcher. They carried the stretcher to the ambulance. The wife followed, holding her purse, holding the keys, holding the things that a person holds when the person's spouse is being loaded into an ambulance, the holding the only thing the person can do, the holding the displacement activity, the hands needing to hold something because the hands cannot hold the person.

Delia rode in the back with Davis and the patient. The ambulance moved. Shakira drove. The siren was on — Code 3 transport, the transport to the hospital, the transport that Delia dispatched from Console 7 with the words "EMS transporting, Code 3" and that she was now inside of, inside the ambulance, inside the transport, inside the thing that the dispatch initiated and the ambulance performed.

The ride to the hospital was seven minutes. Seven minutes during which Delia sat in the back of the ambulance and watched Davis monitor the patient and adjust the IV and communicate with the hospital on the radio, the radio the medical radio, not the dispatch radio, the radio that connected the ambulance to the emergency department, the radio that carried the patient report — "fifty-seven-year-old male, chest pain, onset forty-five minutes ago, vitals stable, twelve-lead shows ST elevation in leads two, three, aVF" — the report the medical information that the emergency department needed to prepare for the patient's arrival, the report the field's communication to the hospital, the communication that was the next link in the chain that Delia's dispatch had started, the chain that ran from the caller to the dispatcher to the paramedic to the hospital, the chain that was the system's response, the system that Delia operated from one end and that she was now experiencing from the other end, the other end that was the ambulance and the stretcher and the IV and the monitor and the seven minutes and the siren and the man on the stretcher whose gray face was gaining color because the nitroglycerin was working and the aspirin was working and the IV was flowing and the system was working, the system doing what the system was designed to do.

They arrived at the hospital. They transferred the patient. The handoff happened — the paramedics to the nurses, the ambulance to the emergency room, the field to the facility, the handoff the transition that Delia's dispatch had set in motion, the transition that she had initiated from Console 7 with the codes and the dispatch and the voice that said "help is on the way," the help having arrived, having treated, having transported, having delivered.

Davis made notes. Shakira restocked the supplies. They returned to service. The ambulance was available. The system continued.

The second call came at 11:43 PM. An overdose on Trigg Avenue. They responded. They arrived at an apartment — a second-floor unit, the door open, a roommate standing in the hallway, the roommate the person who had called, the person whose voice Delia would have heard at Console 7 saying the words that overdose callers said: "she's not waking up, she's not responding, I don't know what she took."

Delia followed the paramedics into the apartment. The apartment was small — a living room, a kitchen, a hallway, a bathroom, the bathroom where the patient was. The patient was a woman in her twenties, on the bathroom floor, unresponsive, breathing shallow and irregular, the breathing the sound that Delia recognized from the headset, the sound of an airway that was compromised, the sound that she had heard through the phone and that she now heard without the phone, heard directly, heard in the room where the sound was produced, the sound not mediated by the phone line or the headset or the microphone but arriving at Delia's ears the way it arrived at the paramedics' ears, directly, immediately, the directness the difference, the directness the thing that the phone could not provide.

She saw the syringe. She saw it on the bathroom floor beside the woman's hand, the syringe the evidence, the evidence that the dispatch codes — "overdose, heroin suspected" — the codes that would have appeared on Delia's CAD screen, the codes that she would have processed as data, as a call type, as a dispatch category, the codes that she now saw as a syringe on a bathroom floor beside a woman's hand, the syringe small and specific and physical in a way that the code was not.

Davis administered naloxone. The naloxone was the drug that reversed the opioid, the drug that the dispatcher asked about on the phone — "do you have naloxone available?" — the drug that Delia had asked callers about dozens of times and that she now watched being administered, the administration the thing that happened after the asking, the thing that the dispatcher's question addressed but that the dispatcher did not see, the thing that the paramedic's hands did at the address that the dispatcher's voice had sent them to.

The naloxone worked. The woman's breathing deepened. Her eyes opened. She looked at the ceiling and then at Davis and then at the room and the looking was the coming-back, the coming-back from the overdose, the returning from wherever the drug had taken her to the bathroom floor and the paramedics and the ambulance that was parked outside and the system that had responded to her roommate's call.

The woman looked at Delia. The looking was a moment — a second, two seconds, the woman's eyes on Delia's face, the looking of a person who had just returned from the edge and who was seeing the room and the people in the room and who saw Delia in the reflective vest standing against the wall, Delia who was not a paramedic and was not the roommate and was a person the woman did not know and would not know, a person who was witnessing the woman's crisis from the position of the observer, the observer who was also the dispatcher who had spent six years sending help to addresses like this one, addresses that were dots on her map and were now rooms, rooms with bathroom floors and syringes and women in their twenties coming back from the edge.

The looking lasted two seconds. Then the woman turned away and Davis continued the assessment and Shakira prepared the stretcher and the call continued toward its resolution.

But the looking stayed. The looking entered the space where the calls lived after the calls ended, the space that held the counting and the breathing and the shaking and the silence, the space that now held the looking — the two seconds during which a woman on a bathroom floor in an apartment on Trigg Avenue had looked at Delia and Delia had looked at the woman and the looking was the connection, the connection that the phone could not provide, the connection that was not voice but sight, not hearing but seeing, the seeing the thing that the ride-along provided, the seeing the thing that changed the hearing.

The shift continued. Five more calls — a car accident on Third Street, the scene lit by flashing lights and the headlights of the stopped traffic, the scene the visual version of the radio report that Delia received at Console 7 ("two vehicles, minor injuries, blocking intersection"); a diabetic emergency on Shelby Drive, an elderly man whose blood sugar had dropped, the man on his couch, his wife beside him, the wife the caller, the caller whose voice Delia would have heard saying "he's confused, he's not making sense"; a fall at a nursing home, the facility quiet, the patient a ninety-one-year-old woman on the floor beside her bed, the woman small and confused and the falling the thing that nursing home patients did and that the system responded to with the dispatch that sent the ambulance to the address; a panic attack at a gas station on Elvis Presley Boulevard, a young man hyperventilating beside the pumps, the hyperventilating the sound that the phone would have carried to Console 7, the sound that was now in the open air, in the October night, the sound of a body producing the fear response that the body produced when the mind overwhelmed it; and a cardiac arrest at 3:17 AM, the call that was the ride-along's center, the call that was the thing.

The cardiac arrest was on Ketchum Road. Not 1847 Ketchum — a different number, a different house, but Ketchum Road, the street that Delia knew from the CPR call, the eighteenth CPR call, the call where she had counted for eleven minutes while Denise Palmer compressed her husband's chest, the call whose outcome she did not know. Ketchum Road. The street was not the address but the street was the name and the name was the connection and the connection was the thing that the ride-along surfaced, the thing that linked the dispatch to the scene, the call to the address, the voice to the place.

They arrived. A house. The front door open. A man in the hallway saying "in the bedroom, in the bedroom." Davis and Shakira moved. Delia followed. The bedroom. A woman on the floor beside the bed, on her back, not moving, not breathing, the woman's face the face that Delia had never seen at Console 7, the face that the phone did not transmit, the face that was the thing at the other end of the CPR calls — the face of a person who was not breathing, whose heart had stopped, whose body was on the floor waiting for the hands that would compress the chest and the machine that would shock the heart and the drugs that would support the rhythm, the hands and the machine and the drugs that were in the ambulance and in Davis's bag and in Shakira's kit, the tools that the dispatch sent and the paramedics brought and the patient needed.

Davis began CPR. Delia watched. She watched from the corner of the room, pressed against the wall, her hands at her sides, her body still, and she watched Davis's hands on the woman's chest — the compressions, the compressions that she had counted a thousand times from Console 7, the compressions that she had heard through the phone as the sound of a caller's hands on a patient's chest, the compressions that she now saw, saw the physical act, saw the hands pressing down on the sternum, saw the chest yield under the pressure, saw the body's response to the force, the force that was the CPR, the CPR that she had directed from the console with her counting, with the "one and two and three and four," the counting that she now saw produced this — this pressing, this pushing, this physical act of a person's hands on another person's chest attempting to restart the heart by pushing the blood through the body that could not push the blood itself.

She watched and she heard — not the counting, not her counting, not the dispatcher's counting, but the paramedic's counting, Davis counting as he compressed, the counting softer than the dispatcher's counting because the paramedic counted for himself rather than for a caller, the counting the rhythm, the rhythm the same rhythm that Delia provided through the phone, the rhythm that the protocol prescribed, one hundred to one hundred twenty per minute, the rhythm the heartbeat, the substitute heartbeat, the external heartbeat that Davis's hands provided while Shakira prepared the defibrillator.

The defibrillator charged. The sound — the electronic whine of the capacitor charging, the sound building, the sound reaching the pitch that meant the charge was ready, the sound that Delia had heard faintly through the phone on the CPR calls, the sound in the background of the calls she took, the sound that was now in the room, in the air, filling the bedroom with the electronic promise of the shock that would attempt to restart the heart.

"Clear," Davis said. The word the word. The word that meant: hands off the chest, no one touching the patient, the electrical path clear between the pads and the heart, the electricity about to travel through the body.

The shock. The thump. The sound and the sight — the body's response to the electricity, the slight jerk, the involuntary movement, the movement that Delia had heard through the phone as a sound and that she now saw as a body moving on a floor in a bedroom on Ketchum Road.

Davis checked the monitor. Shakira prepared the medications. The rhythm was — Delia could not read the monitor but she could read the faces, and the faces said: not yet, not restored, the heart not restarting, the rhythm not returning, the CPR continuing, the compressions resuming, the cycle of compressions and shocks and medications continuing while the minutes passed and the bedroom held the scene and Delia stood against the wall and watched.

Twenty minutes. Twenty minutes during which Delia stood in the bedroom and watched the paramedics work and the twenty minutes were the other end of the eleven minutes, the other end of the counting, the other end of the dispatch. At Console 7, the twenty minutes would have been a status in the CAD: EMS on scene, working cardiac arrest. At Console 7, the twenty minutes would have been the time between the dispatch and the disposition, the time that the dispatcher tracked but did not experience, the time that passed on the map while the dispatcher took the next call. Here, in the bedroom, the twenty minutes were the twenty minutes — each minute lived, each minute present, each minute containing the compressions and the shocks and the medications and the monitor's display and the husband standing in the hallway and the sound of the oxygen and the sound of the defibrillator and the sound of Davis's counting and the silence that was not silence but was the accumulation of all these sounds, the sounds of the other end.

The woman died. The twenty minutes ended not with a restored rhythm but with Davis's voice saying "calling it" and the time — 3:41 AM — and the stopping of the compressions and the turning off of the monitor and the quiet that followed, the quiet that was the death's acoustic signature, the quiet of a room where the effort has ended because the effort has not succeeded and the ending is the death and the death is the quiet.

Delia stood against the wall. She stood in the quiet. She stood in the bedroom where the woman was on the floor and the woman was dead and the paramedics were packing the equipment and the husband was in the hallway and the night was continuing outside the house, the night that contained this room and this death and the calls that Delia was not taking because she was here, at the other end, seeing the thing she had only heard.

She thought of the CPR calls. She thought of the eighteen times she had counted. She thought of the callers whose hands she had directed to the chests of their loved ones, the hands that had compressed at the rate her counting set, the hands that had been the substitute heartbeat while the ambulance drove to the address. She thought of the four known outcomes — four survived — and the fourteen unknown outcomes. She thought of the unknown outcomes and she stood in the bedroom where the outcome was known and the outcome was death and the knowing was the thing, the knowing the thing that the system did not deliver to the dispatcher, the knowing that the ride-along delivered, the knowing that the other end provided, the other end where the outcomes lived, where the dots on the map became rooms and the rooms contained lives and the lives contained deaths and the deaths contained the quiet.

She did not cry. She stood. She stood the way she sat at Console 7 after the difficult calls — the body still, the face still, the professional surface holding while the underneath processed, the processing not visible, the processing internal, the processing the thing that the body did with the information, the information that was not data but was experience, was the seeing, was the twenty minutes in the bedroom on Ketchum Road.

Davis touched her arm. The touch was brief — the same briefness that Patricia had used, the touch that said the thing without words, the touch that acknowledged the seeing, the acknowledgment that said: you saw it. The other end. The thing that happens after the dispatch. The thing that your voice sets in motion and that our hands try to catch. Sometimes the catching works. Sometimes it does not. Tonight it did not. And you saw it.

"You okay?" Davis said.

"Yeah," Delia said.

The word was sufficient. The word was the economy. The word was the dispatcher's word, the word that answered the question without opening the door, the door that the seeing had pushed against, the door that held, the door that was the bank.

They left the house. They returned to the ambulance. Shakira drove. The night continued. The calls continued. Delia rode along.

At 6 AM, the shift ended. Delia returned to Station 31. She thanked Davis and Shakira. She got in her car. She drove to Gloria's house. She picked up Jaylen. She took him to school. She went home. She closed the curtains. She lay down.

She lay in the dark and the dark was the bedroom on Shelby Drive and the dark was also the bedroom on Ketchum Road, the two bedrooms the two ends, the two ends of the system, the dispatch end and the scene end, the voice end and the hands end, the two ends that the ride-along had connected, that the seeing had bridged, that Delia now carried in the space where the calls lived, the space that had been populated by voices and was now populated also by images — the gray face, the syringe, the dinner dishes, the defibrillator, the woman on the floor, the looking.

The seeing had changed the hearing. The changing was permanent.

From now on, when the phone beeped and the voice said "my husband is on the floor, he's not breathing," Delia would hear the voice and she would also see the room. She would see the kitchen or the bedroom or the bathroom. She would see the face. She would see the paramedics arriving and kneeling and compressing and shocking. She would see the other end while she worked this end, the two ends connected in her mind the way the two ends were connected by the system, the system that she operated from Console 7 while the images of the other end played behind her eyes, the images the ride-along's gift, the ride-along's burden, the ride-along's permanent contribution to the archive, the archive that held the calls and now also held the scenes.

She closed her eyes. She slept.

And at Console 7, the next night, the headset on, the screens alive, the phone beeping — the next night, when the voice said the words and the protocol opened and the counting began, Delia counted with the knowledge of the other end, the knowledge of the hands on the chest, the knowledge of the defibrillator's whine, the knowledge of the bedroom and the twenty minutes and the quiet.

The counting was the same. The voice was the same. The knowing was different.

The seeing had changed the hearing. The changing was the ride-along. The ride-along was the other end. The other end was the thing.

And the thing was permanent.