5 AM

Night Shift

Chapter 23: 5 AM

The clock on the CAD system read 4:47 AM. The clock was digital, displayed in the upper right corner of the center monitor, the numbers white on the dark background, the clock the shift's metronome, the clock the thing that measured the distance between now and 6 AM, the distance that was one hour and thirteen minutes, the distance that was countable, that was finite, that was the approaching end.

The approaching end changed things. The approaching end changed the body and the mind and the floor and the calls, the approaching end entering the dispatchers' awareness at approximately 4 AM and settling there for the remainder of the shift, the awareness not a distraction but a horizon, the horizon that the dispatchers could see, the horizon that said: the morning is coming. The headset is coming off. The door is opening. The light is there. The awareness of the horizon was not relief — not yet, not at 4:47 — the awareness was the knowledge that the relief was approaching, that the approaching was measurable, that the measuring was possible because the end was known, the end was 6 AM, the end was certain in a shift where nothing else was certain, the calls uncertain, the emergencies uncertain, the voices uncertain, only the end certain, the end the one fixed point in the night's variable landscape.

Delia felt the horizon. She felt it in the body — the body's awareness of the approaching end manifesting as a subtle change in posture, a slight softening of the forward lean that the early hours of the shift produced, the softening not a relaxation but a modulation, the body adjusting to the knowledge that the work was nearing its conclusion the way a runner's body adjusts in the final mile, the stride not faster but differently paced, the effort not less but differently distributed, the body's remaining energy managed with the awareness that the remaining energy must last until 6 AM and must not be spent before 6 AM because the calls did not stop at 4:47, the calls continued until 6 AM and sometimes beyond, the calls indifferent to the clock's promise.

The calls at 5 AM were different.

The difference was gradual — the call types shifting over the hour between 4 AM and 5 AM the way the light shifted outside the windowless building, the shift imperceptible minute by minute but visible in the aggregate, the aggregate showing the change: the violence calls declining, the medical calls increasing, the composition of the city's emergencies rotating from the nighttime pattern to the morning pattern, the pattern determined by the biology and the behavior of the city's population, the population waking and the waking producing its own crises.

The strokes came at 5 AM. The heart attacks came at 5 AM. The medical literature said that the hours between 4 AM and 6 AM were the hours of highest risk for cardiovascular events — the blood pressure rising as the body prepared for waking, the cortisol levels increasing, the blood's clotting factors more active, the body's systems performing their morning startup sequence and the startup sometimes failing, the failure a stroke or a heart attack or a cardiac arrest, the failure happening in the bed or the bathroom or the kitchen, the failure producing the call from the spouse or the adult child or the neighbor who heard the fall, the call that came at 5 AM because 5 AM was when the body's vulnerability met the body's activity and the meeting sometimes produced the emergency.

At 4:53 AM, the phone beeped. Delia pressed the key.

"Memphis 911, what is the location of your emergency?"

"My mother fell. She's on the bathroom floor. She's not making sense — she's talking but the words aren't right."

The caller was a woman, middle-aged from the voice, the voice controlled, the voice the voice of a person who had assessed the situation and determined that the situation required 911 and had called, the calling the action of a person who recognized the emergency, who recognized that the mother's words not being right was the sign, the sign that the training and the public health campaigns and the television commercials said to watch for — the sign of stroke, the sign that the brain was failing, the sign that the blood was not reaching the brain or was reaching the brain too aggressively, the blood doing the thing that blood did when the vessels failed, the vessels that had functioned for however many years the mother had lived and that were now, at 4:53 AM in October, not functioning.

"What is the address?"

"892 South Parkway East."

"Is your mother conscious?"

"Yes. She's awake. She's trying to talk but the words — she's saying words but they don't make sense. And her face — the left side of her face is drooping."

Face drooping. Speech difficulty. The protocol's indicators — the FAST indicators, Face, Arms, Speech, Time, the mnemonic that the emergency medical community used and that the dispatch protocol incorporated, the indicators that pointed to stroke, the indicators that the caller was reporting without knowing the mnemonic, the caller's observation more valuable than the mnemonic because the observation was firsthand, was what the caller was seeing right now on the bathroom floor.

"Can you ask her to raise both arms? Hold them both up in front of her?"

A pause. The sounds of the caller speaking to the mother, the mother's response inaudible through the phone.

"She can raise her right arm but her left arm — it just falls. She can't hold it up."

Face drooping. Arm weakness. Speech difficulty. The three indicators. The protocol generated the determinant: stroke, probable, high priority. Delia dispatched EMS, Code 3 — lights and sirens, time-critical response, the time-critical designation the protocol's recognition that stroke was a time-dependent emergency, that the brain's tissue was dying with each minute that passed without treatment, that the treatment — the clot-busting medication, the intervention that could reverse the stroke's damage — the treatment was available at the hospital and the hospital was reached by the ambulance and the ambulance was reached by the dispatch and the dispatch was reached by the call and the call was now, and now was the beginning of the time, the time that was the enemy, the time that the dispatcher and the caller and the paramedics were racing against.

"Ma'am, the ambulance is on the way. This is very time-sensitive. I need you to do a few things. First, do not give your mother anything to eat or drink. Do not give her any medication. Second, if she's on the floor, leave her there — do not try to move her. Make sure her head is supported. Third, unlock your front door so the paramedics can get in quickly."

"Okay. Okay, I'll unlock the door."

"What is your mother's name?"

"Alma. Alma Gentry."

"How old is Alma?"

"She's seventy-four."

"Does she have any medical history? High blood pressure, diabetes, heart problems?"

"High blood pressure. She takes medication for it. And she had a mini-stroke — a TIA, they called it — two years ago."

Delia typed. The medical history entered the CAD, entered the dispatch information, entered the paramedics' awareness — the responding crew would know, before they arrived, that the patient was seventy-four with hypertension and a history of TIA, the history the context, the context the information that would help the paramedics assess and treat, the information that the dispatcher gathered and the paramedics used and the patient's life depended on, the information chain functioning at 4:53 AM the way it functioned at 10 PM and 2 AM, the chain unbroken by the hour, the chain holding at the end of the shift the way it held at the beginning.

"The ambulance should be there very soon. Stay with your mother. Talk to her — even if her words aren't making sense, she can hear you. Your voice will help her stay calm."

"Mama, I'm here," the caller said, the words directed not at Delia but at the mother, the words traveling through the phone as a side effect, the daughter speaking to the mother while the dispatcher listened, the listening incidental but present, Delia hearing the daughter's words to the mother the way she heard all the sounds that the phone transmitted — the background noise of the emergency, the human sounds that surrounded the medical data, the sounds that the protocol did not require but that the headset delivered, the sounds that were the life inside the call.

The EMS arrived. The CAD updated. The paramedics entered. Delia heard the transition — the daughter stepping back, the paramedics taking over, the professional voices assessing, the equipment sounds, the organized response displacing the daughter's vigil.

"Ma'am, the paramedics are with your mother. They'll take her to the hospital. Do you have transportation to follow them?"

"Yes. I'll drive."

"They'll likely take her to the Med or Methodist. You can ask them which hospital. Is there anything else I can help you with?"

"No. Thank you. Thank you for being so fast."

Delia disconnected. She logged the call. She typed the narrative. She moved on.

The morning calls continued. A chest pain on Getwell Road — a man, fifty-eight, woke with pressure in his chest, the wife calling. Delia followed the cardiac protocol, dispatched EMS, Code 3. A fall on Third Street — an elderly man, eighty-one, fell getting out of bed, conscious, complaining of hip pain. Delia followed the trauma protocol, dispatched EMS, Code 2. A difficulty breathing on Knight Arnold Road — a woman, forty-three, asthma attack, using her inhaler without relief. Delia followed the respiratory protocol, dispatched EMS, Code 2.

The calls were medical. The calls were the morning's medical, the body's-failure medical, the waking-up medical, the calls that the 5 AM hour produced from the raw material of human physiology, the physiology that sometimes failed in the transition from sleep to waking, the transition that was a vulnerability, the body's systems rebooting from the night's rest mode to the day's active mode and the rebooting sometimes encountering the error, the critical error, the error that was the stroke or the heart attack or the fall, the error that produced the call.

The floor was working. Six consoles, six dispatchers — the full night shift, the shift that would hand off to the day shift at 6 AM, the handoff approaching, the handoff visible in the preparations that the dispatchers were making, the preparations subtle but present: the CAD logs reviewed, the open incidents noted, the information organized for the briefing that would happen at the shift change, the briefing that would transfer the night's unresolved calls to the day's fresh dispatchers, the briefing that was the seam, the stitch between the shifts.

Marcus was at Console 6. The thermos was empty — the thermos had been empty since 3 AM, the coffee consumed over the hours, the consumption a measure of the shift's passage, the full thermos at 10 PM and the empty thermos at 5 AM the bookends, the thermos's contents the shift's fuel, the fuel burned over eight hours of calls and counting and silence and the work, the work that consumed the coffee and consumed the energy and consumed the voice and consumed the person, the consumption the shift's cost, the cost paid in the body's currency of fatigue and depletion and the particular emptiness that the end of a night shift produced.

Barnes was at the supervisor's station. Barnes was making notes — the notes that the supervisor made at the shift's end, the notes that documented the shift's significant events, the notes that would become the shift report, the report that the department maintained as a record of each shift's activity, the record the system's memory of the night, the memory that included the call counts and the response times and the significant incidents and the personnel notes, the memory that Barnes was compiling from the night's data, the data the raw material of the memory, the memory the institution's version of the dispatchers' memories, the institution's version cleaner and more complete and less painful than the dispatchers' version.

Delia felt the end approaching. She felt it in the quality of her attention — the attention still focused, still engaged, still processing the calls with the precision that the protocol required, but the attention now accompanied by the awareness of the end, the awareness that was the horizon, the horizon growing closer with each minute, each call, each log entry. The attention at 5 AM was the attention of a person who could see the finish, who could measure the remaining distance, who could count the minutes between now and the headset coming off.

But the attention did not waver. The attention held because the attention was the training and the training held because the training was the discipline and the discipline held because the discipline was the thing that kept the dispatchers functional through the entire shift, from the first call at 10 PM to the last call at 6 AM, the discipline applied consistently, the discipline not diminishing as the hours accumulated, the discipline the constant in the variable night. The calls might change — the shootings yielding to the medicals, the violence yielding to the physiology — but the discipline did not change, the voice did not change, the protocol did not change, the response did not change. The caller at 5:47 AM received the same voice and the same precision and the same attention as the caller at 10:07 PM. The caller did not know that the dispatcher had been at the console for seven hours. The caller did not know that the dispatcher had taken forty-three calls. The caller did not know that the dispatcher's body was tired and the dispatcher's mind was carrying the night's weight and the dispatcher's voice had been the instrument for seven hours and the instrument was depleted but not done. The caller did not know any of this because the caller did not need to know. The caller needed the voice. The caller needed the precision. The caller needed the response. And the response was there, was still there, would be there until 6 AM.

In ninety minutes, Delia would remove the headset. In ninety minutes, she would log out of the CAD. In ninety minutes, she would stand and walk the corridor and badge out and the door would open and the morning would be there — October morning, the sky lightening, the air cool, the city waking to a day that the city did not know Delia had protected. In ninety minutes, she would drive to Gloria's house and pick up Jaylen and take him to school and the morning would be the morning, the morning the reward, the morning the thing that the night shift earned, the earning not in the paycheck but in the arrival, the arrival at the morning, the morning that existed because the night had been worked and the night had been survived and the night was ending.

But the night was not over yet. The night had ninety minutes left. The ninety minutes would contain calls — more calls, more voices, more emergencies, the city's morning production of trouble and need and the biological failures that the early hours produced. The ninety minutes would contain the work, the full work, the work performed with the precision and the attention and the voice that the job required.

The phone beeped. Delia pressed the key.

"Memphis 911, what is the location of your emergency?"

The city called. The voice answered. The night continued.

Ninety minutes. Eighty-nine. Eighty-eight.

The clock counted. The calls came. The shift worked toward its end.

And the morning was there, beyond the windowless walls, beyond the secured door, beyond the parking lot — the morning was there, approaching with the light, approaching with the traffic, approaching with the waking of the city, the city that would wake and go about its day without knowing that the night had been held by the people in the building on Poplar Avenue, the people who had answered the phones and dispatched the units and counted the compressions and listened to the silence and said "help is coming" to the people who called at the hours when the people needed to hear it.

The morning was coming. The shift was ending. The night was almost over.

But almost was not over. And the phone was ringing. And Delia answered. Because the phone was ringing and answering was the job and the job continued until the job ended and the job ended at 6 AM and 6 AM was not yet.

Not yet. But soon.

The clock counted. The calls came.

Delia worked.