Emergencies

“This is me before I started my new routine, and this,” Danny swipes left, “is me after.” The photos are both shirtless gym pics, the second displaying a significantly more buff Danny than the first. I don’t get a chance to respond before I’m looking at another photo. “This is my one-hundred-and-ten-pound Doberman,” he tells me. “You like dogs?”

It’s easy to believe Danny’s muscles are new — his scrubs are too tight, pulling slightly at the chest and thighs. He’s about my height, five-foot-six or maybe a little taller. Shaved head and a manicured beard. Smallish hands, strong and boxy. We’re sitting in the break room, around two in the afternoon. There’s a handful of nurses looking at their phones and spooning leftovers from plastic containers, Jerry Springer on the TV above the fridge. A box of donut crumbs, a bowl of nacho cheese developing a film, probably from night shift.

“How do you like the job?” I ask Danny, as if it’s his first day, too.

“Listen.” He shakes his head as if disappointed in someone, maybe me. “The job’s alright. You’ll see a lot. But I’ve been here a while — four years. That’s longer than most techs stick around. Not saying anything about you, but…” he laughs, “you’ll see. I’ve got some other plans.” I wonder to myself if this is the kind of job that requires a back-up plan, just to survive it.

It’s my first conversation with a coworker in the ER. It’s January in New Mexico, the first days of 2020. My girlfriend just started grad school, which is why we’d moved here. Six months earlier, I’d gotten certified as an EMT to boost my credibility at another job, taking teenagers on backpacking trips. Getting an Emergency Medical Technician license involves a semester-long course, sometimes crammed into a month-long intensive, followed by endless state bureaucracy. A crash course in pathophysiology, how helicopters work, how to drive an ambulance. I passed all my tests and was ready as any rookie. I was proud of myself that first morning. Giddy in my itchy, navy-blue scrubs as I drove, windows down in the freezing dark, blasting Top 40 into the navy-blue morning.

My suspicion that Danny might be a little slutty is later corroborated by a mix of hearsay and other colleagues’ personal experiences — “He once got laid in decon!” another tech tells me. Besides being the place where we spray blood, shit and vomit off patients, decon is also where the ER stores dead bodies until the morgue comes to pick them up. Another nurse tells me that the reason we can’t go up to the helicopter pad is because too many people got caught fucking Danny up there.

Working in the emergency room, you’re allowed to have multiple personalities. Maybe it’s even better if you do. Almost anything can be forgiven if you’re quick to respond to a Code, if you sink an IV like an artist. I took as much comfort in Danny’s sexuality as I did in his skill as a tech. So straightforward and expectationless that it was generous. Learning I had a girlfriend didn’t deter his flirtation. I appreciated that, too.

In the conference room before shift, nearly fifty of us packed into a space meant to fit about twenty shoulder-to-shoulder at 6:53 in the morning, Danny’s presence was the sign of a good day. A wink across the room, an expressionless head nod. He didn’t mind being called for backup if I was having a rough time in the blood-drawing room, an aggressive patient or just a Hard Stick. That’s what we’d call a patient we couldn’t successfully draw blood from or insert an IV into on the first or second try. Sometimes it actually had to do with the person’s anatomy, but often it was just a bad day.

Some patients proudly self-identified as Hard Sticks. They knew the lingo, had a certain pride in being impossible patients. Maybe it’s a justification of the mediocre medical care they’d received in the past, though sometimes it seemed like a justification of illness itself—if they were going to be this sick for this long, at least being impossible was a kind of power.

“Don’t listen to them,” Danny taught me. “And don’t ever try to look for a vein. You’ve got to feel it.”

*

“Will you just go in and talk to her?” A nurse points to one of the five rooms she’s assigned to today. “She only speaks Spanish. I’m not sure what she wants. She might be a little…” the nurse makes the universal signal for “crazy” — a swirling pointer finger at her temple.

I’d been living in Mexico for the past three years, and speaking Spanish was the only part of hospital emergency response I had any practical experience in. At the hospital I’d been hired as a tech — an EMT who works inside, rather than on the street. I’d learn on the job, that’s what everyone said.

I walk into the room and approach a woman, maybe in her mid-seventies, frail and crumpled in the middle of her bed. I ask if there’s anything I can help her with.

“Por dios señorita.” Her exclamations of pain hit me like a song from the past, sad and lovely. I melt for old ladies in the hospital. My grandma died last year and I still see her everywhere. When I first got to town in August, for instance, days after her funeral in New York. The way the sun shot rays of golden light out from behind the evening rainclouds, spotlighting the mountains. Even with her voice in my head—“Jews don’t believe in angels!”—I’d think of them, of her. And I’d think of the lady at the end of my block in D.F., La Doña Carmen, who sold me limes and beer and always asked after my compañera. When I left Mexico, I knew I’d never see her again.

The woman tells me that she’s in unbearable pain and I explain — words that come out of my mouth at least a hundred times a shift — that her nurse has already given her the pain medication, that she’ll have to wait a while before getting more, that it should kick in soon. But the woman isn’t asking for meds. Eventually, I understand that she wants to brush her teeth and it soon becomes clear that she’s too weak to do it herself. She’s asking me to brush her teeth for her.

I think about my grandma again. When she didn’t speak anymore, hanging out became feeding her, wiping her mouth with a napkin. The soft crinkle of her skin, hands cool and powdery. I’d put my head in her lap and, when I was lucky, she’d stroke my hair absentmindedly, like I was a cat or a pillow. I return my attention to the woman lying in the bed in front of me and nod to her in affirmation.

I walk to the supply closet and use my finger to unlock it. I love the sound of all the doors simultaneously clicking open, their hermetically sealed offering. I find the toothbrush and toothpaste and skip the step where I punch in the patient’s name so the machine can charge her for the supplies I use during her care. I walk back to the room. The woman is now crushed up against the bed’s railing, grasping it with her hands, as if letting go would send her plummeting into the abyss.

“Aquí tengo el cepillo, señora,” I tell her proudly, “y la pastita también.”

I position myself next to the woman’s bed and hand her a cup of water. She can’t hold it without letting go of the bed. I set it down on the table, I have the loaded toothbrush in one hand and a clean, pepto bismol-colored puke bin in the other for her to spit into. But when she opens her mouth, I see that there are no teeth inside of it.

“Señora?” An explanation?

“Es que,” she whispers breathlessly, now very upset, imploring, “no sé en donde los pusieron.”

Fuck. I need to find her teeth before I can consider brushing them. Demoralized, I tell her I understand, that I’ll talk to the nurse, find her teeth and be right back.

“Por dios, señorita.”

I return to the nurses’ station, a desk island of computers and prohibited snacks, and explain the situation. There’s no way we could have her teeth, the nurse explains. I go back to her room to check around and find nothing. I talk to the nurse again.

“Alright,” she gives in, exasperated with me, “I’ll go check.”

I imagine a room that my badge doesn’t unlock, full of real and prosthetic body parts squirreled away, to be sold on the black market when patients die or are just too exhausted to care.

The nurse returns with a red specimen bag, a full set of dirty, fake teeth inside it.

I return to the woman again, this time with good news, and ask her if she would like me to brush the teeth outside of her mouth and then put them in, or put them in and then brush them. She wants to put them in first.

I ask if she can put them in herself and she nods yes. I position myself like I did the first time and go ahead with the brushing, making feeble circles with the brush against her teeth, then pressing the cup of water to her lips. She sips and dribbles the foamy, viscous water into the bin.

*

It’s the beginning of February, two weeks into my six-week orientation. I’m shadowing a more seasoned tech. Nora is younger than me by a few years and has worked here for about as long as our age difference. In the six hours we spend together, Nora oscillates between lackadaisical gossiping and unshakable seriousness, a pattern I’m very comfortable falling into. She tells me which nurses are needy, who I shouldn’t fuck. “My dad’s white and my mom’s Hispanic. Classic New Mexico,” she tells me. “It might not be obvious, but you can tell by my ass,” Nora models for me in the hall. She does have a great ass.

“What are you?” Nora asks me.

“Uh, white. Jewish?”

“Thought so! We used to have another Jewish tech. He was pretty cool.”

“Nora!” Danny yells across the hall as we pass him. “What kind of bullshit are you telling the new girl?”

“Suck my dick, Danny.” This was Nora’s response to every male co-worker, regardless of the subject under discussion. There are two ways of dealing with dick-slinging workplace humor, each a kind of eroticization. You can play-mock it, dissimulating your true disgust, or you can jump into the game. Make a better dick joke.

“Has that douchebag hit on you yet?” Nora asks me before we’re out of earshot.

“Nah. I mean, he showed me pictures of his dog…”

“Ugh! Well, don’t take it personally.”

I need to get “checked off” on a series of tasks, which means that I’m supposed to perform a list of technical skills under the supervision and tutelage of a senior employee. I slink behind Nora as she charges around the floor, the nurses’ stations, the trauma bay and asks the nurses if there’s anything on my list that needs doing. IVs, catheters, wound care. Wound care, Nora tells me “is our crème de la crème. It’s what we do best.”

“Dog bite in room twenty-three, baby.” Nora talks to me like a waitress at a bar I’ve been sitting at long enough to merit some kind of relationship. “The lady’s a meth head,” Nora tells me before we enter the patient’s room. A lot of people with drug histories come into the hospital, usually for totally unrelated reasons. I wonder what meth has to do with a dog bite.

We pick up supplies from the metal cart in the hallway next to the biohazard room. Since I stock the carts every day, I know where our supplies are. A fact I’m proud of. I pick out a few little orange sponges, two bottles of sterile saline, some petroleum-based dressings, and admire how well I’ve organized everything. We head to room twenty-three.

“Hey, honey,” Nora coos to the patient, a Black woman in her early forties. Nora introduces us both. I’m surprised by the softness of Nora’s voice. Will I ever start calling patients honey? The woman is sitting up in her bed and looks like she’s in pretty good spirits.

“We’ve got to check out your dog bite before we can clean it, to see what we’re working with,” Nora tells the patient, who smiles back at her, understanding.

Everything changes when Nora lifts up the bandages. The woman’s leg is torn open — ragged layers of flesh, clotted blood and fatty tissue. How the fuck are we going to clean this?

The woman looks at her leg as if she’s forgotten what happened, and then suddenly remembered. I’ve never been hurt this badly, but I can imagine it — the horror of seeing your body in a state it shouldn’t be in. She’s probably been given a cocktail of pain meds and benzos, a prescription I’ve already seen given routinely to patients exhibiting anxiety in the ER. She seems out of it, but not out of it enough.

As the patient becomes sensitized to her situation, I begin to lose sense of mine. It is understood that, on Orientation, a new hire will jump into new and terrifying work and also observe it. You’re supposed to have an out-of-body experience, to watch yourself perform tasks before you can imagine performing them. To learn from your body as your mind observes it, observes you.

“Oh, no. You can’t touch that,” the woman states firmly.

Nora is stone-faced but her voice is still unsettlingly soft. “Honey, we have to clean this, or else it’s going to get infected. If it gets infected, there’s a good chance you’re going to lose your leg. Do you understand what I’m saying?” The woman closes her eyes, tries to take a deep breath.

Nora prepares the lidocaine. The plan is that she’ll do the injection and I’ll do the cleaning.

“Hold her hand,” Nora tells me. Finally, a task I can imagine.

I walk from the spot by the door where I’m standing, holding our futile supplies, to the patient’s bedside. I tell the woman that I’m going to hold her hand. I tell her to look at me, to focus on my face, that I’m more interesting to look at than her leg, that the lidocaine will help make the cleaning less painful.

But the woman flails her hurt leg as Nora approaches her, nearly kicking the needle out of Nora’s hand. She yells for Nora to stop, that we’re going to kill her. That she’d rather let her leg fall off.

Nora puts the needle down. “Alright,” she says to me, unable to make eye contact with the patient. “Let’s let her cool down.” I am sure that, in her situation, I would need to be unconscious in order to cool down.

We exit the room and return to the nurse’s station. Nora fills the patient’s nurse in on the failed treatment. The nurse calls the physician who ordered the wound care. Nora talks to them both, explains the situation.

I watch the three of them talk. The physician and the nurse don’t look at me, so I ask Nora if she’s sure there’s nothing we can do. I ask her if we could sedate the patient, or just say fuck the lidocaine and pour a tub of saline on her leg at the very least, but the physician answers for her.

“Let her leave,” the physician says. “She said she didn’t want us to touch her leg. So, we can’t touch it.”

The physician and the nurse go back to whatever they had been doing before.

“She’s going to lose her leg, isn’t she?” I ask Nora, not really a question.

“Probably,” says Nora, solemn for a sliver of a moment. She nudges me, her voice returning to its normal gruffness, “Let’s find something else to do.”

*

“So many of the patients we see in Emergency,” writes Lucia Berlin in “Emergency Room Notebook, 1977,” “are not only not emergencies, there is nothing the matter with them at all.” Everyone in the ER — doctors, nurses, techs, clerks, security guards, cops, other patients —believes that some patients are fake and some are real. We prefer the real patients; we want to see flowing blood, a gunshot wound, to run a code — the symphony-like performance of resuscitation, either heroic or absurd depending on a few factors. If the patient lives. If the patient wants to live. Maybe it’s the theatrics, what my EMT instructor called “the sexy side of medicine,” the adrenaline. Or maybe it’s just the fact that you might be able to help. Whether or not you fail, you’re doing the thing you were trained to do.

But after a few paragraphs describing her work, describing patients and colleagues and her own burn-out, Berlin revisits her apathy: “God, have I become as inhumane as Nurse McCoy? Fear, poverty, loneliness are terminal illnesses. Emergencies, in fact.” They’re emergencies, but each a different kind.

I sometimes wonder, surveying the crowd in the waiting room, if an alien’s first stop on earth were an American Emergency Room, what would they think the word “emergency” even meant? An umbrella word, grouping together a slew of physical and social phenomena, often but not always related: broken femur, dog bite, gastrointestinal bleed, liver failure, heart failure, suicide, homelessness, drug addiction, misogyny, racial violence. Maybe the alien would distinguish between long-term and short-term emergencies. A night in the ER might fix your dog bite. It will not fix oppression. The short-term emergency of a dog bite will certainly be exacerbated by the long-term emergency of oppression. Vice versa.

*

Three days a week, my alarm wakes me at 5:00am, my heart racing. I don’t drink coffee until about noon, and then I drink it constantly until the end of my shift. Sometimes I try to jot a few notes down in my journal in the morning while I scarf down some toast. My mind is like a room with no furniture in it. I pace around. I describe my cat sleeping on the refrigerator, just to fill the blankness below a wishfully scrawled date. It’s early March and my windshield is still covered in frost, the sun barely coming up when I reach the parking lot, gold behind the mountain.

Morning meeting in the conference room next to the room where family members get corralled to learn about death, impending or after the fact. Nurses and techs finish foil-wrapped breakfast burritos, Cliff bars, taurine-laced soda. The charge nurse comes in and that’s the first indicator of what your day will be like, who’s going to be riding your ass. You get your shift assignment and head to your post.

I grab my favorite swivel chair out of one of the exam rooms and start setting up to draw blood. I’m getting into the rhythm of it. Line up the tubes, twist the vacuum hub onto one end of the butterfly, lay out a square of gauze, a piece of tape. My hands know what to do.

“Your next patient just got off a plane from China,” the nurse from night shift tells me, peeking into the doorway as I’m setting up. Once she scurries off, I make eye contact with Sylvie, another nurse working triage with me today. She smacks her forehead and shakes her head, which I interpret as, “Wow, the casual racism is strong today.”

The COVID jokes started last week. A coworker shows me memes of a disembodied hand cutting limes into wedges: GETTING READY FOR CORONAVIRUS. Another of a dog with glazed-over eyes, superimposed against a sepia backdrop of fighter jets and toilet paper rolls: ME, TWENTY YEARS FROM NOW WHEN I SEE A CHARMIN COMMERCIAL.

Now the jokes take a sharp turn toward the abyss. Hanging out at the nurse’s station on a night shift, the slow hours between 3 and 6 in the morning, the charge comes over to let a nurse know that the patient he’s been working with for the past four hours might have the virus. The nurse looks back at the rest of us sitting there: “This is how I die,” he says. He’s trying to be funny, but the joke doesn’t land. His tone is flat. He repeats the phrase over and over throughout the shift, “this is how I die.” It’s normal, in the ER, to make jokes about your patient’s death. It isn’t normal to make jokes about your own. At least, it wasn’t before.

We have protocols, kind of. If someone has recently come from Wuhan Province, we put a surgical mask on them, and then slap on our own N-95. I’d used an N-95 once before, putting an IV in a patient who maybe had tuberculosis. Now if you want an N-95, you have to walk all the way down to the charge nurse’s office, where masks are now stacked high among boxes of granola bars.

A woman and a man, presumably her husband, walk into the room. They are both wearing masks already. I ask the woman to sit down and the man leans against the doorsill. The couple whispers to each other in a language I don’t know. They both look exhausted. Maybe they really did just get off an airplane. I wonder what they’re doing in this end-of-the-line city. Neither of them looks sick at all. I draw the woman’s blood and I thank her. I thank every patient after I draw their blood, as I was trained to do, and it always feels weird.

I look at the patient chart. No one in line yet. This is usually a busy time of day, a sloppy, hectic transition between night and day shift. But today is slow. It’s been slow ever since coronavirus hit the news. We, like hospital workers everywhere, wondered where all the strokes were. Were people just dying at home? Cases of mysterious abdominal pain plummeted. The people who do come in are either chronically ill or drunk. Regulars. I kill time looking at coronavirus maps on the internet — swathes of beige, orange and red across the country.

*

My last week was at the end of March. The mornings were still cold, but I’d convinced my girlfriend to drive me to work so I wouldn’t have to take the cramped shuttle from the parking lot to the ER. I walked home at dusk, a thick breeze at my back, wading through the rose-gold sunsets that painted my body, the cottonwoods, the stucco walls of the hospital buildings. By the time I reached my house, the sky was completely dark, and I would take my scrubs off at the front door, unembarrassed about being half-naked in the street.

It wasn’t that bad in New Mexico yet, and my coworkers talked about New York as if it were the moon. I’d check my phone in between tasks or patients: “I have the coronavirus lol,” one friend texted. “It’s crazy, I haven’t been able to smell for weeks and then I googled it…” another friend wrote. Then my dad got it. A hairdresser at a fancy hotel in Manhattan, he’d closed the same day the rest of the city shut down. On the phone, in between coughing fits, he asked me if I felt safe at work. “Don’t worry,” I told him, “I’ll leave when it starts to feel heroic.” I don’t want to be a hero, I’d catch myself thinking, then feel the dark guilt of letting down my coworkers who I’d barely met.

I’d put in my notice reluctantly, almost asking my boss for permission to quit, not expecting he’d give it to me.

“Is it fear?” my boss asked me.

I fumbled some lines about my other job, about my family in New York, about these being difficult conditions under which to learn a difficult job. It felt like breaking up with a high school boyfriend I wasn’t sure I wanted to break up with — who maybe, even, I loved. He told me he was sorry, but that he understood. “I understand,” he told me. “I really do.”

It’s strange to have choices — the choice not to be a hero, to work from home, or to not work at all — that my dad doesn’t have. In the upper echelons of the service industry, he’s still a service worker.

The worst thing about that week was how wonderful it was. The ER was empty, even as the ICU began to fill up (texting with someone who still works there, I learn that now, four months later, it’s still full). The phenomenon where you’re supposed to pretend you’re working even when you’re not working, even when there’s no work to be done (“there’s always work to be done!”) — that vanished. No one cared anymore. Everyone understood that there would be enough work to do, that showing up was enough. We all checked in on each other. Hugged each other in the hall.

During a really slow period, Gabi and I would walk the stairs, seven flights up to the top of the building and back down. She’d call me over our walky-talkies: “You ready?” We’d come back, red faced and exhausted. A high-five and back to waiting around for a patient. Around 5 o’clock, Lupe and I would slather our hands with sanitizer and take a big whiff under our masks, giggling into the empty halls. “Happy hour,” we’d laugh.

Restaurants had started donating food to the hospital, huge tins of enchiladas, falafel, pizza. When the administrators bought us food, that felt different. We’d get emails every day from these same people about how we had to re-use our masks, how we had enough supplies but to maintain that state of enough-ness we would have to do things we’d previously been told weren’t safe. Fuck your donuts, I thought, but eventually gave in.

On my last lunch, I took my free pizza out to the smoking area. I barely smoked anymore, but I liked smokers and the cactus-filled gravel patch between the street and the ambulance bay. It started to rain as I watched an ambulance pull in with a masked patient, a masked medic at the door to check their symptoms and direct them, either to or away from our makeshift COVID ward. A rabbit darted out from behind a prickly pear cactus. I decided that I wouldn’t get up until she ran away, but she just stayed there, we both did, as it continued to rain. I thought this was a good sign.

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