Black Flies

  Table of Contents

  Title Page

  PROLOGUE

  Acknowledgements

  Copyright Page

  PROLOGUE

  I worked in Harlem and the place had begun to annoy me: the gangs of loud-mouthed kids all yowling at each other and goofing twenty-four hours a day, skels with forty-ouncers strolling in front of us to show that no one not even an ambulance could make them hurry, kids tugging at our shirts saying what’s wrong, what’s wrong, is someone dead, what’s wrong, the crackheads, the junkies, and the drunks dropping in the worst places—abandoned buildings, subway tracks, the Harlem River. I hated the sullen, resentful looks. I hated being accused of racism. What would I be doing in Harlem if I was a racist? I hated the graffiti, the garbage, the homeless fucks gathered together catcalling us from St. Nicholas Park. I hated the constant swarm of desperate family members who wanted help NOW! NOW! HURRY UP MISTER! NOW! I hated the weird shit that I saw, remembered, and that accumulated in an undigested glut inside me: blue-gray intestines on a red steering wheel, dead mouths filled with live cockroaches, an overweight diabetic woman’s soiled sock with a few black toes inside it falling out and rolling about on the floor like oblong marbles wobbling to a halt beneath the television and her asking if it’s ok is it do I need a hospital do I?

  Aftera while these kinds of situations started to irritate me, enrage meforno specificreason, until something snapped and I looked around as if in avacuum, bewildered, like what thefuck?Why care? What is it to me? What’s it matter?

  It’s hard to explain this transition to someone who has not lived through it, but when you can’t sleep and your life feels completely empty and you see death so much that it’s commonplace and you’re filled with the secret guilt of being alive among the dead, then you can become the sort of individual who is blunted and immune to the normal sensations of the everyday world, the kind who can stumble across the contorted body of some mangled teenager or the half-rotting corpse of an old lady with maggots crawling beneath her white dress and just stand there looking and not see anything but a piece of meat, not feel anything except the irritation that you’re the one who has to deal with it. That’s protection—being numb—but it carries with it a risk particular to the job. When everything is meaningless, including the life or death of the people around you, then the door is left open to be evil, really fucking evil.

  “This is Camellia. Camellia, say hello. How old are you, Camellia? She says seven. When Camellia was two she stopped breathing. She has asthma. Her airway closed. Her heart stopped. She was lucky. We got to her on time. Did what we’re trained to do. She’s a success story. I want you all to Look at her. Wave to them, Camellia. I bring her in on the last day at the academy. Once you’re on the streets it’s easy to forget Camellia.”

  A lanky kid in a Knicks jersey held his right arm with his left hand.

  “I was on the stairs. I fell. Aw, man, I smacked my arm. It’s killin’ me.”

  “Elevator works. What were you doing on the stairs?” Rutkovsky asked.

  The kid looked at his friends.

  “My arm’s killin’ me and he’s asking about the stairs.”

  All the friends started jostling each other and yelling, “Look at him. His arm’s broke. He’s in pain, man! He’s dying there and you don’t even give a fuck.”

  Rutkovsky tilted his head and ran his fingers along the length of the arm. He felt the joint for swelling. He bent the arm back and forth and felt for resistance. Then he asked, “Does it hurt if I move it?” and when he moved the arm again the kid screamed. Rutkovsky gave me a significant look. “We can bring you to the hospital,” he said to the kid, and the kid said, “Nah, I don’t want no hospital. Shit, man. Like I can wait till I get to the fucking hospital. It hurts now. Gimme somethin’ here.”

  The friends crowded around, yelling, “Aw, fuck, man. He’s in pain. Give him something here.” A guy in a North Face jacket, a black headband, and reflector shades, a seventies look, came into the doorway and said, “Y’all don’t worry about it. They ain’t leaving till they give him something, right?”

  “Yeah, sure,” Rutkovsky said, and walked to the door.

  “Where you think you’re goin?” the reflector-shades guy said.

  “To the drug bag,” Rutkovsky said, and started through the door. I was just standing there next to the bed. Rutkovsky pulled me out with him and as soon as we were in the front room he spoke quietly into his radio, then rested the radio upright on the coffee table. He sat on the couch and opened the drug bag. He took out a bag of saline and drew the saline up into the needle. I stood at the window and looked out at the street below. Tails of white smoke rose from the gray buildings in the slanting winter light: the bleak rows of projects, the rundown abandoned brownstones, the crosshatch of tar roofs and black water towers—all of upper Manhattan spread out beneath us. The kids filtered out of the bedroom and into the living room and huddled around us, watching Rutkovsky with the needle, standing near the door as if to keep us from leaving. Rutkovsky motioned with his eyes and I sat next to him. The kid with the hurt arm wandered over, lay on another couch, put his feet up, and held his arm out, as if waiting for the IV. The guy in the reflector-shades stood over the couch, crossed his arms, and looked skeptically at the needle.

  “What’s in that?” he asked.

  “Whatta you think?” Rutkovsky said. “Medicine.”

  A few of the kids snickered. Rutkovsky pretended to tap bubbles from the syringe. He pretended to get ready to start the IV Then there was a sound at the door and eight cops burst in, shouting to get down, waving batons, throwing kids to the floor, saying, not to fucking move. A minute after that all the teenagers were lined up in the hallway, getting frisked, pushed around, while neighbors stuck their heads out of doors, shook their fingers, saying, “Always up to no good, these kids. Gone wild.” Rutkovsky talked to a cop with curly black hair, a gap between his teeth, a black mustache and a single gold earring. His name was Pastori. This cop walked over to the reflector-shades guy, knocked the shades off his face, and stepped on them. He gripped the guy behind the neck and poked him in the chest with two fingers. “You want a shot at him?” he yelled over his shoulder. Rutkovsky shook his head, and said, “How ’bout you, Cross?You want a shot?”

  “A shot?” I said.

  Rutkovsky and Pastori looked at each other and they both laughed.

  An umbilical cord is thick as your finger. Two veins and one artery spiral together, the veins blue and the artery pinkish—a hose rushing blood from the mother to the newborn, and then back. It’s spongy and tough. You can feel a pulse if you hold the cord near the belly. To cut it, you need something sturdy and sharp, like scissors, a knife, or a piece of broken glass.

  We drove along the stark, grim line of the Polo Grounds projects, past the basketball courts surrounded with chain-link fences and the playground with the swings missing, and arrived at the base of the northernmost tower, where a crowd jostled each other, pointing thirty floors up to the roof, then down to some lump on the concrete. An EMT stood nearby holding a curved piece of flesh the size of a hockey puck between two fingers. As we jumped out of the ambulance the EMT said, “What the fuck is this? What part of the body?”Without even slowing Rutkovsky said, “Hard palate. Knocked it right out when she hit.”

  The girl had cracked the pavement, indenting it. One leg was bent backward beneath her body. Her head was at a crazy angle. She was completely still. Rutkovsky stood over her, studying the position she was in, looking up at the roof, then back at her. He bent and felt her neck and the back of her skull and lifted her shirt to examine her torso and saw what she’d done before she jumped—in rough, scraggly, red letters, the words LIFE SUCKS were carved into her belly. Rutkovsky stood t
here looking for about ten seconds. Then, without changing his expression, he checked his watch and turned and said, “Six forty-three.” A cop behind us wrote the time down. Rutkovsky took a sheet from the stretcher and spread it over the girl, tucking the edges in so it would not blow away. We left her with the EMTs, who had less training than the medics and always had to wait with the dead bodies. Rutkovsky and I walked back to the ambulance. The whole thing had taken three minutes. On the dashboard of the ambulance Rutkovsky’s dinner was still steaming the glass. Rutkovsky got back in the front seat, picked up his plastic fork, and had started eating again when a middle-aged woman walked up and watched us from ten feet away, stepping from foot to foot. When Rutkovsky glanced at her it was like she was stung. She screamed, “Look at him! He’d rather eat than save my daughter. Eating sesame chicken while my daughter’s dying!”

  She ran up and smacked the side window, her distorted face behind glass.

  “My daughter’s dead! He’s eating sesame fucking chicken!”

  Rutkovsky placed his food on the dashboard, started the engine, blared the horn once, and when the dead girl’s mother stepped back, Rutkovsky let his foot off the brake. We rolled down the block. He turned the corner, parked, picked up his food, and went on eating, all without a word. I looked at him. Rutkovsky lowered his fork.

  “What?” he said.

  “It’s the girl’s mother. I know it was hopeless, but she wanted us to work her up. I mean, so she knew nothing was left untried.”

  Rutkovsky didn’t explain that we couldn’t waste a medic unit working up every hopeless patient. He didn’t say that the system was stretched thin as it was and we’d get in trouble for wasting our time on a dead patient. All he said was, “Like I was going to try to save her. I was eating my dinner.”

  “More than a good station or a good tour you’ll want a good partner. Your partner will be your real teacher and he’ll determine whether the job is tolerable. It’s one of the first things you learn on the job. Fuck everyone else. Fuck the patient. Get along with your partner.”

  A half-dissected cadaver lay on a steel table, the interior cavity of the body exposed, the organs visible, the grayish formaldehyde pooled in the folds of the plastic wrapping, and all around us high shelves held jars with floating hearts, brains, kidneys, fetuses, and encephalopathic babies. I was in the A and P lab at Weill Medical School, which is a part of Cornell University and is on the Upper East Side. I was standing over Clara’s cadaver while she prodded the gall bladder with forceps, and said things like “Can you hand me that scalpel, Ollie?” or “Cut there, will you?” Tall, slim, matter-of-fact, Clara had dark, straight hair that went all the way down her back and that she tied up and folded under a blue cap. There was something prim and proper and a little restrained about her. She was a member of every club in college, got A’s, always handed everything in on time. Organized, diligent Clara. She wanted to be a surgeon by the age of thirty and she let everyone know it. I was standing at the foot of her cadaver, studying with her, listening to her lecture me a little, a didactic tone to her voice, while a few other students wandered past. One of these students, a friend of Clara’s, said to me, “What year are you?”

  “I’m not in school here. I’m a paramedic.”

  “Ah, cool,” the friend said in a different tone, and seemed more at ease after that.

  “He was my lab partner in college,” Clara said without looking up. “He’s taking a year off. He’s going to med school next year.”

  “If I get in,” I said, and Clara went on prodding at the gall bladder, not looking at me, but I could tell she was annoyed at my answer. By the way she clacked the scalpel down on the steel counter afterward I could see she wasn’t happy. We heard her friend’s footsteps go off into the hallway and fade. Without looking up, Clara said, “Just tell her you’re going to school, Ollie. Have a little confidence. Don’t say if. Say when.”

  “I’ll say ‘when’ when it happens. Not before. We both know it might not happen.”

  Clara held her mouth shut tightly and went on prodding at the cadaver, not saying anything.

  An old Dominican guy was lying on a picnic bench near the lighthouse beneath the George Washington Bridge, his legs hanging off the end of the bench so you could see his white socks above his old brown loafers. A nebulizer rested in the grass, and an old Dominican woman nearby shouted, “Asthmatica, asthmatica! Ayudame! Asthmatica!” When I touched the guy it upset the balance and he slid off the bench and landed in a lump in the grass. His chest heaved once, and then he lay there, eyes glazed, staring up at me. He was too weak to move.

  “Showtime,” Rutkovsky said.

  He tossed me the tube kit and as I set up the laryngoscope Rutkovsky forced air in with a BVM, then moved aside so I could intubate. I gave Rutkovsky a pleading look, like, you do this one, but he said, “You gotta learn sometime, Cross.”

  “Not on this guy. He’s dying.”

  “Cross,” he said, and just by the way he said it I knew he wouldn’t take no for an answer. I lined up behind the head, set the laryngoscope up, and went in with the scope, trying to find the vocal cords. I couldn’t see them. I tried to force air in with the BVM. I couldn’t squeeze the bag. The airway was shut completely. I tried with the scope again, still couldn’t see the cords, and when I looked up I saw a swaggering, thick-necked medic named LaFontaine hurrying across the grassy field. He was smiling as he lumbered on.

  “What is this, amateur night?” he bellowed.

  “He’s gotta learn,” Rutkovsky said.

  “I can’t see the cords,” I said to Rutkovsky.

  “Look again.”

  “He’ll die.”

  “Look again.”

  “He’s dying,” I said.

  LaFontaine tossed his equipment at the patient’s feet. He grinned at me, and in a know it all tone, said, “He’ll definitely die if you sit there not doin nothin’.”

  I could hear the beeping of each heartbeat on the monitor. It was in the forties, and slowing. The wife and daughter stood to the side, clinging to each other, the daughter holding white mittens tightly in one hand, sniffling and wiping her eyes with the back of her hand. I could feel the cold, moist grass at my knees. I could hear the traffic going over the seams on the George Washington Bridge above us. Rutkovsky and LaFontaine both looked at me, waiting. There was nothing else to do. I gripped the scope again and went in and tried to find the vocal cords. I looked for a long time. I found the cords. They were completely shut. There was no airhole between them. That’s why I hadn’t been able to see them before. I pulled the scope out. The heart rate had dipped beneath forty.

  “I can’t do it, Rut. He’ll die. The cords are spasmed shut.”

  Rutkovsky just tilted his head and made a clicking sound. Silent dismissal. LaFontaine was grinning, but Rutkovsky didn’t look at him. Rutkovsky snatched the laryngoscope from me, pushed me aside, and knelt behind the head. He carefully slid the scope into the mouth. He repositioned himself. He looked for a long time. He seemed alert, but not nervous. The heart rate was now in the low thirties. He was still waiting.

  “Come here, Cross,” he said. “I want you to see this.”

  I got behind the patient’s head. The guy wasn’t moving at all now. I could hear his wife and daughter wailing behind us. Rutkovsky gave me the tube with one hand while he held the scope in place with the other. I bent to look.

  “Those are the cords,” he said. “The two white lines. Remember what they look like. Remember how to find them.”

  “But they’re clamped shut.”

  “Yeah, just wait,” he said.

  We waited. And waited. And waited. Then the guy’s chest heaved once, probably for the last time, and the vocal cords eased open momentarily.

  “Now!” Rutkovsky hissed.

  I stabbed inward with the tube. A moment later Rutkovsky was listening with his stethoscope, making sure the tube was positioned correctly. LaFontaine scowled at me.

  “Way t
o go, Cross. Excellent patient care.”

  “Thanks, Rut,” I said, but he shrugged, said nothing, and went on squeezing the BVM, breathing for the guy.

  As the air went in the guy’s skin flushed and his heart rate went up into the sixties and then over a hundred. By the time we were in the ER the guy was awake and trying to pull the tube out. We’d definitely saved his life. No doubt about it. He’d practically coded in front of us. And now, ten minutes later, he was sitting up trying to pull the tube out.

  Afterward, cleaning up in the ER bay, I tried to act like it was a normal thing—saving a life—like it was something I did everyday, like I wasn’t impressed with what we’d done. It was useless. I couldn’t hide it. I felt pretty fucking good. I mean, we’d just saved the guy’s life! LaFontaine grinned at Rutkovsky.

  “You should’ve let the patient code. Teach Cross a lesson.”

  “What lesson would that teach me?” I said.

  “If you miss your tubes your patients die.”

  Station 18 was on 136th Street between Lenox and Fifth Avenue just across the street from Harlem Hospital. The station occupied a part of the old Nurses Residence, a four-story, dirty brick building with streaked white stains beneath the ledges and surrounded by a listing chain-link fence with razor wire on top. There was an oxygen cage with a padlock to the west of the building and next to that a compressed-oxygen tank that would be covered in frost when it was filled up. There were always bloodstained longboards leaning against the brick walls and all manner of medical garbage blown up against the fence and around the base of the building: old rubber gloves, plastic wrap from gauze four-by-fours, used c-spine collars, medication packaging, bloody bandages, balled medical tape, anything you could imagine. A narrow pathway between two boarded-up buildings led to 137th Street and the EMS parking lot, which was just a gravel square with a sliding gate on a street where steerers for the drug dealers hung out on the stoops.