“Yeah, I remember a 22-I on this street a while back when some guy drove his bike right into the median, flipped him right off it.” The paramedic speaks faster as he accelerates into the shoulder, past the stopped traffic. “Th-that guy hit this, like, thin little tree right in the middle of his body.” Bowman runs his index finger across his belly, made visible only by way of the vehicle’s display lights in the dark evening.

“Cut him right in fuckin’ half. His lower half was, was about twenty yards away from the bike, his upper half maybe like uh, another twenty.” Weary, crimson rings of sleeplessness encircle Bowman’s round eyes. Their pupils flash wildly as the cars fly by us, briefly illuminated by the sterile red and blue flashes our unit radiates.

“Oh, I remember—this is crazy—his spinal cord was like yanked right out of his damn vertebrae, so it just looked like this weird little snake thing flopped out of his pelvis—oh come on asshole!” A vehicle in front of us panics as we approach, unsure whether to cower in the median or swerve out of our way.

“Shit! Can you believe that? You got assholes like that in your town?” Not waiting for my response, Bowman continues, “So anyways, this guy’s guts were in neat little piles all over, small intestine, colon, all that.” Excitement swells in his face as he continues in his ambiguously Southern accent.

“Then this guy’s girlfriend runs up, yellin’ and screamin’, ‘Where’s the rest of his body!? Where’s the rest of his body!?’ Meanwhile I’m pointin’ like ‘Over there, over there, some here.’”

His punchline-induced grin turns terse as he reminds me, “I didn’t actually say that, of course.”

We arrive on scene, but since I am only riding along with the medic, I resign to giving his short, stiff frame an exaggerated shadow with my own tall, lanky form. As an EMT-Basic (essentially a paramedic with far less training and capabilities) in rural Kansas, my conspicuous physical presence parallels my feelings of professional inadequacy, despite my recent acceptance into medical school. My week-long visit to New Orleans seemed like a great opportunity to experience real emergency medicine before I start medical school, so I set up a ride-along with NOEMS (New Orleans Emergency Medical Services).

My previous knowledge of New Orleans was limited to a few days spent wandering the French Quarter. By day, I walked past cramped houses in the January sun to various shops and restaurants with mostly friendly hosts. Climate flux punctuated my experience: reading by the river ends with surging fog that drowns my vision and washes my lungs with each inhalation; entrance into an antique store provides shelter from the stale heat while the exit presents wind-whipped rain.

Tonight, even the weather has succumbed to the darkness, which we slip through with strobes of blue and red. A fenced suburban residence, reminiscent of my own middle-class home, houses the first patient. We find the next at the Falstaff Brewery, which was recently refurbished into an apartment complex after being closed for nearly thirty years. The curb of Bourbon Street hosts another patient among its excess of drifting drunks with beverage in hand. A wavering young woman doesn’t notice our group of EMTs walking past until she nearly careens into us drink-first. Later, red-brick projects splay shadows across us as we navigate their hostile corners on foot. Bystanders surface from the dark with a collective gaze that tells me I don’t belong here. Leaving that scene we find ourselves only a block from the next, where we park on the median (or neutral ground, as they call it here) to attend to the human wrecks remaining from a vehicular collision.

We saw only five patients, but they blur together in my memory like a crude flipbook animation. The embarrassed, alarmed passenger stands in front of her crumpled vehicle, clutches her wrist and falls back into the postictal patient whose tongue and eyes bloat and bulge blankly, staring miles past me before pulling his knees up into the writhing neuropathic patient whose pupils set upon my own with pleading fear that mirrors the mother’s expression as she clutches her febrile baby who erects into the stab victim’s shirtless tattooed chest, betraying past assaults with distinct linear gray scars, disjointed lines that speak of more than the patient’s medical history.

Suddenly, Bowman: “Will someone push fluid on the goddamn line I’m trying to start? Make the light pole do it.” Glancing down, affirming that I am indeed the most light pole-like individual in the room, I grab the IV bag and increase the drip rate. We pass the patient off to the ambulance crew since we can’t transport in our SUV sprint unit. “M-most of our calls are bullshit like that. Guy coulda jogged his own ass to the ER, yet he calls us to be his goddamn taxi service. Ju-just a bunch of bullshit.”

Regardless of the variety of bullshit afflicting them, my medic is at the patients’ side at all times: instructing a bystander to hold a patient’s hand while Bowman starts a line, assuring another her baby will be just fine, re-checking blood pressures manually just to make sure the machine got it right. The casual crude persona Bowman presents to me ebbs into a fluid professionalism of “Thank you, ma’am” and “We’re going to take good care of you, sir.” With patients he is almost unrecognizable—ejaculated stuttering morphs into methodical, sure speech while adrenaline-fueled fidgeting settles into skilled steadiness.

We find a break from the flurry of calls and park at the station for a while. Above us, a network of highways reaches across the foreground of a steel-blue night’s sky. The incessant click-clack of vehicles passing overhead serves as a constant reminder why NOEMS was able to easily move their new three trailer headquarters into this empty lot. The surge of water from levee failures during Katrina and Rita effectively destroyed the former headquarters, displacing a fleet of fifty emergency vehicles to an unworldly location more fitting for a dystopian sci-fi film. A wooden fence conceals the residents of this spurned real estate from a city that incessantly cries out for them through our frequent dispatch pages.

Bowman brags about his work habits. “My record is ninety-six night shifts in a row with no breaks. Have any idea h-how much overtime I clock in that way? Ya’ll wouldn’t believe it.” A weak visage of satisfaction flickers across his face, only to quickly sink back down. “Right now I’m workin’ on breakin’ that, but I still got a ways to go yet. In the meantime I can fund a new trip I’m plannin’.”

He tells me how he’d like to take his Harley cross-country and get his scuba diving certification extended when he flies his plane down to the Bahamas this summer. Working so many overtime shifts has allowed him to accrue several months of vacation time. After hearing of his plans to replace his older model of Escalade with the new Escalade Platinum Hybrid I respond, “That’s incredible. Do you live in the city with all that?”

“Hell naw. Too many punks. Shit. If it wasn’t for these punks, this’d be the greatest city on earth, man.”

In spite of the well-studied threats of destruction resulting from degradation of the wetlands, a negligent federal government, and crippling economic divides, Bowman describes how much pride New Orleans residents have for their city. After an introspective pause, he continues.

“On second thought, this is the greatest city on earth, but without them punks it’d be just perfect. The greatest in history. Anyways, I live out in the suburbs some ways.”

He describes his house as I expect: large and luxurious. To supplement his descriptions, he pulls out his iPhone—which he leans over and holds near the radio so we both can see. The house’s sparse, contemporary adornments conflict with the cramped, antiquated French quarter, and the Lower Ninth Ward’s still-visible scars. Four bedrooms and three bathrooms share 1,600 square feet, encased by undecorated walls, clean furnishings, bare floors, and expensive electronics. “See that past my bedroom, that’s a big-ass Jacuzzi tub.”

“Awesome. That’s quite the bachelor pad you’ve got there.” He quickly laughs, then diverts his gaze out of his window. For a second he says nothing.

“Well yeah I like it a lot I suppose. More room than I know what to do with, ‘cause I live by myself ya know. My German shepherd even has his own room and bed to himself.” A dim grin returns to his face.

“Here, check out these videos.” Over the next twenty minutes he shares a series of videos that appear to have been shot while he was lying in bed. In one, a large, dark dog howls gradually at his master’s coaxing; in another the shaggy mass rolls around on his back while the video screen shakes with laughter. I force a smile as the dog pushes his bowl back and forth across the kitchen. I came here to see medicine, and swallow the common guilt that accompanies a desire for patients: I hope for the dispatcher to tell us another person just became too sick to save themselves.

Suddenly, the videos are over, just a picture now. A different dog, some kind of light brown collie with an expression like a smile. “Anna. She died on me. Seizure, few months back. I brought her in off the street, she had heartworms or some bullshit but I nursed her back. Found out she had epilepsy afterwards though, so got her put on meds for it. Of course, the night before I forgot to give them to her. Next morning I thought she was sleeping, went to get her up for breakfast … but I already knew.”

The picture hovers in the same spot near the radio for a quiet moment. His arm betrays a slight tremor as he slowly draws the phone back to his hip, easing it into his pocket. He stares past the windshield. We sit silently for a timeless instant before dispatch interrupts with a wail. “Aw, not this place again. Prolly some bullshit.”

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