Escalation, Florida by Ron Riekki

I live just outside Miami in a town filled with more gun shops than restaurants.  I wish I could eat guns; there would be so many choices.  I’d have baked PKM, sautéed M1911, cured MP5, fried AR15, seared AK-47.  They make gun names sound like prisoner numbers.  Billion-dollar gun industry.  Billion-dollar prison industry.

I drive into Miami every day for work.  And when I say every day, I mean every day.  I’m an EMT, so I make minimum wage.  I can’t even afford health insurance and I work in the medical industry.  The billion-dollar medical industry.  How the hell am I making minimum wage?  The only way to escape it is to work overtime.  Then you get time-and-a-half.  But a friend of mine did the math and the taxes for overtime are so bad that you actually make $8.92 after taxes.  You lose money working overtime.  But it feels like more money, so we all do it.  It’s the same people I see at work, over and over and over and over.  An ex-Mumbai guy who has five kids so he says he won’t work with anyone who’s sick―yet he’s around quarantined patients all day long.  Then there’s the eighteen-year-old redhead girl who likes to tell E.R. doctors her ideas about the diagnoses even though she’s been an EMT a total of nine weeks, but she gets away with it because she looks like Garbage lead singer Shirley Manson if she had tattoos sneezed all over her body.  And then there’s my (mostly) permanent partner, who is perhaps the oldest EMT in the history of emergency medicine―a man with an Albert Einstein mustache and a back destroyed by gurneys.  We do twelve-hour shifts together.  Twenty-four shifts.  Forty-eight hour shifts.  We drive patients to Orlando, to Alabama, to Texas, taking the same vitals on a patient eighty-nine times so that her thin ballroom arm is memorized, her frighteningly repetitive twelve breaths a minute a promise that will never be broken except by death.

But tonight it’s the pawnshops coming alive and filling a teenager with cupronickel.  I grew up in Houghton, Michigan, a town of copper mines.  Copper―used to make electrical generators and electrical motors and electrical wiring.  And non-electrical bullets.  My father and grandfather worked in the holes of the earth to supply the materials for the guns that each night I have to clean up after.  I don’t janitor the blood; I just stop it.  I just transport it.  I just CPR it.  And this kid is a kid and he’s hit in the leg and chest and foot and wrist.  His worst bullet hole based on appearance alone is in the Christ position, right smack dab in the center of his wrist’s ulnar artery.  The others are grace entrance points, where key organs seem to be missed.  The luck of gun life.  I have a friend who works in the prison in Tallahassee and he said that prisoners can’t die.  It’s like this with teens in Miami.  They seem to take more bullets than NRA silhouette targets.  And by the way, the biggest selling color of those NRA silhouette targets is black.  And this kid is black.  Raisin black.  Licorice black.  Jawara black.  And he’s raisin young, licorice young, Jawara young.  He’s in cardiac arrest from the hemorrhaging, so maybe his chest is hit in worse ways than I thought.  We’re doing CPR, which means he has a ten-percent chance of living, as heart attack from gunshot hemorrhage tends to go very badly in the end.  He’s got blood on the glass casings for the NPAs and OPAs; blood is speckled on the oxygen tank; blood is sprinkled on my partner’s mustache―which, in EMT school, they don’t tell you will happen often.  They don’t tell us that we will have feces on our faces, or that the urine and cerebrospinal fluid and platelets of the world will end up in our hair and on our backs and in our eyes.  You can try to take all the precautions of gloves and gowns and goggles you want, but they don’t make condoms that cover from your entire torso up.

We’re rotating.  There’s two of us in back and we’re switching back and forth every few minutes while the redhead driver in front seems lost with her GPS.  It’s one thing to drive when you’re calm.  It’s another to drive when you look in the rearview mirror and see your back chassis looks on fire with blood.

The whole time another kid is with us.  You should try to never take passengers, but the kid forced his way in back and, before we left, the gunshot victim was A+O times 4 enough to OK the passenger, but now the kid is A+O times nothing, meaning he’s altered mental status and there’s no deeper altered mental status than full-out cardiac arrest.  The passenger is looking at us the whole time like he’s a nine-year-old watching a documentary proving that Santa Claus doesn’t exist.  All I know is if Santa exists, he’d have coronary heart disease, hypertension, and diabetes.  When you leave out cookies for St. Nick, you might want to also include insulin.  But I’m rocking back and forth to the rhythm of “Stayin’ Alive” by the Bee Gees, which is the perfect song for cardiopulmonary resuscitation and we’re at a red light and the driver stops, because―as you’re actually supposed to do in an ambulance with the lights and sirens on―you need to make sure that a cop or another ambulance isn’t also coming perpendicular to you to create a potential T-bone accident.  In the history of my ambulance company, we’ve actually had three of those happen.  And there’s nothing worse than an ambulance with a patient hitting an ambulance with a patient.  You tend not to survive CPR when you end up getting hit driver’s side at fifty miles an hour.  And when our driver stops, the passenger in back with us freaks out, screaming, “Drive, drive!”  Except he’s doing it with a truckload of curse words that sound like a cross between bear sex and parental advisory lyrics.  This just worries our ginger driver more, so she’s being cautious because she can’t hear over the shouting and siren, so the passenger pulls out his cell phone and calls 911.  Now, the problem is that we’re 911, so he’s not going to get anywhere with it, but I can’t stop CPR to try to calm a passenger who was persistent enough to force his way on the ride.  The kid starts yelling that his friend is dying and they ask where he is and he yells, “In an ambulance.”  And 911 hangs up, which I think is illegal, but it’s also commonsensical, because it feels like a prank.  And so the kid yells that he’s going to sue.  And we don’t reply, because I’m currently saying out loud, “Thirteen, fourteen, fifteen, sixteen, seventeen, eighteen” which is the number of compressions I’m doing on the patient and is also the age of the passenger in back.  And then he pulls out a gun and tells me to drive faster and I can’t believe I do this, but I ignore him and just keep with my numbers and when I finish at “thirty,” during the swap to cover the dying kid’s breathing I yell up to the driver that the passenger has a gun and I see the driver’s eyes like two crossword puzzles on her face and I tell the kid that it’s harder to do CPR when there is a gun pointed at you and start actually yelling to him that I’ve read a Harvard study that showed that calm environments actually double the likelihood of heart patients living and I’m pulling this all out of my ass and when we arrive at the hospital we’re greeted by an E.R. team and a sofa-size security guard and two cops who look filled with Axe Bodyspray and anger.  They take care of the passenger and we wheel into the E.R., doing compressions the whole time, blurring by the waiting room, which strangely looks filled with the sorts of people who frequent casinos, as if medicine is just class struggle, as if hospitals are made of labor and capital, as if all the walls are painted to be the exact same color as Karl Marx’s beard.

Ron Riekki

Ron Riekki’s non-fiction, fiction, and poetry have been published in Shenandoah, Bellevue Literary Review, Prairie Schooner, Juked, decomP, Spillway, New Ohio Review, and many other literary journals.



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