The wheelchair was so big, it looked like it ran on plutonium.

It was toward the end of my shift. I remember because I gauge the time of day by what type of hungry I am. When I wake up, it is milk on my Special K with strawberries mixed in. Midday, it’s a greasy carne asada burrito.

At six o’clock, I know it’s dinnertime because I am thinking about spaghetti with a snowlike layer of Parmesan cheese on top. Instead of eating, however, I was on this particular evening lugging around 75 pounds of disease-infested gurney — heading to Paradise Valley Hospital for an urgent pickup out of the Emergency Room.

Urgent is an inflated Emergency Medical Service’s term for a pickup that is unscheduled. To EMS management, unscheduled pickup doesn’t have the same flair that urgent does, so urgent it becomes.

We made our way from the ambulance bay into a bustling emergency department. My partner strolled up to the nurse’s desk, where no one paid attention to him.

This may come off as rude, but it’s just the way it is. It’s no one’s fault — the unit is typically understaffed for the amount of people who come in thinking they need emergency treatment. Whether it’s a lonely guy claiming he has a problem with his John Henry (in hopes that an attractive nurse will look at it), or a frequent flyer, with the same cramps in the same leg week after week, doctors and nurses must wade through a river of malingerers to get to the real patients.

My partner knows that if you need help right away, it’s best to lean on the nurse’s desk and make yourself annoying. Nurses hate it when you lean on the desk. Wanting to get rid of you makes them more likely to help, though they’d love nothing better than to take your metal clipboard and beat you with it. If you’re not in a hurry, stand dead center in the hallway for a while. Eventually, someone will recognize your existence.

“We’re here for Mrs. Doe,” my partner announced. (Of course, that wasn’t the patient’s real name.)

Confused, the male nurse at the desk said, “Why’d they send you?” Then he pointed into the patient’s room, where a large woman sat in what I think of as the Hummer of the motorized wheelchair. The chair was so big, it looked like it ran on plutonium.

“Hello,” my partner said to the woman.

“Don’t touch me,” was the lady’s response. “I am in so much pain, and they didn’t do a damn thing for me here.”

“I’m sorry to hear that,” my partner said, not even trying to sound empathetic.

“When are you going to take me home?”

The woman had come into the ER with phantom symptoms. Meaning, she was the only one who thought that anything was wrong with her.

From this 30-second exchange, I knew that the call was going to be horrid.

Starting from the bottom isn’t easy but it’s a time-honored way to get to the next level. It’s the same in all professions, but the cost of my noble career choice came at a high price: close to minimum-wage pay, grueling hours, and companies that put more value on the bottom line than the care of patients or employees.

I started my emergency medical technician career driving a wheelchair van and quickly earned the qualifications needed to work on an ambulance — real ALS (advanced life support) shifts alongside a paramedic. I was achieving the dream.

Working on an ALS rig was everything I could have imagined and more. I loved every second in that cramped front compartment: eating on the run, backboarding, rescue-breathing, and driving Code-3. When I rolled on-scene, a dual sensation of power and fear intoxicated me.

It was an especially cold winter night when we were posted up in a grocery-store parking lot in a small agricultural town. Cornelius is 30 miles from Portland, Oregon, and known for its treacherous roads.

An ominous layer of fog was settling in, and the night became eerily quiet. At about 10:30 p.m., we got a call from dispatch about an MVA (motor vehicle accident) about five minutes away.

My pulse jumped; blood pumped through my veins with an energy I’d never felt before. With a flip of a switch, darkness was exchanged for the brilliance of red-and-white flashing lights. My siren proudly shrieked though the chilled Oregon air, a reminder to the world that I am here.

Instructions from dispatch were flung at me; I tried to remember everything while navigating my hospital-room-on-wheels through tight turns on narrow roads. The radio beeped and crackled with the muffled voice of my friend Jenny in dispatch. “There are two vehicles involved,” she said. What comes next is information no EMT or medic ever wants to hear: “The number of victims is unknown, but there is one male infant.”

We arrived on-scene to scattered emergency vehicles, firefighters in turnouts with their reflective strips glowing. I didn’t see any other ambulances — I did see the two wrecked cars.

Fear began to sink in. For a second, my mind went blank, but I managed to keep moving. I grabbed the medic kit and headed for one of the crashed vehicles. I didn’t think…I couldn’t think. But I instinctively knew what to do, a sign of good training. I was so excited, I forgot to put on my reflective vest, which landed me a tongue-lashing from a large firefighter with a walrus mustache.

As I approached the driver’s-side door of the mangled Honda Civic, I saw an attractive female about 18 years old. “Hello,” I said. “My name is Christian, and I am an EMT here to help you. Are you having any pain in your head or neck?”

“It feels like my head is swimming right now,” she said.

Swimming? What the hell did that mean?

But I knew from EMT school that if the patient says anything about pain in the head or neck, especially after a car accident, the first thing to do is maintain her in a neutral and in-line position. Next, slap on a C-collar, Velcro her to a backboard, then transport her as soon as possible. This was my moment to shine — no time to screw up. I had to do everything right. I told another firefighter what the young woman had said and offered a recommendation: “I suggest we spinal immobilize the patient.”

The firefighter instantly climbed into the back seat and held the patient’s head straight. He was well trained, too.

The walrus firefighter approached us and took charge of the situation. In a few minutes, we got the girl out of the car and onto a backboard. Another ambulance transported her to a nearby hospital. I returned to my truck to take the family from the other car.

Fortunately, the baby was okay, but another female was also attached to a backboard, like the girl from the Honda Civic.

We took everyone to the hospital, cleaned the gurney, tidied up the back of the truck, grabbed some snacks from the medic room, and went on our way. I don’t know what happened to any of the people involved in the accident, but I did know absolutely that I was in love with my occupation, that neither death nor incapacitation would take me from it. Ultimately, a few detestable ambulance companies would disenfranchise me from the EMS field. As it happened, I only lasted two years.

The next couple of months were incredible. I was working more advanced life support than wheelchair shifts; I got to work with excellent paramedics and gained great experience. I picked up all the extra hours I could. I was the go-to guy, especially during a massive snowstorm that shut down half of Portland. I couldn’t have cared less about the money I was making. I loved my job.

Many of the partners I worked with told me about issues they’d had with the company. There was the negative manner with which management treated paramedics, the refusal by the owner to invest money back into the business, the exodus of several paramedics who had had enough. A coworker once overheard the company’s CEO refer to the paramedics as “a dime a dozen.”

After the economy began to slump, my company was forced to tighten things up. ALS was no longer available to me, and I was sent back to the wheelchair division. I couldn’t even beg my way into a 911 shift. The warnings about management I’d received from my previous partners became a sad reality.

I grew tired of the monotony of the wheelchair division, of squabbling with my managers and my live-in girlfriend. It was as frustrating as the incessant Oregon rain. One day, I arrived for my 4:00 a.m. shift only to have the dispatchers tell us that, after our first call — which took no longer than an hour and a half — we were to clock out. We’d have to sit in our vans, unpaid, until the next call, which didn’t come until 8:30 a.m. I couldn’t take it anymore.

I decided to move back to San Diego and try my luck with a different company. With only $1103 in my bank account, I said goodbye to the gloomy Northwest. I packed only the stuff that fit into my Toyota Tundra and got on the southbound I–5.

To become a paramedic in California, a student must survive an intensive 18-to-24-month program, EMT-basic school, three to six months of EMT experience in the field, plus another two semesters of additional classes. The cost for paramedic school alone in San Diego is $2500 at a community college and about $12,000 at a technical school. The starting pay for a paramedic at a private ambulance company is between $9.38 and $10.56 an hour. As an EMT-Basic, you start out making between $9.56 and $10.00 an hour.

I hooked up with a new company in San Diego. During orientation, the training manager had a stack of paperwork for me to sign. When we got to the hourly wage agreement, he placed the document on the conference room table and slid it over.

“Nine dollars and sixty-five cents, huh?” I said.

“Sorry to ruin your day.” He pointed at the solid black line where I should sign.

The difference between an EMT-Paramedic and an EMT-Basic is like the difference between playing for the Padres and the Lake Elsinore Storm. Paramedics are pros who respond to an emergency call and provide the treatment necessary to get a patient to a hospital alive. EMT-Basics don’t have as much training. They can perform simple procedures, such as administering oxygen and taking vitals, but in an emergency, their greatest life-saving apparatus is a cell phone with which to call 911.

Of the 13 private ambulance companies in San Diego, there are 3 that provide emergency services; the rest provide basic life-support measures. These BLS units provide transportation to and from various medical facilities, such as hospitals, skilled nursing facilities (SNFs, pronounced “sniffs”), and doctors’ offices.

Between the boring sniff calls and pointless paperwork, basic life support soon lost its luster for me. The dialysis appointments were the worst.

Patients with renal failure, having to go to three dialysis treatments a week, were subjected to so much misery while their overall condition continually worsened. Some would be missing limbs the next time I saw them. I pretended not to notice the body parts gone AWOL. What could I say? “Hey, Bob, they took the other one, huh?”

Running dialysis calls bored me to tears, but my aversion to this routine developed into outright moral objection. Like other health-care outlets, most dialysis centers are privately owned; profits depend on the flow of clientele. The product does not offer a remedy to the patient’s health issues, nor does quality of life substantially improve. These people are sold on the idea that they need this treatment. A majority of the patients are Medicare or Medi-Cal recipients, and the companies are assured of guaranteed income. It struck me one day — as three other EMTs and I lifted a gurney with a man too obese to walk on his own — that I had become a part of the broken medical system so many decry.

Much like a predator picking off the weak and half-dead, many ambulance companies prey on patients. Once, while tripping over a wheelchair as my partner and I lifted a lady from her bed to the gurney, I realized that there was no reason this person needed two EMTs and an ambulance. Too many dialysis patients, with wheelchairs sitting next to their beds, were going to their treatments by way of my glorified taxi service. One lady, who lived 1.4 miles from her dialysis facility, had to be lifted out of her wheelchair and onto the gurney to transport. For a routine, non-life-threatening appointment, people should be taken by wheelchair van.

Perhaps my company was more interested in making a few extra bucks than providing the lady with the appropriate service. What’s more, taxpayers were footing some part of the bill for those ambulance rides.

It was recently reported that Rural/Metro, a private ambulance company that operates nationally, had been accused of overcharging the City of San Diego by as much as $12 million over the past ten years. If this sort of allegation can happen with a company described in media reports as a “one-of-a-kind model for how a public-private partnership can work to save lives,” I guarantee that many other less reputable companies are conducting business no differently.

The woman in the wheelchair at Paradise Valley Hospital’s ER posed a significant problem, as the ambulance is not equipped to transport patients in chairs. We could have transported her and left the wheelchair behind, but nobody would’ve liked that idea. The only option was to transport the patient with her chair.

Our company had a separate division — two vans dedicated to transporting patients like this. A couple of minutes after we realized our issue, one of the wheelchair-van drivers came strolling up and informed us that he had been called to transport our patient.

My partner and I were ecstatic. Dispatch must have sent us the call by accident, and we were going to get canceled. I preemptively began loading the gurney into the ambulance while my partner went to make the call. Just as I’d slammed the back doors and started for the medic room for free snacks, my partner approached me with a death stare.

“Pull the gurney back out,” he growled.

“Why?”

My partner was a 21-year-old kid with the soul of a 45-year-old drill instructor. He came from a long line of firefighters but had little interest in carrying on with the family business. As a college graduate — rare for an EMT — he wanted to serve his country and become a Navy SEAL.

Dispatch had instructed us to transport the patient, after all. The other driver was to transport the chair.

My partner had argued with dispatch. “Why would we do a thing like that?”

“Don’t ask questions” was the response.

I grumbled and unlocked the gurney, letting all 75 pounds roll out of the van. We went back into the ER, informed the wheelchair driver of the plan, loaded up the patient, and transported her.

After pulling the van into a constricted alleyway, we arrived at the patient’s house and devised a plan to get the gurney inside. The tight entry leading to the front door made it impossible to go in that way. The only other option was a side door with four or five steps below it. This would not be an easy task, but we had an extra person to help us.

I was at the head of the gurney, while my partner and the wheelchair driver were at the foot. The plan was for my partner and the wheelchair driver to lift their end; I would gradually lift the head up one step at a time. Things were going fine until the lady freaked out and started yelling, “You’re going to drop me, you’re going to drop me!” She reached over the side of the gurney, grasping for fistfuls of air, as if that would circumvent gravity.

As the 250-pound woman and the gurney began to rotate, my entire EMS career flashed before my eyes. I saw it all — the lady falling, the investigation, the lawsuit, and the dramatic final scene, where my manager stands with her arms angrily set on her hips. “Badge and pager,” she demands. At which point, my partner and I toss them on her cluttered desk.

With every bit of strength we had, we were able to compensate for the woman’s displaced weight. We got the lady and the gurney stabilized.

We carefully maneuvered the gurney back out through the narrow hallway, trying to not scratch the wall. Meanwhile, the same lady we’d all but broken our backs for walked to the kitchen to grab a snack.

As traumatic as the whole situation was, what really bothered me was something on the patient’s information sheet. Under the payer’s information, it read “Medicare.” I don’t have the evidence to decisively say who got charged what, but I can’t help feeling that the taxpayer-funded system would be double-charged for unnecessary services.

After two years with these ambulance companies, I lost faith in what I was doing. I’d gotten into the EMS business to help people, but working for a basic life support company, I rarely felt that way. Every workday was a strain on my conscience. I knew I was providing a service to many people who did not need it. I was merely making money for a company I did not like, one that passed most of the bill off to California taxpayers.

I would like to make it clear that I support the paramedics, intermediates, basics, firefighters, and nurses who choose to do a job that comes with a mountain of responsibility and little gratitude. I hope this comes to mind next time there are two EMTs in the back of a Starbucks line, anxiously awaiting their turn to order 20 ounces of much-needed caffeine. Please do the right thing and wave them ahead. ■