Joe Klein

Michael Damm and Roger Fisher. He looks at the screen. “Thirty-seven eighty-four Euclid. Number 8. Got that?” Roger’s searching through a Thomas Brothers’. We’re on Adams, near Felton. “Work up to Fifth, then turn left at Landis. It’s between Landis and Wightman.”

Paramedic unit 201 pulls out of the parking lot of the old AT&T property on 38th Street, now occupied by American Medical Services. It has just gone 6 p.m. The start of a 12-hour shift.

Computerized dispatch system shows the location of every unit.

Roger Fisher and Mike Damm are settling in up front. We’ve just been introduced, but in these intimate surroundings it’s first names from the start. Mike, a German paramedic who’s joined recently and is still on probation, is driving. Roger, the field training officer, is twiddling with the police-style mini-computer.

Drug box. The boys will clean out the detritus of the night’s work, replace any drips and drugs they have used, and then, at 6:00, 12 hours after they began, head for home.

I’m in the back with Joe Klein, the photographer, among the rocking stethoscopes, the suction units, the EKG unit, the Velcro straps swinging from the overhead IV drip hooks, the two spare oxygen bottles. There’s a constant banging from the red hazardous waste container tied to the leg of the side bench. The floor-locked gurney waits for its first customer, its white pillows looking blue in the light from the tinted rear windows.

Five minutes later we’re rolling towards Villa View Hospital. The mother, Rose-Francoise, is sitting strapped onto the gurney with Ferntzy wide-eyed on her knee. She’s talking about the killings that hit Les Cayes, where they came from.

It doesn’t take long. We’re driving west along 805, on our way to 201’s downtown station. Mike is explaining how in Germany doctors actually travel with ambulances, when a “beep beep beep” sounds. A bunch of yellow writing scrolls up on the screen. “Code 1,” says Mike, almost disappointed. “Non-emergency. Three-year-old male with abdominal pains. Been having them for a week. No lights, no siren.”

Wayne Johnson, Dan Lynch. Lynch says American is being held to a higher standard than the previous provider, Hartson.

He looks at the screen. “Thirty-seven eighty-four Euclid. Number 8. Got that?” Roger’s searching through a Thomas Brothers’. We’re on Adams, near Felton.

“Work up to Fifth, then turn left at Landis,” says Roger. “It’s between Landis and Wightman.”

It strikes me suddenly that these two guys dressed in the company’s dark blue uniform are really only kids. Mike is 27 and Roger is 25. Both look younger than that. Tonight they’re going to be deciding whether to shock people to get their hearts going; whether the medicine they want to give will kill a person who already has drugs in him; stick tubes down tracheas, administer heart-valve-opening drugs, decide if surface injuries hide more serious internal ones, without X-rays. These guys are like your Third World barefoot doctors, still relying on their training and judgment, not the battery of diagnostic equipment your average hospital doctors lean on.

But right now, the worry is a more prosaic one. “Uh-oh,” says Roger, reading his screen. “They only speak French.”

Turns out I speak French. The one thing that ever sank in at school. Great. I can be of some use. In a moment we’ve swung into the narrow yard of a balconied green apartment complex. A black couple and a little girl are on the balcony. The woman has a child in her arms.

“C’est vous qui avez telephone?” The woman nods. She’s Haitian. Just got here two months ago with her husband and daughter and twin three-year-olds, Ferntzy and Ferntzou. This is Ferntzy. She comes down the stairs. Already children and neighbors are gathering around Roger. He pads his stethoscope on the kid’s chest and listens.

“He has a good ticker,” he says. “Ask her where his pain is.” Actually, the kid doesn’t look in too much pain.

“Estomac, ” says the mother. “We went to Dr. Bidjou. He gave us some medicine, but while I was out of the bedroom, the twins drank it all.”

“A whole bottle of medicine! Have her husband go get it,” says Roger. The father comes down with a big plastic bottle.

“Ah,” Roger says. “No problem. Pediatric electrolyte water. Gatorade for kids.”

Five minutes later we’re rolling towards Villa View Hospital. The mother, Rose-Francoise, is sitting strapped onto the gurney with Ferntzy wide-eyed on her knee. She’s talking about the killings that hit Les Cayes, where they came from.

“Two hundred forty!” she’s saying. “The soldiers, they came and shot 240 of them. We could not stay.”

“Child in no distress whatsoever,” Fisher is saying through the telephone to the hospital near the gurney. “Could be gas, poor diet.” “My favorite medic!” It’s an ER nurse in Villa View Hospital greens. She comes out and hugs Roger.

“This guy!” she says. “He did my ACLS class. Taught it. Advanced Cardiac Life Support. Tested me. He’s a very knowledgeable guy.”

It turns out Roger — the training officer who is 25 but looks 19 — also teaches classes in CPR, pediatric advanced life support, pre-hospital life support, has a B.A. in neurophysiology from UCSD, teaches paramedics at Southwest College, and is on the board of directors for the paramedics’ association — when he’s not actually being a paramedic.

Mike writes out the pre-hospital run sheet. “Seven minutes, from dispatch to the scene, 6:20 to 6:27,” he says. “And that’s no-siren.” Then he starts on the green Emergency Medical Services form. Rose-Francoise sits happily waiting in ER, with young Ferntzy on her knee, looking like he felt this whole ambulance ride thing was fun but hardly necessary.

“Bonsoir, Madame,”says Mike.

“Au revoir, monsieur,”calls Rose-Francoise. Fifteen minutes later we’re sitting in Rubio’s, on Fourth and E, sharing tables with two cops. Both the cop car and the ambulance are parked on the red line outside. “The fire department would tell us,” says Roger, “if they needed the spot.”

We get talking about why they do this. The answer is always the same. “You get such a high from being there in a life-and-death situation and being able to make a difference. To practice what you’ve learned in real-life situations. It’s instant thrills. Instant gratification,” says Roger. “Plus there’s all the busting through red lights, the sirens.”

The guy is swift-talking, bright, and in contrast to many paramedics I’ve seen, slightly built. I ask him what the worst calls are.

“The worst?” he says. “Freeway calls. Those are the ones I’m most afraid of. You’re trying to maybe get someone out of a car with traffic roaring past you at 50,60 miles an hour, two feet away! I’d much rather be at a shootout.”

7:40 p.m. There’s a beep! at their belts. Both reach for their pagers, hold them up to the light. “We’re off,” Roger says.

“Did you get to enjoy any of it?” says the waitress, who’s obviously been through this before with them. She wraps up the fish tacos and gives the pack to Roger as he leaves.

The call’s for a 70-year-old woman who’s fallen at the Westgate Hotel and may have broken her hip. Code 1 again. Still no red lights and sirens, dammit. The dispatcher-triage people at the communications center have decided that. We cruise up across Broadway the few blocks between Rubio’s and the hotel on Second. I notice a teddy bear has been stuffed in the ambulance’s drug shelf, next to the throw-up basins.

“This lady took a slip,” says one of the guests hovering over a smartly dressed woman hobbled in a chair, who’s looking down at a bright-red gash to her right knee. Roger and Mike have wheeled in their gurney, past waiting lobby staff, but leave it out of sight, around the corner from the refined dining room.

“I went down with a bang,” says the lady, Viletta.

“Do you feel bad?” Roger asks.

“My head is turning around,” says Viletta.

“Did you faint?” asks Roger.

“I slipped on the marble steps outside. They’re so deceptive. I’m supposed to be going to the L.A. Chamber Orchestra tonight.”

“I’m not sure if that’s wise,” says one of the guests.

“Have you had any previous falls?” asks Roger. “I broke my hip on the left side, and hurt it on the right side.”

Roger is kneeling down beside her. “Well, now I’m worried about your hip. We can’t tell here if you may have done something to your hip. I think you should check it at the hospital. Do you want to go to the hospital to check it out?” “But I have my ticket. I have my clothes. I’m booked in for the night. I have my medicines up there. I have to have my medicines. I’ve had a stroke. I just put in enough for tonight. I have my car here.”

“I think you should go,” says the guest. “Would you like me to pack up your things? I’m sure it would be best.”

Roger nods to Mike. Mike goes out and wheels in the gurney.

We’re bouncing gently along in the ambulance towards Mercy Hospital. “Now my sister will find out,” says Viletta, lying down on the gurney in the back of the wagon. “I lied. I told her I was just going to a late lunch at the Westgate. If I’d said I was actually going to the concert and staying overnight and everything, she would have fussed and fussed. Now she’s really going to fuss.”

“That’s nice movement to the knee,” says Mike, who’s writing down details to tell the hospital while Roger drives. “Now when were you born?”

“5/31/13,” says Viletta. “I’m almost 81.”

He takes her blood pressure. “A little hypertensive.”

“What accent is that?” says Viletta.

“German,” Mike says.

“Ah, well, our own young people, they don’t have initiative, drive anymore. That’s why you young foreigners are getting the jobs these days.”

“The chance that she has something wrong with her hip is 5 percent,” says Roger confidentially from the front. “If she were younger we wouldn’t even request her to go with us to the hospital. But she has an old hip injury. I have to use my judgment, although we never advise, ‘Don’t go.’ We can’t, under the contract. When someone has dialed 911, even if it’s for a stubbed toe, we’re more or less obliged to take them.”

“Actually the gross majority of people we’re sent to pick up are ‘toothpaste medicine,’ ” says Mike.

“ ‘Perceived emergencies,’ ” says Roger. “And part of the reason we go is — frankly — to keep the need for us 150 paramedics out on the streets.”

“Even if we know you could go by taxi, we don’t refuse you,” Mike says.

This, it turns out, is not just American’s policy. American is bound by its contract with the city to offer transport to all 911 calls, presumably to save them both from the possibility of lawsuits. But profit is also a factor for all parties in the medical provider chain.

“Sure, it’s the most expensive way of doing medicine, using ER rooms for every problem, large and small,” says Roger. “And this is abuse of medical insurance, but in a way we’ve come to depend on the problem, because it’s in our interest to take the call, just as it’s in the hospital’s interest to take the patient, even if there’s nothing really wrong. Because it’s turnover. Money. Even if it’s just Medicare. We’ve all come to depend on it.”

At Mercy, we wheel Viletta into ER. It looks like she’ll be here for the night. In the white lights of the ER area, Ken Foster, another American paramedic, is on his way out.

“Brought in a chest pain,” he says to Roger. He’s based in Pacific Beach. Roger’s put in for a change to Pacific Beach, just to get away from the sleaze of downtown for a while.

“We get a cleaner class of transient at P.B.,” says Ken. “But that doesn’t stop them from drinking. Drinking’s still our number-one call. Accidents, fights, falls.”

Roger asks where his buddy is. “Out back, arguing with my guy’s daughter. She’s, uh, had a few,” says Ken.

There she is, the angry daughter, telling off Ken’s partner Randy Stark.

“I demand to talk to your boss. I didn’t know the wife of a patient wasn’t good enough to sit in the front seat of the ambulance. What kind of a service is this?”

We leave Viletta lying on a bed next to two old men who’ve also been wheeled in, separated by green curtains. All three lie looking at the ceiling, a few feet but a world away from the good-time bonhomie of their younger benefactors at the nurses’ station.

We get into the wagon. Radio tells us to go to the Point Loma area to cover for another ambulance that’s responding to a call. But on the way comes the Real Thing.

9:15 p.m. Beep beep!

“Code 3,” calls Roger. All right! Someone’s having a seizure at the Marine Recruitment Depot. Mike’s driving. He mumbles something into a microphone, and suddenly we’re lurching forward. Our lights are flashing. A disembodied yowl of a siren turns out to be ours, just through the roof.

Okay. We’re kids again. We’re looking for red lights to bust through. There’s a lot of swinging and braking and surging and that beautiful Voice of Authority at crossings, BAAAA-RP! Our air horn. Boy, does that send them scattering.

“Okay, next right,” Roger’s calling over all the noise. “We need to get on Pacific. Barnett. Okay, this one.” We’re zooming through a red light, BAA -BAAARP! The air horn busts up a clogged artery, clears a path. Blurred faces turn, swerve! We avoid a truck panicking, trying to get out of the way.

“Look for Montezuma,” Mike’s saying. “There’s a divide. Tripoli and Montezuma. Montezuma’s right. Take that.” For all the electronics aboard, it’s still the good old Thomas Guide, a flashlight and a finger on a map guiding us.

Navy base fire engine 20 is there when we pull up amongst MCRD housing, outside a social hall. Silhouetted faces are peering in. A woman in a white faux-silk wedding dress waves us in.

There’s a man in a tux on the floor on his back but slightly curled, fetus-like. There’s some blood and froth about his nose. “I’ve been with him all the time,” this red-bow-tied guy is saying. “Since we were young. I’ve never seen him do this.”

“He went pam! in the head when he fell back,” says a maid of honor. Roger leans over, holds the head.

“Can you hear me?” He shines a flashlight into the man’s eyes.

“He fell straight,” says the girl. “Straight like a board. Then he shook. Bit his tongue. It started bleeding. I put a spoon in his mouth to stop it.”

“Can you stand?” says Roger. He tries to sit the man up.

“I’ll bring your rig up close,” says a hoseman from the fire truck.

“Oh, thanks,” says Mike. The bride and groom are standing back, near the uneaten three-tiered wedding cake. Three little satin-swathed bridesmaids just stand there, three in a row, wide-eyed.

“This party’s over,” says someone.

“He was playing football two years back,” says the maid of honor. “He never knew he broke his neck. But he wore a halo seven months.”

“Okay,” says the hoseman who’s gone and brought up the ambulance.

“Only room for one in the ambulance,” Mike is saying.

“Well, I’m his best friend. How do I get there?” says his best friend.

A fireman borrows pen and paper to draw him a map to Sharp.

“Make way!” says the hoseman. The man wobbles out through the phalanx of guests and firemen and Marine Corps dependents who’ve come to see the wedding.

“You’ll be fine, Reggie, fine,” says a voice.

“Remember where you are?” says Mike.

Reggie shakes his head. “No seizure,” he mumbles. “Never had one. My head. It hurts.”

“I’m coming with you,” says the maid of honor. “I’m coming with you, Reggie.”

“Huh?” says Reggie.

We’re in the wagon, bouncing towards Sharp. “Bite your teeth, sir — now!” At that instant Mike stabs the man’s longest finger with a pin. Reggie winces. Mike siphons blood into a little plastic disc. He watches the color change.

“He doesn’t seem to have raised sugar level: 93. Pretty normal.” He looks at Reggie, strapped into the gurney. “He’s not fully with the program. What day is it?”

Reggie looks at him blankly. “He doesn’t know what day it is.” Mike looks at the EKG machine.-The man’s been plastered with leechlike suckers all tracing wires up to the little machine. His heart climbs regular hills to sharp peaks for a while, then starts swooping with great wild sweeps of the needle. Mike gets on the phone. Calls through to Sharp’s ER.

“Witnessed grand mal seizure. Patient still slightly confused. Got him up, ambulated to the rig. Skin’s warm, dry, and normal. First time seizure. Two years ago sustained neck injury necessitating halo. Blood sugar is 93 deciliters. ETA three minutes. Okay? Thanks.”

He leans over towards Reggie. “Okay? Off we go to Cabrillo.” Then he turns confidentially, still looking at those heart fibrillations. “Know what I suspect?” He mouths the word “coke.” He puts air tubes around the patient’s head and places oxygen inserts into his nostrils, puts on a supplemental mask, and turns on the oxygen.

Reggie’s EKG is jumping again as we roll towards Sharp-Cabrillo. All eight interior lights are on here in the back. It’s like an operating room. Reggie’s girlfriend is in the front seat.

“Okay,” says Mike, with a pre-hospital form on his knees. “I’m going to need your date of birth.”

Reggie looks up.

“Birth date.” Reggie mumbles something under the mask.

“What?”

“Naa See Seefa. ”

“What?” Mike lifts the mask.

“Nine six sixty-four,” says Reggie. “Like I said.”

“Social Security number?”

“Faavaanaatwo. ”

Mike lifts up the mask. “Again?”

He just finishes before we arrive. Roger backs the wagon up to the ramp. The two haul Reggie out, letting the wheel legs spring to vertical like moon-landers, and roll him into the waiting elevator. Five of us crowd into the elevator. At the ER floor, Mike hands the patient over to a nurse, signs off, and has officially “delivered” responsibility for him.

“I can’t believe it,” says the maid of honor, now looking slightly surreal in this clinical environment. “He was fine, during the whole reception. Talking with everybody. Then I heard a faint cry. Kind of, ‘Uurrghhh. ’Then I heard his head hit. He fell back into a fetal position. I ran up to him because he jokes a lot, but he was spitting up blood. Foam. He was just vibrating. Biting his tongue off. I was saying, ‘Reggie — breathe!’ It lasted a good ten minutes. It ruined the party.”

Reggie’s lifelong friend comes in. His tie has gone. “Is he okay?”

“He’s being looked at,” says Roger.

“You know, I never drink,” says the guy. “Maybe one or two cans of beer a month. But Reggie — now that boy, he drinks a lot. When he gets up in the morning he’s got to reach out for a can. He can’t swallow enough of it. The man is tragic.”

As we leave, two other American paramedics are coming in from Point Loma. They have a motorcyclist with what looks like a broken arm.

“Guy cut in front of me,” he says from their gurney.

“He’ll never complain about the helmet law again,” says Clyde, one of the medics.

“I went right into his windshield,” says the guy. “It saved me.” He pats the blue helmet with his good hand.

“We’ve got to cover Southeast San Diego,” says Roger, looking at his screen. “Oop — no. We’re going downtown.”

We hear rig 118 get a call to go see a two-year-old having difficulty breathing. That’s often a cover for kids who’ve been beaten by their parents, Mike says. As we drive, vaguely in the direction of downtown, Mike is typing a message on the computer in German. “Guy at communications is learning it,” he says.

Ten minutes later we’re backing into the main fire station for the city of San Diego. A big, cavernous place near the courts, which is 201’s home port. Behind us, a giant Bureau of Alcohol Tobacco and Firearms truck sits. A truck for the Metro Arson Strike Team, a light-and-air truck (a special vehicle to replenish firemen’s oxygen tanks and provide light to a scene).

“Quiet night, for a Saturday,” says Roger. It’s about 11:00; we’ve had three calls in five hours.

“Still, 10:00 to 11:00 p.m. is usually the busiest — though actually only 5 percent are really genuine Code 3s. Most of our clientele is what you’ve seen tonight.”

That’s fine with me, compared with the horror stories I heard yesterday. Like the tape one of Roger and Mike’s supervisors played me. This may have been their most famous call, handled by a supervisor named Ken Marsh.

“Emergency Operator 10.”

“Yes. Three-oh-eight-three Meade Avenue. Uh, there are two guys sleeping in the same apartment and one shot another one with an arrow in the neck.”

“Okay. What address?”

“Three-oh-eight-nine.”

Police operator interrupts.

“You said 3083.”

“Okay. Uh, 3079. No.”

“Three-oh-eight-three?”

“Uh, yes.”

“This is the police. You said 3083?”

“Yes.” Marsh again. “Okay, so is this their neighbor?”

“Yes, it is.”

“And somebody got stabbed in the neck? With an arrow?”

“Yes.”

“Okay, and is the arrow still in his neck or what?”

“Yes.”

“Is he okay?”

“Well, I don’t think there is any serious pain.”

Voice from background:

“It is serious. It’s right through my HEAD!”

“Well, it’s serious...uh, he’s here.”

Marsh: “Still there?”

“Yes, still here.”

“Can you take a clean cloth and put direct pressure on?”

“You don’t understand. The arrow is through the back of my neck, and it’s through my head sticking out my eye.”

“Sir?”

“Yes.”

“Listen to me. Is the arrow still inside you? Is it still in through your neck?”

“Yes.”

“Okay.”

“And it’s through my head and it’s sticking out my eye on the other side.”

“Okay. What I want you to do then — is it bleeding?”

“Yes. Blood’s coming out my nose.”

“Okay. I have help on the way. We’ll be there in a few minutes. What I want you to do is sit down. You may start to feel a little faint.”

“And the miracle was, he wasn’t badly damaged,” says supervisor Wayne Johnson.

We were into a session of paramedic war stories here. “It gets a bit ghoulish,” says Johnson. “But that’s, I guess, part of the way we get rid of stress, when we’re really dealing with these things. Sometimes you’ve got to laugh about them.”

“I had one,” communications director Orin Jones says, “where a guy calls up. He’s stuck a screwdriver six inches into his girlfriend’s neck. Not in anger or anything. He was using it to relieve her stress, he said. As a kind of acupressure tool.”

We all give that one a shiver. “The worst, the worst,” says Wayne, “had to be that madman who had wound the intestines of his mate around the plumbing in the bathroom and then rang.”

“What about Sagon Penn?” asks Jones. “Weren’t you there?”

“Sure,” says Johnson. “The place was a madhouse. Cops, sheriffs, CHP, helicopter. I treated Thomas Riggs [the policeman Penn shot]. The big mistake was letting that doctor come. The anger, the tension was unbelievable. We should have flown Riggs out, but instead this doctor came. And he said, ‘He’s dead.’ Well, I tell you, the moment he uttered those words, shotguns clicked all around us. I thought, ‘Jeez, I hope this guy Penn doesn’t choose this moment to give himself up.’ He wouldn’t have lasted five seconds. ’Course he did the wise thing and surrendered the next day.”

The stories go on. Wayne Johnson telling of picking up two U.S. military personnel in Tijuana, after a traffic accident, only to be chased all the way to the border by federales eager to imprison them. About the no-moon nights in the heat of summer when drive-bys always seem to increase. About the religious nut who cut off his own penis in the shower.

“I tell you, if you don’t laugh about it you go mad. That’s it,” says Johnson. “Fortunately, most of our calls are little old ladies with sore thumbs.”

11:25 p.m. The boys have taken the rig down to the corner of Fourth and K for a coffee at Mekka Java, a kind of sofa-ridden joint where you can spin your coffee out as long as you want. We’re just about to buy when the beepers on the boys’ belts go off. “Code 3,” they say together. “Seizure — again.”

This time Roger’s driving. Joe’s in the front seat. Mike’s leaning through from the back jump seat, yelling instructions. This is a Red Lights and Sirens Code 3-E. The fire people have been called too.

“Direct me, Mike!” says Roger.

“Get onto 5,” Mike shouts.

“Can we get up India?” calls Roger. “Can we get off at Washington? Washington — San Diego Avenue?”

“Uh, yeah, you should be able to.”

We get off on Washington. “Okay. Go straight a couple of blocks.”

“What way do I go, Mike?” The hazardous waste bottle is banging around the floor. You can see our exterior lights flashing through gaps in the walls. “Go San Diego and Washington. Slightly left — now!”

Mike’s head is down in his Thomas’s, flashlight close.

“Okay, which way do I go from here, Mike?”

“Go right and right — here! This should be it.”

Suddenly we’re in a quiet tree-lined street. We’ve stopped right behind a fire truck. Fireman leans over Roger’s window.

“You’re not needed. Patient just wants to go spend the night at Mercy. Psychological.”

But we stay, since we’ve come. Inside the house two policemen are helping an elderly woman (“Jean,” not her real name) find her slippers.

“Here’s your glass slipper, ma’am,” Officer Daniel Stuber says gallantly. Roger talks to her. It’s Mother’s Day tomorrow. She just doesn’t want the strain of it with her son; she can’t take it. She shows bottles and bottles of pills. Idthium, other antidepressants.

“I don’t want to be a burden to anyone,” she says.

“Do you know what all these medications are?” asks Roger, putting them in a paper bag.

“I can’t tell you because it boggles my mind,” she says. “I want to stay there at Mercy for a little while,” she says.

“Have you ever been to CMH [County Mental Health]?” Roger says.

“Oh God, don’t send me there! Will they please take me at Mercy?”

“I’m going to talk to the hospital and see, okay? I’ll be right back.”

When he comes back he’s mumbling. “Know what we’re missing, boys? Big accident and a triple stabbing.”

Midnight at Mercy Hospital. Roger is wheeling Jean in. “I can’t stand it,” she’s saying. “My stomach is going round and round and round. I want to go to the psychiatric wing.”

Roger rubs her shoulder. “Now, Jean, relax. We’ll have you inside in a moment.”

“I mean, Jean is just as important,” Roger says a few minutes later as we wait for the triple stabbings to come in. “But it’s luck of the draw. If we’d been available a few minutes later....”

The first of the stab victims’ ambulances roars up. A tall American medic gets out. “Oh my gosh,” says Roger. “I might have known. David Martinez. That guy’s a magnet for all the big ones. Accidents, fights, stabbings. They don’t happen till he comes on duty.”

A grizzled-looking face wheels by us with Dave and a hospital nurse, who holds a swab to the knife-wound in the chest, stanching the bleeding.

“Lost 200ccs of blood,” Dave says as he goes by, taking the victim straight into surgery through the first door. The man’s eyes slide to us as he rolls past.

“There were three of them,” says Dave when he returns. “Two had come to rob the third guy’s place. He was there. Found a knife. He stabbed the first robber but got stabbed in the arms himself by the second. Then a neighbor came with a gun, fired at the second guy but had no bullets, so he pistol-whipped the second guy on the head. Nice neighborhood.”

“Dave wrote the numbers 1,2, and 3 on their heads with a felt-tipped pen so we could know who we were talking about when we were triaging them,” says Dave’s training officer, Kathy Rogers, a bouncy 43-year-old mother of four and grandmother of one. “I think we got to them in time.”

I ask her how she copes with this sort of violence night after night.

“Well, you know, I make it a game,” she says. “I want to win, and the patient’s life is the prize. Of course, it isn’t a game. But that’s what I’ve got to do — one, two, three, four — to get through and do a good job. Been doing it ten years. You need something like that. ’Course, it has its joyful sides, too. I’ve delivered 20 babies.”

I suddenly realize that governments and “provider” companies may come and go with the city’s four-year paramedic contracts, but these are the people they all use; from Medevac to Hartson to American, the people who actually do the lifesaving are the same. Their motivation really isn’t money.

But what about disease: AIDS, hepatitis B, TB?

“It’s a risk,” Kathy says. “We can wear goggles and mask if someone is spouting up, spraying. If you get a needle prick, you only have a 1 -in-200 chance of contracting AIDS. I was exposed to meningitis last week. There’s only been one case of a crew catching something; one of our boys got TB.

“But I still love it. It’s a good living. I support my children. And I’m halfway through nursing school.”

There are a couple of cops waiting here too, on the emergency entrance ramp. They’re listening to the two-way radios.

“Lost a leg,” says one. We cluster around. He’s got word that two of the SDPD’s policemen stopped a motorist on the freeway in North County and another car plowed into them. One lost his leg, an hour ago. Roger looks at me. He shakes his head.

“Just like I said,” he mutters. “Freeways. God.”

Kathy Rogers leans against a pillar, looking at the ground. “I’ve been in one of those,” she says quietly. “It was my weirdest moment ever. We had a call to 805. Big traffic accident. And while we were trying to help someone, another car came and smashed into one of our ambulances. I was just walking towards it as it did. The driver of the car died right then, and I swear, at that moment, the man’s soul was there. I could feel it. Weeping, wailing, gnashing of teeth — it enveloped me. A shriek. Just that instant his life was being wrenched from him. That was the weirdest thing. It tends to make you a believer.”

So why do they do it?

“You know my theory?” says Kathy. “We were all abused kids. We’re all trying to make things right with the world, because they never were for us when we were growing up.”

Although our crew’s not getting to great drama tonight, it’s certainly swirling around us. Mark Karlin, the supervisor for the night, is talking on the radio to another of his ambulances, rig 120. Craig and Clyde, the two who’d brought in the motorcyclist, are in the middle of a battle.

“There are no cops there, because we couldn’t tell a fight was going on when we got the call,” says Mark.

“The guy’s coming back to the guy he beat up before,” says Craig’s voice through the radio. “He’s looking pretty wild.”

“Just leave with the guy you’ve got,” says Mark. “Take off. And quick. Get out of there.”

“Guess you boys should make your way downtown,” says Mark to us. “Bars are about to close.”

We take off for downtown, and when we get there there’s nothing on the computer screen for us so we stop for a cappuccino at the open-air coffee stall on Fifth. The place is full of people pouring out from Ole Madrid, which shut down at 2:00 a.m. We stand around chatting, munch hot dogs, and drink good coffee (great to help stay awake).

2:41 a.m. Beep beep! Stabbing, possible gunshot, Fifth and F. We ditch the coffees, jump in, and switch everything on. This is Code 3. Mike, in the back, puts latex gloves on “for blood.” The teddy bear rocks as we heehaw down towards 94.

“Stand back,” calls Roger. The police have told them not to come on scene till they have caught the perpetrator. We cruise, slowly. At a 7-Eleven we see police scurrying. Roger’s listening to the radio. “Got him there.”

But when we get to the ghostly gasoline station looking over the 94 freeway, there’s just this one guy, Miguel, sitting in the open door of his car with blood on his knee, a bit like Viletta back all those hours ago at the Westgate. Turns out a guy pushed him from behind when he was waiting to pay for gasoline. He didn’t see a knife, but a little billy club. The guy kicked him. He ran away. He tripped, fell, and scraped his knee. A girl who saw him rang the police; she thought he’d been stabbed.

Mike cleans the wound, sticks on a bandage, and when Miguel refuses to go to the hospital for a checkup, Mike has him sign an “Against Medical Advice” form. Miguel wants to go see the Chavez fight — even though his leg still hurts like hell.

It’s nearly 4:00 a.m. when we get back to base, the fire department headquarters downtown. We reverse off the lonely street, park ahead of the ATF (Alcohol, Tobacco, Firearm) vehicles, and make for the firemen’s living quarters. We end up in the watch room, surrounded by TV screens and winking lights and “Order of the Day” boards. Only two hours to go.

We get to talking about the current controversy over American Medical Service and how good a job it’s doing.

A report out last month criticized American for being too slow and charging too much. An audit of American’s operation was due before the city council’s Public Services and Safety Committee June 1.

The fire department is in no doubt that it, not American, should be operating the paramedic ambulances of San Diego. “That’s the future of the fire service,” John Thomson, the vice president of the firemen’s Local 145 told me. “Today 80 percent of the calls we respond to are medical-related anyway, not fire. We’re a city entity. We have a better geographical spread; we have fire engines based in 42 areas. American has ambulances based in 20 to 22. Our response is six and a half minutes average. These reports confirm American often can’t get to scenes in ten minutes. And at American’s rates, we could be putting money in the city’s coffers, not pocketing the profits as American does.”

“That’s nonsense!” American’s youthful general manager, 31-year-old ex-medic Dan Lynch, told me recently. “The fire department is needed on only the more severe medical calls. We’re sending ambulance crews out to 4500 to 5000 calls per month. The fire department’s only sending out — this is my guess — 2100 to 2300 calls per month. So they have double the number of units and half the calls. If they had our responsibility loaded on them, they think they could stay as quick?

“Plus, they stay usually for the first 15 minutes only, because they don’t have to worry about transport. We are usually tied up for an hour, preparing the patients, loading them, transporting them to the hospital, and off-loading them. The fire department doesn’t know what the transporting business is. Their average response time is six and a half minutes? Our average response time is 5:42 minutes. But figures lie and liars figure: averages don’t mean much. And remember — the fire department is not held to a standard, like we are.”

To the complaints that American is charging too many people for advanced life-support services — at a figure averaging $455 per transport — when they only needed non-paramedic basic transport services ($289), Lynch says that before his company won the contract, there was no lower rate. “Hartson billed all calls at a paramedic rate. The billing practices of American are in compliance with the city contract and all Medicare guidelines.”

What’s more, Lynch says, American is being held to a higher standard than the previous provider, Hartson. Hartson was required to arrive at the scene within ten minutes of dispatch 90 percent of the time; American must arrive on scene 93 percent of the time. American is operating to that standard 93.43 percent of the time, says Lynch. Hartson achieved that only 86.10 percent of the time before they lost the contract to American, according to Lynch.

“We’re delivering the quickest service in San Diego’s recent history, and we do that without requiring any subsidy from the city,” Lynch says, unlike Hartson, which needed $2.2 million of the taxpayers’ money to operate, or the fire department, whose bid called for $1.7 million in city subsidies.

“That extra money the city has now pays for around 20 to 30 more cops on the streets,” adds Lynch.

“We have firehoses 26 years old,” says the firemen’s John Thomson. “The revenue generated by our operating the ambulance service could provide money we desperately need for engines and equipment.”

5:00 a.m. Jim Poladeck arrives back in the station after an all-nighter at the accident scene where the officer lost his leg. He runs the light-and-air truck. “I swear,” he says. “Seventy-five percent of people on the freeway after midnight are drunk. It was a helluva scene.”

It’s getting hard to stay awake. Mike’s asleep back in the television room. Roger’s waxing philosophical. “I guess the most satisfying call I ever had was back four years ago,” he says, stretching his legs out over two chairs. “Southeast San Diego. Me and my partner were two brand-new paramedics. Idealistic. Got a call to this 23-year-old girl. She had severe abdominal pains. She had a ruptured ectopic pregnancy — in the tubes. It actually ruptured while we were there.

She went straight into ventricular fibrillation. That means the heart was not beating. It was fluttering. She was dying. We poured every medication we could into her. Liters of IV fluid. Shocked her five or six times with the defibrillators. Spent 25 to 30 minutes resuscitating her. By the time we left for Paradise Valley hospital, we had a pulse back. And luckily they had an obstetrician ready to operate straight away.

“For two months we went to the ICU to see her. And she got better and better. We talked to her family. She was discharged. She was alive! Of course, I haven’t had a call like that since, a clear-cut save when you help bring back someone from the brink like that to total health. But if that’s the only person I save, I’ll have something good to look back on in my life.”

5:20 a.m. No one can believe it. A call. Somewhere at First and Island, a person having difficulty breathing. Elderly female, 4503 First Avenue. We scramble aboard. On go the lights, on goes the pernicious siren at crossroads, though there’s precious little traffic to warn.

“Big dip!” Roger shouts as we bounce over a storm drainway. We pass the mural on the factory wall saying, “Let Freedom Ring!” In less than five minutes we’re there.

Except there is no there. When we get down to First and Island, there is no 4503. We cruise back and forth, until a message comes through from the dispatcher. “Sorry. This call was relayed through a taxi. It’s an El Cajon call.”

We head north for 5 and 15 and American’s headquarters on 38th Street. The boys will clean out the detritus of the night’s work, replace any drips and drugs they have used, and then, at 6:00, 12 hours after they began, head for home.

Two cars turn up in the yard. Holly Hamm and Mark Caviness. The next 12 hours aboard 201 are theirs.

“I’m off,” says Roger. “Two hours’ sleep then go see my mom. Mother’s Day,” he smiles. “Otherwise I’ll never get any rest.”