Paramedic Victor Cange is weathering an ugly pink beanie. It’s really one of the ugliest hats anyone has ever seen. If it were day time a supervisor would have told him to take it off. He is working Transport Unit 808 out of the Transcare base in Canarsie, Brooklyn. He is fairly slim and wears thick black spectacles. It’s Christmas and he shouldn’t be here, but his seventh day adventist church teaches that Jesus wasn’t really even born on the 25th, not even really born in December. His partner is the tall, serious Jamaican named EMT Mickhi DBrisk. Michkhi is smoking a Newport out the Ambulance window, watching the snow, and thinking about his son Jayden. Specifically about all the expenses the city generates that the job doesn’t ever seem to cover.
“I just need to get out of Transcare,” Victor mutters to Mickhi.
“This shit ain’t ever worth no $10.25 an hour,” Mickhi responds, “We can make more at Starbucks.”
“When is yer Medic upgrade class finishing?”
“It’s complicated.” That’s Michkhi’s way of saying he doesn’t wanna go into it. He’s in the LaGuardia Associates program for paramedic, it’s stressful, just like everyone says.
Suddenly Michkhi becomes talkative.
“Son, no one has ever heard of my job classification. I am technically not an “ambulance driver” because I do not generally ever drive, being that I have no license to do so, and I am not a “medic” because that would imply I was a Paramedic in our EMS vernacular; and my qualification certainly prolongs life, but does little to diagnose and virtually nothing to treat. You can become State certified to do my job by sitting through a three month class and being over the age of 18. I believe people as young as 16 perform our skill set on Volunteer Ambulances and as young as 14 in developing countries. It’s about eight basic life support skills you need to perform for a medical and traumatic emergency and sixty some odd sets of signs and symptoms it would be good to memorize, but a frighteningly small percentage of my graduating EMS class could recite off less than six months out of the program.”
“What’s yer plot point brother? Didn’t you read the memo, no one’s ever gonna say thank you except God, definitely not the patients, ” Victor Cange says.
“I can’t remember the last time that happened. I was one of ten brothers in my class of 65 at LaGuardia Community College which is viewed as one of the best EMS training centers in NYC. They made this game out a whole lot different than it turned out to be.”
“Well if you’re white in EMS: you’re crazy, a fuck up, or tryin’ to be a fireman for the FDNY. Then again, if you’re any other ethnicity in EMS you gotta be just a little crazy, a fuck up, or attempting to become a nurse. Because when it comes down to it: we are the hip hop of the Healthcare Industry. We make money by moving lives, not saving lives bro. Ain’t savin’ nobody on the long enough; not even yo self.”
“We can’t make you better like a doctor can, we don’t have to slightly pretend to care like a nurse does; we can’t stabilize in a pre-hospital setting via our own training like a PA can; we are EMS; people shoot at us because we look like police in the din of narrow housing project lighting; we might not know what you have but we can keep you alive for at least seven more minutes; and unless you’re missing your head, you’re not legally dead until we get you to a hospital.”
“Ain’t that the truth,” says EMT Mickhi DBrisk.
On the wall of the Transcare Men’s room at the Brooklyn Base in Canarsie on 800 Bank Street: ‘We scare ‘cause we Care’ is scrawled in sharpie in the men’s room’s second stall.
“I work for the Wal-Mart of the ambulance corps I’m fond of saying. At $10.25 an hour I have a worse healthcare package and wage than a Starbucks employee. And I don’t get any stock options after six months. We are the city’s, and soon to be country’s largest ambulance provider. I was hired exactly two months ago; most employees quit or transfer after six months when they go to 911; and be nervous about the ones that don’t. Transcare is an enormous business like virtually everything else about Healthcare in America. I spent less than a day of the five day training being reassessed for skill retention; the remaining time went into how to prevent myself (and the company) from being sued, how to tastefully obtain patient insurance information, and how to properly fill out the Patient Care Forms so that that we can legal bind the patient incase their insurance won’t cover the cost of their trip.”
“This shit is business more than its medical profession,” notes Mickhi.
“Like most Americans, you and I are terribly misinformed when it comes to the dark underbelly of how the Healthcare system functions in this country. It may be illegal for us not to transport a person who can’t or won’t sign, but this company will terminate technicians that transport those that can’t sign “too often”.
Mickhi tosses his mostly finished boag out into the falling snow. Mickhi is an activist with Adon’s club; on paper at least it’s “Chief-of-Operations’ ‘. Cange talks like an activist, but he isn’t one. Like most of EMS, he likes to explain, likes to complain, but it won’t lead to activism. Mickhi gets that, Sevastra and Adon don’t. Everybody in this job is the walking dead. Broken people that then many saw too much over time.
Victor pauses then resumes his critical stress debriefing, “During patient assessment a transport EMT obtains vitals; while the other ensures the airway, adequate breathing, and circulation. We gather a past medical history, a list of medications, any known allergies, and pick up any paperwork from relatives of the hospital or nursing home that might give us more clues to the patient’s current condition. At some point, generally when they’re loaded onto the ambulance, we ask them to sign a form that most EMT’s describe as a patient confidentiality statement, but it is actually a billing release. It is drilled into us in our retrain days 2 through 5 that we must always obtain a signature. That’s because it costs several hundred dollars for an ambulance ride. People wrongly think that calling 911 is a quick free way to see a doctor. That isn’t a very realistic conception at all.”
“Nope, FDNY shakes um for about 500 too,” says Mickhi.
“My work for Transcare brings me into the projects, townhouses, homes, and apartments of New Yorkers in all five boroughs. We also bring patients to places like Connecticut, Long Island, and Upstate New York. I always have a different partner because I work irregular shifts generally overnights and weekends. Most shifts will mandate you to work over 12 hours. One makes plans with a cushion when working; you’ll always be late if you have plans after work.”
Mickhi has heard all this before, said a hundred different ways. The paper articulates a lot of these basic points, putting in writing what most already know via word of mouth.
Says Victor Cange, “My partners fall into two categories of which I am in the second. The first have been here more than six months and have made a profession in EMS transport; that is to say non-911 pick-ups of the morbidly obese, chronically ill, or psychiatrically unstable. They like the job because by the third year it comes close to Starbucks pay and is particularly accommodating to larceny and laziness collectively. Going to 911 would mean working harder, going to another Private company or FDNY might mean working harder and being more tightly scrutinized.”
Only about one/fifth of Transcare employees in EMS (they also operate a fleet of non-EMS Access-a-Ride Paratransit buses) are in this category.
Everyone else is out of here in six months, Mickhi and Victor included.
The remaining group is generally right out of school and looking to quickly accumulate experience before they either go 911 and transfer to a better private, or a hospital or get accepted into the FDNY Academy for EMS.
“A small subgroup of the second category is just logging the 200 hours they need to go Paramedic. The real difference in partners is those that want to do this career or those that see it as a complicated hustle getting paid to do precious little. It should reassure you slightly to know that most of the people who will be doing this on a 911 level care enough to keep their skills sharp if not care enough to care.”
“I care enough to care,” admits Mickhi DBrisk, “One day when Ayden asks what an e.m.t. is, I’m not going to recount even a single story about my work. There’s something really, really trite and cliché about an EMT or Paramedic rattling off some crazy war story. The only thing more pathetic I feel is when an alcoholic or drug addict does it. You should take it for granted that we see things that are crazy every single shift we work. It’s a big city full of people that are sick and dying.”
“I find that most of my partners from your second category have a micro/macro view of our work. On the larger macro level we are a vital link in the emergency response chain able to get the sick and wounded to a hospital that in NYC is never more than seven minutes away,” Victor responds.
“Our job at its most basic is to quickly bring the dead and dying to somewhere they can be kept alive,” says Mickhi.
“On the one on one micro-level we are the people bringing out the sick and dying when they are scared and with the people they love. More than any other link in the Healthcare chain we deal with people at their most vulnerable and it falls on us to earn their trust with our compassion. I keep songs on my cell phone in sixty different languages; people’s faces light up when I play them as we drive to the hospital,” explains Victor.
“One of my partners keeps several copies of the Malcolm X Autobiography for when we transport wounded prisoners to psychiatric wards and infirmaries. Another keeps teddy bears in his jump bag,” laughs Mickhi.
“A lot of people are a little out of it when we move them. Some beg for Jesus to take them or tell terrible stories of tragic lives. A lot of people want to die because this life has been so hard on them. I try to make them feel special, or at least respected. Sometimes I’ll get people over a hundred years old and I’ll try and get them to tell me a story about their life. Sometimes I’ll transport a desperate middle-aged soul still quite totally confused about the purpose of their life.”
“It’s sort of easier to give someone a toy or a book and competently engage in a transport than to have that sort of universal empathy that lets you communicate your sympathy in a way that’s genuine; if it’s forced it is counterproductive and you should stick to the competency and giving of gifts,” says Mickhi.
“You can’t just nod your head and whisper sweet nothings of compassion; you have to empathize via a real experience to be related back. You have to honestly care, not transCare,” states Victor.
“People are either very scared or very intent upon dying. I’ve seen a person survive a nine-story drop because they were hyped up on PCP and believed in a thing called love,” war stories Michkhi.
“I’ve seen a partner restore stable vitals to someone with a “Do-Not-Resuscitate-Order” with a bag valve mask and the blasting of gospel music,” war stories Victor.
“I’ve seen people slip twenty to a bunch of kids when their single mother went to the ER so they could get something to eat,” war stories Michkhi right back.
“We are absolutely not paid enough to care. We can only engage in this line of work on a long enough time line because of the human good we are able to do. Death and suffering would surely take its toll on our mental health if we did not find outlets to make our works worth more than a skill set,” explains Victor, “that’s why I’m gonna become a doctor one day.
“I’ll tell you straight up; I would never have gone into East New York if it hadn’t been for this job. I wouldn’t be learning Spanish, I wouldn’t have such a large collection of foreign music; I wouldn’t know my city nearly as well as I’m about to in the next few years. This job is good because it is compatible with my sleeping habits, values, and allows me to flex my empathy,” says Mickhi, lighting another Newport. Victor cringes.
“You will learn to believe in a thing called love when you a carry a nameless 87 y/o woman in your arms who has no legs, has an external bladder you must also carry called a Foley Catheter that has made her sheets stink of urine; and although quite blind she “sees the light in you” and wants you to pray with her even when you ain’t been to church in a hot minute,” says Victor. Victor went to Church yesterday. He’s rubbing it in with Mickhi as he sometimes does.
Victor continues: “I always feel like I’m bearing witness to the end of the world each Friday I go out. The clamor of the ER, the speeding around on lights and sirens, the murmurs of your dead and dying, and the precious little we’re good for except maintaining your vitals and proving to you we care. Or perhaps each shift we must prove it over and over again to ourselves; because it isn’t the paycheck and benefits that keep us out in that bus; it’s a love we can’t explain for people who we are not obligated to love or empathize for; but have to if we want to keep up this work.”
“There are a lot of sick people in this city; some made sick by circumstance, some by trauma, and many by ignorance about personal health. We will treat them all irrespective of class, race, religion, gender, or sexual orientation,” says Mickhi almost paraphrasing the Banshee Operating guide he helped write.
“But I’m only busting out the pillow if you’re old, or if you’re Haitian,” jokes Victor.
The night is brick as hell. Christmas dinner for Mickhi was a Bodega sandwich and a pack of Newport regulars from Obama Fried Chicken bodega on Rockaway Parkway. He fills the tiny confines of the compartment with carbon monoxide.
“I don’t play games and I don’t take prisoners; I got buck wild debt, I got child support to pay and big dreams,” says Dbrisk.
“Just nine more hours of this bullshit to go, then we get up off the plantation.”
“Hey brother, amen,” says Victor Cange.