Synopsis
Book by Connelly Joe
Extrait
I parked the ambulance in front of Hell's Kitchen walk-up number 414 and Larry and I pulled the equipment from the back. It was midnight in April, and the full moon lit the street like a saint's festival, and as I walked toward the blue-covered brownstone, the faces watching from its windows, I thought again of how much I'd needed this night to be quiet, of how I'd walked the seven blocks to work with my shaking hands actually clasped together in the act of praying for a quiet night, and of how, for all that, I'd been dispatched immediately, and without coffee, to this cardiac arrest.
The stoop stairs were littered with revelers drinking and shouting to a radio on the first floor, and when we reached the front gate the singers stopped shouting and then the music was only static. They cleared a lane up the steps, kicking empty cans out of our way, crowding at our sides for the bad news. What apartment? What apartment? Like they were holding lottery tickets no one wanted to win. Oh Jesus it's Mr. Burke, the oldest woman said, and the group gathered behind us to collect the stories of the man from 5A, of his drunken son, his spiteful daughter, his wife the saint, and his bad heart.
The front door opened, a young boy holding it. He was crying, and when we got inside the screams met us on the ground floor and I knew them well, like the patched rotting steps, the gray-yellow paint, and the red steel doors with three locks in every building I've climbed through to get to those screams at the top--they're always at the top. I knew Mr. Burke was dead and what an awful thing to know, and to have learned through time, and to have to climb.
Four flights. We were ushered into a small front room crowded with red velvet chairs and porcelain. Mrs. Burke stood in the center, surrounded by neighbors, and when we entered, their cries became choked voices, and the old woman's eyes had run dry, and she squeezed them tight. Over here, said a man standing in the hallway like a robbed and beaten sentry. He led us past the kitchen and a small bedroom, into a large back room with a king-size bed upon which lay the figure of Mr. Burke. A woman was kneeling over the old man. She looked up briefly as we came in and then turned and pressed her lips against the already colder, flaccid mouth of her father.
"We were just watching television," said the man who led us in, "and Dad yelled out and started punching his chest and before we could do nothing he locked himself in the bathroom. I said we oughta call you guys but he swore us not to. He was crying and I never once heard the old man cry and after a while we couldn't hear anything, so I broke the door in and he was barely breathing. I put him on the bed there and he just stopped."
Larry and I moved the body to the floor. "How long ago did he stop breathing?"
"Maybe ten minutes. The woman on the phone was telling us how to do CPR. Please, you gotta do something. This is gonna kill my mother."
"We'll do all we can," I said, wanting to sound confident, but ten minutes was too long, and CPR on a bed is useless. Even as I pulled out the Ambu-bag I wanted to put it back, to sit with the family and pour a few drinks, toast the life they remembered, for there was nothing to celebrate in the body whose heart I was supposed to start. Patrick Burke's time had come. He probably knew that when he locked the bathroom door.
I opened his mouth and felt a box of cool air pass through my fingers, like the morning breath of heavy snow, the last of his life leaving. I'm sure it was just gas built up in the stomach from CPR, but in the last year I had come to believe in such things as spirits leaving the body and not wanting to be put back, spirits angry at the awkward places death had left them, and though I understood how crazy I was to think this way, I was also convinced that if I looked up at that moment I would see the old man standing at the window, staring out over the tar-paper plots and gray ditches of his birthplace. I didn't have to look; I could feel him there, pressed against the glass, waiting for us to finish.
"Frank, what are you doing?" Larry was hooking up the wires to the electrode patches he'd just placed on Burke's chest. He plugged them into the EKG monitor and turned it on. I opened my eyes. "Come on, Frank, let's move along here."
I put the mask over Burke's face and squeezed the bag, though my heart wasn't in it, hadn't been in a long time, and neither was Mr. Burke's, whose EKG rhythm on the monitor was a flat green line. The spirit was gone. Standing by the window. If we did manage to jump-start his heart, there'd be only blood to fill it.
But my hands took over; they always do: trained on hundreds of cardiac arrests, they're automatic. I pulled out the long steel laryngoscope blade and inserted it into his mouth. Using it like a lever, I lifted the tongue up until I found the white vocal cords, like Roman columns, and I grabbed the thick plastic tube and carefully passed it through those gates, through the dark cartilage of the trachea, into the branched entrance of the lungs. I secured it, hooked the bag up to the tube, and pumped it hard.
I called for a backup. Dispatch said first available, which meant we would be on our own for at least twenty minutes. I didn't want to involve the man's daughter any further, but I needed her hands. She knelt by her father's head and I showed her how and when to squeeze the bag. She tried very hard but was lost looking into his eyes, her head falling back. "Squeeze," I had to keep saying.
Larry was crunching down violently on the man's chest and as I fit into the slim space between the bed and the man's right arm I heard one of the ribs crack, like deep ice in a winter lake. I turned the arm over, found a trace of blue vein, and plunged the needle in. I hooked up the IV and watched the bubbles ride the salt water into his arm.
Epinephrine first, one milligram pure adrenaline, a liquid scream in the vein to make the heart feel it's trapped in a burning shirt factory. Followed by one half milligram of atropine, a more subtle agent that rings an alarm and tells the heart it's not dead, only sleeping. This heart wasn't fooled. I waited a minute and gave him another epi, but the flat line only shivered a moment before flattening again. So I decided to hit him with everything at once, get it over with. I shot in an amp of calcium; gives the heart a Joe Louis punch. I drew up a vial of Isuprel and stuck it into the IV bag and let it run. Isuprel scorches everything in its path. It sets the heart on fire, and the heart can either come back to life to beat the flames out or lie there and burn like dead pine. I added in another epi and atropine and sat back to see what would happen.
The flat line on the monitor ran untouched, seemingly infinite and perfect like the axis of the universe, then suddenly it flexed, then bowed, a minute later exploding into one thousand shaking points. I could see the vibration in the chest under Larry's hands as every muscle in Burke's heart fired wildly in different directions. I charged up the paddles and placed them on his chest, twelve inches apart. "Clear," I yelled. "Clear." The daughter let go and then screamed when the man's frail body left the pinewood floor. The green line continued to dance, so I shocked him again. The man's face reared up to mine like a challenge. His daughter groaned and rubbed the head that had thumped heavily upon her knee.
The shock of defibrillation is like a slap in the face to the hysterical heart. Sometimes the slap alone gets the heart to pull itself together and start beating normally, but often the soft voice and soothing hand of lidocaine is needed. Just relax, the lidocaine says; everything will be all right. I gave him eighty milligrams and prepared to shock again, but the daughter would not let go. "No more," she said, and she was crying. "Please don't." Larry pulled her arms away from her father's face, and I hit him at full power. This time the body hardly moved. There was nothing left. The line on the monitor stopped dancing. It ran straight and smooth and showed no intention of rising. Larry returned to the man's chest, grunting with every compression. I heard another rib snap.
Larry was exhausted. Sweat dripped from his nose onto the man's blue shoulders, and he wheezed with every compression. Larry had trouble mowing his suburban quarter acre without a substantial nap, and a four-flight climb followed by ten minutes of CPR was more than his well-rested body could bear. There were a number of reasons why Larry should have become a plumber or a lawyer--anything except a medic--but chief among them was the way his body moved during CPR. He had a heavy gut, stretched by years of dozing off in his stain-guarded Naugahyde recliner, his head tilted forward just enough for him to swallow his beer without choking. When Larry knelt over the dead, his belly would swing like a bowling ball in a shopping bag. The force of this gyration met the force of gravity somewhere in his lower lumbar and inspired a number of unfortunate reflexes. With each compression, Larry's heels kicked up, his pelvis shot forward, and his head jerked back, giving all present the impression that Larry's work stimulated him far more than most would consider the limits of professional behavior.
"Why don't you let me take over," I said to him, "while you call Dr. Hazmat and ask for an eighty-three." After starting CPR and delivering a regulated set of treatments, medics have to call the on-call physician to receive orders for further treatment, or, as in the case of Mr. Burke, to call a dead man an eighty-three. He had been down over twenty minutes, and by the time Larry woke the doctor and explained the situation it would be thirty. All first-line drugs had been used, with little success. The man was dead. We were tired. It was time to pull out the tubes and catheters, unplug the monitor, put the man back on the bed, cover him, and leave this poor family to their grief. Time to get a cup of coffee and park the ambulance by the river for a few minutes of rest. I knelt in Larry's place and pressed my hands down on Burke's chest. Under the cracked ribs the heart felt like a flat tire. I apologized to him for both of us and gently built up to a soft, steady rhythm. For the first time I looked around the room, at the dust-covered artifacts of the man's life: unmatched socks under the bed, one gray suit in the closet, pictures scattered on the walls. I thought of all the hours I'd spent in rooms like this, kneeling on the floor, crunching the chests of dead strangers while putting stories together from the pieces they left behind.
Burke's wedding picture sat on the nightstand. He wore a black tuxedo and posed happily with his young bride on the church steps. From the top of the tall dresser in the corner Private Burke stared down, trying to look tough and ready to fight the Communists but succeeding only in looking young. On one side of him was a Purple Heart in a brown velvet case and on the other was a smaller photo, three GIs arm in arm, standing at a muddy crossroads. A signpost listed distances to different cities: NEW YORK, 7,862 MILES; SEOUL, 40 MILES. On the wall above that was a plaque from the New York Times to Patrick Burke, forty years of service, 1952-1992. Next to it, a photo of the man in work clothes, hands and feet dark with newsprint, looking small before the blue metal girth of the printer.
Across the bed, above Mrs. Burke's low, wide bureau, was a mirror as big as a bay window. In its glass a dark portrait of Christ stared at me from somewhere behind and above. He was pointing to his chest, to where the red robe opened, the heart wrapped in thorns, crowned by flames. At the foot of the bed, next to the window that opened on a wall of windows, the Burke family was born and raised. In its center were three collections of bald, smiling babies. Around them the two older sons became boys in baseball uniforms, then high school graduates. One of them, the son who had shown me in, was married near the window and had two smiling boys of his own. The other never made it that far, his life trailing off to the left, a photo of him bundled up and laughing in the snow, two dried-out palm leaves crossed behind the frame.
Both sons' lives appeared foreshortened in some way, shunted aside, as if the boys had been rushed toward adulthood to make room for their sister, the blond-haired freckled-faced favorite, whose life filled more of the wall than the window. I watched her climb out of diapers, start walking, and go to school. She prayed for all of us at her First Communion, loved to paint and play the violin. She won swimming medals and cheerleading awards, and she always smiled, a smile that grew brighter as her life grew higher, to the top of the wall, queen of the prom, the most beautiful daughter in the world, her place as sacred as the Christ looming behind me.
The girl's life on the wall ended there; no graduation or wedding or babies, nothing superseded that smile, and when I looked at the woman kneeling next to me I understood why. Her face was sharply lined, almost anorexic, still beautiful but harsh and pale as raw quartz. Her blond hair was dyed black and chopped into short, straight bangs. Black makeup ran down her cheeks, and the loose-fitting black tank dress she wore showed the bleached points of her shoulders. It seemed as if she hadn't smiled since that night at the prom, as if she had spent the last ten years fighting her way off that wall, and there, on the floor, as she held her dead father's head between her knees, it seemed she had succeeded miserably.
"Squeeze," I said. I wanted to give some lasting consolation. There was none. "Maybe you should take a break. Your brother could come in for a few minutes and then my partner will be back." "No." She shook her head. "He couldn't handle it." I felt bad for bringing her into this, but she was right: it was a job best done by the already fallen and, in my case, the still falling. I tried to imagine our sitting like that on the Great Lawn in Central Park, a picnic lunch between us on a bright blue and green spring afternoon. I opened the wine and she smiled and stretched her back on a cool breeze. Two young people.
"Do you have any music?" I said.
"What?"
"Music. I think it helps if you play something he liked." I was already using the past tense.
"John," she yelled, "put on the Sinatra."
John came in. He was crying.
"Play the Sinatra," she whispered.
The opening strings of "September of My Years" drifted through the room. Not salsa, I thought, not a good rhythm for CPR, but what music to leave with. Unconsciously I picked up my pace and concentrated on my hands. There was a time when I believed music could make a dead heart beat again, and I once believed my hands were electric and bringing someone back to life was the greatest thing one could do.
I have done CPR in grand ballrooms on Park Avenue and in third-floor dance halls uptown. On Park they stand tall black panels around you to shield the dancers from an unpleasant view, while the band keeps up their spirits with songs like "Put on a Happy Face." Uptown the music never...
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