Chapter 1: Welcome to the Four-Four

We called it the Four-Four. Just like that, always with “the” preceding it, always with the number fours individually enunciated. And though we generally had no reason to put “the Four-Four” in print, everyone knew, all the same, that those “Fours” would be capitalized if we did. The Four-Four was more than just a geographic area defined by boundaries on some Novelado County official map, it was a living, breathing thing with a life of its own, a patch of the world that had achieved proper noun status by means of sheer infamy. After all, Medic 44, for which the Four-Four was named, was but one of fifteen county run ambulances that provided 911 service to more than half a million residents. None of the other Medics’ first-in territories were referred to in this manner. They were simply called “Medic thirty-three”, or “Medic forty-seven”, or, as my recently abandoned six-year assignment had been known, “Medic seventy-eight”. The Four-Four was special that way, the place where rookie paramedics and EMTs had to work, the place they got out of as soon as they accumulated enough seniority to do so, the place they declared they had “done my time” in once free of. No one ever voluntarily bid for the Four-Four, this despite the fact that one of the two day shifts there had weekends off, a rarity indeed in our little corner of the world. No one, that is, until I did one fine autumn day.

My name is Eric Townsend. At the time I put my bid in for Medic 44A I was a sixteen-year paramedic and a fourteen-year employee of the Novelado County Department of Public Health, Emergency Medical Services division. My reasons for making the move from my relatively cushy shift out in the suburb of Deer Forest to the worst urban ghetto in our territorial boundaries was not masochism, was not the urge to serve the underprivileged, was not to do field research for a doctoral thesis on street gang culture, but was actually more practical. A sudden change in the circumstances of my life made having nights and weekends off a necessity. Medic 78 was a unit that worked twenty-four hour shifts which meant, obviously, that my presence was required there at night. In addition, the twenty-fours worked what was called a “Kelly Schedule”, the same schedule the fire department used. Though someone working a Kelly got an average of twenty days off per month, the actual days in question were different from week to week. This simply would not do. Only by bidding for one of our twelve-hour shifts could I have fixed days off and no working at night. Unfortunately, there were only three twelve-hour schedules that included Fridays, Saturdays, and Sundays off every week. Two of these were units that worked parts of town that were not so squalid and, as such, had long since been colonized by higher seniority paramedics who wanted those three days off for reasons of their own. That left Medic 44A as my only choice. And so, with nothing else to do, I put in my paperwork when the unit became available. I didn’t even have to wait for official approval by the DPH-EMS bureaucracy. I was the only one to put in a bid.

And so, it came to pass that on Monday morning, October 15, I pulled my battered, ten-year-old Honda Civic into the main DPH-EMS deployment center east of downtown Novelado at 6:35 AM, ready to start the first day of my new work life. I did not know at the time that I was about to embark upon a life-changing journey of discovery. The Four-Four would turn out to be everything I dreaded it would be. It was a place full of shallow, ignorant, hopeless people who horribly abused every system put in place to assist them, a group of people whose sense of entitlement in our society had grown to super-ego status. My already shaky sense of hope for the American way of life and the very fate of human civilization itself would soon be destroyed forever. And yet, while my hope for mankind itself was being annihilated, my hope for myself, my family, my very soul would be reborn anew.

This is my story. And this is the story of the Four-Four.

The Novelado County DPH-EMS deployment center was located under the elevated lanes of California State Highway 60 in what had once been a Cal-Trans operations center. There was an office building and a garage bay that was actually built into the structure of the concrete support columns that held up the freeway. A parking area for the ambulances and the support vehicles sat directly beneath the lanes and was surrounded by chain link topped with razor wire and watched over by six security cameras. The employee parking, on the other hand, was outside of the complex, more than a hundred yards away, across a busy downtown street and nestled up against a row of old Victorian houses that had been converted into halfway houses for ex-cons and psychiatric wards of the state. It was protected by a four-foot chain link fence without razor wire or even a lock on the man-gate that granted entry. There were no security cameras but there were warning signs on the fence that only DPH-EMS employees were allowed to enter. If you took the precaution of driving an old, crappy car, as I did, and if you remembered not to leave anything even remotely of value in plain sight in your vehicle, you could reasonably expect to only have your car broken into once a year or so.

As I stepped out of my car that Monday morning I was already dressed in my uniform: a pair of dark blue cargo pants, steel toed, ankle length boots, and a dark blue uniform shirt with the County of Novelado Paramedic patches on the shoulders and a little tiny silver badge on the left breast. I carried a lunchbox that hopefully contained enough food to get me through a twelve-hour shift and a backpack that contained my work jacket, my rain jacket, a couple of novels, and a few other odds and ends. A pair of cheap sunglasses was perched upon my head and an even cheaper wristwatch was on my left wrist. I left the parking lot through the man-gate, walked fifty yards down the sidewalk of 27^th Avenue until I got to the crosswalk and then waited patiently while cars continued to zip by, their drivers oblivious to their legal duty to yield to pedestrians. Finally, there was a break in traffic long enough to allow me to trot across. From there, it was only another twenty yards to the man-gate that led into the facility grounds. It was protected by a lock that required a five-digit code that was changed every time an employee was fired or quit. I dug in my shirt pocket and pulled out a piece of paper upon which I’d written the latest code, which had been put into place two weeks before when John Quinones—the paramedic I was replacing on Medic 44—and his EMT partner, both resigned in lieu of firing when they mutually tested positive for marijuana on a post-accident drug test. I punched the code in, screwing up the first attempt but getting it right on the second. The lock disengaged. I had officially arrived.

Our ambulances were officially called Medics. That is what the Novelado County Public Safety Dispatch center called them. That is what the police and sheriff officers who often requested our presence called them. That is what the fire department crews we ran with on every dispatch called them. Among ourselves, however, we called the ambulances rigs or buses. They were converted Ford vans with a red light bar on the front, little flashy red lights on the sides, and little flashy red and yellow lights on the rear. They were painted white and had the department of public health’s logo with the words EMERGENCY MEDICAL SERVICES plastered on each side. An eight-inch-wide orange stripe bisected the patient compartment, passing horizontally through the middle. The cab doors each had the county’s official seal. The word PARAMEDICS was stenciled on the front of the hood, though using the plural form was a misnomer since each rig was typically staffed with only one paramedic and one emergency medical technician, or EMT.

At the back of the deployment area, up against the chain link that secured the eastern flank, were two rows of reserve rigs. The front of this row contained rigs that were six to eight years old and had more than two hundred and fifty thousand miles on them. When a front-line rig went down for maintenance or needed repair, these were what would temporarily replace it. The rigs in the back row were ancient, rumored to be the oldest vehicles the county owned for any purpose. Every one of them was pre-millennium and were meant to be used only in extreme emergency, like an earthquake or a breach in the levees, or a plane crash at the airport. Most were covered with a layer of dust and had cobwebs in their wheel wells. It was doubtful that they would even start if they were suddenly called into service.

Over toward the actual office, on the other side of the mechanic’s bay, was the main deployment area where the in-service rigs would park during crew change. In-service rigs all had placards on the sides and backs designating who they were. Currently there were three of them over there, Medic 52, Medic 60, and Medic 44. The newest of them, Medic 60, was four years old, one of three purchased the last time DPH-EMS had added to its medic fleet. Medic 44’s rig was six years old and looked it. The orange stripe was faded and worn, with a few chunks actually missing from it here and there. The county seal on the passenger door had lost a good portion of its upper right section. The E from the word PARAMEDICS was also missing, declaring us a couple of PARAM DICS. A permanent smear of greasy black ran vertically down from the fueling port, the result of years upon years of dribbling diesel fuel. The rear of all four fender wells was coated with a crusty layer of black road grime that a sand blaster probably wouldn’t be able to remove. This would be my office for the foreseeable future, the mobile intensive care unit where I would sit and work for an average of eighty hours each two-week pay period.

The side and rear doors were standing open as the off-going night shift was in the process of replacing the supplies they had used. The paramedic I would be relieving was John Stillman, a young guy, maybe twenty-five or so, who had earned the nickname “Vestie” because he was the only medic or EMT in Novelado County employ who actually wore the Kevlar ballistic vest we were all issued upon hiring. The vest that was his namesake bulged beneath his uniform shirt, giving him the look of more torso bulk than he actually had. This was a good thing—perhaps the very reason why he insisted on wearing the thing—as he was sporting only a hundred twenty pounds or so on a six-foot frame. His black hair was fashionably styled in a spiked pattern that flirted with, but did not actually violate, our grooming policy.

“Wassup, Eric?” he greeted. “I heard you were the nutcase who actually bid into the Four-Four.”

“I’m the nutcase, all right,” I confirmed. “How was the shift?”

“Busy, like usual,” he said. “We had a girl that got stabbed over on Hemingway, a couple of pain med seekers, a drunk driver that ran into an oak tree and tried to say it wasn’t his fault.”

“It wasn’t his fault that he hit a tree?” I asked.

“Apparently the tree just appeared there out of nowhere,” he said.

“Well, that’s a very Tolkien thing to happen, isn’t it?”

Vestie’s brow wrinkled in confusion. “How’s that?”

“Never mind,” I told him.

His partner was Lisa Mendez, a tiny Hispanic girl who was twenty-two but looked sixteen. Her uniform was extremely baggy on her five-foot frame because the private company that provided our work clothes did not make them in her size. She chuckled a little—a real chuckle, not just the polite one that went with not disrespecting your elders. “I loved that movie!” she proclaimed. “The walking trees were one of my favorite parts.”

“I’m glad someone gets my reference,” I said. “I never saw the movies myself, but I’ve read the books a few times.”

“Oh ... did they make books out of the movies?” she asked.

I blinked my eyes and took a small breath, reminding myself that I could not relate to the younger generation. I turned back to Vestie. “So ... how was the stabbing you had? Any good?”

He shook his head sadly. “It was a cat fight. Apparently, our patient was boning the other girl’s boyfriend so the girl stabbed her in the stomach with a steak knife.”

“A steak knife?”

“A steak knife,” he confirmed. “It probably didn’t even penetrate past the fat layer—looked like a tiny little laceration more than anything. Still ... it was in the abdomen. How do I know it didn’t get the spleen or the bottom of the lung?”

“No way to know,” I agreed. Paramedics spend a lot of their time and effort assuming a worst-case scenario that usually doesn’t exist. Such was our lot in life.

“Anyway, here’s the keys,” Vestie said, handing me a set of two keys attached to a round silver keychain with the rig’s official identification number stamped onto it. These were the narcotic keys, the passing of which was a crew change ritual. Technically, we were supposed to sign the narcotic log at this moment as well, so both of us could verify the drugs were present and accounted for. Most paramedics didn’t do this. We simply signed our names in both of the required places at the end of our shift and turned over the keys. As a group, we tended to trust each other on this matter. I’m not saying we’re all brutally honest or that none of us have a problem with narcotic analgesic abuse, I’m just saying that none of us are willing to risk our decent paying county job for a few ten milligram vials of morphine.

“Thanks,” I told him, taking the keys and stowing them absently in the left front pocket of my uniform pants. “How long have you been working the Four-Four?”

He made a sour face. “Eleven months, fourteen days,” he said. “Ever since I got picked up here.”

“Almost a year, huh?”

“Seems like ten,” he said. “It should be over soon though. Now that Tony and Mike got fired and created a couple of openings, the ripple effect should bust me out of here.”

The ripple effect was what happened whenever a field employee left our fine establishment. An opening would be created on a shift. Anyone within the former employee’s job classification could then bid for that opening if they so desired. Whichever bidder had the highest seniority would be the one awarded the shift. This would then leave another opening which would then be filled by another bid. This rippling would go on and on, sometimes for weeks, until there was a vacancy that no one wanted to bid on, at which point it would be filled by hiring a new employee off of a civil service waiting list of paramedics and EMTs that had already been tested, given their physicals and completed their background checks. Typically, one of the two night shift Medic 44s was where the bidding came to an end as the lowest seniority paramedic or EMT would flee when the opportunity came available and no one else would make the leap to replace him or her.

“Do you have more seniority than Gilmore?” I asked. Frank Gilmore was the paramedic currently assigned to Medic 44B, which was the night half of my Medic 44.

“Two months more,” Vestie confirmed with a smile. “I don’t care what shithole night weekend shift opens up, I’m outta here when the dust settles.”

“Is the Four-Four really that bad?” I asked. Back when I was hired, assignments were handed out differently, with management’s discretion, or more often than not, management’s impulsive whims, being the way people were moved around. As such, I had never actually worked the Four-Four on a full-time basis. I had run back-up calls in the Four-Four while working adjoining areas—the Four-Four produced far more calls for service than one unit could handle alone—but I had never been fully immersed in the experience as I was about to be.

“It’s worse,” Vestie assured me. “The worst fucking place I’ve ever worked, hands down. There have been times I considered quitting this place and going back to running transfer calls at private ambulance, just to get away.”

“You’re not really easing my mind here,” I told him.

“Sorry,” he said with a shrug. “Just telling it like it is. I don’t understand why you bid out here with your seniority. You can have practically any shift you want, can’t you?”

“Practically any,” I said, “but not any any. And, unfortunately, my need to have weekends off overrides my need to not work in the Four-Four.”

He pondered that for a moment and then shook his head. “No,” he said. “It doesn’t. Whatever your reasons are ... they’re not good enough. Trust me on this.”

“I’m forced to agree with him,” said Lisa. “Get out now ... while you still can. The Four-Four will either kill you or drive you crazy.”

And with those words of wisdom, they left me, heading out to start their weekend.

I was definitely bracing myself for the unpleasantness of the Four-Four that first day. But it wasn’t just the actual response area I was going to be working that was causing me concern. The woman who was to be my EMT partner was high on my list of anticipated dreads as well. Her name was Rhonda Mills. She was a three-year employee of DPH-EMS who had bid for the open Medic 44 day shift in order to finally get out of working nights. Rhonda was a dark-skinned African-American in her late twenties. She was a self-proclaimed butch lesbian. She was also a ranked amateur boxer with a record of fourteen wins (eight by knockout) and two losses.

Neither of these first two things were the reason I was anxious about working with her. I grew up in a mixed-race neighborhood and went to a high school that was forty percent black. As cliché as it sounds, I can honestly say I have had many black friends in my life. Nor do I have anything against lesbians. The emergency services profession—cops, firefighters, paramedics, EMTs, nurses—is a favored source of employment of the lesbian demographic and our little corner of the world was no exception. At DPH-EMS there were more than a dozen declared lesbians and perhaps another dozen strongly suspected non-declared ones. I had worked with lesbian partners many times throughout my career and to me they were just women who happened to like other women—a quirk of personality that was none of my concern or business.

That Rhonda was a ranked amateur boxer, however, did factor into my unease. It wasn’t the fact that she was a boxer, per se. On the contrary, having a partner who had been specifically trained in kicking ass could come in handy, particularly in a place like the Four-Four. The problem was that she was rumored to have significant difficulty in turning off that aggressive boxer personality. I had never worked with her before, had never really even spoken to her except for the basic nods and “how’s it going” s when passing each other in a hospital, but the word among my peers was she had anger management issues, usually with mouthy patients or family members/friends of patients, but sometimes with hospital staff, law enforcement officers, and even her paramedic partners.

There were many specific stories of her legendary temper rearing its head. Perhaps the most notorious incident was the time she had been suspended pending termination for punching a patient in the face and knocking him unconscious. Granted, the patient had been an ex-con with Aryan Brotherhood tattoos who had called her a “nigger-dyke” and tried to spit on her, but the fact that he was handcuffed at the time could not be overlooked. Fortunately, for Rhonda, the Novelado County sheriff’s deputies who had fought and handcuffed the man, breaking his nose and several teeth, and thus prompting the call for a medic unit in the first place, refused to file charges against Rhonda because they considered her actions self-defense. Their rationale was that the “handcuffed subject”, as their reports referred to him, had hepatitis A and was bleeding into his mouth, thus making his spittle a weapon capable of causing great bodily harm to Rhonda or anyone else it contacted. Without a criminal charge to back them up, our management was on shaky ground pursuing a termination level offense against her, but they tried anyway. They were stymied by the fact that the “victim” absolutely refused to cooperate with them, as that would have made it publically known and recorded that a nigger-dyke had kicked his Aryan Brotherhood affiliated ass. As such, Rhonda ended up being reinstated with two weeks worth of back pay.

That was the most extreme of the stories about her. There were many others, all negative. It was said that she had once pushed a mouthy family member against a wall and threatened to pull his eyeballs out and insert them into his rectum. It was said that she had once challenged a member of the Novelado County Sheriff’s Department’s SWAT team to meet her after work for a one-on-one fistfight to see who had the biggest pair of testicles. It was said that she had once threatened to crush her paramedic partner’s trachea with her bare hands because he had dared to chastise her for interrupting his assessment of a patient with questions of her own.

While all of these things were concerning to me, it was this last rumor that bothered me the most. For an EMT to interject himself or herself into a paramedic’s questioning of a patient was a blatant faux pas. As a veteran paramedic, I was set in my ways and had little patience for this sort of thing. I am normally pretty easy going but if there is one thing that will get me upset with a partner, it was this. So, what was going to happen if Rhonda pulled this particular boner? I was certainly not going to keep silent about it, as that would just encourage it to happen again. So, when I did have to speak to her about this—I was already under the assumption that this was going to be an issue—was she going to threaten to crush my trachea? And if she did, what was my response going to be? I foresaw conflict coming, something that I did not particularly enjoy in my life. I wondered if I would at least be able to get through the first shift before it reared its head.

And speaking of Rhonda, where in the hell was she? It was pretty much standard practice for field employees to show up for their shift fifteen minutes early. This allowed time to get everything settled into place and to give the rig a once-over before the office supervisor started screaming for us to get out to our district. It was now five minutes to seven, the night crew had already left, and she still wasn’t here. The irritation-in-advance I was feeling for her kicked up another notch.

She finally showed up at 6:59, exactly two minutes before she would have been considered late for work. By that point I was already in the back of the rig, giving it more than just a once-over since it was my first time working out of it. I was looking for missing equipment, broken equipment, or supplies that were kept in odd places. The slamming of a backpack into the cubbyhole next to mine alerted me that she had arrived. I looked up at the sound and beheld the woman I would be spending as much as fifty hours a week with for the indeterminate future.

My first impression of her was not a good one. She was wearing her uniform pants and her boots but had not yet put on her uniform shirt. As such, she stood before me in a navy blue sleeveless half shirt. Her breasts were small, contained tightly in what I assumed was a sports bra. Her abdominal muscles were a firm-looking six-pack that any male gym rat would envy. Her biceps and triceps bulged with fighter’s muscle, making the skin tight and the veins prominent. High on her left arm, tattooed in white ink that contrasted sharply with her dark brown skin, was a chain of female symbols—crosses with O’s perched atop them—that encircled the arm. High on her right arm was a graphic representation of a cartoon fist smashing into a cartoon face, sending cartoon blood spraying upward onto her shoulder.

She looked at me, gave a slight nod of greeting, and grunted, “Hey.”

“Hey,” I said slowly, forcing my eyes to stop looking at her physique and her tattoos and to look at her face instead. It was a face that might have once been pretty and feminine, but was no longer. Her left cheekbone was sunken a bit, causing a subtle but definite asymmetrical shape. Her nose had a smashed and swollen appearance to it, probably the victim of several fractures during her sanctioned and unsanctioned fights. Her hair was cut short, shorter even than my standard high and tidy. Her eyes were a dull brown, angry looking; the sort of eyes that made a person nervous to look into for too long.

“Looks like it’s you and me for awhile,” she said.

“Looks like it,” I agreed.

“You worked the Four-Four before?” she asked, opening her backpack and pulling out her uniform shirt. It was folded neatly into a square. She grasped it by the collar, giving it a shake and unfolding it.

“Not on a full-time basis,” I told her.

“You’re lucky,” she said. “I did seven months on Four-Four D-shift when I first got picked up. Can’t say that I’m glad to be back.” She chuckled. “Nothing personal, you understand?”

“Nothing personal,” I assured her. “I’m in the midst of a big cloud of self-doubt myself.”

This earned me another chuckle. She put on her uniform shirt and buttoned it up. And then, with absolutely no sense of shame or modesty, she unbuckled her leather uniform belt, unbuttoned her pants, and opened them up, showing me that she was wearing candy-apple red bikini panties with white trim. She tucked her shirt tail into the pants and then closed them again, zipping back up and re-buckling the belt.

“There,” she said, running her hands all around her waistline, searching for unevenness. “All nice and legal now. Shirt tucked in, no visible tattoos or unusual piercings.” This was a paraphrase from our policies and procedures manual regarding uniform regulations and grooming standards.

“Me either,” I said.

She laughed, as if the very thought that I would have a tattoo or piercing was ridiculous—which it was, of course, but I didn’t really appreciate her assumption of this fact. “That’s good to know,” she said. “How’s this rig look so far? Anything I need to grab?”

“So far it looks pretty good,” I said.

“Cool. I’ll just take a look at the C-spine and the bandaging stuff real quick and then I’ll check out the front to make sure we have gloves and paperwork.”

“Uh ... sure, sounds good,” I said, feeling strangely surprised that she was proposing doing exactly what it was she was supposed to do.

It took us a little more than twenty minutes to inspect the rig. Steve Wiggins, the office supervisor, stayed in his little air-conditioned office, doing whatever it was he did in there, and left us alone. I wondered if he was cutting us some slack because he knew it was the first day in the rig for both of us or because he was afraid of Rhonda crushing his trachea. I kind of leaned toward the latter theory as Wiggins, known as “Weasel” by the field crews, was not known for cutting anyone any slack for anything. Whatever the reason, it was time well-spent as Rhonda discovered we were low on cold packs and completely out of disinfectant spray while I discovered more than ten different medications that had expired anywhere from two months to almost a year before.

“Fuckin’ lazy assholes that work this rig,” Rhonda opined as we raided the supply room to replace the missing stock. “I wonder when the last time anyone actually went through it completely was.”

“Well, it’s for sure that no one has done an expired med check for at least a year,” I said. Our policies and procedures manual dictated that this check was to be done the first of every month.

“We’ll have to keep an eye on those fuckers,” she said suspiciously. “If they’re not checking out the rig on a regular basis, they’re probably not putting back all the shit they use each shift either.”

“Yeah,” I said, wondering what she would do if she discovered one of the other crews slacking on resupply. Would she push them up against a wall and threaten to damage their reproductive organs?

We put everything away and closed the rig up. It was time to head for the Four-Four’s first-in area and start earning our money. I walked to the passenger side of the cab and climbed in, closing the door behind me. Mounted between the seats was a computer screen and keyboard, the user operated portion of our mobile communications terminal, or MCT. The actual computer itself was locked in a cabinet behind the driver’s seat. Management kept the cabinet locked, not because they were afraid someone would steal the computer, but because they were afraid of crews trying to access it with flash drives or smart phones. Just below the MCT keyboard was an 800-megahertz radio that was currently tuned to the north county Fire/EMS channel for the Novelado County Regional Emergency Dispatch Center, which dispatched all police and fire departments within the county’s boundaries, the sheriff’s department, and, of course, us in the emergency medical services department. Since a fire engine was dispatched on pretty much every call that we rolled on—there were a few exceptions, such as calls in the county jail or calls at the airport—we shared the Novelado County Fire Department’s channel, or they shared ours, depending on your point of view. Just below the radio, on the floorboard between the seat and behind the drink holders mounted in the engine cowling, was a plastic box, about two feet square, that contained boxes of neoprene gloves, small through extra-large, and a clipboard stuffed with all the paperwork we would need during our shift. Under the glove boxes, seldom used, were paper map books of Novelado county and two of the adjoining counties. These were back-ups in case the mapping software in the MCT went down, something that occurred from time to time.