Into the Breach: A Year of Life and Death with EMS

Into the Breach: A Year of Life and Death with EMS

by J. A. Karam

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Into the Breach is the true story of paramedics, emergency medical technicians, and heavy-rescue specialists fighting to control trauma and medical emergencies in one of America's toughest and most violent cities: Newark, New Jersey. A riveting account that hauls readers on a first-hand tour of street medicine today, Into the Breach shows what really happens inside an ambulance and some of the diverse and bizarre places EMS workers tread.

Through authentic accounts, every facet of emergency care is on display-from the first 911 call to patient discharge or death, including an exclusive look at what is perhaps the biggest decontamination operation ever conducted, which crews performed for victims of the September 11, 2001 terrorist attack.

A hybrid profession that blends public safety and public health, EMS attracts careerists and volunteers from all sectors of society-from Boy Scouts and housewives to Fortune 500 vice presidents and work-fare recipients. The men and women that make up the Newark EMS graveyard shift, one of the busiest, full-time teams in the nation, are quintessential EMS workers: intense, irreverent, hard-working action junkies who crave autonomy and the instant gratification of solving critical problems in real time. This unflinching profile hones in on award-winning EMS workers as well as those who pollute the industry, ironically, sometimes one and the same.

Into the Breach offers an unusual opportunity to bear witness to unimaginable suffering, heroic stoicism, and the inventiveness of American EMS workers fighting to save lives.

Product Details

ISBN-13: 9781429976121
Publisher: St. Martin''s Publishing Group
Publication date: 04/01/2010
Sold by: Macmillan
Format: NOOK Book
Pages: 304
Sales rank: 1,028,390
File size: 421 KB

About the Author

After witnessing a car hit a bicyclist and going to the victim's aid without real knowledge of how to help, Jana Karam took a community first-aid class and became an emergency medical technician. The bicyclist's near brush with death inspired her to leave her business career behind in favor of reporting and writing, a passion she has had since childhood. She earned her M.S. in journalism from Columbia University. Into the Breach is her first book. She lives with her family in Morris Township, New Jersey.

Read an Excerpt

  1DUSKSpring showers have rained down on Brick City and soaked its streets for seven days straight. The sun is setting and the deluge has abated, leaving steam rising from the many brick buildings that crowd Newark, New Jersey’s Central Ward. Tonight, members of University Hospital’s EMS B team will fight to control urban trauma and medical emergencies under a severe thunderstorm watch. Eugene “Geno” O’Neill has come to work early, as usual. Crews who ride the Rescue truck do. The reciprocal courtesy means that when 6:45 rolls around, whether A.M. or P.M., relief is on campus, and the duty shift can walk away without another thought.Between ominous clouds, streaks of apricot sunlight wash over O’Neill’s oblong face, squared off at the top with a tight buzz cut and at the bottom by a strong chin. He sports a soldier’s trim build with skin as weathered as an ace bombardier’s flying jacket. Because he works at night, however, his face is an incongruous shade of cotton-candy pink. O’Neill flips open his box of Marlboro Lights, and taps it hard against his fist until a butt slides out. He has rolled up his uniform sleeves and cuffed them below his elbows. The muscular cords of forearms flex with even the simplest movement. After lighting up, he stuffs the pack in his pocket and squares his stance on the tarmac outside EMS headquarters.Against the backdrop of a squat, one-story building with flaking blue paint and a corrugated tin roof the EMT and rescue specialist straightens his spine, rests a wrist on the small of his back, and pinches the cigarette between his thumb and forefinger before taking a long, deep drag. He sucks in the tar and nicotine, and his clear blue eyes close to slits. An agile and tightly wound man, at thirty-four O’Neill has been involved in emergency health-care more than half his life. A severe Catholic-school education took the edge off his propensity for defiance, but O’Neill’s parents made additional efforts to keep him out of trouble. When he turned fourteen, they had him volunteering at a local hospital.Between drags, he pensively rolls the cigarette between his thumb and index finger. He smokes, and admires the sunset through the compound’s chain-link fence, which separates quarters from the Georgia King Village garden apartments and other area residences. The soft hues of dusk do little to diminish the staccato sounds, screaming sirens, and troubling sights around him. There is no sign that the city is bedding down for the night.A paramedic, passing O’Neill on her way to swipe in for duty, remarks casually, “This city never sleeps; all it does is get dark out. It’s like an eclipse or something. It just keeps going.”

EMS administrators have been angling for a structure better suited to house its crews, fleet of vehicles, dispatchers, instructors, and paper-pushers for more than ten years; they predict five more years will pass before that vision is realized. For now, their roost is a secondhand “temporary” building, erected in the 1960s with concrete blocks and a prefabricated metal shell. Prior to EMS’s occupancy, the medical examiner conducted business here; the floors inside slope slightly toward drains designed to draw excess blood and fluids.O’Neill has already clocked in, signed for his radio, and taken a quick tour through quarters. Inside, the top portion of the concrete-block walls is painted vanilla. The bottom third is raspberry-colored. But the building is anything but appetizing. Glass-shielded bulletin boards line the halls. Floors are scuffed. The day’s detritus spills off crowded counters and overflows from garbage pails onto the kitchen floor. O’Neill stashed a snack in the refrigerator, hung an extra uniform in his locker (it pays to be prepared), hit the head, and checked his mail in the perpetually darkened TV room. A few day-teamers, aka day-pukes, lounge there, lumps on coffee-colored couches, their feet propped on a square brown table along with remnants of lunch. A sheet lies crumpled in a corner of a couch, defying a recent management decree that EMS workers shall not use linen for personal comfort.A computer junkie, O’Neill has stowed his personal digital assistant and laptop in the Rescue office, a cramped Pepto Bismol-pink space stuffed with desks, awkwardly juxtaposed cabinets, and a gallery of children’s artwork.

More day-pukes camp around a rickety picnic table outside HQ, slugging soda and finalizing last-minute paperwork. Billy “the Squirrel” Heber, O’Neill’s partner, is already putting the 38,000-pound Rescue truck, aka “the Beast,” through his nightly meticulous inspection. He examines tool after tool, more than 375 of them. A burly German-American with wavy chestnut hair and a dusting of freckles, Heber drove trucks before joining the service nineteen years ago.Back then, EMS here was still in its infancy. Paramedics were still new to New Jersey and few in number. Heber and a partner worked the ambulance and routinely handled twenty-five to thirty jobs during their eight-hour shifts. Budgets were tight, and sometimes supplies ran short. A colleague remembers. “We’d find ourselves asking, ‘Is this patient sick enough for me to use one of my four-by-fours [bandages]?’ Whereas with Heber, it was never a problem’cause he always had plenty of everything squirreled away in little hiding places.” Dashing between hectic ERs, Heber might borrow a spare box of bandages here, a few surplus cravats there. He’d be quick to claim equipment abandoned at accident scenes. He’d stuff every nook and cranny on his bus with every conceivable supply and tool. In a pinch, colleagues soon realized, Heber was the best and fastest source for whatever they needed. They dubbed him “the Squirrel,” and his resourcefulness became legendary.

Paramedic Vincent Francis “Fester” Cisternino, a twenty-nine-year-old colossus of German-Italian descent, swipes in and tromps outside to the picnic bench, where he greets O’Neill, “Hey, meat.” At six feet, one inch and 270 pounds, Cisternino dwarfs the wiry O’Neill. He’s not kindly disposed to the day-scum either; he finds them careless with the equipment—prone to overstuffing his bus’s med bag with catheters and sticking trauma dressings inside the airway kit.Each spring, as a sign of spiritual renewal, Cisternino shears his thick, curly brown locks to reveal a blue-white scalp. Six years ago, he converted from Catholicism to Buddhism. He carries a crimson strand of hand-carved rosewood prayer beads that a Buddhist monk gave him. He secretes a miniature Tibetan flag in his pocket and a miniature Cartman, the roly-poly, cheeky character from TV’s South Park. He’s had an elaborately detailed and colored dragon of his own design tattooed on his body. It bursts through a violent sea on his shoulder, rides his right chest, soars over his scapula, and wraps its tail around an ornate cherry tree on his biceps. Cisternino says it reflects his dual nature: fierce and gentle.East Asian studies is one of two majors Cisternino doggedly pursues in his decade-long quest to complete his college degree. He would have finished it years ago but for the fact that he didn’t know much about budgeting, and, at eighteen, tried to finance tuition, books, and living expenses on his first credit card. It took him years to pay off the debt, which he has done while attending school and juggling three or more jobs on the same 168-hour week as the rest of the world. It has been a tough haul, even for the colossus Cisternino, who has since perfected the art of piling each minute high with activity. He first cultivated this ability in high school. In addition to classes and a full-time job as an office/shipping clerk, the teenager worked as a bouncer and a lifeguard. He also lifted weights two hours a day to sculpt a fifty-four-inch chest and thirty-eightinch waist and biceps that bulged like bowling balls. In his spare time, he volunteered as an EMT for a Pallisades Park emergency squad.From behind his Oakley polarized Straight Jackets, Cisternino grins at O’Neill, who holds court at the picnic table with others who have begun to assemble. Cisternino wears his University baseball cap backward; it displays his nickname, “Fester,” in neat embroidery. When he smiles, the impish six-year-old he must have been once is briefly visible. One hardly notices his tongue bar. He lights a cigarette and takes a seat.Those who dare greet the ascetic O’Neill with a dulled “Good morning.” Although it is twilight, their day is just beginning. Others, eyes downcast or straight ahead, squeak by hoping not to draw attention. If O’Neill and his buddies are not otherwise engaged, they might focus on a passerby. It’s part instinct, one medic explains. Whenever they shake hands with someone, they subtly check out the veins and assess how easily they could slide a catheter in. A fat person walks by; they’re a potential case of congestive heart failure. A really fat person waddles across the road, another quips, “Basically, he died three years ago. He just hasn’t lied down yet.” And work-related romances or “knocking boots,” no matter how secret the parties imagine them to be, are fair game for ridicule, too. Nothing is sacred.Cisternino, O’Neill, and a few others compose the Council of Elders, which they characterize as “a nondescript government agency loosely affiliated with the Foundation for Urban Combat Survival Systems,” a fantastical entity they have nicknamed FUCSS University or FUCS U. Why waste the effort they placed into Y2K preparations? they joke—explaining FUCS U as an alternative to wilderness survival programs. It’s harder to endure the hostile and austere conditions of a large urban center than to crash-land in the Peruvian jungle, O’Neill says. “For a thousand bucks, we train Americans and select foreign nationals in the nuances of not only surviving, but flourishing, unarmed, in an environment that most people won’t admit exists.”O’Neill discusses an upcoming camping trip. Cisternino checks out a camouflage-colored water-storage device that one of the other medics received as a birthday gift. The two, and a few other blue-shirts, have taken several FNGs (fucking new guys) under their wing. Through ambitious outdoor excursions, hazing, and errands only eager-to-please pledges could endure, the veterans hope to toughen their charges, improve their street smarts, and shape their perspective to the team’s benefit. The B team considers itself a fraternity; most members have at least ten years’ experience, and they are close on and off the job. They try attracting EMS workers with a similar mind-set, but they don’t control assignments. They do have some say, however unofficial, as to who makes the cut. The waiting list is reputedly long. And openings, which are infrequent, are no guarantee that newcomers will find a home.Smart neophytes used to keep their mouths shut, work, and speak when spoken to. Eventually, those who hung on the longest would improve enough to be folded into the pecking order. Cisternino and his partner, Tracey Ann Fazio, say more than a year passed before anyone spoke to them conversationally. But something in the culture has changed of late. The FNGs are still too timid to sit at the table when veterans are present, but now they talk too much.For example, one of the new hires yaps about a job he went to earlier. He found a quadriplegic locked inside a room. Caretakers had left the man flat on his back on top of a bare and filthy mattress. They had torn a hole in the bedding beneath his buttocks. When the man defecated, his waste splashed into a bucket below. Maggots infested his flesh. The medic was appalled, but no B-teamer within listening range broke a sweat. War stories do not impress them; they say they see more in two months than most EMS workers see in a lifetime. O’Neill, for instance, has seen patients whose bodies burst apart from contact with downed electric wires. He has witnessed child abuse, hostage takings, disembowelments, dismemberments, and other grotesque atrocities. He has watched fire-eaten roofs buckle under coworkers minutes after he descended. In his twelve years on the job, O’Neill says he has buried four team members. Talk is cheap. B-teamers think of themselves as “hard-core, bad-to-the-bone rescuers.” They pride themselves on eating their young.The Council of Elders has tasked the FNGs with a precamping exercise to shut them up and engage them in proving their worthiness. O’Neill orders them to construct a twenty-item survival kit inside an Altoids’ tin. At minimum, he barks, they should have twenty feet of parachute cord, a biohazard bag, six feet of electrical tape, thirty feet of waxed dental floss, twenty feet of snare wire, a wire saw, safety pins, a button compass, a razor, cotton, sewing needles, four windproof candles, four waterproof matches, fishing weights, finger cots, cotton balls, anti-inflammatory pills, and a whistle.“On a kit like this, my dad survived two weeks in the jungle,” a seasoned EMS worker says about his mud marine father. O’Neill nods knowingly. As a five-year-old, he watched with awe the first time he saw his dad rifle through the first-aid kit he used as an army medic in Korea’s demilitarized zone and parts of Indochina.As the FNGs scramble to comply, Patricia Vogt rests a foot on the rescue truck’s bumper and lights a cigarette. The only B-teamer who is also a grandmother, Vogt once managed an auto body shop. Her boyfriend became an EMT first, and she joined him. Surprised to find EMS a relief from stress at the shop, she changed careers.

“Last night it was chicken noodle,” Chief Paulie Visoskas mutters to himself in a veteran smoker’s gravelly voice. He strolls toward the group and lights up. “Tonight, it’s probably cream of chicken.” He knows a popular nearby diner’s menu by heart, and recites it aloud as he considers what to eat for breakfast. “It’s pea soup on Thursday, and Sunday is chicken corn chowder. Or is that Friday?” No one answers.

While O’Neill lectures, one of the Elders approaches an escaped stretcher, twists a lever, and converts it into a chair. Next, he whips out his set of hair clippers and slaps the back of the chair, which causes O’Neill to pause his lesson and take a seat. O’Neill wraps a sheet around himself with a flourish and submits to the clippers.“After the fall of society, we’re going into the barber business,” O’Neill declares, rising from the chair totally bald but for a faint velvet brush on the top of his head. “Jesus Christ, I love being a man among men. This is fucking fabulous.” He polishes his newly shorn skull. “You can’t get this in the corporate world!”“Yeah, they’re not giving high-and-tights in the Prudential building,” someone chimes in.Then Cisternino gets up from the table and steps into the chair with a wicked smirk.“But he’s bald already!” someone shouts.“Let me do your eyebrows,” the amateur barber begs. “And then I’ll file your teeth into points!”Enjoying the moment, Cisternino nods a greeting to his partner and friend of many years, paramedic Tracey Ann Fazio. A curvaceous five feet, eleven inches, with cascading hair the color of raging flame, Fazio parks herself at the table, opens her cosmetics case, and inserts her contact lenses. Next, she applies mink dark mascara, and glosses her lips with raspberry tint. Her lips, sometimes rose-petal pink, tomato, or berry, are often the only bright spot on the neutral canvas that is Newark at night—a dim palette of cream, shades of gray, dusky blues, and muted greens enlivened by scattered, twinkling lights. It’s doubtful that any other female on the team could get away with such fastidious attention to appearance, but the twenty-nine-year-old Fazio has proven her mettle during her eleven-year tenure, and no one messes with her. “I’m like Ma Barker and these are my boys,” she says with a wry smile and a faint lisp.Ignoring the high jinks around her, she leafs through Bride magazine; her wedding to a fellow paramedic is just a few months away. The magazine rests on a pile of patient-care reports (charts), which an administrator has evaluated and stuffed in her mailbox to review.Fazio also fell into EMS while in high school, after accepting a dare from EMT classmates she had teased because they wore uniform jackets, with patches and pagers, to school. “You couldn’t do it,” they challenged her. Fazio had been around “old-time ambulance folks forever,” because her mother worked as an ER nurse and Fazio sometimes accompanied her. She decided to prove her classmates wrong. She volunteered for her municipal squad and worked for an ambulance transport company in college. That’s where she met the air medical paramedic who persuaded her to work at University.For years Fazio held a second job at another area hospital, where she sometimes worked with Cisternino. She convinced him to come to “the dark side,” one of their nicknames for University. During their time together, she says, she has seen him transition through several phases, from a “dapper, Mr. L. L. Bean, GQ type” to the cowboy-hat-and-boots look to his current incarnation: bald head, surgical-steel body jewelry, and penchant for tattoos.Although her coworkers are colorful, working the graveyard shift can be grim. Still, Fazio wouldn’t trade it. We definitely have the better part of the night, she thinks, watching day-team stragglers head out to their cars. I like it when the sky is half indigo and full of stars, and the other half is lit by the sun, and the two compete with each other.Then the city wakes up and it all turns to shit again.She has a talent for finding the silver lining in any situation, even if she has to force it. The nice thing about pollution is that it makes the colors go in really nice layers, she muses as garish streaks of lemon and lavender striate the evening sky. Fazio is observant that way. As a second job, she designs online environments for fantastical computer worlds. She is a natural storyteller, attentive to the big picture and to the details, too. She can synthesize and structure large chunks of complex information in her mind and then deliver a rapid-fire analysis with gravitas and stunning precision. Her handwriting is exquisite. Administrators at other institutions have written EMS managers to compliment Fazio’s reports. But she senses that the charts stacked beneath her bridal magazine are riddled with criticism.Fazio has always been proud of her chart-writing skills, but there is new quality-assurance system in place, which has been tripping her up, nipping at her heels. She’s supposed to review the charts, sign them to acknowledge that she understands the administrator’s comments, and return them promptly. With a sigh and a drag on her cigarette, she sets the magazine aside and stares at one chart until she remembers the job all too well.She had arrived at an apartment to find her patient deceased, absolutely unsalvageable. With a doctor’s permission, which she obtained by radio, she pronounced the man dead, and checked off the “Dead at Scene” box on the chart. She filled in the hundreds of other tiny boxes, wrote a clear, succinct narrative, and attached the patient’s flatline ECG (electrocardiogram). The manager declared the chart unacceptable, because Fazio didn’t also mark the boxes labeled “unconscious,” and “respiratory arrest,” and “cardiac arrest.” “Dead at Scene” should be sufficient, she thinks as her brows knit with exasperation. If the patient is dead, he is neither conscious nor unconscious. And what is dead if not a persistent lack of heartbeat and breath?Fazio copes with her disappointment and wounded pride by lashing out with blazing indignation. Many of her charts go unscathed, but because she treats a lot of sick people and uses aggressive procedures,1 her charts come up for inspection more often. “The QA process here has no human element,” she complains as others around the table nod in agreement. Spirited invective concerning the administrator they’ve dubbed “the Chart Nazi” follows.Discouraged and frustrated, she stays on the job nevertheless. The pull of the pension is part of the reason. And, like several of her comrades, she’s enmeshed in a powerful love-hate relationship with EMS. The job’s autonomy, the inherent responsibility, and the B team’s brand of camaraderie are magnetic in their appeal even though her patients’ lives can be profoundly depressing and the blue-shirts are constantly engaged in a no-win battle with bureaucracy. “We have a bit of combat mentality,” Fazio explains. “We despise our surroundings and circumstances, but we muddle through and try to have a good time doing it.”Paramedic Tommy Opperman is especially grateful to Fazio. Recently, his mother died at home after carotid-artery surgery. He found her in the bathroom, and admits the grief he felt as a mourning son overpowered all his instincts as a medic. He struggled through the funeral and returned to work. At the time he was partnered with Fazio. Coincidentally, Dispatch sent them to a female patient who had died in her bathroom. When they arrived, Fazio told him, “I’ll get this.” Opperman figured, She’s a good medic. She can do the pronouncement. I don’t have to double-check her. A week later, he says, it dawned on him that she deliberately spared him a flashback.One of several siblings in his large half-Irish, half-Hungarian family, Opperman also became an EMT as a teen. He despised the Catholic school he attended, where nuns cracked rulers over his knuckles. He felt much more at home with friends on the local emergency squad. A thirty-eight-year-old, Opperman has worked the B team for nearly twenty years. Not long ago, he switched from the overnight shift to the noon-through-midnight tour in order to have more time with his wife and daughter.He has discovered that Newark has a different face at night. For the most part, the ubiquitous graffiti disappear. Caved-in fences melt into the background. Dark shapes glide along dark sidewalks. Toddlers and parents roaming the streets in the wee hours seem grossly out of context; parading whores are obscenely cliché. The bleak despair that cries out from worn, sunlit buildings is muffled by shadow except for chunks of neglect spotlighted by the occasional harsh peach-and-silver glare of security lights. “At night you kind of blindly drive by it all,” Opperman says. “During the day, you can see it. It’s a pretty depressing town.”

At the edge of the tarmac near Littleton Avenue, EMT Benny Cardona uses an arm-length scrub brush and a barrel of suds to scrub down Bus No. 103. His usual vehicle, Bus No. 108, is under repair. The brakes failed while the bus was sailing through a thunderstorm the other night. But it is always out of service, it seems. The other day, he and a team of corrections officers helping to transport an inmate found roaches scurrying about. He’s not sure whether they came aboard with the ninety-nine-year-old patient who spent the drive to the hospital crying that the insect in her ear was eating her brain. Cardona hates roaches. He sent the bus, which his partner, Vince Callahan, dubbed “a straightup ghetto truck,” to be fumigated.Cardona keeps his bus spit-shine clean. He puts his muscular shoulders to the task. Black sunglasses shield his eyes from the setting fireball. Toasty breezes blow. Spraying off the residual foam with a hose, he makes the white truck gleam. Its distinctive orange and yellow stripes encircle the vehicle, interrupted by hot yellow blazes streaking down the sides.Meanwhile, Callahan stocks it with gauze, tape, cravats, linen, sterile water, saline, dressings, and other supplies. A B-team veteran of eighteen years, like “the Squirrel,” Callahan remembers the early days, too. He never takes a full supply cabinet for granted.Tonight, the two almost rush through their ritual, eager to get on the road. They towel off the truck, and Cardona wipes himself down, too. At 1850 hours it is ninety degrees in Brick City.Prior to his foray into EMS, Cardona worked armed security. By arguing that the guards would be better assets if they could defibrillate cardiac-arrest victims, he persuaded his employer to train the force in first aid. To his surprise, he found he had a knack for it. When layoffs ensued, he became an EMT. That’s how the partners met. Callahan’s mother suffered an allergic reaction to shrimp and EMTs rushed her, in anaphylactic shock, to the closest hospital. Cardona was working there as an ER technician. He helped stick a tube down her throat to prevent it from constricting, arranged an oxygen-pumping machine to assist her breathing, and hooked up a nitroglycerin drip to reduce her skyrocketing pressure. A year later, Cardona went to work for University and, to their mutual surprise, the two became partners.Callahan, age forty-one, protects the twenty-nine-year-old Cardona as a big brother would. “They all pick on him because he wants to be a cop,” Callahan says. “But he’s the best partner I ever saw.” And he’s seen his share of EMS workers. Callahan was eighteen when a friend invited him to come along as he explored options at an Army recruiting station. The recruiter tested Callahan, too, and offered him a surprising variety of choices. The next thing he knew, Callahan was an Army medic.

At 1855 hours, Walter Joseph “the Commander” Drivet, a bald and bespectacled thirty-nine-old, walks briskly across the compound, determined to clock in before the shift officially begins at 1900 hours. The picnic-table crowd and others on the tarmac crisply salute the team’s de facto leader. Most everyone looks up to Drivet, because of his knowledge, stability, and professional demeanor.A sought-after lecturer, Drivet also teaches extensively at home and abroad. He works a second medic job, too, in Elizabeth, New Jersey, another busy urban center. And he commands a team of tactical medics who back up law-enforcement officers on SWAT missions. In fact, he just returned from leading a cadre through recertification at an elite SWAT school. There, he trained with an arsenal of weapons, from submachine guns to sniper weapons systems, and allowed police to assault him and spray him with Mace while he defended his weapon.2 “I’m like a white Anglo-Saxon Protestant who can’t even take spicy food!” Drivet cracks. “This was like having Tabasco sauce thrown in my eyes.”An avid and expert skier, Drivet discovered that he could get more time on the slopes and free lift tickets by getting his first-aid credentials and joining the ski patrol, which is how he came to join his local volunteer rescue corps at age sixteen. Now he helps oversee ski-patrol operations at a posh resort. This, his nth job, doesn’t pay much, but it still affords him the chance to ski a few days each week throughout the winter.Drivet became a paramedic while in college. No longer willing to live at home, he opted for self-sufficiency and fell headlong in love with EMS. His campus studies paled by comparison, and he drifted away. But Drivet’s family wanted more for him. (People often think of EMS as a way station on the road to police work, firefighting, traditional medicine, or other opportunities.) For years, they pushed and pleaded with him to finish his degree and give the family business, a school lunch program, a chance. Drivet complied. He earned better money, but after a decade as an urban medic he found the challenge of getting children their Friday-afternoon pizza anticlimatic and returned to the streets.In his heart, he has always wanted to be a Navy SEAL. At the Defense Department, where he has trained to fight the effects of terrorism, Drivet met and befriended a bunch of SEALs and made them laugh with characteristic self-deprecation. Over a few beers, the portly would-be military man called himself the Navy’s real secret weapon: a Navy walrus.Despite his rotund physique, Drivet has ramrod-straight posture. He spends far more than the department’s $250-a-year wardrobe allowance keeping his uniform sharply pressed, his black patent-leather shoes shined, and his silver name tag and shield polished. With a black stethoscope draped over his shoulders and his blue canvas briefcase tucked under his arm, Drivet resembles the Navy man he always wanted to be.Cisternino says Drivet approaches his job “like a child headed for recess.” When Drivet walks into any one of Newark’s hospitals, nurses will stop what they are doing to hug and kiss the chubby charmer. Doctors discuss unusual cases with him. Drivet is a diplomat, too. He remembers the hospital staff’s birthdays. He buys the card, obtains team-member signatures, and makes his partners look good by suggesting they present it. His savior faire is palpable. Patients—from gangbangers to psychotics—relax and let him take charge.When the Commander exits the building after swiping in, everyone at the picnic table quickly shuffles to make room. Drivet sits and switches his stylish Oakley Frogskins to a pair of bifocals so he can review the marked-up charts he, too, found stuffed into his mailbox. Ironically, he held the administrator’s job for two years but, admittedly, did not fit into the “corporate culture.” Despite the advantages the white-collar slot offered, Drivet did not enjoy being a “carpet-dweller,” his term for the administrators whose offices have the luxury of industrial carpet. He found he was spending more time than he wanted to on budgets, disciplinary actions, investigations, and operations. He accomplished a number of goals, such as helping to launch Newark’s tactical medic support team and drafting a memorandum of understanding between New York and New Jersey in the aftermath of the 1993 World Trade Center bombing. But he missed the challenge of patient care under pressure and returned to the line.Ensconced among his teammates, Drivet buries himself in a medical textbook. Soon enough, Dispatch will call or his partner will want to get breakfast. He doesn’t go out of his way to acknowledge any of the FNGs or outcasts, but he doesn’t snub them either. Colleagues have confided in him that walking the gauntlet, past the packed picnic table and its irreverent blue-shirts, is the hardest part of the job. That says a lot, considering that they also have to spend twelve grueling hours a night working in a city their Policies and Procedures Manual describes as “one of the most violent in the United States.”

Founded in 1666, Newark has a distinguished pedigree. The crews take pride in knowing the city’s rich history and which fascinating stories took place from one corner of Newark to another. For example, they know where Thomas Edison labored, where Abraham Lincoln spoke, where Civil War—era jails housed Confederate prisoners, where celluloid film was discovered, where beer magnate Peter Ballantine lived.But Newark has also struggled with socioeconomic problems for decades. After World War II, city planners discovered that Newark had been declining for years. The city had hemorrhaged jobs and industry. Property values had been eroding. The tax rate had increased but revenues had fallen more than twenty percent. The hospital was overcrowded. Streets had deteriorated. Schools were dilapidated. A third of its housing was characterized as below “the generally accepted minimum standards of health and decency.”3 Thousands lived without private toilets, baths, or central heating. Hundreds lived without electricity and running water. Half of the city’s blacks, who had come to Newark to work in the war-related manufacturing plants, lived in “unhealthful and unwholesome quarters” and paid slumlords handsomely for the privilege.4Although periods of prosperity and revitalization followed, Newark never satisfactorily addressed its problems, particularly housing. By 1967, a brew of despair, racial divisiveness, and political corruption poisoned the climate. People were displaced in the name of urban development. With whole neighborhoods already on edge, an incident between police, a taxi driver, and a crowd ignited race riots. Angry residents smashed windows with bottles and bricks, looted storefronts, and set the city ablaze.56The 1967 uprising was not the first the illustrious city sustained, but it may have been the most damaging. For decades since, Newark has struggled to heal itself. Much of its business district is well scrubbed and thriving. The Newark Bears’ shiny new minor-league stadium is colorful, well lit, and drawing crowds. Its New Jersey Performing Arts Center attracts top acts and packed houses. Restaurants entice patrons from outlying areas. A $355 million YankeeNets stadium is the talk of the town. And, the potential to turn the sagging, toxic riverfront into a development property similar to Baltimore’s Inner Harbor is a hot topic, too.Chocolate-box town houses have replaced high-rise public housing projects turned towering slums. Although some of the picturesque new buildings are lovingly maintained, EMS workers see evidence that they may ultimately fail, too. Inside some, the walls and floors are so smeared with filth, one has to wonder what goes on behind the tidy white fences, miniature lawns, and closed doors. Studies say residents from the poorest neighborhoods feel excluded from the most recent urban-renewal thrust. Much infrastructure remains in grave disrepair even as infusions of cash flow in. Cisternino follows Newark real-estate transactions, politics, economics, and scandals. He points out when local politicians do the Jersey version of “the Potomac two-step” and goads his colleagues into discussing the meaning of persistent urban decay. Many wonder whether the much-ballyhooed renaissance will ever trickle down to the back of the ambulances where patients still wrestle with mundane, but deadly, problems such as malnutrition.The mayor’s administration has adopted laws to reduce pollution and protect the environment but has not compelled the citizenry to pick up after themselves. Garbage plasters pockets as far as the eye can see. Newark’s Central Ward, where University Hospital sits, remains visibly depressed, although a $200 million neighborhood project is under way just blocks from the campus. Charred and boarded-up buildings, crumbling sidewalks, and abandoned storefront churches surround the medical complex, a forty-six-acre sprawl of puttycolored concrete buildings and prefabricated shelters that vary in height and breadth. With shifts lasting twelve arduous hours, and overtime to boot, this is the B team’s home away from home.An urban-policy expert once described parts of Newark, walking distance from “glittering new office buildings,” as having “some of the worst conditions in America, like Dresden (Germany) after World War II”7 Barbed wire, floodlights, aggressive dogs, and prolific violence are just some of the reasons EMS workers here compare Newark to Saigon.INTO THE BREACH. Copyright © 2002 by J. A. Karam. Foreword © 2002 by Paul M. Maniscalco. All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles or reviews. For information, address St. Martin’s Press, 175 Fifth Avenue, New York, N.Y. 10010.

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