Backwoods E.R.

There is no ambulance in our town. Depending on the location of the telephone pole you clip with your pickup, or where you're standing when the big one hits, an ambulance will be dispatched from a town nine miles to the north or nine miles to the south of our little village. Some of us on the volunteer fire department are basic EMTs and first responders; we'll set out with a pack of rudimentary medical supplies and do our best to stabilize the situation until the ambulance or medical chopper arrives. Sometimes that means crawling into a tangled car in an attempt to keep an unconscious victim breathing. Sometimes it means simply holding the hand of a sickly grandmother or a suicidal farmer.

The business of "rescue" is often rough and impersonal -- you cannot put a tube down someone's throat and deliver a shock to his heart without engaging in a certain level of assault -- but out here, we often get to reassure someone we know, take time to tell them we'll call their brother, or aunt, or grandson.

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I became an EMT 12 years ago. I had just finished nursing school, and thought working on the ambulance would be an exciting diversion. I took a 110-hour class through the technical school, passed the National Registry exam and started pulling 48-hour weekend shifts for a private ambulance service in a mid-sized city. We had a high call volume, and I got lots of valuable experience. But when I moved back to my hometown in 1995, the experiences became more personal. I found myself being reacquainted with faces I hadn't seen for 12 years. When you serve as a rural EMT, you meet your neighbors one crisis at a time.

It's a rare privilege, really, a way to thread yourself into the fabric of a place. A few winters back, we were called out for a heart attack. When my partner and I arrived, we found an old man, his body sunk in the snow. He had been dead some time. There was nothing to do but wait for the coroner, and so we stood there, scuffing our feet in the melting drifts, recalling the man we now recognized from our childhood. "He used to feed me cranberry juice in the summer," said my partner. For my part, I remember him standing tall behind the wooden counter of the old general store, beside a large candy jar. He lay dead at our feet, but from the perspective of memory, he smiled above us.

We are by no means isolated. A major highway runs right past town. But our coverage area is large, and extends well out into forest and marshland. Our clients are a mix of townies, farmers, upper-crusters who own lake property and a wide range of trailered recluses. Other areas are far more remote, but we have our pockets of darkness, and we're often the first to discover them.

On a night when it is 20 below and our breath freezes on our beards, I follow our fire chief into a skeletal, slouching farmhouse. The fire we'd been called for has been extinguished, but the air inside the house is toxic with the odor of scorched carpet and raw fuel oil. A black dog woofs thunderously from beside a greasy couch. A young woman is cradling a baby. The baby's lips and nose are soot-stained. A crooked length of copper tubing snakes over the slanted floor to a small heater the husband has rigged. He is tattooed and wiry, and has a burn across his forearm. Like his baby, his face is soot-stained, and he has a hacking cough. The only light in the room radiates from a garish aquarium and a huge console TV.

We take the family to the rescue van, give the baby and father oxygen and wait for the ambulance. The father worries about what our help is going to cost. (His concerns are not uncommon. When one of our crews arrived at the cabin of an Illinois tourist recently, his wife met them at the door with a handful of plastic. "What credit cards do you accept?" she asked. When the crew told her pre-payment wasn't necessary, she was flabbergasted. "Where we're from, you have to pay before they'll take you.")

A practical note: When we respond on behalf of our fire department, there is no direct charge to the patient -- the charges are paid by the townships we serve. The ambulance service bills patients directly, but since many of our patients are covered by Medicaid or Medicare, the service receives only partial payments. Most of the remaining costs are subsidized by the townships, but the service "eats" a number of delinquent accounts every year. The bottom line is, if you call the ambulance, it will come, and you will receive care regardless of your ability to pay.

I warm a stethoscope and listen to the baby's lungs. I hear the air go in and out, and I wonder what this little life will come to. Back in the lopsided house, the aquarium is bubbling, and Jay Leno is giggling with a starlet.

I keep using the nominative I, but only because I am telling the story. The story is not mine. The place is not mine. Our roles -- those of the rescuers and the rescued -- are not clearly defined. Out here, rescue is less about throwing ropes or stanching blood than assuming a role in a quirky narrative that weaves itself without seams, until one day you look back and it has become history.

Every two years my fellow EMTs and I take a 30-hour refresher course and complete an additional 48 hours of continuing education classes on our own. We are trained, and retrained. But we are never completely prepared.

A man is having a heart attack in the middle of nowhere. When we finally locate the patient, deep within the stygian woods, he is standing staggered in the snow, leaning against a tractor, surrounded by a leery knot of men who reek of bacon grease and banjos. One of the men detaches from the group, puts his rawhide face in mine and, in a boozy, baccy-stained gust, announces, "He coded three times. I did mouth-to-mouth."

It's a little strange, out here in the moonless boonies and snot-freezing blackness at the tail end of some logging trail, to be informed by an alcoholic apparition in stained coveralls that someone has "coded." Later I will decide that he picked up the term from TV, and that after a long day of whiskey-stoked ice fishing, his buddy hadn't coded, but simply passed out. I don't doubt for a moment, however, that he revived whenever Dr. Deliverance laid on the lip-lock. The very thought tightens my spine.

We'd been led here from the county road by two guys in a car who signaled our rescue van with their flashers, then we'd careened down a snaky dirt trail paved with nothing but snowpack. We were already 12 miles from town when they led us off the paved road, farther and farther into the forest until the road petered out and we were fishtailing up this twin-track logging trail. We kept radioing directions to the ambulance -- still several minutes out -- right until the logging trail opened into a clearing and our headlights illumed the banjo boys.

The patient is big and bearded. I try to give him oxygen, but he isn't having it. He acts woozy, but his eyes are fierce. When the ambulance struggles into the clearing, I give a report to the lead EMT, explaining that the patient had reportedly experienced cardiac arrest, whereupon one of the coverall contingent, hearing the word "arrest," rushes me and threatens to knock my teeth in if I take his friend to jail. The other men form a protective circle around the patient while I commence a rather hurried review of medical terminology.

Apparently my explanation penetrates the ethanol fog and paranoia and is deemed satisfactory, as the patient is released back into our care, although not until he has whispered into the ear of his chief defender, who then clasps him by the head, looks deep into his eyes and says, rather mysteriously, "I promise, man, I promise."

Once on the cot, the patient commences to thrashing and cursing and tearing his shirt to reveal slack tattoos of an unprofessional sort. The trip back to the county road is a trial and a test of our goodwill, although the patient's determined efforts to wrassle provide us the opportunity to surreptitiously pat him down for weapons. When we finally emerge from the trees and reach blacktop, we transfer him to a waiting chopper and gratefully release him to the sky.

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