2

2:30 PM marked their sixth call that day. It also marked Peter's and Hesam's third unsuccessful attempt at having lunch.

Since leaving the Presbyterian, they had been called to the East Village to take a man to the hospital who was complaining about chest pain, and who had suffered a myocardial infarction before; then they had done another patient transfer to an asthma clinic.

After they had delivered him to the Bellevue, they'd driven up to Central Park, where a thirty-five year old man had collapsed playing soccer. While they were en route, they heard a Basic Life Support car – with just two basic level EMTs – being dispatched to a motor vehicle accident on 1st Avenue, as there was currently no paramedic unit available.

The man in Central Park somewhat feebly protested that he was fine, while his buddies had stood around laughing at him. Hesam would have preferred to take him, but since the man absolutely didn't want to go, they couldn't take him, so they just have him sign a refusal and cleared from the call. Hesam was not surprised that, the instant they'd been cleared, dispatch asked them to come to the assistance of the EMT's on the 1st Avenue MVA.

Hesam cast his sandwich on the dashboard a longing look but acknowledged, and hit the lights and sirens.

"This is the big bad one," he told Peter with a sidelong glance. "Had one of those yet?"

"I did a cardiac arrest last week. And a smaller MVA before that."

They were only a few blocks away, and reached the crash site within minutes, but since they'd been called on scene so late, the accident had happened close to thirty minutes ago. Hesam grabbed his equipment and jumped out, and Peter followed his lead. Police and fire department were long on scene, and had taped off a large portion of the street. The other ambulance, 833, was parked near the wreck of a motorbike; a convertible had crashed headlong onto the wall of a building on the corner. There was no fire, but some spilt fuel splattered across the site, obviously from the motorbike. Hesam could see the FDNY working on the convertible; the two EMTs were also from the fire department, and were crouching on the ground. Hesam had never met either of them, but in New York City, this was the usual.

Hesam sent Peter to get a report from the fire fighters while he went over to the EMTs with his airway kit. They'd removed the motorcyclist's helmet, rolled him on the long board to immobilize his spine, and put him on the monitor. His pulse was weak and thready, and his breathing was erratic. Neither of the EMTs was allowed to intubate or put in an IV line, and relief was evident in their faces as they saw Hesam. They had been trying to ventilate him using a non-rebreather mask and the ambu-bag, but as soon as Hesam got out his stethoscope to listen to the man's chest, he heard at once that his trachea was obstructed and he wasn't getting enough air.

Hesam listened to their quick report as he got out the laryngoscope from his airway kit and prepared to intubate the man in order to get some oxygen into him.

Just then, Peter returned with a report on the convertible. "It's bad," he said bleakly. "Front of the car's been pushed together, some twenty to thirty inches of intrusion. Driver's alone in the car. Legs and abdomen are pinned, prob'ly multiple fractures and I'm guessing bleeding both internal and external. Serious injuries to his face and upper body. I could get to him through the windshield, but barely. Nothing I could do without extricating him. I couldn't get a pulse." He turned to stare at the firemen working on the wreck with flame cutters. Hesam realised heavily that he'd have to contend with a lot of misplaced helper's syndrome now. The day came inevitably for every EMT, when you had to accept that, if you couldn't save two lives, you had to choose the one that was more likely to be saved.

"You can't do a thing back there without a flame cutter," he told Peter reasonably. "I need your help here. Get a line in, OK?"

Peter had to shake himself in order to concentrate on the patient at hand, but then he unzipped his bag and got out a 14 gauge catheter, and went in search of a vein while Hesam passed the tube between the man's vocal chords using the laryngoscope. He had one of the EMTs ventilate as he checked for lung sounds, and found he was in. The patient's cardiac rhythm improved at once, and Hesam saw some colour returning to his face.

Just then, he heard Peter curse as he missed the IV. Hesam guessed that this didn't happen very often, especially since their patient had huge veins that any paramedic might dream of.

"Just try the other arm," he told Peter calmly, and took over pressing a 4 by 4 compress on the man's arm. A haematoma was beginning to form where Peter had gone right through the vein with his needle.

Peter got the IV on his second attempt, and Hesam spiked a bag of saline. "Keep bagging him," he told one of the EMTs. "And get him to the hospital as quickly as possible."

He helped the EMTs place the board with the patient on their stretcher and secure him, and then turned to see Peter standing and watching the firemen working on the wreck, his jaw working.

Hesam lightly touched Peter's arm, and the other man flinched. "Get the long board and stretcher from the rig," he told him. "That way, we can take him and run as soon as they have him extricated."

He didn't think it would be necessary. Judging by the state the car was in, the time that had passed, and Peter's assessment earlier, there was almost no way the driver was still alive.

Peter was about to go back to the ambulance when they heard the firemen at the wreck yell for a medic. They had him free.

Hesam helped Peter extricate the convertible's driver. Peter seemed to have made the man's survival his personal concern. It was a quarter past three, well past Peter's end of shift, but neither of them gave this any thought.

Hesam knew at once that it was no use. As Peter was working feverishly, pulling the man's mangled legs from under the shredded hood and laying him cautiously down on the street with Hesam's help, Hesam searched for a pulse but wasn't surprised when he didn't find any. The man's face was cyanotic, turning purple where his head had lain against the wheel. Hesam guessed he had been killed almost instantly. The back of his head was matted with blood, and there was a clear hole in the cranium. IIL, Hesam thought. Injury incompatible with life.

If they had been able to get to him sooner, they would have taken him, put him in the rig, and raced him off to the hospital, but it was too late, much too late.

Peter was still working like a madman, readying the bag valve mask for resuscitation. Hesam wordlessly took it, nodding to Peter to perform CPR. He could have told him to stop right there, that it was no use, that circulation must have stopped more than half an hour ago, but he realised that Peter wouldn't want to hear any of it, and needed to experience it for himself.

Minutes passed, Peter pressing down the crash victim's chest and telling Hesam to squeeze the bag every five seconds, the intervals in which he said "breathe" becoming shorter under the stress after a while. As Hesam had expected, nothing happened, and still Peter wouldn't cease his efforts. Hesam suddenly felt as if he was part of a bizarre drill, with the long-dead man in front of them replacing the more off-the-rack dummy, while Peter was imploring him to breathe.

"Peter," Hesam finally said, quietly. "It's over."

Peter still continued to press down on the man's chest, seeming completely oblivious to his surroundings. "No, I can save him."

Hesam slowly let the bag valve and mask sink to the ground. "It's no use. He's dead."

Even this didn't stop Peter from continuing with CPR, and Hesam finally gripped his arm, in order to stop this gruesome scene.

"Hey."

Peter cast him an almost startled glance and apparently came to his senses. Hesam held his eyes for a moment, then Peter looked away.

"Dammit…" he whispered. "I could have saved him."

"No, you couldn't!" Hesam replied firmly as they both got to their feet. He was aware that nothing he could say was going to stop Peter from blaming himself for the man's death, but even so, he felt the need to make it somewhat easier. "He bled out in the car."

"Should have got to him faster…" Peter said, staring at the blood on the ground as he pulled off his gloves.

Hesam knew the routine, he'd seen it with other non-seasoned paramedics. He'd probably done it too, once. "He was pinned in there!" he argued.

"So I should have been stronger." Peter finally looked at him, with an expression that made it clear he actually meant what he said. Hesam remembered the sight of him tearing at the driver's door for all it was worth, and in Peter's eyes, he saw deep, personal failure.

"You can't save everyone." Hesam realised it was stale comfort. It wasn't as if Peter didn't know this, or hadn't heard it before. In his classes, probably also from Karen or Nicholas. Definitely from Nicholas.

Peter remained standing there for another few moments, seemingly struggling for something to say. Then, he turned his face away and started trudging back to the truck

"Should have been stronger," Hesam heard him murmur.

.

Peter didn't drive back with Hesam, but took a cab from the crash site after helping to pack their things back together and stash them in the ambulance. He'd received a phone call from somebody named Claire which seemed to have unsettled him, not long after the dead man's body had been taken away in a hearse. Hesam had told him to go. His shift was long over, and Hesam would just drive back to pick up his replacement. Cleanup and restocking of the rig was negligible, since their patient had never seen it from the inside. Peter had already done most of the paperwork for the day as well.

Hesam felt sorry for Peter, who'd had one of the worst days at work that you could get in this job, and then must have encountered another, probably personal, emergency to top it off. Hesam would have liked to offer some more comfort, even though he knew that it probably wouldn't have been much use.

The next morning, before going off to work, Hesam remembered to check the Presbyterian Hospital website for the newborns. He didn't really expect them to have yesterday's births up already, but smiled when he found Caitlin Harriet Cunningham, 6 pounds, 5 ounces and 19 inches long born on June 14. He looked forward to telling Peter later.

Peter, however, didn't show up at work at all.