"if you have a good seal, the chest will rise" by Carrie Mac

Warning: This story contains strong language.

We park the ambulance at the top of the alley, just behind Main and Hastings. 

"You'll get your overdose," Iain says. This is the last protocol I need to do, and then my on-car training will be complete.

So he's brought me here, to Market Alley, lined with dark doorways and overflowing garbage bins. Crows and seagulls. Power lines like bunting between the backsides of buildings. Tiny packets palmed from one hand to another. A woman sits on a stoop, shooting up in her foot. A man takes a piss behind a garbage bin. Another man lights a cigarette, fumbling the matches, and then he strides away, arms swinging, hips heroin-loose. 

Iain takes a sip of his coffee. He slides his seat back and opens the paper. 
 
Later, four men stumble around the corner holding a girl overhead, and I'm not sure what I'm looking at. Someone is yelling. The girl is grey, her legs spread, skirt hitched up to her hips, pink lace underwear, scabs on her thighs, her arms dangling down.

"Voilà," Iain hops out. "Come on."

Everyone is talking but all I can hear is her shallow, sucking breaths. 

"Carrie," Iain says. 

"What?" 

They've put the girl on the stretcher. I pull her skirt down. Straighten her tank top. Slip a strap back over her shoulder. Pink Converse. One lace undone. I reach to tie it. 

"Carrie!"  

I take the other end of the stretcher instead, and we lift her into the ambulance. Her boyfriend bangs on the door. He wants in. He's banging and banging, and then he stops and it's quiet. She's not breathing anymore.

There are obstacles to a good seal. Beards, fat necks, broken teeth, sweat, vomit, displaced dentures, seizures, blood, piercings. But this is a good seal.

Iain hands me a bag valve mask and a selection of airways. He turns on the oxygen. Her chest is still. It's like looking at a picture of a person. "How long are you going to wait?" He reaches for a bag of saline, tubing, a tourniquet.

I mash the BVM onto her face.

"What the fuck are you doing?" 

Everything is a jumble, and then it settles into order — protect the airway first.

I yank her mouth open and cram the plastic tube down her throat. I grip the mask and her jaw with one hand and squeeze the bag with the other. Her chest pops up suddenly, and then falls.

"Easy does it," Iain says.

I squeeze again, this time not so hard.

Squeeze, release. Rise. Fall. There are obstacles to a good seal. Beards, fat necks, broken teeth, sweat, vomit, displaced dentures, seizures, blood, piercings. But this is a good seal. Squeeze, release. Rise, fall. She pinks up.    

"Crisis averted." Iain sets up the IV. "What's your plan?"  

"Obvious history. Tracks." I go over the algorithm. "Narcan."

"Pupils?"  Iain holds open her eyelids. 

"Pinpoint."  

The shhhh of oxygen in the tubing. Someone outside says fuck, fuck, fuck.

"She's going to be pissed." Iain secures her hands to the stretcher with Velcro restraints, which are not in the algorithm. He watches my face. "Would you rather she punches you? You're wrecking her high. She worked hard for it."

Squeeze. Rise. Release. Fall. Repeat. Rise, fall. Beautiful pink cheeks. Sticky mascara on her eyelashes. Grey shadow. Brows in tidy, powdery arches.  

"But I'm the reason that she's even breathing right now." 

"I tie down my overdoses." Iain finds a vein, slides in the catheter, the flush of blood up the line before the saline pushes back. "When it's your bus and you're in charge, you can go ahead and let them break your nose." He holds out the ampule, a syringe. "Time for the magic show." 

Within moments, she's bucking the airway, gagging. Eyes wide, pupils dilated.

"Welcome back." Iain pulls out the tube.

"What the fuck?" She strains against the restraints. "Let me the fuck out of here."

"Not so fast, sweetheart." Iain sits the stretcher up, but he doesn't take off the restraints. 

"Let me go!" She thrashes on the cot.  

She looks familiar now. But maybe only because she looks like the girl in the picture of the girl who was so still and grey. 

"You'll go down again if we leave you," Iain says. "You're coming to the hospital."

"No, I'm not."

"Yes, you are," Iain says. "Say thank you to the nice paramedic who saved your life. You're her first overdose."

"Fuck off." She glares at me. "Let me out."

"Say thank you," Ian says.

"Where's my boyfriend?" she says. "Let me out."

I want her to be quiet again. I want her to lie still. I want her to be the grey girl in the picture. 

After she's been triaged, we let her off the cot.  

She bends over to tie her sneaker and I catch a glimpse of the tattoo on her lower back — a crude heart with feathery wings.  

I've seen that tattoo before.  

*****

She was sitting on a stool at the bar with Tony — lumberjack coat, a police-issue baton tucked in one inside pocket and a mickey in the other, a thick jumble of keys on her belt. Tony works at the hotel up the street from the bar. Her desk is behind bulletproof glass, in a tiny office by the front door. She buzzes people in, changes light bulbs, calls the exterminators for cockroaches and bed bugs, mops the halls. She tells the girls that they look pretty when they head out to work. 

Tony's big hands around this girl's tiny waist. You're beautiful, she said. The girl said what fucking planet are you from? But she let Tony pull her to the bathroom, slender fingers with long painted nails circling Tony's wrist, the one with the scars.    

I'd held Tony's wrist before. I'd run my fingers along those faded lines. I kissed her there once. She called me beautiful. I just stared at her, not sure what to say, so she said it again. You're beautiful. I think you're beautiful. 

Tony has things to offer. A bump of cocaine, a hit of acid, ecstasy, a pin-rolled joint from the tin she keeps in her back pocket. She'll tuck a girl inside her jacket, let her cry on her shoulder. 

The girl tears off her hospital bracelet.  

"You got a cigarette?"

"Don't go," I say. "Not yet. The Narcan only —"

"I know all about Narcan."  

The PA overhead beeps. Code Blue, Trauma 1. Code Blue, Trauma 1.

"No cigarette?"

When she was grey and quiet and still, she was beautiful. 

"Whatever. I'll get one in the waiting room." She pulls her hair over a shoulder, slips an elastic band off her wrist and makes a ponytail. "What the fuck are you looking at?" 

*****

Tony came back to their drinks alone, eyes sparkling. The girl headed for the stairs to the street, the winged heart framed by her waistband and halter-top.   

Tony has things to offer. A bump of cocaine, a hit of acid, ecstasy, a pin-rolled joint from the tin she keeps in her back pocket. She'll tuck a girl inside her jacket, let her cry on her shoulder. Or she'll hail a cab and hold the door. She used to walk me home, her hand at the small of my back. In return, girls let Tony slide her big hands up their skirts, pull aside panties. Calloused fingers that smell of bleach and cigarettes. She's a heavy breather. A good kisser. She means it. Your back against the wall, her knee between yours, her arm above your head as she leans in.

Tony watched the girl leave too. I felt a tiny flare of jealously, even though I was the one who told Tony that I didn't want —

That I didn't think that she and I were —

In all honesty, I was scared of her.

Tony finished her drink, and then ambled onto the dance floor with her signature swagger. She headed for another girl dancing alone in the dark corner by the speaker, wide hips in low-rise jeans, a belt with glittering stars. Tony's lips at her ear. You're a beautiful thing.

*****

I follow the girl to the waiting room. She collects two cigarettes from a man with bleeding knuckles and a black eye. She slips one into her bra and lights the other as the door wheezes open. She heads for Burrard Street. Business suits and pressed skirts and briefcases and cell phones and everyone is wearing black, but there are her pink sneakers and long, pale legs, her ponytail bouncing as she crosses the street.

"Hey, Paramedic." One of the nurses pulls me into the trauma bay. "We could use a another set of hands."  

The steady thump of chest compressions as the doc asks for this med, that one, draw up more epinephrine, call the RT. We'll need to intubate. I stand behind a nurse — she is up on a stepstool, pumping on the woman's chest. Someone calls time, and we switch out. I step up, grip one hand with the other and start pumping. The woman on the stretcher stares past me. Her skin is sweaty and pale, dotted with freckles. Her cheeks are still pink.