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Ron Riekki’s latest book is The Way North: Collected Upper Peninsula New Works, Wayne State University Press.

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Ron Riekki

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The HIV patient with esophageal varices vomited in my partner’s face.


The blood did a swipe across his eyes, mouth.

He leaned up to me and I saw him in the rearview.

“Tell them we have two patients,” he said and went in back.

Esophageal varices is a volcano of blood.

Patients with it can aspirate. Choke. Die.

Not much we can do other than transport.

Los Angeles.

West Hollywood.


Brad Pitt isn’t far from us right now. Buried somewhere in this night. The exact opposite of us.

The city looks like it has hepatitis. All the people crossing the street, going into restaurants, in line, drunk, sitting with signs at stoplights, running, late—they all seem like leukocytes, erythrocytes, an aggressive production of antihepatitis antibodies. Bodies as antibodies.

My partner is an idiot. You wear a mask. You sit at a 45-degree angle. And, if they have HIV and esophageal varices, you sit behind them. You make sure they have an airway. You take their BP once and then just monitor them. Lie about their vitals. Otherwise, you can end up a patient.

Do we have a sink in the back of an ambulance?

Course not.

Can he clean up? These critical moments when he needs to decontaminate. Nothing he can do.

Spit. Over and over.

Curse. Over and over.

Blink. Over and over.


If he’s infected, his body is raging right now. An intense response.

We’re lights and sirens. And in his body, alarms are going off everywhere.

Secondary response.

The man has spit up, vomited so much blood at this point that it’s sloshing in the back of the vehicle. The floor red. I hit the brakes for a stoplight (and yes, ambulances are required by law to stop at those) and the blood sloshes up towards me.

We get paid shit, by the way.

If you ever see a paramedic, an EMT, those are people barely getting by.

Those are people who live in the hood.

Who bring their own lunch to work. Put it in back of the ambulance where patients cough on it.

We eat bacteria.

We drink viruses.

That’s our job. To expose ourselves.

Decent exposure.

We get to the hospital.

Mark, that’s my partner. Mark wants to abandon the patient. Wants to run inside, wash, clean, rewash, rush to the doc and demand some miracle treatment. Antivirals. $2800 a dose.

If he’s infected, his whole insides are being changed forever.

He’s diaphoretic. Sweating.



The vital signs of worry.

Just got his paramedic license and this is his congratulations.


Welcome to the team.

I tell him if he leaves me with the patient, that’s abandonment. He can get fired, sued.

The patient is the priority.

We bring him in.

Blood man.

Down his shirt.

That gets attention.

So does a partner who looks tachycardic with worry. Wearing a blood beard.

The nurses swoop in.

In paramedic school, they tell you nurses are worthless. They look at charts. They sleep at night. They sit. They flub vitals. They’re worthless. Over and over, they tell you that. Worth less.

Truth is, minus a select few, nurses are better than docs. They defibrillate the world. A world full of dysrhythmias and they organize it all.

If you can ever marry a nurse, do it.

They’re pixies.


Fairies with stethoscopes.

Jesus Christ was a nurse.

Trust me.

Gandhi, a nurse.

Mother Teresa, nurse.

I sign some papers. The nurse signs too. And we’re clear of the patient. He can die now and it’s cool. He can ascend to the heavens for all I care. I’m free. I did my job. I drove.

I look at my shoes. They’re clean. They shine.

My partner is gone. I ask the head nurse what I should do. But Mark’s been whisked off. Swooped into the medical system. Like the court system. A vast array of veins and arteries and capillaries that will suck you in and sweep you away until you disappear. Sometimes forever.

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