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wrecked and broken place; it’s apparent in the way everyone yells their hellos and seems to know each other.
    Ruth and Carl wave their own hellos at a trio of transients standing in an alley. “I’ll bet you lunch we pick up Sadie before eleven,” Carl says.
    “By nine,” says Ruth.
    Our first call comes in at 0816. I’m beginning to recognize my pager’s language: “57/ M ALOC” means a fifty-seven-year-old man has an altered level of consciousness. Ruth pronounces every acronym as if she were reading off the letters of an eye exam, but Carl refers to this one as “A-lock.”
    Ruth hits the gas as she flips on the lights and sirens. “Map me to my call!” she yells. “If I make it before you’ve mapped me there, you’re going to polish our boots.”
    I open my Thomas Guide and quickly reel off directions to 134 Kansas Avenue, but Ruth shows no sign of approval. She switches to quizzing me as she swerves around cars, her aggression clearly habitual. “What are possible reasons a person might be altered?”
    It’s shocking to witness how many drivers refuse to pull over to the right.
    “They could be hypo- or hyperglycemic, or it could be a drug overdose or a stroke. They could be in shock, maybe from trauma. Like a blunt force injury to the head?”
    “Normal range for blood sugar?”
    “Between 70 and 140.”
    “What’s hypoxia?”
    “Hypoxia. Hypoxia. That’s when brain cells are deprived of oxygen…” My brain is being rattled for loose change. “Oh, right! If a person has a seizure, there’s the post-ictal phase afterward, when they’re disoriented.”
    “How do you treat a seizure?”
    “Turn them onto their side so they can’t choke on their tongue, give them oxygen, do a rapid trauma assessment for injuries.”
    “Stroke?”
    “Check eyes, motor, verbal, try to get onset and duration from witnesses.”
    Carl adds playfully, “I’m usually ALOC on my days off. Due to EtOH.”
    “What is that?” Ruth uses even Carl’s sense of humor as a means to quiz me. “We talked about this.”
    Other drivers’ faces are a blur as they ignore the emergency vehicle’s howl and flash. People talk on the phone and sing along to music. One guy is picking his nose and looks up, caught, as we fly past. I remember the jaundiced patient the other day, the way he had reeked of booze and his eyes had lolled.
    “Alcohol? You say that if someone has been drinking?”
    “Correct. EtOH is the chemical abbreviation for ethanol. It’s a way of saying your patient is drunk without them knowing what you’re talking about.”
    She slows and parks, aligning the rig with 134 Kansas Avenue. Leaving the emergency lights on, she uses the radio to tell Dispatch we’re on scene. In front of the leaning one-story, a rusted Chevy sits on blocks inthe oil-stained driveway, and a couple of stray cats clean themselves amid the tall weeds of the front yard.
    Carl puts on a pair of gloves with a loud snap. “Let’s go say hello to Teddy boy.”
    We fall in line with the firefighters, who arrived moments before us, moving up the driveway, the gurney bouncing along in concert with the gaping cracks in the pavement. One of the firefighters, who looks as though he is never not in uniform, thrusts his chin in my direction.
    “Who’s the boot?”
    “Piper.”
    “They treating you okay, Piper?”
    “Yes, sir.”
    “Don’t call me ‘sir,’ it makes me feel old. I’m Vick.”
    “Hi, Vick.” I smile at him and turn my head just in time to see Ruth glowering at me.
    The front door is ajar and leaning off its hinges; we lift the gurney inside. Vick is in charge. He calls out and there’s no answer. We walk into the next dimly lit room and see a shape sprawled on the couch. One of the firefighters searches for a light switch with his flashlight. I can just make out his reflective yellow pants moving around the room, the glow of the flashlight’s halo swiveling above.
    When weak light spills from an overhead lamp, I