Night 126 was the usual hot, swealtering Boston summer night. The kind of nights we rolled through the city with the windows up and AC on. Smells came from everywhere - always the same thing. Sticky green trees thick with a peculiar nausiating smell I always associated with the Puerto Rican neighborhoods where I grew up. Something about the heat and drenching humidity that made them that way. It mixed with everything else in our work - Blood, vomit, isopropanol. Rolling through the city in the ambulance was a way to escape the depressing heat and crime by somehow flying above it. Dropping in on situations, one after the next, and then escaping. Old Boston brick buildings, pothole streets and broken sidewalks, loud music blaring from cars, bloody drunks, kids swarming around the back of the truck to get a look at whoever we had inside, stinky food in hot crowded apartments, situations too numerous to count, quickly unravelling into clusterfucks or never turning into anythying.

On night 126 we got a call to a run down apartment complex in Roxbury. Some of these streets were legendary for murder rates. John was my partner that night, he was kinda new so I gave him the drill on locking up the truck before we got out. I didn't like the looks we were getting from some of the teenagers standing on the sidewalk. I pulled the truck partway up onto the curb at the front door of the building. I had to make sure my walkie talkie was ready, we got our equipment and went outside.

Somebody downstairs pushed the battered door open for us. It was about 7:30 and the lights were starting to come on. The front foyer had the usual wall of mail boxes, long since busted open and doors hanging useless. Hand laid tilework on the floor dated back long before the white flight changed city hands. Only one of the flourescent ceiling lights was working, behind crusty yellowed plastic and flies. The second door in had a Lexan sheet over it, and a thick spring that would slam it shut behind us. Door trim was chewed and ruined, barely holding the heavy plate over the lock. Somebody else walked us into the dark hallway. Our Mag lights bounced bright white beams over the ceiling, casting a ghoulish wash down on us as we moved through it. Dispatch traffic squalking from the walkie talkie was a way to announce our presence.

Once in the staircase, up overhead I could hear apartment doors squeaking and slamming, people shouting. We trudged up the stairs, headed for one of the upper floors. Sweaty uniform shirt stuck all over my skin. I didn't like being too far from our truck - I thought about finding a window once we got upstairs and just checking down in the street to see what those kids were doing. Every flight we walked up, people just looked at us.

We got to where someone was holding an apartment door open for us, it was about the 4th floor by this point. One of the relatives lead us into the living room. A mother was leaning over the sofa, her 4 year old son lying on his back. She was telling us she didn't know what to do, he was wimpering, he had fallen, where did he fall, out there, out there, look, over here, I had to turn down my walkie talkie, he was wimpering, somebody else was telling John, look, down there, out the window, more noise and more people at the door now...

More people came into the apartment, some of the kids from the street. "I saw him fall I saw him fall! That little boy busted his head I saw him fall!" I could hear the people talking but I was only looking at his eyes. John was talking to the others in the apartment. I opened the kid's eyelids to check for responsiveness. He was trembling. Barely any tears but scared like he dare not move. He was petrified, as if from sheer pain, but without crying - just a stifled wimpering. The mother was saying she had brought him upstairs. Four years old and she had carried him all the way up from the street down below. He had fallen from the second story window down to the street, cracked the back of his head on the top of a steel dumpster as big as a truck.

Everybody was talking and shouting. The mother was just looking from her son to us, back at her son. She kept saying she didn't know what to do. John and I both were gathering the story - The kid had fallen backwards from the window, the other kids playing below saw him bounce the back of his head off the steel rim of the dumpster wall. We checked for the usual signs of skull fracture, CSF fluid in the ears / Battle's signs behind the ears / etc. But so far he didn't show classic symptoms - only his general expression - Wimpering, but not quite crying, scared, too scared to even try to move, like he had a knife in his back.

This wasn't right. I stood up and turned to John, said to go down to the truck and bring up the short board and supplies. Already this was starting to sound unconventional. The idea of bringing up all that equipment - designed to be used on adults in car accidents - up the narrow stairs to use on a small child in an apartment building was not a classic case from EMT training. But it's what we had. And with virtually no words between us we were totally in sync. I paused and realized, for one of the first times in life, the understated significance of a decision like that. I hadn't considered myself to be particularly experienced as an EMT - boarding the kid was just what we had to do. John was really bright and one of the best partners I'd worked with, and he was just like, "cool". As he went down the stairs, leaving me with the kid and the mother and all the other people in the apartment, the whole scene somehow shifted, in a subtle way.

By the time John came back up the stairs, I had already finished examining the kid. No outward signs of trauma, except that his trembling and wimpering. He could barely move his extremities, limited by immediate shooting pain. The way he was lying there, flat on his back, whincing without crying - it wasn't normal for a 4 year old - He was immobilized by a sort of fear. As far as we were concerned it was going to be spinal trauma.

We began by slowly squishing the short board under the kid's body, pressing down against the sofa cushions. One of us held tension against his jaw while the other secured his shoulders, torso, and hips. We used tape and straps around his body, and cloth bandages around his head and against his chin. Every few minutes we re-took vital signs, especially watching for head trauma signs like pupil response. He was totally stable so we had time.

We made the whole package as secure as possible, but still allowing for a quick disassembly on the other end at the hospital. By the time we were ready to move him, the kid was wrapped against the board like a mummy.

On the way down the stairs, we had to hold him level to keep him from shifting - The boarding held spinal tension and it couldn't be disturbed. We had to keep the other people from trying to help. John was leading and I had the head, stooping over the whole way down the stairs to keep the board level.

We got out to the ambulance and loaded him in. I started up the truck, got the AC going, John was getting situated in the back. It ocurred to me that we had a dilemma. The Boston City Hospital has two separate entrances for emergency treatment: The adult side has a large ambulance bay with wide swing-out doors that lead straight in to two of the best equipped trauma rooms in the city. But the pediatric side was actually another entrance, a long flight of steps down below street level. The adult side was always busy and well-staffed, with all sorts of critical care trauma and lots of equipment - They had gunshots, stabbings, facial avulsions, you name it. On the other hand, the pediatric entrance, far down below street level, was a small waiting room with ear infections.

So I pulled the ambulance down off the curb and started up the lights, keyed up the radio to call ahead for a patch to the BCH ER and advise them of our approach. Would they want a 4-year old CNS trauma patient lugged down the stairs and put next to baby fevers, or laid out in a fully-equipped trauma room on the adult side? Problem was, I couldn't get any response. The radio wasn't working. (I found out later the kids on the street had climbed over the truck and snapped off the antenna.)

When a suspected spinal fracture is boarded up and has stable vital signs, there's no need to go speeding over Boston potholes and racing through red lights. I drove along priority-2, lights only and siren on demand, still trying on the radio. I tried on my walkie talkie but it was stuck down on my belt, locked in a swing-out safety holster that required flipping it upside down to get it out. Being wedged down in the seat like that it wasn't quite tripping city dispatch.

I finally just gave up on the radio and told John the rest of the plan: We'd have to go into the adult side of the Boston City ER, without authorization. The BCH is usually the busiest ER in the whole city. Sometimes a total cluster in there and you can't even stop to tie your shoe as it might disrupt the whole flow of things. Plus, pulling something like rolling a 4-year old kid into the adult side of BCH trauma was sure to spark ridicule from other EMT's. And it would really be a mistake if we got turned away from the adult side.

John was a little concerned - He leaned up through the cabin port from the back of the ambulance and reminded me the plan could really backfire. But the idea of sending our patient down more long stairs to the pediatric side just didn't seem right.

We finally got to City Hospital and I backed the truck into the adult ER ambulance bay. This was it. I went around back, John opened the doors, and we unloaded the stretcher onto the ramp. I smacked the wall plate to swing open the hospital doors, and rolled our 4-year old inside.

I found the triage nurse, just as people were stopping to look at our mummy kid. The nurse was starting to say "pediatric entrance..." as I quickly explained he'd fallen 2 stories and cracked the back of his head on a dumpster - did they really want us to trudge all the way over to pediatrics with him? Just then a doctor came over, saying no no no, this isn't the pediatric side. Why didn't you call us? Something's wrong with the radio. Look, he's got a suspected spinal fracture... The triage nurse is supposed to decide who goes where, but with the doctor standing there he didn't say anything. The doctor was doing the scolding.

Then a second doctor came over, this time somebody I didn't recognize. Taller, too. He snapped, to the first doctor - "No!" "No, he is our patient!" He pointed his finger. He looked at me and quickly said "it's OK we'll take him" Then right back to the first doctor and seemingly threatened to shout again. Wow this was serious. I was looking for a way out. The triage nurse knew when to take sides and he started pulling the stretcher into Trauma-2. These are the rooms with the huge bright lights and equipment on rolling carts pushed back in a neat circle around the single table in the middle. I heard the second doctor yelling again, further away. The kid was gone.

I dropped back outside, John had already gone out and I don't blame him. It was my call and my fault. I was shaking. We stood behind the ambulance and I told him what had just happened. But somehow it wasn't so crucial to me. This was night 126, and there were hundreds of nights like this, but it wasn't really my career, just a chapter that has since vanished.