16. Nash
NASH
The specialized ringtone cuts through the ambient noise of the ambulance station like a blade. Three short bursts, pause, three more. My blood doesn't run cold—it never does anymore—but my hand moves to the burner phone tucked inside my jacket with practiced efficiency.
"Callahan, you're up." Rodriguez jerks his thumb toward the garage where our rig waits. "Overdose on Fifth Street."
The message deletes itself after fifteen seconds. It always does.
"Coming." I slide the phone back into my jacket and grab my gear bag, my expression neutral. Rodriguez is a good guy—ten years on the job, two kids, coaches little league on weekends. He doesn't need to know that the call we're about to run isn't quite what it seems.
The ride to Fifth Street takes twelve minutes through afternoon traffic.
Rodriguez drives while I run through my mental checklist. Marcus Chen.
The name doesn't ring any bells, but that's not unusual.
The people who end up on my burner phone's hit list are typically small-time players who've made big-time mistakes.
Drug dealers who skim off the top. Bookies who forget where their loyalties lie.
Informants who talk to the wrong people.
I don't ask questions about why they deserve what's coming. In this business, curiosity is a luxury I can't afford.
The apartment building is a five-story walk-up in one of those neighborhoods that's trying desperately to gentrify but hasn't quite shaken its gritty past. Rodriguez parks the ambulance outside the main entrance, and we grab our equipment from the back.
The weight of the defibrillator case feels heavier than usual in my hands, though I know that's just my mind playing tricks.
"Third floor," Rodriguez says, checking his notes. "Anonymous caller reported an unresponsive male."
We take the stairs two at a time. The building smells like stale cigarettes and industrial cleaner, with an underlying note of something less pleasant that I try not to identify. The hallway on the third floor is dimly lit, fluorescent bulbs flickering intermittently.
Apartment 3B sits at the far end of the hall. The door is slightly ajar.
Rodriguez pushes it open and calls out, "EMS! We're coming in!"
No response.
The apartment is small and sparse—a studio with a kitchenette that's seen better days and a fold-out couch that serves as the bed. Marcus Chen is sprawled on the floor beside the couch, his face a disturbing shade of blue-gray. Empty pill bottles are scattered around him like confetti.
"Shit," Rodriguez mutters, dropping to his knees beside the victim. "This doesn't look good."
I set down my equipment and take in the scene with clinical detachment. Chen appears to be in his late thirties, thin build, wearing jeans and a faded band t-shirt. His breathing is shallow and irregular—maybe four breaths per minute. His pupils are pinpoint, classic sign of an opioid overdose.
Under normal circumstances, this would be straightforward. Naloxone, artificial ventilation, IV fluids if needed. Chen would probably be conscious and complaining within minutes.
But these aren't normal circumstances.
"Pulse is weak and thready," Rodriguez reports, his fingers pressed against Chen's neck. "Respirations are maybe three per minute."
I move with the practiced efficiency that comes from five years of emergency medicine, but there's a subtle difference in my actions. When I check Chen's airway, I'm a fraction less thorough than usual. When I prepare the naloxone injection, my hands move just slightly slower.
It's not enough for Rodriguez to notice—I'm still doing my job, just not quite as aggressively as I could be.
"Narcan's going in," I announce, administering the injection into Chen's thigh muscle. Under normal circumstances, I'd be preparing a second dose immediately. Instead, I take my time checking his vitals again.
Rodriguez starts manual ventilation with the bag mask, forcing air into Chen's lungs with steady, rhythmic compressions. "Come on, buddy," he mutters. "Don't do this today."
I watch the monitor as Chen's heart rate fluctuates between dangerously low and barely detectable. His oxygen saturation hovers in the seventies—not immediately fatal, but not sustainable long-term either.
"Should I prep another dose of naloxone?" Rodriguez asks, sweat beading on his forehead despite the cold apartment.
"Let's give this one a minute to work," I reply, my voice steady and professional. It's not technically wrong—sometimes naloxone takes a few minutes to show effects. But I know that in a case this severe, immediate re-dosing is usually warranted.
I kneel beside Chen and check his pupils again, using my penlight. Still pinpoint. His skin is cold and clammy, with that waxy quality that suggests his circulation is shutting down.
"BP is dropping," Rodriguez reports. "Eighty over forty."
I nod and reach for the IV kit, but my movements are deliberately measured. By the time I get the line established and start pushing fluids, precious minutes have ticked by.
Rodriguez glances at me, and for a moment I think he might question my timing. But then Chen's breathing becomes slightly more regular, and Rodriguez's attention returns to the patient.
"There we go," he says with relief. "I think he's responding."
Chen's eyes flutter open briefly, unfocused and glassy, before closing again. His breathing improves marginally—enough to keep him alive, but not enough to bring him fully back to consciousness.
"Let's get him packaged and transported," I say, already reaching for the backboard. "He's going to need ICU-level monitoring."
We work together to secure Chen to the backboard and carry him down to the ambulance.
Rodriguez climbs in back with the patient while I take the driver's seat.
The hospital is eight minutes away under normal conditions, but I take a route that adds an extra two minutes to our response time.
Not enough to be suspicious, just enough to matter.
In the rearview mirror, I can see Rodriguez working over Chen, adjusting the oxygen flow and monitoring his vitals. He's a good paramedic—thorough and compassionate. But I also notice he hasn't administered a second dose or done more for him.
Like he knows something neither of us are saying.
The emergency department at Mercy General is controlled chaos, as always. We wheel Chen into trauma bay three, where Dr. Sarah Kim is waiting with a team of nurses. I've worked with Kim before—she's competent but not overly curious about the details of how patients arrive in her care.
"What do we have?" she asks, pulling on gloves.
"Thirty-seven-year-old male, apparent opioid overdose," Rodriguez reports. "Found down in his apartment, pinpoint pupils, shallow respirations. We gave him four milligrams of naloxone with minimal response."
Dr. Kim nods and begins her assessment. I watch as she checks Chen's pupils, listens to his heart and lungs, tests his reflexes.
Her expression remains professionally neutral, but I catch the brief glance she gives to one of the nurses—a subtle communication that suggests she's received her own set of instructions about this particular patient.
"Let's get him on continuous monitoring," she says to the nursing staff. "And prep another dose of naloxone, but let's see how he responds to supportive care first."
The phrasing is careful, diplomatic. To Rodriguez, it sounds like standard medical practice. To me, it sounds like confirmation that Marcus Chen's recovery isn't exactly a priority for the medical team either.
We transfer Chen to the hospital bed and hand over our equipment. Rodriguez completes the paperwork while I gather our gear, both of us moving with the efficient routine of professionals who've done this thousands of times.
"Think he'll make it?" Rodriguez asks as we head back to the ambulance.
I shrug. "Hard to say. Depends on what he took and how much. Some of these street drugs are stronger than they used to be."
It's a non-answer, but Rodriguez accepts it. He's seen enough overdoses to know that survival often comes down to luck as much as medical intervention.
We're barely back in the rig when the next call comes through dispatch—a cardiac arrest at a senior living facility. Rodriguez lights up the sirens and we race across town, the Marcus Chen call already fading into the background.
This time, there's no burner phone message. This time, I pour everything I have into saving a life. I work with the kind of aggressive precision that made me top of my class in EMT training, the kind of focused intensity that Rodriguez has come to expect from me.
The elderly woman we're treating responds beautifully to our interventions. Her heart rhythm stabilizes, her breathing improves, and by the time we get her to the hospital, she's conscious and asking for her daughter.
"Nice work," Rodriguez tells me as we clean up our equipment afterward. "You've got good instincts."
If only he knew.
The rest of our shift passes without incident—a minor fender-bender, a kid with a broken arm from playground equipment, an anxiety attack that turned out to be nothing more serious than too much caffeine. Normal calls with normal outcomes.
It's after seven when we finally clock out. Rodriguez heads home to his family while I head toward the subway.
Ten years ago, if someone had told me I'd be taking money to let people die, I would have laughed in their face. But ten years ago, I still believed the system worked. I still thought good people got saved and bad people got punished and the world operated according to some kind of moral logic.
New York City taught me differently. It taught me that sometimes the people who deserve to die walk away clean while innocent kids get caught in the crossfire.
It taught me that justice is a luxury that most people can't afford, and that sometimes the only way to make things right is to make sure the scales tip in the right direction.
Marcus Chen won't be missed by anyone who matters.
Whatever he did to earn a spot on someone's hit list, it was probably something that made the world a little bit darker.
My phone will buzz tomorrow with a notification about a bank transfer—enough money to cover my rent for two months and help fund the clinic in Queens where I volunteer on weekends.
I have far too much in that account for an EMT, but I don't live like it—the nest egg is nice.
It's a trade-off I can live with. It has to be.