Tyler McAndrew

It is 2009 and everyone I know is trying to get out of Syracuse.

I'm 22 years old and it will be another year before President Obama's Patient Protection and Affordable Care Act is passed, allowing dependents to remain covered by their parents' insurance until 26 years of age. By then, I will be working as an EMT, the first job I ever have that provides me with health insurance.

But right now, 9.3 million people across the country are unemployed. 46.3 million live without healthcare.1 My kitchen table is a growing stalagmite of unpaid hospital bills and letters from collection agencies. Three new scars decorate my stomach, each indicating the route by which a laproscopic camera, a fiber optic light, and a small blade have been inserted in the removal of my appendix. Even after the hospital's financial hardship discount, the surgery bill comes to more than $10,000, not including the additional costs of ER services, radiology, and post-surgical care. This is, according to my recent tax return, more money than I have made in an entire year.

It is 2009 and the U.S. Census Bureau defines the poverty line for a single individual as $10,956 or less per year.2

Fast forward: the first thing you learn when you become an EMT is to treat every situation as a potential emergency. Symptoms can be misleading and what seems like a mild complaint could be indicative of a more serious underlying problem. The classic example: a person who appears drunk, presenting with slurred speech, poor motor control, and acetone breath, might actually be suffering a severe diabetic emergency. It is better to treat every patient fairly, to take precautions and assume the worst, than it is to be responsible for further damage on account of skepticism or neglect.

Becoming an EMT allows me to quit my job working the line in the mailroom at the local newspaper, where lay-offs and mandatory unpaid furloughs have become epidemic, proof of the headlines we regularly print regarding the economic recession. It will be an opportunity to see things that I wouldn't otherwise get to see in a city that I'm convinced has nothing left to offer me, and it will be a way to make tangible, visible impacts on the lives of other people while I struggle to cope with the stifling helplessness of post-college, Recession-era life in a city that has been slowly dying since the 1950's.

Syracuse, New York. Population: roughly 150,000. Land area: 25.04 square miles, not including the suburbs that press against its immediate borders.3 Most famous for its record-setting snowfalls and a successful college basketball team, as well as being home to Onondaga Lake, which, for the past several decades, has been identified by environmental groups, such as the New York State Department of Environmental Conservation, as the most polluted lake in the United States.4

Before the city existed, the land Syracuse is built on was home to the Onondaga, one of the Native American tribes that make up the Five Nations of the Iroquois. Onondaga Lake is historically known as the birthplace of the Iroquois Confederacy, the place where the Five Nations made peace after millennia of war and violence.5 Today, the lake's surface is swollen with toxic mud-boils and the bottom is a mercurial stew of pesticides and sewage contamination. Since the early 1800s, the lake has served as a dump for the city as well as a number of industrial and municipal waste companies.6 My coworkers at the ambulance joke about going fishing there and pulling up three-eyed carp.

Anyone who has lived in Syracuse long enough recognizes the line that is drawn by Interstate 81. East of the highway is the university neighborhood, an area commonly referred to as The Hill. Here, you will find restaurants and art galleries. Coffee shops, grocery stores, libraries. Hospitals. All of the establishments that make a place worth living in exist within a relatively short distance.

West of I-81 is the rest of the city. The paramedic who trains me offers this description: on one side of the highway are the college kids, on the other, the black people. Walk down The Hill, away from the university, and you pass beneath the highway into patches of housing projects known as The Bricks. Past that, the empty streets of downtown. Past that, residential neighborhoods scattered amongst decaying industrial districts, boarded-up storefronts.

But like I said: working on the ambulance was partially an excuse to have new experiences that I wouldn't have otherwise. A nursing home in the middle of the night can be a terrifying place. With no light but the red glow of emergency exits, the halls fill with the sound of people crying from darkened rooms. The staff leads you to a woman who has been exhibiting stroke symptoms for the past ten hours and who, for whatever reason, has only now become a concern. You drive to the South Side, where a teenager is ODing on the floor of an unfinished house with pipes and insulation still exposed on the walls, plastic-covered windows that shake in the wind. Like playing connect the dots between nightmares, each call lands you in some hallucinatory new landscape. The homeless shelter on Oxford where half of the people are dying from AIDS. The projects on East Fayette where you have to step over puddles of piss in the staircase, where the cops refuse to enter in groups of fewer than three. But no matter where you go, you always end up back in the ER, watching convoys of stretchers roll up and down the perfect white halls.

My boss tells me stories about "the good old days," before the mid-90s, when small cameras that hang beneath the rear-view mirror were installed in each of the trucks. The cameras are activated by G-force—anytime you hit a pot-hole, accelerate or brake too quickly, or clip the curb rounding a tight corner, a red light comes on and the camera saves one minute of footage spanning thirty seconds before and after the activation. The cameras are mostly for insurance purposes, to make sure we're driving safely, but the broader effect is stress, paranoia. Back in the good old days, my boss tells me, there were no cameras, nothing to worry about. If a patient got combative or out of hand, he says, you punched him. A black eye presented no risk. You were friends with the nurses, so in your report, you noted that the patient had bumped his head while climbing into the truck. Who would you believe: the guy who is tied to a stretcher, shouting and bleeding from his head, or the calm, collected gentleman in uniform whose job it is to save lives?

The good old days.

To read the rest of Tyler McAndrew's essay, purchase issue 27.2 here.