Photograph

We were sitting in the ambulance, parked at the pedestrian mall known as Downtown Crossing, when the call went over the air.

"It’s a man down," the dispatcher said, giving the call to a pair of EMTs in the Back Bay. "Inside the men’s room, at the mall on Huntington Avenue. No further information."

“Just watch,” I said to my partner. “We’ll be added to that call even before the other ambulance gets there. Somebody else will call to say he’s not breathing. It’ll be a heroin overdose.”

My partner just smiled and nodded. We’ve had a lot of heroin overdoses lately--most of them, like this call, in public rest rooms.

Sure enough, less than a minute later, the radio sounded again. The dispatcher sent us to the same call. Just as I’d predicted, someone else had called 911, and had described the man as unconscious. The shift commander said over the air that he’d respond, too.

I was wrong about a couple of things, though. We arrived to find that the man hadn't overdosed at all. He was fifty-two years old. He wasn't only unconscious, but dead.

Firefighters started CPR. My partner inserted an endotracheal tube. I started an IV. The line on the cardiac monitor was flat. We gave him some epinephrine and atropine. The line on the screen jumped up and down. Our medications had caused his heart to quiver, a condition known as ventricular fibrillation. This is better than a silent, motionless heart, but not by much.

I told everyone to move away from the body. Then I pressed a button on the monitor. A high-pitched warning tone sounded. I pressed another button, sending a 200-watt jolt of electricity through his body. His arms shot up from the floor, his back arched, and then he was still again. A faint odor of burned flesh hung in the air.

My partner checked for a pulse. There was none. The line on the monitor was again flat. We gave him more epinephrine, more atropine. One of the EMTs pumped on his chest some more.

And so it went, back and forth, the heart quivering for a while, then going silent, as we kept shocking him and giving him more medications. Finally it was time to bring him to the hospital. Technically, we could have declared him dead right there in the men’s room, but being a public place, that would have been inconvenient for everyone. It was easier simply to continue CPR and bring him to the hospital. He could be pronounced dead there.

As we got ready to leave, the shift commander rummaged through the man’s backpack, looking for identification. He pulled out a couple of newspapers, a Teamsters’ Union membership card, a family pass to a local museum. Then, at the bottom of the bag, he found a cell phone. Turning it on, he turned it toward me and said, “I wish I hadn’t seen this.”

The screen on the phone had been loaded with an image of the dead man. In the photo he was smiling, surrounded by four young children. Those were his children, undoubtedly, which would explain the family museum membership.

Suddenly, the whole thing felt a lot more tragic. It was bad enough that the man had to die. Sadder still was the fact that he had died unexpectedly, apparently with no time to prepare. But until then, as far as we were concerned, he'd been an anonymous figure. We'd never known him in life. In our minds, he was more of an object than a person.

That photograph changed everything. To some extent, he'd lost his anonymity. He was a real person, with a real family--people who knew him and loved him, and would grieve his passing.

Later that night, in a house somewhere in the Boston area, four little kids would learn that they would never see their father again, not even to say goodbye.

And that was a fact I could have done without knowing.