INTO THE BREACH by Jana Abrams Karam


A Year of Life and Death with the EMS
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A disturbing descent into the maelstrom of city life with a New Jersey EMS team.

“Coming upon decapitations, hemicorporectomies (bodies torn in half), suicides, child abuse, miscarriages, and other troubling scenes is stressful,” remarks journalist Karam with stunning understatement. For more than two years, she worked with an emergency medical service unit operating out of University Hospital in Newark, a municipality particularly rich in urban malfunctions thanks to its extreme poverty and severely overused road system. Karam shadowed several teams in a unit divided among BLS (basic life support), ALS (advanced life support), Rescue, and Dispatch. Her method is to accumulate anecdotes, which over time add up to character profiles of her EMS team members. It’s character, as much as equipment and skill, that keeps this service going. Here’s a typical start for BLS partners Benny Cardona and Vince Callahan: their evening “warms up with a feverish, sexually active woman with AIDS and severe stomach cramps; a psychotic middle-aged man who tried to ‘stick up’ the Cozy Corner bar with a ‘stick’; and a middle-aged diabetic man vomiting blood.” Excretions of all kinds are par for the course. “Blue-shirts” inch into incredibly squalid living quarters, moderate the continual drama of sex, violence, and intoxication (by alcohol, heroin, bug spray, etc.), and try to remember why they are doing this. It isn’t unusual for a BLS unit to haul a 300-pound emergency case down four or five flights of rickety stairs, while trying to keep control of 60 pounds of equipment. Towards the end, the anecdotes prove too much of a good thing, crushing Karam’s more general portrait of how the medical and security infrastructure functions in a large city.

Medical melodrama will always be a TV staple, but this searing tour of duty suggests that an EMS docudrama would never work: few could bear so much reality.

Pub Date: Nov. 1st, 2002
ISBN: 0-312-30617-2
Page count: 304pp
Publisher: St. Martin's
Review Posted Online:
Kirkus Reviews Issue: Oct. 1st, 2002