The call comes in at 11:18 in the morning. Possible overdose on skid row, just half a block from one of the busiest firehouses in the United States.
Firefighter-paramedic Dave Chavez, 42, grabs a blank incident report and marches toward his Rescue 9 ambulance with partner Juan Penuelas. At 11:20, they pull out of the station, and Chavez is taking in the devastation on San Julian Street in downtown Los Angeles.
People stumble and rant, they lie in filth, they trap you with eyes that threaten and plead. Roughly 10,000 people flop on skid row streets each night, up to half of them mentally ill. The landscape is relentlessly bleak, the stench of rotting trash and misery everywhere.
We're on the scene at 11:22. The possible overdose is on her side, writhing on the grimy sidewalk. A few of her friends close in like a flock of ghosts, ulcerated skin ripped raw by needles.
The woman is 25 and says she shot up 10 hours ago. Right here in the open, where heroin is easier to buy than a quart of milk and crack pipes light the night like fireflies.
"I think it's syphilis or gonorrhea," says Sporty, a bony addict who calls the distressed woman his friend. "It's driven her mad."
No, says a female junkie. She got some bad heroin and the needle prick got infected. She was so desperately ill, they'd all been telling her to go to the hospital, but she wouldn't listen.
Chavez examines her with hands encased in white rubber gloves. She looks young and old at the same time, with broad cheekbones and haunted eyes. She squirms and wails, jerking too wildly for Chavez to get a blood pressure reading or a good EKG.
"What's your name?" he asks, trying to calm her.
The answer is mush. She tries again and again, rubber-mouthed.
It sounds like she's saying "Kristina," which Chavez writes down.
Her tongue is dry and caked, and she says her eyes are burning. It doesn't add up, says Chavez, who thinks she's "got some other things on board" besides heroin. He wants to tap a vein in case he needs to run an IV line, but she's got nothing left for Chavez to work with.
"You can see the track marks in her neck," he says, pointing out the chicken-footed etchings. Twenty-five, and she's destroyed herself, drugged out and curled up on wretched streets.
Chavez finally gets a blood pressure reading and a pulse rate of 75. She's stable, or so it seems. The siren parts traffic as the ambulance starts off on the well-worn route from skid row to County-USC Medical Center.
The firefighters call it the Big Screen. It's Station 9's gaping front door, through which they sometimes watch the show outside: the platoons of wounded vets, the mumbling hordes haunted by voices, the doe-eyed children of skull-faced addicts.
At night, crack-addled prostitutes trick in and out of Porta-Potties down the street. Amputees roll by in wheelchairs. Dealers brazenly peddle slow death. Chavez once watched an argument turn into a knife fight directly across the street from Station 9. The loser, his throat slashed, crossed the road for help, then collapsed and died in the firehouse driveway.
Skid row exists because we've created it — although until now, with the downtown renaissance approaching its borders, we've mostly been able to ignore it.
By shutting mental hospitals, adding thousands to the rolls of medically uninsured, skimping on rehab and keeping social services out of respectable neighborhoods, we've guaranteed this teeming human landfill.
Paramedics like Chavez are left to deal with the wreckage. He delivers babies on sidewalks and treats open sores crawling with maggots. He can tell you about Naked Man, who strolls about in the buff and carries on erudite conversations as if he were in coat and tie, and about the once-esteemed professor who wandered the streets in a death spiral after his family perished in a car crash.
Chavez knows the rain will bring bogus 911 calls from those trying to scam a dry night in the hospital. He knows shoplifters in handcuffs at the local police station will fake an overdose to get out of jail.
"I try to treat everyone the way I'd want to be treated," Chavez says. "You meet some of the nicest, most interesting people out here."
On my shift with him, I saw Chavez move like a dancer under the most stressful circumstances. He gently questioned a middle-age woman who had been robbed, badly beaten and dropped next to a dumpster in a skid row alley, her left eye swollen shut and her hair a stringy, bloody mess.
"Are you with me?" Chavez called to her when she seemed to be fading out. Then, straddling her gurney, he perfectly tilted his patient sideways at the precise moment she vomited a stream of blood and mucus, knowing full well she might have choked on it if he hadn't.
He was nonstop motion, quick, nimble, calm. It was battlefield ballet.
Kristina has taken a turn for the worse on the way to the emergency room at County-USC. By the time Chavez and Penuelas pull her out of the ambulance, she's rigid, her eyes wide and blank.
"Circling," Chavez calls it. As in going down the drain.
"Let's get her in," Chavez says. "I've got a pulse of 32 on her."
Chavez is running as he pushes the gurney through double doors. Kristina takes what sounds like a last breath as she flies into the yellow light and constant chaos of the emergency room. The sick and wounded watch her go by, waiting their turns by the dozens, witness to the endless horrors that race in off the street and crash through the door.
It's in the hands of doctors and nurses now. A team of 10 closes in around Kristina, with four students peering down from a balcony to see how it's done. Chavez hangs around in case they've got questions for him and because he still can't figure out why things went south so quickly.
Another overdose victim lies next to her, along with a guy who fell off a forklift.
"They've got a stabbing victim coming in too," Chavez says, and a young man comes through the doors flat on his back and covered with blood.
"He's got no pulse!" someone yells as another team goes to work on him.
Kristina is bad and getting worse.
"Clear," says a doctor, trying to jump-start her with a current.
The jolt lifts her off the gurney.
"Three hundred," says the doctor. "Clear."
Three-sixty. Another shot.
How many times has Chavez seen this? Too many to count, and it all runs together in the end, as much of a blur as the ride from skid row to the hospital.
"We have a rhythm," a doctor says, but when I look to Chavez, he isn't ready to celebrate.
He's seen them come back for an instant and then fade just as quickly.
"Is she back?" I ask him.
Chavez looks at Kristina and then at the emergency staff.
He turns back to me and shakes his head.
"She's gone," he says.
Her eyes are still open, looking at nothing. Kristina's clothes are removed and her body is wrapped in white plastic. They make the last fold and she's gone, and the stabbing victim next to her isn't far behind.
Chavez leaves the emergency room with heavy steps. Over coffee a few minutes later, he's still wondering why Kristina turned so quickly and what did her in, besides the obvious ravages of heroin.
"I just hate that helpless feeling," he says. "You're standing there watching, and there's nothing you can do."
But the calls keep coming, so there's no time to dwell on it. Besides, Chavez has probably saved more skid row people than he's lost.
"You can't let it get to you," he says. "If it gets to you, your career is over."
Chavez should have moved on from Station 9 by now, worn down by the endless wail of 911 calls and the psychological toll. Others deal with it for a few years and then, jumpy and jaded, bounce back to firefighting. Or they transfer to quieter stations and the relative comfort of ordinary disaster.
Not Dave Chavez. He has kept this same job — a young man's job — for 10 of his 23 years with the Los Angeles Fire Department. He keeps at it because he's good and because he likes bringing along the younger talent.
And maybe, too, because there is no better way to honor his father, a retired firefighter, than to work in the busiest station and handle the job like a pro. At the end of his shift, Chavez often stops at the Cerritos home where he grew up. He and his dad sit there with their coffee and their stories, and the day begins.
Back on San Julian Street, I break the news.
"Who's dead?" Sporty asks, hyped up and jittery.
Kristina, it turns out, wasn't her real name. But nobody knows what it was. No one knows her last name, either. They think she was from El Monte, but who could say?
All they know is that she slept here among them when she wasn't in jail. They say she had a baby recently. No one knows where the baby is. No one knows anything out here, except where to get heroin. She wet herself regularly, too far gone to bother getting up, no strength left for anything but the needle.
Those are her things, someone says, pointing to a black garbage bag that contains everything the dead woman owned. No one wants to open it. It wouldn't be respectful.
The bag is still there at midnight, under three bouquets of flowers and a sign:
"We Miss You Homegirl."
Sporty is still there, 34 and a former gang member. So are most of the others who live in this encampment. A woman of 20 is sitting on a blanket, calmly lighting a crack pipe.
"We treated her like a leper," Sporty says of his fellow addict, suggesting a social order among junkies.
Even as drugged out as he is, it's eating Sporty up, the way he and others gave her such grief for not taking better care of herself.
"I feel sorry I didn't treat her a little better," he says. "I wish I had treated her with a little more humanity."
I wonder if what's really bothering Sporty is that he's dying too, killing himself the way she did. Right here on San Julian, a half block from the firehouse where Dave Chavez is waiting for the next call.
Follow Steve Lopez's experience on skid row and ride with paramedics at latimes.com/skidrow. Reach the columnist at firstname.lastname@example.org.Copyright © 2014, Los Angeles Times