He was a big man, sprawled limply across a bed in a tiny back bedroom on Mentone Avenue. He just couldn't seem to stand up, he said. "When I lay down and tried to get up again, I couldn't," he said.
The man looked at the two paramedics with bewilderment. Someone had pulled his T-shirt up over his stomach and loosened his belt, and his beefy arms lay lifelessly at his sides. "I can't move my legs," he said.
Matt Thompson, a 15-year veteran of Pasadena's corps of paramedics, bent over the man, peering into his face like a detective searching for clues. Thompson's partner, Todd Witt, slapped some adhesive patches onto the man's chest. One-two-three-four-five, each patch was connected to a wire.
"We're going to check your heart now," Witt said. He switched on the Lifepak, a portable life-support machine. It began to beep regularly, and a graph of the patient's heartbeat began to unroll on a little screen.
It was a fairly routine case, in the middle of the paramedics' hectic Wednesday shift. "We get many, many cases like it every week," Witt said, shortly after the ambulance had taken the man to a hospital.
By 8 Thursday morning, the end of their 24-hour shift, the two paramedics had handled 11 cases, charging along city streets in Rescue Ambulance 36, siren wailing and lights flashing, all over Northwest Pasadena. They had treated and transported, among others, two police officers hurt in a traffic accident, a man with a knife wound to the scalp, a child trapped in the chimney of a brick barbecue pit and a man knocked off his bicycle by a passing car.
The Mentone Avenue patient was 64, had had three heart attacks and a stroke since 1972, and appeared to have lost some motor function on his left side.
"It's probably some sort of stroke," said Witt. "Maybe his pressure built up so high he burst a blood vessel in his head."
Until recent years, paramedics were considered the city's heart attack team, equipped with hypodermics and portable defibrillators, racing to revive people in cardiac arrest.
"When I started with the city in 1975, the only thing we were expected to do was go out and take care of acute myocardial infarctions," said Thompson.
Nowadays, paramedics handle almost any medical problem imaginable, including a lot of nuisance calls--all of which they must hastily respond to.
Last year, the city's three rescue ambulances, each staffed 24 hours a day by two paramedics, responded to almost 9,500 calls for help. That was about 700 more than Glendale's privately contracted paramedic service, which has one more ambulance than Pasadena.
So fast and furious has become the pace of trauma and illness in Pasadena that, on an average of once a day, dispatchers must scour the region for private ambulances to answer calls because all three city paramedic units are tied up.
Private ambulances aren't always immediately available, said Fire Chief Kaya Pekerol, whose department has been in charge of paramedics for five years. And when private ambulances do respond, they're not necessarily staffed by paramedics, who are trained to administer intravenous medicines or to operate such sophisticated equipment as the Lifepak.
"It's like going back to the old scoop-and-run," said Pekerol, referring to a time when ambulances just picked up patients and raced them to emergency room physicians.
The city's Board of Directors this month will consider a Fire Department request for a fourth rescue ambulance. In a year when budget demands appear to be outpacing revenue, the board must consider whether to find an extra $300,000 to $500,000 to staff the ambulance or risk further overburdening the city's 30 paramedics. Three-quarters of the calls to the Fire Department for assistance are medical calls, a department spokesman said.
But ambulance service is fast becoming one of the city's biggest uncollected bills. Last year, the city billed patients for almost $2 million worth of paramedic services but collected less than half of that amount.
The problem is that, as are other cities, Pasadena is feeling the effects of a gradual breakdown of the nation's health care system, said Director Rick Cole. "There's been a wave, a crushing wave, of people with no health insurance or inadequate health insurance showing up in hospital emergency rooms," he said.
Paramedics no longer just provide emergency treatment, Cole added. They are now "the doctors of last resort" for a medically neglected segment of the population, he said.
Rescue Ambulance 36, a red-and-white 1987 Chevrolet Silverado with 110,000 miles on its odometer, operates out of a down-at-the-heels fire station on North Raymond Avenue. "Ft. Raymond," firefighters call the station, because of its isolation on the wild and woolly side of Pasadena.
The ambulance is a marvel of modern medical technology, equipped with all of the latest life saving devices: defibrillator, laryngoscope, an array of heart medications and painkillers, and a radio to keep the paramedics in contact with doctors at Huntington Memorial Hospital emergency room.
Paramedics complain that the ambulance is often used just to take mildly ill people to hospitals. "Some people just see it as a red and white taxi with lights on it," said paramedic Mike Barilla, who staffed the ambulance on a recent Monday along with his partner Myron Cooper and trainee Robert Culhane.
During their shift, an unusually tranquil one, the trio responded to a call for assistance to a woman with a "head injury." The paramedics found she had fallen in the hallway of her apartment building, bruising her knee. She elected not to go to the hospital after the paramedics examined her.
Then they raced to a "stabbing" victim, a woman who had been jabbed in the arm with a table fork by her sister. They cleansed her small puncture wounds and returned to the station house.
Such calls could represent an abuse of the system, Fire Capt. Lloyd Wade said. "Ten years ago, if a child broke his arm, his mother put him in the car and drove him to the hospital," Wade said. "Now, people call an ambulance."
All paramedics have tales of wasted trips, which they can't refuse because of the possibility of exposing the city to lawsuits.
"There's a report of someone with difficulty breathing," said Wade. "You get to the place and there's a guy sitting on the edge of his bed, smoking a cigarette. You may have tied up two paramedics and three or four men from an engine company. Meanwhile, you've got an accident on the freeway or a shooting somewhere, and you've lost valuable time."
Barilla told of responding to a "difficulty breathing" call recently and finding a woman with a head cold. "She said: 'Yeah, I have trouble. When I try to breathe through my nose, I have trouble breathing.' "
But the life-and-death calls come frequently enough. Culhane, on just the third of 20 round-the-clock shifts he must complete to qualify as a paramedic, delivered a baby. Later, he and the two paramedics revived an elderly woman whose heart had stopped while she was being bathed in a nursing home.
"That's when you really feel good," said Barilla, describing the incident.
Thompson and Witt felt similar gratification after they delivered the stroke victim to St. Luke Medical Center. It was one of those cases that had been mined with unpredictables.
Unable to get their gurney into the patient's house, the two paramedics had to carry the man, a bulky 270-pounder, to the front yard. Thompson, who prides himself on being able to insert a hypodermic intravenously on a bumpy street at 40 m.p.h., couldn't find a vein in the man's fleshy arm. Then, as Witt drove around a sharp curve, Thompson almost went sprawling across the patient.
When the patient was safely in the care of emergency room physicians, the two paramedics headed back to the relative tranquillity of the fire station. When would they get the next in that endless succession of emergency calls?
"The rule of thumb," Witt said cheerfully, "is that you expect it to come during lunch, during dinner or sometime after midnight."