The combination of Alma’s obesity and the water-balloon-like consistency of her body makes it almost impossible to lift her. My partner and I grab the sheet beneath her and with it manage to slide her from her bed onto our gurney. Her fat fingers are wrapped around a liter of coke and a box of powdered doughnuts. When I tell her she cannot bring food into the ambulance, she glares at me and pulls her contraband close to her chest, tightening her grip. We begin to argue. I kindly remind her that she is hyperglycemic and she should not be eating so much sugar in the first place. She tells me to shut up. Being that her argument is better, I tell her that she can bring her food if she lets me carry it in a closed plastic bag. With pursed lips she reluctantly accepts my offer, letting me know that she is doing me a huge favor. 

In the back of the ambulance, supine on the gurney, Alma’s squishy flesh folds over the straps that struggle to keep her in place. Her large breasts hang over the sides of the bed; the left one periodically brushes against my knees causing me to throw up a little inside my mouth. I can’t remember why I wanted to become an EMT. Alma’s quick, heavy breathing makes me uncomfortable and I find myself praying that when she finally falls into a diabetic coma that it not be on my watch. I lift the back of the bed a little so that she can breathe better and she screams out in pain. I calmly lower her back down and ask her what is hurting. Alma says she feels unbearable pain in her right foot — the foot of a leg that was amputated over a year ago. 

The other EMTs have warned me about Alma. They say she is a pain in the ass and completely insane. They say there is nothing you can say or do to comfort her. I am annoyed by her but when she complains of pain in her nonexistent foot I believe her. She watched her foot die while it was still attached to her body and then one day it was gone. I don’t think that she is crazy. I think of the people I have loved that are no longer with me and their absence causes me pain. But when I talk about them, I feel like they are with me and it’s not so bad. I think I can relate to Alma. So I ask her to describe the pain in her foot. I ask if she would like me to put a pillow under her feet. Maybe that would help ease the pain. She says she doubts it but I can try. I lift her left foot and place it on a pillow. I do the same with the invisible right foot and sit back down. I ask her if her foot feels any better. She stares at me long and hard and then shrugs. Alma spends the rest of the trip telling me about her lazy husband and her disappointing children. 

We arrive to the dialysis center and the nurses roll their eyes when they see Alma. They offer no help as my partner and I struggle to move Alma onto her chair. I say goodbye to Alma and she ignores me, her attention completely focused on the soap opera playing on the clinic’s small t.v. I climb back into the ambulance discouraged. My attempt to connect to one of my patients has failed. A few hours later my partner and I receive a call from our dispatcher saying that Alma specifically requested that we be the ones to take her home. On our way back to the dialysis center, I wonder if I have in fact made a connection. Excited by the prospect of being the world’s greatest EMT, I cannot wait to see Alma. I walk over to her chair and I notice that she is tired from the treatment. But she smiles as soon as she sees me. Success! On our way over to the ambulance, I ask Alma why she wanted me to pick her up. I flash her my most irresistible smile and ask her if it was because she had a good time riding in the back with me earlier. She stares at me blankly and says “no. I forgot my doughnuts.” I think she likes me.