Published: May 25, 2008

In the early 1990s, lacking direction after a breakup with a girlfriend, Shannon Burke left New Orleans (where he’d been working in a bookstore), moved to New York and took a job on an ambulance crew. He was drawn to emergency medicine partly out of guilt, he later explained to a paramedic friend. Back in the French Quarter, he had come upon a tourist, shot in the head, and had been unable to help her. “I thought I should have known first aid,” he recalled. “Like I could have saved her.” Burke went to Manhattan as a kind of personal test because “I figured it would be the most extreme place to do it.” In the five years he served on city ambulances, first as an E.M.T., later as a paramedic at Station 18, on 136th Street across from Harlem Hospital, he saw unspeakable horrors. Unspeakable, but not inexpressible.

In two searing and morally resonant novels — “Safelight,” published in 2004, and now “Black Flies” — Burke has wrestled with the meaning, and meaninglessness, of the suffering and human failings he witnessed during those disturbing years, both among the patients he treated (many of them malingerers, addicts and criminals) and the medics he worked with, some so hardened by their years on Harlem’s front lines that they would brutalize patients out of spite.

Although “Black Flies” is a novel, it contains more reflections of lived experience than some memoirs (particularly recent memoirs). Reading this arresting, confrontational book is like reading “Dispatches,” Michael Herr’s indelible account of his years as a reporter in Vietnam. Like Herr, who endured the ordeals of warfare at first hand but at a journalistic remove, Burke was both a participant in and an observer of the scenes he records, distanced from the men he worked with by his capacity to isolate and analyze his memories and by the fact that he had not been compelled to join the fray but had chosen to do so.

Be warned: as in “Dispatches,” many of the most vivid scenes in “Black Flies” make for harrowing reading. Visceral and mercilessly detailed, they are not included for sensational purposes — not as an E.R. version of “war porn.” Instead, Burke uses them as shock treatment for the conscience, like the paddles that resuscitate a 12-year-old girl who has been electrocuted. “It was the most eerie, unnatural thing I’d ever witnessed,” says the medic who saves her. “I watched death recede from her.” For anyone who has flirted with fashionable jadedness or suffered disappointments that led to a sullen fascination with the darker side of human experience, Burke blows apart the pose.

The protagonist in “Black Flies” is a rookie, Ollie Cross, who becomes a paramedic after failing to get into medical school. Eager for acceptance from the pack of regular guys at Station 18, Cross is overwhelmed by the traumatic nature of the job, ashamed of his comfortable middle-class background and determined not to appear “soft.” He studies the most brutish of the medics as if they were textbooks of masculinity. Early on, he and his partner, Rutkovsky, a laconic hothead, inspect the body of a girl who has jumped off a building. As they work, an E.M.T. holds up a stray piece of flesh “the size of a hockey puck” and asks what it is. “Without even slowing,” Cross observes, “Rutkovsky said, ‘Hard palate. Knocked it right out when she hit.’” Rutkovsky returns to the ambulance and starts eating his takeout meal of sesame chicken, even as the dead girl’s mother smacks at his window and screams at him for not trying to revive her daughter. Sympathizing with the mother, Cross loses face when he questions his partner. “Like I was going to try to save her,” Rutkovsky retorts. “I was eating my dinner.”

Quickly, Cross learns to mimic this tough-guy attitude. When he volunteers to enter a room where a putrefying corpse awaits, surrounded by a cloud of black flies, the most twisted of the medics jokes approvingly: “I can’t believe it. ... This guy comes creeping in here those first weeks. Mister MCAT book. Now look at him.”

Only gradually does Cross begin to understand the harm his ghastly duties — and the unnatural code of conduct that surrounds them — has done to his psyche. His girlfriend catches on before he does. “If you go too far from your natural manner it can be damaging,” she warns, after their split. “Your good qualities aren’t being used. They’re getting beaten down.” What Herr said of himself in “Dispatches,” Cross could say of his own experience in Harlem. “Talk about impersonating an identity, about locking into a role, about irony,” Herr wrote. “I went to cover the war and the war covered me; an old story, unless of course you’ve never heard it.”

As Cross begins to break free of his borrowed role, Burke offers up one of the book’s most disturbing images, a tragedy of the everyday variety that produces headlines but quickly fades from the news. Five medics, smoking and arguing, stand at the closed door of an elevator that has plummeted down a shaft. As the door squawks open, the men quit bickering and jump up, reacting to “a tangled mess of limbs in contorted, grotesque shapes, tossed grocery bags, blood and eggs and a bag of Cheese Doodles covering the writhing bodies.” They are so desensitized that it takes a scene of sickening destruction to jar them into cooperative action.

Burke crosscuts the narrative with excerpts from two transcripts. One, from a video of a “famous graduation speech” given by Station 18’s chief to medics when they leave the academy, provides an overview of the dangers and rewards of the job. These excerpts are cautionary and hint at lessons Cross is about to learn: “Everyone talks about the ability to stand blood and gore, to live through tragedy, but the real quality needed is altruism. ... Without it, the job becomes a relentless tour of the worst parts of life. Without some form of altruism, the job is unbearable.” The other excerpts come from a manual on difficulties associated with childbirth. “Newborns are purple when they come out,” one reads, “and are said to ‘pink up’ once they start breathing on their own. This pinking up can take as long as five minutes. If the newborn does not pink up it needs oxygen, suctioning or a tube down the throat.” As Cross sinks deeper and deeper into a culture of cynicism and morbidity, these glimpses of the effort and care required to bring a child into the world underscore the waste of life — and the wasted lives — he encounters every day.

In “Black Flies,” Burke recapitulates much of the experience and many of the conflicts that animated “Safelight.” But these two novels are different kinds of exorcisms, crafted with different authorial tools. In “Safelight,” Burke shielded his protagonist from Cross’s intensity of feeling by making him not only a medic but a photographer and by furnishing him with an H.I.V.-positive girlfriend whose troubles distract him from his own. When out on emergency runs, he takes photographs of his patients. In his spare time, he shoots gallery-quality pictures of the poor, the sick and the demented.

The narrator’s descriptions of his photographs in “Safelight” take the place of the revealing interior monologues Burke gives Cross in “Black Flies.” The photographer knows what he has witnessed, but not what it means. As Herr wrote in “Dispatches,” recalling the horrors of war: “You didn’t always know what you were seeing until later, maybe years later.” Looking at a picture of a dead child, he thinks: “It was like seeing the kid for the first time. Tiny hole in his forehead. Large, grotesque splash behind him. Blank eyes. ... It struck me with more force than the actual event but without some of the horror.”

In a conversation with a fellow medic from Station 18 that’s been added to later editions of “Safelight,” Burke explained why he sent that novel’s narrator to the darkroom: “It’s the safe representation, the echo, of what he felt. It’s the first step toward him dealing with it.” In “Black Flies,” Burke has taken a further step, trading the darkroom’s safelight for the stark light of day, letting the reader see what Cross sees as he sees it, with all the force of the actual events and more of the horror — unmediated, unprocessed, unairbrushed. Exposed.

Publishers Weekly

 Gunshot wounds, crack pipes and rotting corpses abound in this raw and fascinating novel about Harlem paramedics in the mid-1990s, the second novel from former EMT Burke. Oliver Cross graduated from Northwestern as a middle-class do-gooder. But he and his partner, Rutkovsky, a jaded Vietnam veteran and one of the city's best medics, see enough massive trauma to put Cross on the fast track to deep disillusionment. Of the bizarre, tragic and often shocking emergencies encountered during Cross's rookie tenure, the crisis comes when he and Rutkovsky respond to a call from an abandoned building where a crack-addicted, HIV-positive mother has just given birth to a premature baby, and their handling of the mother and child-believed to be stillborn-will alter the course of both men's lives. Burke is a poet of trauma, and his expert, macabre portrayal takes its toll on the reader just as the job takes its toll on Cross. (May)

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