The Devil Is Loose. Drownings, shootings, high-speed accidents, immigrants in labor — the life of a border paramedic

For the paramedics in Laredo, Texas, the only event more concerning than a Dallas Cowboys’ loss is a fight night. Saturday, May 7, the eve of Mother’s Day, was fight night. Throughout the afternoon, the cemeteries were full of people carrying flowers to their mothers’ tombstones, bright tributes laid down in the searing heat. That evening, much of the town gathered around flat screens to watch the Mexican champion Canelo Álvarez and a British contender named Amir Khan slug it out for the middleweight title. Not many were rooting for Khan. Before the fight started, I joined the medics at Station 7, down by the Rio Grande next to a rough neighborhood nicknamed Las Canta Ranas — The Singing Frogs. Pickup trucks were parked diagonally out back, near an unused weight rack. Inside the station, air conditioning blasted, and men sat around the dining-room table in blue Laredo Fire Department uniforms. Behind them, on the wall, was a sign featuring an owl that read WE NEVER SLEEP . The TV was on. The TV is always on in the fire stations, streaming sports highlights, car-buying shows, life-hacking shows, and action movies. Now it was showing a Jurassic Park sequel — dinosaurs racing around onscreen, a woman running to her truck. Alfred de la Cruz, a 5-foot-6 paramedic who goes by Fred and has his kids’ names tattooed on his forearms, nodded at the TV and said, “There’s no way that jeep starts.” Fernando Mata cackled. Thirty-eight with a wide-open smile and a spherical physique, Mata (nobody calls him Fernando) is revered in the station. He had entered the profession as a 110-pound single father on food stamps, but that was a lot of 911 calls and Whataburgers ago. He served himself some ice cream and told a story about the time when he nearly choked to death while fishing with his paramedic friend Bobby. “Bobby shows up with some double cheeseburgers,” Mata said. “We grab ’em like animals. BOOM ! We get ’em, right? It was a complete occlusion.” Mata signaled to Bobby that he was choking, Bobby gave him a Heimlich thrust, and the burger popped out. Point being that they were calm because of their training. “It was so funny,” Mata said. “I call Bobby my fat angel. He’s fatter than me.” First responders love gallows humor, and I heard a lot of stories like this when I spent time with the paramedics of Laredo this past spring. I was accompanying them because they have an unusually clear view of the most politicized stretch of land in the country: the U.S.-Mexico border. Located in southwest Texas on the Rio Grande, Laredo is one of the least diverse cities in the country — its population is 96 percent Latino. According to the census, that adds up to 255,000 souls. But this figure accounts for only the documented. The actual number, everyone told me, is closer to 300,000. Just across the river is Nuevo Laredo, a city of nearly 400,000 dominated by the Zetas drug cartel. Like all border towns, Laredo is swamped by law enforcement. Uniforms are everywhere: the olive green of Border Patrol, or La Migra, which has about 1,600 agents in the area; the navy blue of Customs and Border Protection, whose agents check the documentation of people crossing Laredo’s five bridges. There are sheriff’s officers, constables, and highway patrol; in less public view, three for-profit detention facilities employ a small force of correctional officers. Working for La Migra or in a private prison can be a complicated arrangement in a town that’s almost entirely Latino — steady employment with the whiff of betrayal. Paramedics, on the other hand, are legally bound to treat anyone in need. The only questions they ask concern a patient’s medical history. Border Patrol agents get spit as a topping at a local takeout joint; paramedics get discounts. A blue light lit up overhead and an automated female voice intoned, “Ambulance, special duty.” Fred rose. He sometimes calls himself the Angel of Death, because when he is on the R.Q., or rescue unit, bad things tend to happen. Two nights earlier, he had transported two patients who eventually died. The electronic voice above continued, “Patient with a low sugar dose,” and everyone sighed. It was just a frequent flier — a regular, someone who occasionally calls in with low blood sugar, dizziness, or general exhaustion. Fred left, lights flashing and sirens wailing. The fight started, and calls sped up. A boy was hit in the face with a baseball bat. A woman complaining of fatigue turned out to be a heroin addict. Fred had to break down a door to reach a guy who’d been beaten to a pulp. Cars wrecked. Then a call came in. Something about a girl at the mouth of Chacon Creek. Something down by the river. The medics have a saying for nights like this: Se suelto el diablo. The devil is loose.

The language in the fire stations is a fast blend of English and Spanish. While speaking Spanish isn’t technically a prerequisite, you’d be hard-pressed to find a Laredo medic who doesn’t. Seen from this angle, the city’s 388 firefighters reflect the population they serve. Seen from another, the department is remiss: While it’s full of brothers, uncles, and nephews, it doesn’t include any women, or females, the word used by most of the guys. Station life is dominated by movies and cookouts and practical jokes. “It’s awesome,” Fred said. “Kind of like being in a frat house.” It’s an exclusive frat house. In 2015, 4 percent of applicants to the fire department were accepted as cadets, and less than half of those became paramedics. Getting into Harvard is three times easier. The medics then rise to engine drivers, captains, chiefs, and administrators and can retire with generous pensions after 20 years. Some guys, though, stay on the R.Q., tending to drownings, shootings, stabbings, overdoses, and high-speed accidents. “I had no clue,” a medic named Rudy told me, “what I got myself into.” When I arrived in late April, I found my way to Station 7, a 35-year-old, tan-brick building that Mata showed off with pride: the parking lot; the grill; the dining room where everyone hangs out, covered in firefighter paraphernalia and American flags, dominated by the huge TV, and opening onto a kitchen with a high-end gas range. The locker room felt old and lived in, the wooden cubbies stuffed with Alka-Seltzer and decorated with Cowboys stars and photos of kids. It was noon, the golden hour when calls rarely come in. In the bunkroom, men lay on mattresses in the darkness, their faces illuminated by the glow of iPhones. The TV was off. Then, at 1 p.m., it flicked on again. A call came in for a kid locked in a car. I hopped into the back of the bright-red ambulance. Fred was the attendant, meaning he was both the primary caregiver and the DJ. On the radio, he cranked Journey, Steve Perry singing, “Someday love will find you” above the siren’s howl. We went to check on the kid, but by the time we arrived, someone had opened the car door. Then a call came from Walmart, where a pregnant girl accused of shoplifting claimed a policeman had pushed her to the floor, hurting her unborn child. But when Fred offered to take her to the hospital, she declined; the cop smirked. The calls started to mount. Blood poured from the skull of the loser of a bar fight. A woman with lung cancer breathed through an artificial oxygen mask, tendrils of gas rising off her face as the medics wheeled her past her altars to the Virgin of Guadalupe. People called in with dizziness, nerves, fatigue, and other codes for loneliness. Many of the calls were in the old, south part of town, a leafy and slow neighborhood of fading beauty that bears no resemblance to the subdivisions and box stores of the wealthier north side, which has metastasized since the enactment of the North American Free Trade Agreement in 1994. It is widely known among the medics that much of the town’s undocumented population lives on the south side. The medics treated everyone with the same robotic efficiency. They’d walk into the patient’s home, diagnose the injury, and, if necessary, wheel him off on a stretcher, attaching electrodes to his chest and a saline lock to his hand in the ambulance. The medics never asked about health insurance. As Fred told me, “We never give someone a reason not to go to the hospital.” One day, a philosophical medic named Joey Lopez Jr., who also works as an emergency-room nurse, took me to float the river in a kayak, alerting his buddies with Border Patrol in advance. We put in north of town, on a private ranch, and paddled down. The riverbanks were lined with salt cedar, hackberry, invasive cane, and discarded clothing; the flyway was thick with green kingfishers, white-collared seedeaters, painted buntings, gray hawks, and Border Patrol helicopters buzzing low over the water. Joey is an enthusiastic birdwatcher and kayaker, the river his sanctuary. It was also the site of one of his worst calls. He once responded to a wreck in which a coyote was being chased by Border Patrol. The smuggler floored the gas pedal, pointed the car in the direction of the river, then rolled out of the vehicle just before sending his human cargo hurtling to their deaths. I asked Joey whether he stayed in touch with any of the undocumented migrants he’d treated over the years. “We transport them, and they’re gone,” he said. “They’re ghosts to us.”

Once, when I returned to Station 7 following an ambulance ride with Fred, a show about aliens was on the TV. “Do you believe in aliens?” Mata asked. I said I didn’t. “You came to South Texas to do a story,” he said, “and you don’t believe in aliens?” He laughed, as did everyone else. Station 7 is less than a mile from the Rio Grande. Until about ten years ago, the medics were responsible for body recovery in the river. Then the fire department’s union objected, and the Laredo Medical Examiner’s office took over the duty. The medics don’t miss that work. Mata once had to shoo a feeding vulture off a floating body. “The skin sloshes off in your hand,” he said. “This is still in my mind.” The Rio Grande is now significantly smaller than when Spanish missionaries first crossed it. Dams and drought will do that. The cities may be geographically closer than they’ve ever been, but in almost every other way, they’ve never been further apart. Up until the early 2000s, Americans frequently crossed into Nuevo Laredo to eat, party, or get quick, affordable medical care. Those days are over thanks to a series of cartel-related massacres. Three years ago, 23 people were found hanged from a Nuevo Laredo bridge or decapitated. I asked the guys at the station if they crossed the river, and the answer was a universal no. One of the station’s drivers is a circumspect, large guy with a sharp grin named Angel Garcia. Forty-six, Angel became a firefighter when his shoe-exporting business faltered. Upon joining the department, he found it a lot like being on a sports team, which he liked. Angel told me he doesn’t allow his children to go to Mexico, a common refrain among the guys. His son doesn’t speak Spanish; his mother, who was born in Mexico, doesn’t speak English. Two of Mata’s kids speak Spanish, and two don’t. Fred, who learned Spanish only after joining the fire department, joked, “My kids are total gringos, bro.” For the most part, the medics live in the shining northern part of town — farther away from the border and deeper into America. A medic who was born in Nuevo Laredo was frequently mocked by the other guys for his heavy accent. They sometimes called him an Aztec. But the few white guys in the department can also be the butt of jokes. A medic from Tennessee asked if I like NASCAR after we first met. When I said I didn’t, he looked relieved. “A lot of guys assume I’m all into NASCAR because I’m white,” he told me. Another medic was partly of Anglo and partly of Mexican descent. He spoke lightning-quick Spanish and cooked up elaborate Mexican meals. Over dinner, someone asked him what he’d do if Trump were elected. “I’m moving to Mexico!” he yelled. Hundreds of people still pass over Laredo’s bridges every day carrying various kinds of visas, and some get hurt. Many are U.S. residents who suffer injuries while visiting family in Mexico, and some are Mexican women with late-stage pregnancies hoping to deliver children — “anchor babies,” in the crude parlance — on U.S. soil. The baby deliveries make for some of the happiest calls. “The best feeling in the world,” I heard it described. Some of the most unhappy calls also happen at the river. That’s because critical patients often arrive at the bridge in the Mexican ambulances, or the Cruz Roja. I asked the medics if they’d ride in a Cruz Roja ambulance, and they all laughed. One said, “They’re good guys, but they’re not really trained. They usually ask for supplies. They work with nothing.” Everyone has a Cruz Roja story: a medic pulling traction on a patient’s neck with a rope and a sack of beans, or a soda bottle pinch-hitting as a catheter repository. I saw Cruz Roja one hot Sunday when two medics got a call from Bridge 2. We pulled into a bay at the north end next to a small red vehicle that said Rescate. Inside were a mother and daughter, both U.S. citizens, who had been in a car accident in Mexico 12 hours earlier. The daughter was throwing up and suffering seizures, with purple marks on her forehead — signs of potentially critical head trauma. According to the mother, the Mexican hospitals had refused to treat her because the family didn’t have enough cash. While Customs and Border Protection officers patrolled and German shepherds sniffed vehicles, one of the medics negotiated with the Cruz Roja driver over a foam backboard. The girl was strapped to it, but the driver wanted to take it back before transferring her. The Laredo medic refused, and the haggling further delayed the ­emergency-room visit. “It’s messed up,” the medic said, after finally dropping the girl at the ER. “When it’s kids, it affects you more.” The Cruz Roja guy followed closely behind, hoping to reclaim his backboard. I later told the guys at Station 7 about this call. Someone wondered aloud whether the Cruz Roja medics wore bulletproof vests. Mata said, “I don’t think a vest would help you very much over there.”

Laredo is located in Webb County, a flat block of land three times the size of Rhode Island extending north and east from the Rio Grande. Most of its 3,400 square miles is a brush of mesquite, cactus, and huisache — privately owned ranchland. Outside the city limits, only about 14,000 people live in the county. Picture a thorny expanse with the population density of Western Sahara and comparable heat. Undocumented immigrants are often found dehydrated, abandoned by coyotes in the 105-degree summer. Border Patrol usually arrives first. Then come the medics. Laredo Fire provided ambulance care for Webb County until 2012, when the department demanded more money. The county balked and began looking for a private alternative. Angel Garcia, along with two partners, had started an ambulance company called Angel Care and offered to keep three vehicles on call for $64,000 per month. He then hired 30 or so buddies from the fire department to work on their off days. Most Angel Care paramedics I spoke with said that while the ambulances might not look as nice as the city’s, the services are the same, given the personnel overlap. They also said that their most gruesome calls are accidents out on rural highways — wrecks in which a pickup full of migrants flips at 80 or 100 miles per hour. I went down to Angel Care’s office one afternoon. Two white Ford Econoline ambulances were parked out front of a strip mall that houses a loan service, a car-window-tinting shop, an automobile wheel shop, a Western-wear store, and two Mexican restaurants. When I walked in, I found Fred waking up from a nap. He’d just come off a 24-hour shift at Station 7 and was now on at Angel Care for 24 more hours. “It’s mostly chill here,” he said. “But this is where we see the bad traumas. This is where I saw my first severed arm.” He sat on the couch and watched TV along with his partner, Polo, a mustachioed 44-year-old sheriff’s deputy with EMT training who works at Angel Care on his off days. We talked for a while about the bad wrecks they’d both seen, then Polo took out his cellphone and scrolled through to a series of photos. The images showed a gravel pile, body bags leaking blood, and a lot of bright lights. On February 18, Polo was working with the sheriff’s department when he received a call at about 4 in the morning for a rollover 32 miles out on Highway 59. When he arrived, he found an overturned Dodge Ram missing one of its front wheels, bodies scattered on the shoulder, and “a shitload” of Border Patrol agents. None of the Border Patrol agents or the Webb County firefighters who responded were EMTs or paramedics, so Polo started triaging the wounded. One patient, a young Guatemalan, was missing half his face, the skin dangling off. Polo put him on a backboard and affixed a C collar. Soon Angel Care’s first ambulance showed up. Polo loaded up the Guatemalan and backboarded another patient, a teenage Mexican boy, but then the kid’s pulse stopped. “Four died,” Polo said, “and four went on the ambulance.” I asked if it was a Border Patrol chase. There was a pause. “Border Patrol was there,” he said. “They’re not going to say they were chasing.” The door to Angel Care opened, and a new guy walked in: Rey Veliz, a soft-spoken 46-year-old Navy vet. I asked again about Border Patrol chases. This time Polo chuckled. “That happens very often, man,” Rey said. “There’s no evidence. We’re not there,” Polo said. “We’re not there to ask who caused the accident. That’s not our job,” Rey said. “They’ve had fatalities before when they’re chasing,” Polo said. The men started trading stories about bad calls over the drone of the TV. Just a couple of days earlier, Polo had transported two women who were run over by a coyote in Rio Bravo. On Thanksgiving weekend, Rey had picked up a migrant with an open fracture on a ranch. “There’s a lot of stuff you will never know about that happens here,” Polo said. For dinner, Fred and I went to one of the strip mall’s Mexican restaurants. Fred had been a running back for his high school football team, but in the year after entering the department he ballooned from 180 to 216 pounds. Then one of his best friends, the star quarterback on the team, who was also a firefighter, died of cancer, and Fred dedicated himself to fitness with maniacal resolve. He works out once or twice a day, often at 5 in the morning, sweating it out at a Crunch gym. As we ate, he told me about the time he pulled a 1-year-old girl out of a wrecked car following a head-on collision. “It was a Ford F-150 versus a Ford Focus,” he said. The girl was in the smaller vehicle. “The mom was dead, and there was this little pocket of steel around her, like the Lord himself had protected her.” The girl survived. I asked Fred if he was religious. “In this job, you have to believe in something,” he said, “because if not, you’re going to lose your sanity. Every time we work something real tragic, something is taken from us. I don’t know what’s taken, but something is taken from me.” After I left, the images from the February rollover stuck in my head. I kept imagining an 18-year-old boy flying out of the truck after riding up the gravel pile, a kid missing half his face, four dead among the windshield glass. I spent a long time trying to figure out whether this accident was caused by a Border Patrol chase. The attorney for two of the surviving migrants said that his clients felt as though they were being pursued, but they couldn’t say by whom, since they were hunched down in the cab of the truck. I did learn that a father and son were in the vehicle, that the deceased 18-year-old Mexican boy’s name was Gerardo Vasquez-Gutierrez, and that someone of the same name had been arrested crossing the Rio Grande in January, just weeks before the accident. I also learned that, since January, at least four deadly crashes in the county were the result of Border Patrol chases. I asked Border Patrol’s public information officer about it. “There’s a misconception that these are chases,” she said. “We call them failure-to-yield scenarios.” Later I drove out to the site of the accident. The windshield glass was still there, shining like glitter among discarded soda bottles and a Chick-fil-A box. I thought about something else Joey had told me: “We can’t go anywhere without seeing ghosts.” On top of the gravel pile a sign read PROPERTY OF THE STATE OF TEXAS .

On another day, Rey Veliz, the Navy vet, offered to take me and a photographer to Rio Bravo, a rural area south of town. We hopped in Angel Care’s off-duty ambulance and drove until we reached a bunch of colonias — poor neighborhoods that have no running water. I asked Rey what percentage of calls Angel Care billed for, and he shrugged. “A lot of these people don’t have insurance,” he said. Upon leaving the Navy, Rey had wanted to work in Border Patrol, but the agency had lost the results to his entrance exam. He is now relieved he ended up a paramedic. “It would be hard to see that type of human suffering day in and day out,” he told us. We drove down to the river and parked at an overlook. It smelled awful, because someone had discarded bait on the shore, but the river was green and beautiful, full of birdsong and ripples where alligator gar swirled near the surface. “I like to fish here,” Rey said. “But I bring my gun.” We got back in the ambulance and started to drive up the dirt road. Rey talked about growing up ten blocks from the river. “Back then it wasn’t a crime to help illegals,” he said. “I remember being in the front yard with my grandmother as she was watering her plants. You’d see four or five coming along, and they’d ask for water or food, and my grandmother would feed them.” A green-and-white Border Patrol truck passed us, heading toward the river. Rey waved to the agents. “I grew up being sympathetic to the illegals’ cause,” Rey continued. “Back in the day, Laredo and Nuevo Laredo were one and the same. And my mother had this bird feeder, and she —” Rey stopped the ambulance. “These guys are pulling us over,” he said. The Border Patrol vehicle had swooped around behind us, and four agents were now walking toward the ambulance. “See, this is what’s frustrating,” Rey said. His face flushed. “This is frustrating. As a citizen, to be treated like you’re breaking the law.” He rolled down his window. “Yes, sir, how you doin’, man?” he asked. A trim agent with a crew cut and his hand on his holster said, “Hi. What country are you guys citizens of?” “We’re U.S. citizens,” Rey said. “We work with Angel Care. These are reporters, and I brought ’em down to see the river. That’s all.” “You got anything in back?” Rey indicated that there was nothing in the back besides ambulance equipment. “Do you mind if we look in the back?” Rey paused and asked, “Do you have to?” The agent didn’t answer the question, instead summoning Rey out. Following the search, we drove on. Rey said, “I’m a service member. My kids are service members. My father-in-law served in Vietnam.” We toured Rio Bravo, where women sold used clothes off chain-link fences, then headed back to town, where Rey insisted on treating us to a lavish lunch.