A series of vignettes of life as a paramedic on the streets of Harlem in the early 1990s, Shannon Burke's Black Flies is a novel, but it reads like a memoir - specifically, a combat memoir along the lines of Michael Herr's Dispatches, about its author's experience of being a reporter in Vietnam. This is a result of its basis in fact: Burke worked on New York ambulances for five years, first as an emergency medical technician (EMT), then as a paramedic at the notorious Station 18 on 136th Street.
Burke's fictional stand-in is Ollie Cross, who has taken a year off to be a paramedic before going to medical school. (Unlike his prim, studious girlfriend, Clara, he has failed to get in twice and hopes experience acquired on the streets will earn him a place at the third attempt.) He wants to help, to make the world a better place. But his idealism is tested to breaking point by what he witnesses: gunshot wounds, road-accident victims, rotting corpses lying undiscovered in grimy tenements - the whole panoply of urban misery and decay.
Surly, unafraid Rutkovsky is a Vietnam vet with "a crew cut, dark brown eyes and a mouth shut perpetually in a tight slit". The closest the book gets to emotion is the moment when he and Cross's grudging mutual acceptance shades into friendship: Rutkovsky invites Cross back to his tiny one-bedroom apartment and gifts him an expensive stethoscope. Most of the time, though, Black Flies is confronting hard, brutal truths about a hard, brutal job. We view Cross's moral disorientation through the prism of the paramedics' alpha-male, locker-room camaraderie. Something of a psycho, LaFontaine keeps obsessive track of the number of people who don't thank him for saving their lives (most of them) and expresses a commonly held - though rarely articulated - belief among paramedics when he declares: "These people are animals. Give 'em a chance and they'll tear your head off."
Burke lives in Knoxville, Tennessee with his wife and two sons, but grew up in Wilmette, a suburb of Chicago. After graduating from the University of North Carolina, he drifted through minimum-wage jobs such as delivering pizzas and selling T-shirts outside baseball stadiums so that he could concentrate on his writing. In the early 1990s he moved to New Orleans, where he experienced a kind of epiphany. 'I was walking home from work one night and I saw someone shot," Burke remembers. "She was a British fashion designer on vacation. The woman was lying on the pavement. Her fiancé was screaming and crying and trying to wake her up. I was with her for maybe 10 minutes, trying to help her. The woman died and I felt guilty afterwards that I hadn't known first aid, so I took an EMT class. When I finished it I got my EMT licence, moved to New York, became a paramedic and got hired by the New York City Fire Department. I requested Station 18, which was in Harlem, and almost as soon as I was sent there I was writing about it. It was a great place: huge, chaotic, considered the most uncontrollable station in the system. It was ruled by a group of old-time medics who decided whether you belonged or not, almost like a gang. If they thought you didn't belong, they made life miserable for you.
"Drafts of both my novels [Safelight, Burke's debut, was published to acclaim in 2004] were written that first year, though it was years and many drafts later before either were readable. Black Flies was written first but I couldn't make it work, so I turned to Safelight. Pieces of both books were moved back and forth between them." Many of the episodes in the book happened for real or are only slightly fictionalised. "In terms of what happened on the ambulance, the truth is worse than what was written. Having said that, the general dramatic arc is fiction. I didn't become as desensitised as Ollie, though I felt the pull of it."
In the novel, the Station 18 team has its own codes of practice, its own way of being: "To tell any story about how you actually helped anyone was bad form." It's a reaction to the constant assault and battery of life on the streets: shouted at for turning up too late, shouting at for "not trying hard enough" to save someone or for not giving junkies the drugs they demand. Still, the more time Cross spends in Harlem, the less respect he has for Clara and her medical-school friends, who suddenly seem hopelessly naive. Cross reacts angrily to their middle-class snobbery: "I was proud to be a Harlem medic. I was forced to act boldly, decisively, make quick decisions that had real consequences. And I was getting better at it. I knew I was."
This may be true, but the strain is starting to affect his academic work and relationships. There are worries, too, about Rutkovsky - that he's been out there too long and may be on the verge of burn-out. The crisis everyone has been predicting occurs when the pair respond to a call from a crack-addicted mother who has just given birth to a premature baby who she believes is stillborn. They screw the job up, royally - and the consequences have a momentous effect on both their lives.
Part of what makes Ollie fascinating is that we can't quite tell whether he's losing or finding his moral compass. It's important that he toughens up and learns that Clara isn't right for him. But he goes too far. "I had a clear moral vision," says Burke. "I went into the job with a relativistic worldview, but I came to believe that there is absolute good and evil. Saving a kid's life is an undeniable good. Relieving pain is good. And harming others out of impatience is evil. This may seem obvious, and yet people do bad things, evil things, all the time, usually when they are unhappy themselves. But there's a covertness and banality to these evil acts. It's just someone reaching over offhandedly and turning an IV off and walking away. I wanted to show how these truly abominable things happen, but make them understandable and almost logical in context. And as you point out, I wanted to show how the deterioration can be intertwined with the good, so it makes it hard to know the right path at the time."
What of Rutkovsky? He is such a rich character - a wonderful study in repression and male compartmentalisation. "He was based on an old medic I rode with from time to time. He was a really scary guy, a totally disaffected misanthrope. I was always terrified of making a mistake when I was with him. With the character of Rutkovsky I was trying to reproduce the feeling I got from this medic - of competence but also complete indifference. He was fiercely protective of his patients while he was treating them, then totally indifferent afterwards.
"He was famous for having worked at Harlem before I got there. He'd been the best medic in the history of the station but was then kicked out for doing something awful, unnameable. I asked around but no one would ever tell me what he did. I never found out." Is there a sense in which the writerly part of Burke was drawn to the job because of the wealth of material it promised or was it more complicated than that?
"I don't know. Maybe. Yeats once said a writer should go into the thing he is least fit for and I guess I followed that advice because I was the least likely paramedic. I wouldn't say I'm particularly outgoing, and at that time I was spending a lot of time alone trying to write. Being a medic was good for me. It forced me to go out into the world and see things I never would have seen or experienced on my own. Truthfully, I don't know if I consciously did this to expand myself, or for material, or just because I needed a job. Probably a little bit of each."
For the last 10 years Burke has had a parallel career as a Hollywood script-doctor. "I did a lot of work on the script of Syriana, as I have done on all of [the film's writer-director] Steve Gaghan's scripts since Traffic. He read an early draft of Safelight, liked it and I started working for him from time to time as a sort of heavy-handed editor. Slowly, we've become collaborators." Their next film together, announced in September, will be an as-yet-untitled action thriller about an elite deep-cover operative who becomes a Brooklyn cop. Film rights to Black Flies, meanwhile, were bought by Paramount with Darren Aronofsky in the frame to direct, but the project is currently in limbo: "About 12 people have asked about it, so if it doesn't happen at Paramount it will probably go another round somewhere else."
Burke's prose has a pithy, pared-back intensity that reflects his love of Ernest Hemingway and William Faulkner. It wants to rub our noses in the truth - or at least explode a million ER clichés. "I did want to break the myths," Burke admits, "but it was much trickier than I expected. It's amazing how much TV and movies affect how you think of real events and even how medics and cops experience them. Slowly, over time, I had to parse out what was true about an event and what I felt about it."
Safelight occupied similar terrain to Black Flies: it's about a screwed-up paramedic, Frank, who is redeemed by a doomed romance with a young HIV sufferer, Emily. Burke says he misses the medical life and contemplates returning to it at some point. (He still has a licence to practise.) But he is locked into a different groove now, and currently at work on something completely different - a historical novel. "I'm on about the fourth draft," he says. "It takes me a long time. Slowly, though, the edges are sharpening. I keep thinking it will get easier, but it hasn't."
Black Flies is published by Harvill Secker.