COEUR d'ALENE - The fishing boat in the driveway blocked access to the front door for the stretcher.

Inside the Plymouth Circle home, 73-year-old Tim sat on his recliner in front of the 10 p.m. television shows, suffering a myocardial infarction, or heart attack.

It had begun, actually, the day before, Thursday.

It started as a slow, dull ache in Tim's chest, but by the time he called paramedics the pain had exploded, shooting to his stomach and spreading through his shoulders to his neck and back.

Two miles away on Wilbur Avenue, 60-year-old Delvin argued with his girlfriend. They slapped each other once. When Delvin's girlfriend locked Delvin out of the apartment, he banged at the door.

But the priority was the fishing boat, so the Coeur d'Alene Fire Department's red team shift - 38 hours into its 48-hour shift - carried the stretcher to the back door of the house and inside they found Tim, with only 20 percent of his heart working, throwing up.

Paramedics Scott Dietrich and Bill Deruyter hunched in, as Tim described his pain.

"It hurts so bad," Tim said. His face was sweaty and white except under his eyes, and sweat started to soak through his white T-shirt. "I can't breathe. I'm choking."

"We need to get him to the hospital," Scott said.

The stretcher couldn't make it through the doorway.

It sat at the bottom of the back steps, and the board to carry the man couldn't fit through the angle of the back porch stairway.

As firefighter Craig Etherton checked the cupboard for Tim's medication, firefighters Matt Tosi and Blaine Porter brought a wooden chair from the kitchen table. Everything in the house was tidy and put away and the television ran with the volume low.

"I don't know if that's sturdy enough," Scott said, checking it.

It is, Matt and Blaine said.

Tim coughed and wheezed. Twenty percent of your heart working means standing and taking even one step would make it stop.

"I can't breathe," he said.

The team lifted Tim and put him on the wooden seat, and Tim cried out.

"I got you," Matt said. "You're not falling."

Then Matt and Blaine hoisted the seat, Matt walking backward, Tim's head near Matt's chest, Blaine carrying the feet, and Matt said, try to relax, trust us, this is going to feel strange, like you're falling, but you're not falling, and keep your hands in.

Tim groaned and coughed.

Outside, down the steps, the team strapped Tim into the stretcher and moved him into the ambulance as Bill and Scott climbed in, and in the ambulance Tim said the pain was an eight on a scale of one to 10.

There was a three-lead EKG machine on board to test for myocardial infarction, but it is not as extensive as the 12-lead machine that was on the engine and can look at the heart from 12 different angles. But the ambulance was loaded and everything was under way and Scott stared hard at Bill and Bill caught it when Tim said the pain was spreading, spreading, reaching new parts not just the chest, and the stare was like the test results from the 12-lead machine, just in one moment.

Nobody knew it was 20 percent then. The doctors told them later.

"OK, Blaine," Scott, 36, called to the driver.

Then the ambulance started down the road slowly, lurching over speed bumps on the residential street while in the back, bumping up and down with the bus, Bill and Scott inserted IVs in each of Tim's arms, strapped oxygen to his nose and covered the man's chest with the wires of the three-lead. The bus bumped up and down again and Scott leaned across the man's body and hooked nausea medicine into one of the thin, clear tubes, and as the bus banged over another bump and the tube began to fill, Bill lifted Tim's back as Tim threw his head forward to vomit again.

"It's a pressure," Tim said, "a bad pressure."

He lay back down and groaned.

"I'm going to give you a nitroglycerin tablet," Scott said. His voice was elevated. He wanted to keep Tim listening. He put the tablet beneath Tim's tongue, and then the ambulance got going faster, the speed bumps behind it, until the steady hum of speed filled the back of the van.

Tim swore, and for a moment he just lay there.

Scott asked where his pain level was now and now it was a 10, Tim said. Scott gave him another tablet to relax Tim's blood vessels, then four aspirin, which were the hardest to get down, because Tim's throat burned like it was being strangled.

"I'd like to see the full 12," Scott said about the machine. "See what we're missing."

Then the paramedics radioed Kootenai Health.

Talking to Tim as their hands worked, they found out Tim's birth date, allergies, Social Security number, and that he had a son in town. They had his heart rate and blood pressure. The medicine was in. More medicine and another team would follow. It was the transfer, and they looked out the window and found a cross street and calculated the minutes from that street to the hospital and four minutes later the ambulance arrived and Bill and Scott pushed the stretcher down the emergency room hallway and then moved him to a bed.

"Super diaphoretic," Scott said to Bill about Tim's sweat.

"Yes, he is," Bill said.

"Hand me the pink thing, quick," Tim said, meaning the bucket.

The EKG nurse tested Tim and Tim threw up into the pink bucket and the machine verified what the team saw as Tim was in front of his television and the nurse said, "It's positive." Then her head turned toward the hallway and she said, "Will you let them know I have an MI and I need a monitor that works, please."

The transfer is like a tide. Doctors come in, and the firefighters leave.

Outside the ER, around the parked ambulance, they relaxed, and re-stocked supplies. They moved the 12-lead machine from the engine to the ambulance, which they called the bus.

"That was a good call," Scott said, sweating himself.

Good means necessary.

And good describes these guys.

In the 48 hours I spent with the five-member team at Station 2 on Ramsey Road, I never fully understood that line of separation. A job that relies on crisis, but never roots for it. Adrenaline, without celebration. Emotionless, not heartless. Driving with full sirens, is called "coming in hot" and the team came in hot while some people held on by a fingernail and they came in hot to a man who, it seemed to turn out, got dizzy from beer and sun while he set up for a wedding reception.

The department goal from call to arrival is eight minutes. It averages five.

"Man you guys got here fast," a teenager told the crew after the man setting up the reception waved off medical attention, and the crew climbed back into the engine.

"Which one are you stationed out of, Ramsey Road there?"

I asked Matt after we returned from the wedding call if there was ever a feeling of letdown if an expected emergency doesn't materialize. He said there wasn't. We talked about the feeling of knowing it's a job, but at the same time knowing it's not just a job, and Matt described each call as a situation, how the team looks at the room and asks what is happening, and what can be done, almost a little removed, like solving a puzzle, the way a barber sees patterns along a person's scalp or how a writer looks for the pith of a conversation in one sentence.

Good does not mean favorite. Favorite would be the call Friday afternoon to replace Sandy's fire alarm batteries at her home near the Coeur d'Alene Public Golf Course. The recently widowed woman couldn't change them, and it beeped and beeped. She tried to put tape over it, like a sound buffer, but the bus was in the area, swung by, and helped her.

She offered to pay them.

She said she wished she had beer in the house to give them, then she said, "You know, I lost my husband on Thanksgiving and you came out. I didn't know who else to call. I knew this wasn't that kind of call, but you came."

We responded to 12 calls the first day. The daily average is 19 calls. That's 7,000 calls a year, 2,000 of which are for advanced life support.

Pocatello, five stations and 66 on its team, hit around 6,000 calls last year.

But they don't root for calls. A good luck wish from a firefighter leaving work to another beginning it is, "Have a quiet night." Luck is boredom.

And right then outside the hospital, Colorado tourists Matt and Kay were walking arm-in-arm to Shari's restaurant across U.S. 95, and uptown, the argument between Delvin and his girlfriend escalated. Back at the hospital the team packed in the rigs to leave, and told me I was losing my white cloud status.

That's a rabbit's foot, a good luck charm. Its opposite is a black cloud, the one who is cursed. Everything between is routine, and it shifts.

Firefighter Craig Etherton's black cloud streak, he later told me, came years ago when he heard an Advanced Life Support call to his own address. In the days that followed, he responded to calls of kids dying. He shook his head at the dinner table on the second night of my shift when he told me this.

The first day started slowly, but picked up. There had been seizure calls, a car accident and medical transports. There had been an 84-year-old man with a 103 temperature who couldn't keep his head on a pillow. It just sort of hovered like he was trying to get up, and his toes stayed curled.

The neighbor of a young mother called when he heard the woman moaning. Her husband had beat her up, but by the time we got there he was gone with their child and she lay face down in the doorway, blood on her nose and chin.

There'd been a fire too. It turned out the children left a plastic bucket on a burner and it filled the house with smoke as it melted down, like butter. The kids cried. The mother came from work and she cried too, then settled down, and the dogs, who got out of the house, licked everyone.

That had been Thursday.

But Friday was different. When it goes, it goes quickly, and even 48 hours can fly.

And by the time we returned to the station Friday night Kay had rolled her ankle getting to Shari's, and we turned around and picked her up a block away from the hospital.

"Oh my God, oh my God," she said over and over again in the ambulance, her hands covering her face. Blaine made a splint for the ankle out of duct tape and a pillow. Waiting in the ER for a room to clear he chatted with her.

"This is the part where I make small talk so you forget about your ankle," he said.

"I know it!" she said.

But then, back up at Wilbur Avenue, the rage buckled Delvin's knees and he crumpled to the concrete walkway. He lay silent and sweaty.

"My chest," he said quietly as the firefighters surrounded him. "A deep pain in there."

And it was just like an hour before but this time the 12-lead pinpointed the heart attack precisely, and Delvin lay silently on the stretcher as the tubes and wires hooked to him and the medicine started.

"Sir," Scott said, voice elevated, leaning toward the stretcher. "I think you're having a heart attack."

"That's what I thought," the man whispered, and he whispered that his pain was an eight and again when it reached 10.

It would go all night. My back would hurt from the climbing in and out and the jumping. The last thing I wrote was about a man crying outside an Appleway Avenue hotel at 7:30 a.m. Saturday, suffering an allergic reaction from nuts. He cried and said he wished he could die right now and then my pen went out so I stood and listened to him cry with my notepad in my pocket. That's how it ended.

But I remember as Delvin lay silently, my knee nearly touching his forehead, as the medics leaned in and worked. I saw every movement in front of me and my reflection and everything behind me in the dark back windows, as though everything was suspended, and Delvin whispered and waited as the ambulance moved down the empty street while the paramedics worked.

* Names of patients have been changed in this story to protect their privacy

Cd'A Fire Department

The Coeur d'Alene Fire Department has three stations, which are staffed 24 hours-a-day.

The minimum staffing in a 24-hour period is 14 firefighters, three of which are certified paramedics. All of the 48 firefighters are medically trained for emergencies, and 16 are certified paramedics. Shifts for the teams at each station begin at 8 a.m. and run for 48 hours.

A fire engine and ambulance each respond to basic and advanced life support calls to expedite response time, as well as to carry proper amount of staffing to the scene. The department's goal is be at the scene within eight minutes of the call. According to Fire Chief Kenny Gabriel, it averages five minutes.

The fire department is the second largest department in personnel, behind police. It has an approximate $7.45 million budget proposed for fiscal year 2012.