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They are called the "invisible ones." Oh, some of them are visible enough, but most folk walking along the city sidewalks choose not to notice them. Others are not so visible, blending in with the background, looking like they belong, or hidden off somewhere where they do not have to overwhelm themselves with non-vital preoccupations. As is the way with the emergent complexity of things and the intersection of personalities in the world, the "invisible folk" eventually bring around themselves a variety of services and ethnic elaborations - some genuinely beneficial; some merely opportunistic. It is inevitable, with my background and avocation, that I should be drawn into their invisible, but pervasive, culture.

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"Can you tell me where the problem is?" I asked my patient, who was currently supine on the sidewalk, emitting short gasps. My assistant, Freda, hovered behind me, ready to support or advise a diagnosis.

There was no reply from the patient, a victim of a collision with a city garbage vehicle, save a shivering of the joints and a sudden spastic extension of one limb. The gasps ceased and the patient's hand slapped the gritty sidewalk and thrashed, clenching and unclenching for a moment, before going still. A foul odor assaulted my nostrils and I turned my head away. I knew the origin of that odor and what it meant. I turned to Freda and said quietly, "We're FTD here. Call for a stat cash-run and help me get her packaged." The slang was not meant to be offensive, but served to protect the patient from blunt information that needed to be exchanged quickly. My patient was indeed "fixing to die," and I was hoping, against all experience, that I could get an immediate helicopter transport to one of the city's high-tech trauma centers.

"You kidding?" replied Freda in a quiet voice. "No way they'll authorize a cash-n-dash to a trauma-one. Definitely not cost-effective. No way."

"Call anyway. Do it now!" I insisted.

There was a sudden, rapid, beeping by my knee. The portable DiaComp was lighting up across the board and my patient began to die quickly from multiple causes. The comprehensive diagnostic monitor could not refresh its multiple displays fast enough to give me all the bad news. The body gave one more heave, as if to throw off death, and then sagged. Then, one by one, the displays began to show flat traces and the Low Numbers, some of which were already zeroed out.

"You still want that chopper, boss?"

I laid my hand on one of my patient's limbs. "Touch the patient," one of my clinical instructors reminded us continually. But now my patient's body was just so much dead-weight, cold as the pavement on which it rested. "No. Cancel the call."

I looked around. Freda had not moved. "It's OK," I said, "Cancel the call."

Freda merely looked away. I knew then that she had never made the call in the first place. She knew it would be useless. She would know, having being one of them for so long.

Our street medical teams were composed of two members: an emergency care technician, sometimes a physician with the appropriate training, and, always, one of the former homeless. It made it possible to form that all-important connection that needs to be made in a few moments between an emergency worker and the patient. The ex-homeless knew the language, the environment, the needs -- all the cultural necessities that made our work possible.