(An encounter with the Health Care System)
I woke up one morning a quarter to nine
With an awful feeling in that body of mine
And I knew that was not a very good sign
Since in my whole life I always felt fine.
How strange to feel so on a sunny day
As we’re nearing the merry month of May.
Even Morris felt spring—he’s started to stray—
And wasn’t purring into my ear as I lay.
Suddenly it jarred me straight out of bed
‘What could it be? Is it inside my head?
No, inside my belly since it feels like lead.
Is it an illness that’s started to spread?’
I somehow got up’n dressed myself quick
Thinking the old potion would do the trick.
I groaned and moaned as I swallowed it
But on its way down it made me more sick.
‘What could it be that’s so wrong inside me?
Perchance it’s the flu, or that horrid TB!’
I rushed for my mirror my face for to see
And what looked back so frightened
‘Perhaps it’s my bladder or even my spleen,
Or something else that lies in between?’
I felt my groin, then my liver and belly;
I pressed on my breast and it felt like jelly.
My heart—it skipped and fell down a rung;
‘Oh no, not an MI, I’m way far too young!’
I checked my eyes and stuck out my tongue
And was startled to see it sideways slung
On top were bumps—no, lumps—they’ll tell
If I’ll live or die. . . ‘Oh gad, they smell!’
My hands they shook, my mirror fell,
My knees were weak and I felt like hell.
‘Oh yes, I know it’s a cancer gone stray!
It’s crept through my body but where’s it lay?
This musn’t be true. No, not cancer I pray.’
Then my mind twisted ‘round in a terrible way.
‘I’m sick. I’m ill. Must I suffer real long?
If it’s not cancer then what could be wrong?
Perhaps a fungus or virus—both last quite long.
Where could they be from?’ I wish it all gone.
One moment I’m hot and then I felt chill.
I wished to know what made me so ill.
‘I’ll find a good doctor who’s not “run of the mill”
One who will cure me with a brand new pill.’
I went to the phone book and ran down the “D’s”
And found me a doctor as quick as you please.
C-r-a-c-k-e-r-j-a-c-k‘s the name, bet he’s tops in disease.
I quickly felt better ‘cause he’ll cure me with ease.
I dialed this Crackerjack at 800-CAL-MEBK
They offered a menu—‘they sell food in the back?’
I hollered “Hello, no menu just give me the doc!
I’m sick. I need help. . . am I on the right track?”
I heard music, then noise but no human sound.
I yelled “Help. Help, I am fast losing my ground!”
Silence took over then beeps started to bound.
‘What’s wrong with this doctor that I just found?’
“I need an appointment, I need it right now!”
Then silence followed with a burp and a pow
As a fever was starting with sweat on my brow.
I can’t lose much time; I must reach him—how?’
In the phone book I read that doc Crackerjack
Had his office on Main Street in Hackensack.
So I put on my coat and grabbed my old hat
And started for Main Street in Hackensack.
I rang the front bell and marched myself in
There was no one around; the lights were all dim
So I hollered real loud “Is anyone in?”
It was so quiet you could hear a dropped pin.
I banged on the glass and shouted once more
“I’m sick and I’m gnarly and hurt to the core,
If you don’t come son I’ll be dead on the floor.”
Then I heard a door open—back in the store?
Out walked an big woman who looked on me down
“What is it you want, dear?” she said with a frown.
“I’m sick and I’m dying and have come from ‘cross town.
You see what I look like with my skin yellow-brown.”
Then she said with dignity right to my face,
“I’m sorry dearie, we’ve no time to waste.”
“But there’s no one here, can’t you make me a place?
I know he’s a great doctor and he’ll cure with haste.”
“No. No! You need an appointment to start,
And then you need paperwork secured in a chart —
And then I make sure that you can manage your part
Because we avoid charity right from the start.”
“But lady, just look here I’m sick and I’m trying --
For God sakes you don’t think that I’m simply lying?
I feel downright awful and I’m ready for crying.
Please make an appointment before I’ll be dying.”
“Well all right then” she said, with her head up high,
“I’ll give you a chance. I’ll just give you one try”
She looked in her book and said with a sigh,
“We’ll make it on Friday, the eight of July.”
“On the eight of July!” I cried out in despair
That’s more than two months; such time I can’t bear.
I’m feeling real weak please find me a chair.
Oh lady—it’s wrong, this all’s just not fair.”
“This is a big practice and we are busy each day.”
She opened the book and pushed it my way
Saying, “Look here my dearie you see there’s no way—
Unless, you are able at this moment to pay.”
I opened my purse and pulled out a bill,
But she held up her hand which brought on a chill.
“First fill out these forms right now if you will,
I need your insurance, and meanwhile keep still.
“We need your health history and your organ donation,
A DNR and living will can start your patient creation.
And, two references while you’re on your probation.
Also money in escrow will hasten your relation.”
“Insurance? Living will with D and R? What are these?
What is health history and escrow? Tell me PLEASE.
Will they help me get cured with greater ease?”
Suddenly, I felt faint and gave out in my knees.
Just then the doctor came in through the door.
“What’s this?” he said as I lay on the floor.
“Ms. Smith, get her up! Such acts I deplore.
I don’t have much time—it’s way past four.”
I was dragged to a room and plopped on a chair
Where he looked me over with a gruesome stare
From the tip of my toes to the top of my hair.
“Now what is the problem you’re willing to share?”
“Oh doctor, oh doctor I’m feeling so bad!
I’m not sure what’s wrong but it’s more than a tad.
I’ve never been sick, and I never have had
Such a problem that’s now driving me mad.”
He said, “That’s not enough. Tell me much more.
Is it your head, your belly or your legs that are sore?
When did it start and how long’s it been for?
I demand you expand to help me explore.”
“Oh doctor, it’s hard, it just moves throughout
It started this morning with its very first bout.
It doesn’t stay still and it has no set route.
It’s all just so crazy I want simply to shout.”
“But you must tell me more, you leave me blind,
You’ll have me examine your whole body and mind—
From head to toe and from mouth to behind.”
Then lord only knows what problems I’ll find.
“Oh doctor, oh doctor that sounds so wise!
I’m sure to this baffling occasion you’ll rise.
Do whatever it takes to uncover its guise
And from the results you then can surmise.”
He told me, “Undress and put on this gown.”
And when I saw it I just had to frown.
I got on a table and was asked to lie down.
Then I felt worse as my thoughts ran around.
He proceeded to prod and to poke everywhere.
I stuck out my tongue; put my arms in the air.
I had to roll over as he checked my derriere—
He poked me in places I didn’t know were there.
I had never been probed in the way he did
But I knew it was needed to find what’s hid.
I couldn’t wait of this exam to be rid—
To put on my clothes and hear his verdict.
“Dear woman, there’s nothing wrong—just yet.
But you’ll get many tests—just don’t fret
From these I know an answer I’ll get
With which I’ll cure you real fast—I bet
You’ll get x-rays, EKGs, MRIs, PETs and CTs.
Then we’ll try echocardiograms and colonoscopies,
Some cardio catherizations or endoscopies,
And there are always exploratory surgeries.”
“Oh doctor, oh doctor I don’t understand
All these tests that my problems demand!
Those MIRs, EKBs and XYZs I hope to withstand
But surgeries are far more than I ever planned.”
“Silly woman” he said, “if you want to be cured
You must trust in me and be totally assured
I’m the best doctor you could have secured.
Now just do as I say and remain demurred.”
“Oh doctor, I certainly believe you know best
I’m sure you’re a cut above all the rest.
So now where‘d I start and with what test
And give me some medicine to take while I rest.”
So he gave me pink pills to take four times a day.
And some red ones at night when in bed I will lay
Then white ones twice daily throughout all of May.
For these two hundred and fifty in cash I’d pay.
Then he left in a hurry without saying goodbye
And I’m left with that woman who might make me cry.
She made me complete all those forms—but why?
‘Tho she knew I felt bad – so bad I could die.
I got home to my house depressed and so sick
I looked at those pills and realized real quick
That I sure didn’t know which ones to pick.
I stared at the labels and my eyes blurred a bit--
‘What in the world is PRN, at HS or QID,
And what is the meaning of two fifty m-g? ‘
And what were these pills for, was way beyond me.
Since I have no clue should I now wait to see?
‘But I’m sick and the doctor’s a very wise man
And he’s trying his best to help me out of this jam.
Did he say two pink and four red as he ran? . . .
And I think one white whenever I can.’
So I took some water and swallowed them down.
Then I took off my clothes and put on my gown.
Next I washed my face and stumbled around;
Found my pillow and never uttered a sound.
I woke real slow and couldn’t open my eyes,
In my head there were buzzing hundreds of flies.
My two arms and my two legs they were paralyzed
And my brain wasn’t working as far’s I surmised.
I began to think hard—‘m I alive or possibly dead?
How could I manage to get out of this bed?
This thought made me panic but my inner voice said,
‘Just focus your thoughts and start using your head.’
From the sun I could see it was late in the day
But then I had trouble—could it be Wednesday?
I was sure it was April—or maybe ‘twas May?
How long had I slept? How long did I lay?
Then finally I sat up and look all around:
My head was spinning; I heard an odd sound;
My stomach was burning; my heart it did pound.
I tried to stand up but slipped to the ground.
Then Morris rubbed against that leg of mine
I knew he was looking for something to dine
As his green eyes searched for a positive sign.
I could tell he was thinking, ‘My mom isn’t fine.’
I managed to creep to the bathroom real slow
And stared at my pills all lined up in a row
The bottles all seemed to shrink and then grow
As I teetered and tottered to and fro.
When I finally sat down at my kitchen table
I slowly began to feel somewhat stable.
So I tried to eat but I sure wasn’t able.
Instead I phoned my best friend Mabel.
“Oh Mable” I said, “things have gone bad;
I’ve gotten so sick that it’s driving me mad.”
“Dear Sally I’m sorry that makes me real sad
And it’s such a short time since you lost Chad.”
“But tell me” she said, “how can I help out.
Did you catch the flu or perhaps the gout?”
“No, Mable it’s neither” I said without doubt,
“I’m battling a monster, bout after bout.”
Then I told her the story from beginning to end
And asked her to watch Morris until I mend.
“Now I must go Ms. Smith not to offend
For she has plenty of tests for me to attend.”
I took a deep breath and phoned dear Crackerjack
And that woman answered, “Oh, you’re calling back!
The doctor’s left orders for the tests that you lack
Now write them all down and don’t give me flack.
An x-ray and CT on 6th and Main for nine thirty.
An MRI at Oakland and High at about ten thirty.
An EKG and EEG at St. Johns at eleven thirty
An endoscopy plus colonoscopy at twelve thirty.
Then you must come back for a thorough PAP
And don’t forget your money to pay us back
Since our fees for these tests leave a gap
Between what you’ve paid and what you still lack.”
“Why so many tests that’ll take me through town
When I have such trouble to walk on the ground?
And the expense—I’m now sure that its bound
To cost me more money than I have around.”
“This is your illness and somehow you must
And do not give us a whole lot of fuss.”
Then she hung up . . . I felt left in the dust
And inside my heart was ready to burst.
I gave a deep sigh and put on my coat
Left plenty cat food and Mabel a note.
Then I went through my tests as if by rote—
Though I had trouble just staying afloat.
I finally got back to Doc Crackerjack
Where I experienced my very first PAP.
For this test I certainly will never be back.
Then into a chair in his office I sat
From behind his desk he said with stern face,
“I’ve managed to gather your results with haste.
The test all show that you’re still here by God’s grace,
So now we must start on a life and death race.”
“My Lord, what is wrong what has happened to me!
You frighten me so that I’m hardly able to see.
Is it my liver, my spleen or perhaps my kidney—
Or maybe the cartilage in my arthritic right knee?”
“It’s nothing so simple, nothing so plain
You’re having bad symptoms and too much pain.
It’s your parahippocampal gyrus that needs a drain
And for just such a problem I have world fame.”
“My what? What does it do; where do I have it?
Oh no, I bet’s from that dog that was rabid”!
“Control yourself now. Go to your chair—sit!
You wouldn’t understand; you don’t have the wit.
Just know this problem with its complexity
Requires a long surgery with great dexterity
Which I will arrange for with much rapidity
And assure you no danger from morbidity.”
“Oh doctor, oh doctor you frighten me so
I now feel worse and depressingly low!”
“Woman, don’t worry, just go with the flow
Relax and go home for tomorrow you’ll know.”
Somehow I managed all pills and the night
Although I was stuck in this horrible plight.
In a daze I dressed just as the sun started bright
And made my way to St. Joe’s with great fright.
Then I sat and I waited—forever it seems.
Filled out more forms that will haunt my dreams.
They asked me so much—I wrote great reams—
I said I’m a widow, have a cat and few means.
They showed me a room and was told to undress.
I put on a gown. . . it barely covered my breast
Then it took them an hour to get me—I guess—
Since I seemed to have passed out from stress.
I found myself in a huge, very bright room
Where I was plunked onto a table, kaboom
They strapped me down—I thought of my doom—
And attached me to lines at about noon.
I got so scared so that I could hardly see
The five faces that were staring down at me.
Suddenly I had the urge to get up and flee
And tugged at my arms but couldn’t get free.
They jabbed in a needle attached to a line
With a bag that ran fluid into that body of mine,
And when they pushed stuff for the third time
I got dizzy and groggy, and then felt just fine.
I heard many voices around my strange bed.
I felt some drilling around my numb head
And I saw something gushing a very bright red.
Then the lights went out and I felt l-i-k-e — d . .
I was rocked gently on waves in a great sea.
I felt the great warmth of God’s love for me.
Not far stood a man with a big golden key
And smiled as he gave a white gown to me.
He proceeded to lead me on a beam of light
And I calmly followed without any fright.
Soon we arrived at a most wondrous sight—
There stood my husband to my greatest delight.
Now you have heard my whole medical story
As I wander with Chad trough the land of glory.
On occasion we look down on the sick that we see
Hope they get more compassion than’s given to me.
We then held a meeting in which all concurred:
A declining kindness in medicine’s occurred.
There’s a need for the sick to be seen and heard—
A needed correction that must not be deferred!
Poet's statement: As a health care provider I have enclosed a poem that expresses my sympathy for those unfamiliar with the health care system. Elderly people who have been fairly healthy throughout their lives or those with little economic means, or both, face not only the fright of their sudden illness but the great frustration of dealing with a system that is not only very confusing but also without compassion for those who are unfortunate enough to be naïve of the process and/or the language it requires to participate in it. Hence, we are dealing with the poor, the elderly and the immigrants who generally have no health insurance and who do not have the ability to pay their way and/or do not have sufficient grasp of the English language to navigate the system. My heart goes out to all of them.
Inge Faust provides primary and urgent care at the VAHCS in New Jersey. Here she has served both veterans and employees for the past twenty five years in addition precepting advanced practice nursing students in their clinical rotations. Prior to her career in health care, she was involved in research in biochemistry and alcohol addiction, as well as in an extensive teen pregnancy intervention study for Suffolk County, NY. She received her master of science in nursing from Columbia University of New York and her doctorate in the medical humanities from Drew University in Madison, NJ.