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Nolan Snider

People say it's the last place
They want to go.
But when push comes to shove,
It's the next-to-the-last place.
Although there are some who are
Ready to move on to that last place.
Others stay as long as they can in this,
The last place they thought
They would ever want to go.
Clinging on, year after year,
Staying here to avoid
The last place.

The demographics have changed
From twenty years ago.
It's not just the old and older.
Many beds contain the victims of excess.
End-stage hepatitis
Alcoholic encephalopathy
End-stage COPD and lung cancer
Consequences of diabetes ignored
Or diabetes and smoking
Or diabetes not treated aggressively enough
Or diabetes with everything done right
But still a stroke or heart attack.
Here because they just ate and ate and ate,
And now they are just too big to walk
Or breathe or clean themselves.
Here because the government
Decided asylums were unnecessary,
So now Grandpa's roommate is a madman.

The staff is the same, only spread thinner,
Due to corporate's struggle to break even,
Caring for sicker, heavier and crazier.
And emotionally it's harder when
The dying patient is closer to your own age.
Fewer workers means more hours,
And fewer to cover when someone doesn't show.
More tired means more soda and more stress.
And stress means more eating
And, for most, more smoking.
More weight, more diabetes, more lung disease.
Going home after each shift thinking,
"That's the last place I want to go."
And each day inching closer to the door.


About the poet:

Nolan Snider is a family physician with Cox Senior Health in Springfield, MO. "I have been writing poetry since my second year of medical school, as a way of processing the many difficult life experiences that we and our patients endure. In the last year, I have become one of the many (about 25 percent, in our area) primary-care physicians who have left clinic practice to escape the ever-growing charting demands and to regain some much-needed time with family. Many of my clinic patients down through the years have stated, 'Just keep me out of the nursing home.' Now, in some ways, my job is to keep people from leaving the nursing home."

About the poem:

"When I changed to my current job, I had not provided nursing-home care in a few years and was struck by how young the residents seemed (or am I just older?). I was also dismayed by the percentage of staff who smoke. This poem developed from looking at the unhealthy behaviors of those needing care--and of those providing it."

Poetry editors:

Johanna Shapiro and Judy Schaefer

Comments   

# LUCY A FALATIC 2017-05-09 15:52
Not sure Trump is making people smoke or eat and eat and eat. That comes from stress and lifestyle and personal choices.
This poem is so honest and real. This is us. This is how people live and how people end up, at times, somewhere they never intended and didn't see coming....for some reason. Because people never think those rules apply to them and anyway....life is stressful and tough...isn't it?
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# Robert Finlay 2017-05-05 19:23
Corporate greed, and it is getting worse. Donald Trump has emboldened the hatred and greed, and it is the only thing that has trickled down from the top. Good by to overtime pay too for the underpaid caregivers at this level of medicine.

Nice Poem, thank you for sharing.
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# Nolan Snider 2017-05-14 16:41
Interesting comments, but not related to this poem's content. I'm actually working in the nursing homes due to lack of greed. I was offered a Radiology residency, and as a radiologist, I would have made 2-5 times as much, and had much more time with family. I chose Family Practice to provide the kind of care I felt people deserved. I did rural practice for 18 years, and thought I would do that until I retired, likely retiring later than average due to my love for that practice. Unfortunately, Obamacare dropped my income by 40%, made it so I could not spend the time talking to patients about their care in the manner they/I wanted, and took ALL of my family time away, due to the charting demands. This poem was written in 2015.
One of the corporations I worked for had to sell their home and haven't paid me for the last 3 months due to governmental fines (which multiplied exponentially over the last 8 years.) Trump isn't who I wanted, but he's not who destroyed my life.
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# Christopher Carr 2017-04-28 22:41
This is beautiful.
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# Sharon Dobie 2017-04-28 20:33
This is a very meaningful and equally disturbing poem. My take was a bit different than your comment, Nolan. You allude to this about the overworked staff, and I feel it applies to the residents too. What are the upstream parts of this story? While each of us has and make choices, I believe so much of this should be allocated to the upstream factors and that is where interventions should lie.
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# Ronna L. Edelstein 2017-04-28 17:56
Your poem beautifully captures the "last place we want to go" with precise word choices and perfect details. I pray that I can skip the "facility" part of my so-called Golden Years, but time will tell. I also pray that changes occur that will make facilities better equipped and more responsive to the needs of the residents.
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# Sandra Miller 2017-04-28 17:53
Excellent poem. Sharp, insightful, chilling. Should be required reading. Thank you.
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# Larry Halverson 2017-04-30 22:14
I have been priveleged to read many of your poems Nolan. I appreciate the depth of your caring and your wrentching pain from watching people mortgage thier health for immediate gratifications.
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