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Medical Home

A model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety.   –Patient-Centered Primary Care Collaborative

It’s a philosophy
not a place.
I get it.
Certainly we never used that term
to describe what we offered
there in the broken heart of the city

but we had a townhouse
with a fireplace and a living room
where patients waited and shared their laments.
We played music during office hours–
gospel and Latin mostly–and sometimes
invited the homeless or distressed to rest
in the upstairs room we called the chapel.

My godson K spent his infancy
in a basket under the front desk
where his mother, once our patient, presided.
She handled the chaos each day seemed to bring
and drew out each patient’s story in full
despite the havoc it wreaked with the schedule.

She assigned each clinician the patients
she deemed us best suited to treat
and, after each consult, verified
that every symptom, question and fear
had been expressed and addressed. If not,
she sent them back to be heard.

This sort of thing cannot last forever.
The braiding together of disparate lives
over all those years took its toll.
Our demons sometimes bested us.
New rules came down for premises,
labs and insurance. We struggled
to pay the bills.

But ask K, now a man, about the best
most stable years of his life
and he’ll say these were the ones.
Ask me about the best job I ever had
and I’ll say this was the one.
Our old patients have mostly died
or been forced out of the neighborhood.
The clinic, too, was doomed by gentrification.

I don’t know if this is a poem
or just a memory
that has slipped into words
but I remember some lines from Frost
that describe what we had:
a place where, when you have to go there,
they have to take you in.