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