By Krista Elizabeth Hammaker*

Encounter #1:

An emaciated 30-year-old Black man,
Cracks “Is this assisted living, or jail?”
Post wide gluteal excision, anemic.
A nursing home crisis, a pandemic.

Diagnosis: Hidradenitis suppurativa.  
En route to doctor, he asks for sativa.
Pain found in hell’s conditions and terms.
He said, “At least I’m finally headed to Derm.”

His facility – the biggest dump in town.
Government funded. No justice around.
He’s all clean and ready for big medicine’s foolishness.
No option for comfort but right lateral decubitus.  

Reason for visit: Humira and wound inspection
Care delivered: None (and little affection)
“No Humira insurance, after a 7 month wait?”
Care delivered: candy bought and ate

Humira healed his sister, after they were both diagnosed.
After their Grandmother died, and he turned to a ghost. 
That was the woman with the love and the kitchen,
Who got them through college and made them pitch-in.

Last minute, he asked for an insurance number.
Everyone’s ready to go, he’s outnumbered.
Nurse re-enters, new patient in a slumber.
“We’re still waiting” I said to disencumber.

The nurse returns, insurance details in hand.
A 10-minute wait for basics, we can demand.
No wound inspection, time to leave the room.
Ethics have limits in an EMT costume.

Encounter #2:

A B-12 shot, surely won’t take all day.
Then I smelled death in the hallway.
Putrid sheet mountains, piled up to his nose.
Food feeding fungi, I gloved up to dispose.

Sheet-drag to stretcher. “No! Lift. Bring pillows.” 
Knee to bed for leverage, my heart billows.
His mattress, a wetland, filth never obtund.
Towels, not bandages, over his wounds.

On our trip “home” he verbalized his abuse.
He knows they’re busy, but it’s no excuse.
I froze like sharp ice… and gave his traps a massage.
Medicaid and I wondered where to find enough gauze.

I called a seasoned partner and an EMT instructor.
This… just after I returned him to his abductors.
They said, “report, sounds like he’ll die, this is mankind.”
“Sounds like he’ll die and violence echoed in my mind.

Then I cried, glass of wine, and I sat on my deck.
I needed an atlas far more than this paycheck.
Ruminated for days, wrote down all that I saw.
Wrote the perfect report. Thought of my every flaw.  

Time passed… Halted abuse investigations?!
Cuz a 0.1 micrometer virus met our Nations.
Friends and family at private facilities could enter.
Not here, where he said “to care is to be a dissenter.”

Encounter #3:

They stopped calling us for him, so it has been some time.
They don’t call reporters to the scene of this crime.
Reason for visit: Humira. And I am ready for fights.
Then he said, “I can stand” and he stood to great heights.

“You’re so tall!” I yelped as an old man grinned,
rolling the hallways for his own second wind.
He said, “Humira is working. I can bathe myself.
Though my skin has certainly thickened.”  Interesting how a first encounter’s wait, for an insurance number, that felt so inane,
Was my most important 10-minutes to date.

About: This poem recounts three clinical encounters between a transport EMT (me) and a man with Hidradenitis suppurativa. His condition was so severe that he required admission to a long-term care facility. At the time, I was working for a private ambulance company that had transport contracts with local nursing homes and long-term care facilities.

These events occurred in the early waves of the COVID-19 pandemic, and the situation was complicated by the well-publicized devastation COVID-19 had on patients in nursing homes and long-term care facilities.

During encounter #1, I first met the patient. Substandard care was delivered, hospital staff were rushing us out of the office, and the patient asked if we could wait for an insurance number that he needed to help get his Humira approved. At this time, I also got to learn about his family. During encounter #2, I observed clear evidence of neglect and the patient told me that he was being abused and ignored. After mandatory reporting, I learned that abuse and neglect investigations had been halted because of the pandemic. Further, the nursing home stopped calling our contracted ambulance company for the patient’s regular transports. During encounter #3, after months of not being called, he finally appeared on the schedule, to be taken for Humira. On arrival, he was no longer cachectic and was able to walk, improvements he attributed to Humira.

The moral of the story is to take time for simple administrative things, like making insurance coverage easier for patients. Funny… I spent months worrying about this patient, but the 10-minute wait during our first encounter, before I even knew he was being mistreated, is what enabled him to advocate for himself and heal. KEH

• Krista Hammaker is a non-traditional medical student in her third year at Northeast Ohio Medical University. Prior to medical school, she was a member of National Ski Patrol, studied biology and liberal arts at Juniata College, studied naturopathic medicine at Bastyr University, earned a Certificate in Clinical Research from University of Pittsburgh School of Medicine, and had been active in clinical research since 2008. During the early waves of the COVID-19 pandemic, she worked as a transport EMT. In her spare time, she enjoys long walks with her husband and dog, trying new food, playing guitar, and singing/songwriting. krista.e.hammaker@gmail.com