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Poetry and Medicine
March 25, 1998


Author Affiliations

Edited by Charlene Breedlove, Associate Editor.

JAMA. 1998;279(12):896. doi:10.1001/jama.279.12.896

Once sized for subsidies,
mostly black, mostly skinny, mostly
children line the clinic halls.
The children can't see rails spreading
beneath their feet, those steel connections
feeding outer Dubuque to inner Cleveland,
all Enid to Orlando. Neither can they see
beyond these walls—to Oklahoma,
summer sand burying the plank house, its family
shrunken, alone. And, over there, Montana,
potbellied and quick, a chill rattling among the pines,
leaving them bitten, done. Behind them isn't that
Dallas, the wire line dipping, dungarees strung?
There, it must be school's first day, because down
the block, bells buzz, charged voices rush
before a loud static slows, as if someone
heard some shots and talk, they say,
is of a showdown. And in Detroit,
the Little Engine That Could replugs its cheeks,
tagged to empty before Phoenix, there to reload
leftover cheese, too many stops, too little time
to gauge the gullies or estimate the odds.
All about this tangled land engines rumble,
dust piling, bridges listing, and chickens turning thin.
And here the line crackles with tiny fires, kids
popping sparks, their green wood barely burning.
Count it all, the cored cotton bud, the combine
and chain saw, the pilfered engine parts—
with maids from proud tobacco halls
sweep the trashed receipts from courthouse steps,
grab what's there and paper the walls
with all that's lost. Run the ledger's tall columns
until it's clear—the sum is nothing
and all that's left is unmeasurable heat.