Katy Giebenhain is the author of Sharps Cabaret (Mercer University Press). She is part of the monthly Narrative Medicine group at WellSpan York Hospital in York, Pennsylvania. Her poems have appeared in The Healing Muse, The National Academy of Medi… — Katy Giebenhain is the author of *Sharps Cabaret* (Mercer University Press). She is part of the monthly Narrative Medicine group at WellSpan York Hospital in York, Pennsylvania. Her poems have appeared in *The Healing Muse*, The National Academy of Medicine's *Expressions of Clinician Well-Being* online gallery (Athena, Dialing), *The Arkansas Review, The Glasgow Review of Books, The Examined Life* and elsewhere. Her poem “Swedish Fish Rescues” appears in the Fall 2019 *Intima: A Journal of Narrative Medicine.*

I love the flap book illustration included in the Spring 2019 Intima (“The Breath Series: Anatomical Flap Book” by Marianne R. Petit). The black contours, use of primary reds and yellows and the framework of the ribs keep it aesthetically clean and unfussy. “The Anatomical Flap Book” is approachable and old-school interactive, like Pat the Bunny. It’s also serious. Without breath we’re screwed.

This art strikes a kind of kinship with my poem “Swedish Fish Rescues.” Managing blood glucose, likewise, is serious business. Intima defines Narrative Medicine as “the intimate interface between two people, one as healer, one as being healed, who both yield and gain from the experience of the clinical encounter.” One of the things sawing at the foundation of clinician-patient encounters is the practice of drug formulary exclusions. We should be talking about this more in Narrative Medicine circles.

I’m reminded of Richard Gunderman’s familiar remark from his 2014 Atlantic article addressing clinician burnout: “Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.” One such betrayal of purpose happens every time a choice about a medication is taken away from the people who should be making the decision together. For chronically ill patients engaged in 24/7 management of their disease, exclusions both undermine the authority of the prescribing clinician in front of them and disregard the experience and attention these patients consistently bring to their own care. Through drug formulary exclusions pharmacy benefit managers usher shareholders into the exam room. Even patients with “good” insurance coverage are vulnerable.

While the accessibility of the “Anatomical Flap Book” and the urgency of getting the brain what the brain needs now in “Swedish Fish Rescues” do not overtly address formulary exclusions they still remind me that Narrative Medicine’s interdisciplinary character is poised for the kind of conversations we need to have around equity and choice. Artists of all kinds can call out injustice around access to necessary medicines in lively, inventive ways. Don’t relegate it to journalists and patient advocates. Help out.

Katy Giebenhain is the author of Sharps Cabaret (Mercer University Press). She is part of the monthly Narrative Medicine group at WellSpan York Hospital in York, Pennsylvania. Her poems have appeared in The Healing Muse, The National Academy of Medicine's Expressions of Clinician Well-Being online gallery (Athena, Dialing), The Arkansas Review, The Glasgow Review of Books, The Examined Life and elsewhere. She co-hosts the coffeehouse poetry series "Upstairs at the Ragged Edge" and works at Carroll Community College. Her MPhil in creative writing is from University of South Wales.