Surprising cacophony may often occur
To tell on actions nether, covert;
With popping and creaking and swishing and more,
It squeals a tale—when privacy preferred.

Expressive the telling with “oohs” and “aahs,”
Dramatic pauses, then flurry of sounds.
Some groans to protest, moans to cry,
And exclamations matched to frowns.

At thirty-feet intestines long,
The muscular gut has massive work.
With gassy hazards in the  mix,
The laborers think they're owed a perk!

Embarrassing, though, and fearsome oft,
No cause for alarm is usually meant.
Most noisy cases are healthy speech
Unless delivered with other event,

Like nausea, vomiting, bloody stools,
Excessive gas, abdominal pain,
Diarrhea, fever, heartburn, cramps…
Borborygmi else are safe and sane.

​

The patient who enters clinic referred
A certain status deserves.
With proof of ailment pre-confirmed, 
Frivolity none observes.

Referral, though, may not involve
Professional contact made.
The first practitioner, wise and quick,
Oft has no office staid.

Take heed the pain that rears its head
Despite no injury known;
It means, no doubt, you've been referred
From self-referral zone.

A pain left arm or of the teeth
May tell of heart attack,
And shoulder pain there on the right,
Gallbladder on the rack.

“Referred pain” is its name and badge,
A hint to not be lax.
Consult physician, be not shy,
Referred without a tax!

​

The word “even” is most commonly used as an adverb even though it may assume the role of at least three other parts of speech: noun, adjective, subordinating conjunction. For example, in the preceding sentence, it is serving in combination with “though” as a subordinating conjunction,  which, by definition, introduces the dependent clause that follows. Writers sometimes wonder whether a preceding comma is required in such situations.
 
The general rule regarding commas with subordinating conjunctions applies here for “even though” and similar combinations, i.e., apart from a couple special cases, a comma is only required when the dependent clause is shifted to the beginning of the sentence.

While most other uses of “even” do not call for a comma, this punctuation is also required when “even” introduces an interrupting phrase that can be removed without altering the meaning of the sentence or is there only to emphasize the surprising nature of something. 

Another notable situation where a comma is mandatory occurs when “even” introduces a participial phrase at the end of a sentence; a participial phrase that ends a sentence is always preceded by a comma.


We think of “even” as “balanced” or “flat”
Or meaning “exactly,” “fully,” or “just”;
Of variation claiming slight;
Surprising states yet emphasized.

As adjective, adverb, noun or verb,
It ranges broadly, role and site;
A speedy tour in orbit grand
Leaves little pause for comma's plight.

But interrupting phrases all,
Participial ones at endings, too,
Are comma's friend when “even”-strung
Like clause dependent firstly grew.

“Thus, even though it's moonlit bright, 
The forest trail seems grave tonight.”
“The bus today was later, even
Forcing them to bum a ride.”

“And once arrived there, even late, 
They walked with pride and smirking smiles.”
Thus illustrated, queue reversed,
Are three of “even” for the files.

​