In Reply:
Grateful for the opportunity to dialogue regarding my sonnet, I must first express my complete shock at its reception.1–7 Throughout my poem’s8 multiyear evolution in creative writing workshops and then through this journal’s peer-review process, nothing of this sort was mentioned by anyone.
Clearly, something was missed.
If this poem shames patients, it is wrong. If this poem perpetuates bad science, it is wrong. If this poem damages the transplant process, it is wrong. If this poem discourages patients and families from considering such a gift, it is wrong.
By wrong, I mean both a professional failure and a moral violation. Regardless of my intentions, the interpretations and accusations in the preceding letters weigh very heavily.
During classes for my master’s degree in creative writing, this poem was conceived in a series of sonnets about how mythologic characters might interact with the contemporary American healthcare system. My purpose in writing this one was to explore the wonder, gratitude, and sadness I experience when providing the anesthetic care for organ procurement and (nonliver) transplantation. I find the surgical techniques and medical immunomodulation astounding. The nobility of organ donors humbles me. But as life-giving as these procedures are for some, I am sad that the only reason most organs are available is because the original users no longer need them. These three things—the science, the second chances, and the sadness—were my meditation.
Limited by the constraints of sonnet form (14 lines mostly in iambic pentameter, a particular rhyme scheme, a volta that helps synthesize two ideas or moods presented, among others) and my skill set as a poet, I wrote the best piece I could at that time. Like Rorschach blot tests, our creations—and interpretations—are based on our experiences, our beliefs, our professional interests, our pet peeves, our lifetime’s reading, and the rest of our lives’ experiences.
Although not first stated by Davidson and Fraser, they succinctly capture this idea when describing poetry as dialogical, meaning poems rely “for their significance on both writer and reader, and thus [are] never totally conclusive or singular” in contrast to being “receptacles of pre-conceived meanings or planned-out topics.”9 They also write, “Seeing poems as essentially devoid of social, political, or historical value—as merely modes of self-expression—severely limits the power of poetry to ‘speak out’ and converse with the wider world... Creative writing continually reflects and refracts larger cultural realities and concerns.”9
Some readers saw “realities and concerns” that they felt should have been directly addressed in my poem, although these were not my focus of the poem at the time of its writing. I was trying to get inside the head of a 6,500-yr-old demigod associated with the vine, wondering how he would respond to the sadness of a donor dying. However much I might regret the distress this poem caused, I cannot change that.
But I myself have been changed. I could not now write without being more sensitive to the myriad of issues raised in these letters. This is one of the ways art works. Over a given piece, readers and artists converse, although it is rarely this explicit. This poem has connected people worldwide, and that speaks of the value the creative arts can add in a medical journal. JAMA and Annals of Internal Medicine have had a creative section for decades.
Dr. Robertson7 mentioned the ongoing lawsuit in the United States about liver allocation. Science will never answer that question for us. Science offers no epistemology for ethics, beauty, kindness or—regarding organ allocation—justice. The arts are one tool that enables us to consider other perspectives, explore our emotions about issues, persuade others of our positions, and relate as individuals.
These abilities are important for physicians. Reading and writing poetry help me to do them. Despite the white coat, I am no different than any of my patients. I am just as mortal, just as fallible, and just as needy. I hope I treat each of my patients with the dignity and respect each deserves as a fellow creature.
Competing Interests
The author declares no competing interests.
