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when transfusions are gifted with sleepless hours voices grow dazed with tragic powers as if we’ve transcended the phase of gathering flowers & magically ascended countless towers with no stars outside of the night to climb into bed with us & no mornings giving water from a faucet of rust & what begins as a dog becomes a different dog with so little control over its bark-like instinct we examine our bruises blindfolded in a fog of pain covering everything with a god-like fabric because no mercy is bright enough to pass this fatigue onto another— treatment tolerability is a sister that failed our mother & grand sentimentality is its little brother

An important aspect of caring for patients with complex chronic illness, especially older adults with cancer, is understanding how treatment is tolerated. Yet barriers to seeking this information are many, including the debilitation caused by not only illness but also the adverse effects of treatment itself, which can effectively silence patients. In “Treatment Tolerability,” poetry becomes a vehicle for addressing these challenges, and imagining what patients may experience when receiving treatment (in this case, multiple transfusions). Immediately noticeable is the lack of capitalization and punctuation throughout the poem, which suggests the subordination of patients to the imperatives of urgent treatment in the quest for a cure. Adverse effects, such as confusion and weakness, are then conveyed by the haphazard rhyming in the poem; breathlessness, perhaps, is felt in the short, enjambed lines. Even the vague nursery rhyme feel of the poem seems a caution against how clinicians might infantilize and speak down to patients when attempting to assess treatment tolerability. That the poem’s speaker is not the patient but an observer seems to underscore the risk, even with the best of intentions, of supplanting the patient’s voice with our own. Finally, the speaker’s recognition of the inescapability of these concerns, and the frustration, shared by clinicians, that often accompanies them, are deftly expressed in the searching lines, “blindfolded in a fog of pain/covering everything/with a god-like fabric/because no mercy/is bright enough to pass/this fatigue onto another.”