Transplant Rejection

The anti-rejection medication list is long
I know because he has to sit, on Sundays, and fill in little boxes for the week — 
the rattling sounds of morning, noon, evening, bedtime — 
 
Sometimes, his hands tremor uncontrollably, his voice shakes
his eyes wring out tears
and he finds himself wondering — 
Is it the medication or him?
 
He feels obligation to take them as a thank you
to the person, a much younger person,
whose lungs now reside in his chest — 
 
When it rains outside, or when it snows
the large scars hum and throb and make themselves heard — 
I wonder what it’s like, to carry someone else inside your body — 
Then I realize that perhaps one day I will know, in a different sense — 
 
The anti-rejection medication list is long — 
I know because on television, I see people with microphones proclaim
that certain people who come to this country, or who are born in this country do not belong — 
I watch them activate a cascade that is forming a clot in the heart of my America
 
Have any of us ever belonged?
 
We were all transplants, we all should have been rejected
but still we grew, we became a part of the tissue — 
Useful, indispensable in our new host — 
We created the medications they would take from us
so that they would not reject us — 
 
Though it is hard to compound and bottle and dole out love
that is what we try to do with words
and silence
and hugs and light and prayer and reason and
Peace
 
Even in the face of unspeakable rejection
When antibodies take bodies
Simply for loving other bodies
We continue our vaccination campaign of love
 
We say there are natural killers
But is it unscientific of me to refuse to believe it?
 
We immunosuppress
We try to stop the parts of the body that recognize the new tissue as foreign
We try to stop the parts of our body that recognize ourselves as foreign
With each new pill we think we’ve moved on,
we hope that rejection is a thing of the past, until it happens — 
And we are devastated
 
The immune system is trigger-happy when it turns on them, when it turns on us
An insistence on hygiene becomes a loaded gun — 
Taking a good history could have told us this would happen — 
This failure of tolerance,
the danger of focusing too much on self vs. non-self
 
So what is our plan? I find no ICD code for this pain — 
If nothing else, we have learned this year that
the best laid plans of doctor and patient often go awry
 
But if you ask your patient, they’d say it’s simple — 
The most validated tool to go from stasis to progress is love
 
Love is not friable, it is not well-circumscribed but like a trophoblast invasion
it is not malignant, it sustains life
 
We present with intractable idealism and they tell us it will wane, and maybe it will
But maybe it will wax again, like the moon,
revolving around our patients, around each other — 
 
To care for a transplant as you do your own tissue
Is beautiful
Is possible
Is everything

-Vidya Viswanathan, MS2

In addition to being an awesome Perelman medical student, Vidya is a passionate writer who started the organization Doctors Who Create. Her goal is to encourage and embody creativity in the medical profession. Visit the Doctors Who Create website at www.doctorswhocreate.com.

If you have a creative piece that you’d like to share in PDInsight, please email us at penndi@mail.med.upenn.edu.


This poem was featured in the October 2016 issue of PDI’s newsletter, PDInsight. For the full issue, please visit the campaign archive.