Poseidon’s Potion

I sport an easy-access docking station.

Poseidon eyes my port with rapt fixation.

He pierces skin, infusing grim libation:

seasickness swells; I sink in resignation.

As chemo flows, I try to be heroic.

Could be my bravery lies in being stoic.

Will you dismiss the dread within my heart—

a heart Poseidon so coolly tears apart?

A sea-squirt drug halts tumors scuttling fast,

but Poseidon’s potion is a poisonous draft,

destroying my marrow, my liver, my thought;

it’s making me jaundiced and distraught.

I seek to find the ghost in my machine;

if I’m just matter, what can my life mean?

Empty and dispirited, my brittle will snaps:

dualism’s undone; my eigenstates collapse.

I’m a nobody who’s feigning to be wise;

daily it gets harder to keep up this disguise.

You see, chemo and sarcoma are conspiring:

clarity recedes as my neurons cease firing.

About Prometheus, what do I admire?

His shaping of clay as humanity’s sire,

and theft of fire, sparking Zeus’s ire;

yet his grit and defiance truly inspire.

Being a martyr was never his ambition;

eternal torture is a dreadful proposition.

He gasped as those raptors tore and ravaged;

he couldn’t expire as his liver was savaged.

To be a hero won’t be all that great,

since searing pain is my implacable fate.

As vicious vultures laid our titan low,

sea-god’s elixir deals me a mighty blow.

But now I strike a most dissonant note,

toxic chemo gets my unexpected vote.

My death’s delay is utterly sublime,

I grasp the titanic gift of borrowed time.

In this poem, Michael Avidan explores the paradox of chemotherapy as both poison and gift—a toxic elixir that inflicts profound suffering yet grants the reprieve of additional time. He explores the psychological and existential terrain of advanced cancer through the lens of a patient who is also a physician. Using the medium of poetry, he offers clinicians, as well as a broader audience, a deeper understanding of how patients with cancer experience toxic chemotherapy. He tries to convey that even those with incurable cancer retain a passion for life and an ability to live life to the full. The themes addressed are universal and are relevant to all clinicians, patients, and human beings.

Poseidon’s Potion is a poem about a chemotherapy called trabectedin, a drug that was originally isolated from sea squirt in 1969.^1,2 Avidan’s life changed dramatically after he was diagnosed unexpectedly in 2022 with stage IV leiomyosarcoma. ³ His life now centers on cyclical infusions of cytotoxic treatment, which is physically, mentally, and emotionally brutal. At times, he has the impression that choosing to receive chemotherapy is like choosing Scylla over Charybdis: two monsters both bent on destruction, with Scylla only marginally less deadly.

The poem conveys the damage inflicted by trabectedin.^1,2 This drug attacks malignant cells but is indiscriminate, destroying rapidly replicating cells in the bone marrow, liver, gastrointestinal tract, and nervous system. As the late author and critic Christopher Hitchens observed about his own illness, “I’m not fighting cancer—it’s fighting me.” ⁴ Poseidon’s Potion is fighting Avidan’s cancer, and Avidan portrays himself as collateral damage in this war.

While the poem reflects his personal experience with chemotherapy, its themes extend to other life-prolonging interventions that can diminish quality of life, such as mechanical ventilation, renal replacement therapy, mechanical cardiac support, or tube feeding. ⁵ Avidan endures chemotherapy because his life remains rich in meaning. Under different circumstances, perhaps he would not accept this debilitating therapy, even if it prolonged his life.

In the fourth stanza, Poseidon’s Potion takes a metaphysical turn. The focus shifts from physical torment to the disintegration of self. For many, the notion that consciousness might be annihilated with death is intolerable. The term “eigenstates” is a concept from quantum mechanics, suggesting that a system can exist in more than one possible state. Analogously, the brain and the mind might exist independently of each other, or dualistically. But when a quantum system is examined, it collapses into a single “eigenstate.” Evidence from general anesthesia, a method of probing or examining brain states, suggests that consciousness depends on the physical substrate of the brain. ⁶ When anesthetic agents impair neuronal connectivity, consciousness appears to be extinguished. ⁶ If awareness can be snuffed out pharmacologically, it seems unlikely that it could survive the death of the brain, arguing against dualism. However, no one can know for certain that consciousness ceases with general anesthesia or corporeal demise.

Avidan reflects on a challenging inversion that affects many patients with advanced cancer. For his whole life, he has been an expert in his field. Yet now his lived experience is that of a disempowered patient, with limited agency, and his fate dependent on other people’s decisions and expertise. He feels insignificant, and this feeling is heightened by his disease and the neurotoxic chemotherapy, synergistically impairing his cognition.

Most humans are heroic in quiet ways. We all face tremendous adversity in life, and the bravery we summon often goes unseen and unheralded. To struggle for life and to accept death are two sides of the same courage coin. Avidan’s stoicism does not mean he is unafraid; he remains terrified of pain and suffering. Bravery, in this context, lies in choosing life despite dread and in recognizing that equal courage may lie in choosing death. Clinicians must support patients regardless of the path they take, for who can judge how another human faces the most profound existential challenges? ⁷

The poem ends with a consoling message. Despite the heavy costs, Avidan so cherishes the prolongation of his life that he willingly accepts the potion. The poem suggests that the most precious gift we can receive is time, even if it’s borrowed and tenuous. As humanity’s sire, the titan Prometheus gave us fire, but perhaps his greater gift was teaching us forbearance: the capacity to withstand suffering so that we might savor the sublime and find grace in the brief, flickering miracle of continued life.