|Photography by Marju Randmer|
It is not uncommon for practicing clinicians to receive gifts of gratitude. Patients have their way of expressing their appreciation for whatever service they believe we offered them in the course of their health misadventures. The prevalence of gift-giving may vary with the healthcare system (state or private), the status and location of the physician (family doctor versus hospital specialist), the extent and duration of the doctor-patient relationship (acute severe versus chronic lingering disease), and the ambient cultural tradition of the people (my limited experience suggests that Greeks may be in the forefront). So over the years one is likely to collect various mementos from sick people who came under one’s care, regardless of the final outcome.
Such presents come in various shapes and guises. They can be roughly classified as consumables or perennials. The former category includes the usual bottles of wine and distilled spirits, the aniseed flavored ouzo and its non-flavored brother tsipouro being the majority in my home turf (if I were to drink all those bottles, I would not be fit to practice). There are also homemade cookies and jam and honey and oriental syrup-and-pastry sweets which get shared with the clinic staff as soon as they appear. A special treat may be the occasional village sausage, or even small game such as rabbit or wild boar, which provide an opportunity for a festive dinner (accompanied by some of the aforementioned wine and spirits).
The “perennials” are different, and special. From my personal series I have selected five, as much for their individual character as for the fact that they are souvenirs of people now gone. None of the donors is physically alive—most of them had lung cancer—but they all live in the department of medical memory.
On top of my bookcase sits a wooden miniature model of an ancient Greek temple. The late artist, a man in his eighties, spent most of his waking hours doing woodwork at home: getting his raw material, whittling and carving it into shape, assembling the pieces, painting and polishing the finished item, whatever that might be. He had an extensive range of themes, and worked with his heart until his last days.
My wardrobe includes a red woolen waistcoat I received many years ago from a woman of 58, a professional knitter. She brought it on one of her chemotherapy visits (“I made one for you and one for the professor. There is a blue and a red, so you can toss for the colors”). I still wear it when the chilly season starts.
Then there is the traditional Byzantine icon of St Anthony, handpainted on cured wood with a gold leaf halo, which stands on the mantelpiece of my sitting room. The patient who gave it to me, only 43 when he presented, died soon after in a most tragic fashion. His small cell tumor had eroded the superior vena cava, which ruptured suddenly, leading to exsanguination within minutes.
A rare edition of the Dictionnaire Grec-Francais (published in 1894) brings to mind a learned 54-year-old lady of foreign descent, married in Greece, whom I had the privilege to attend at home during her final illness. The dictionary (a hefty tome of 2,200 pages) covers the ancient Greek language, from Homer to the Gospels.
And more recently, I looked after an elderly professor of mathematics who was admitted with a large malignant pleural effusion and multiple liver lesions. He had already lived with his slowly growing cancer for six years, and now the end was in plain sight. I only did a couple of chest taps for symptom relief before he passed away, a few days later. In between he offered me a brand new copy of his three-volume textbook on statistical theory with an autographed dedication on the flyleaf.
To this odd collection I must add another pair of unusual books. Their authors, a Jewish man and a Greek woman, were not distinguished scholars but ordinary people. Their common link was the sinister number tattooed on their forearms: they had both been inmates in the Auschwitz extermination camp, and fortunate enough to return to their birthplace, my hometown, alive. The books are first-person accounts of their nightmarish experiences. I had visited Auschwitz as a student many years ago; getting to know survivors of that infamous camp brought the whole experience to the forecourt of memory with a vengeance.
Such unexpected presents are always emotionally touching. These patients pay their regular fees, and this is their way of adding something extra, of their own initiative, each in their unique and simple or more sophisticated way. They do not demand special favors or privileged treatment; they just give from their heart. They usually do not proffer any explanation: the unselfishness of the act speaks louder than any words. It is behavior like this that makes me forget the injustices of the system, the small and large tragedies that I encounter daily in the practice of medicine, and keep going.
How did I come to write about gifts? The idea occurred to me a few days before Christmas, when I had an unscheduled office visit from an elderly lady whom I had been seeing for some years. She had no new medical complaints, and she was coping adequately with her severe obstructive disease. She lived out of town and had driven an hour’s distance in inclement weather. For what purpose? To bring me a big pomegranate from her garden (“for good luck and prosperity”), a vase of raspberry jam of her own making, and a small bottle of liqueur, also prepared with her good hands. “Just to wish you a very happy Christmas!” she said, putting on my desk her personal version of gold, frankincense, and myrrh.
ANTHONY PAPAGIANNIS, MD, MRCP(UK), DipPallMed, FCCP, is a practicing pulmonologist in Thessaloniki, Greece. He received his MD degree from the Aristotle University of Thessaloniki Medical School in 1981. He trained in Internal Medicine in Greece and subsequently in the United Kingdom, and specialized in Pulmonary Medicine. He also holds a postgraduate Diploma in Palliative Medicine from the University of Cardiff, Wales, UK. He is a postgraduate instructor in palliative medicine in the University of Thessaly, Larissa, Greece.