Photography by Pellaea
Late afternoon in early August, Thessaloniki, Greece. A crazy time to be at work. Most colleagues are off for their summer vacations. I usually take mine in installments, a week in July, another week or so in the second half of August, depending on patient load and general circumstances. The summer heat is on with a vengeance, and the sun blazes down mercilessly on the heads and shoulders of those left in the city. On days like this one I usually regret my decision not to visit a cool place like England for a summer break. I would need a light jacket there, maybe even an umbrella, while now sweat fuses my shirt to my back.
This summer afternoon feels different, but not in terms of heat. We have had higher temperatures in the past. The country is in financial crisis, and its consequences are evident all around. One cannot help noticing the rows of padlocked shops that look vacant and deserted, their windows papered up mostly with “To Let” or “For Sale” signs, and a very occasional polite “Thank you for your custom.” Although the summer sales period is officially on, shoppers are scarce not only because people are away, but also because money is tight. This factor also probably keeps some patients away from private doctors like me. On top of all that comes the taxi owners’ strike, which has been going on for more than ten days now. This makes the city streets more manageable for the remaining traffic, but also poses a problem when you need a faster way to go home after a sweaty evening spell in the office. I seldom drive to my downtown office; our public transport network is good for most of the daily commuting.
Passing by the cathedral on the short walk from the bus stop to the office I take a habitual look at the notice board. Funeral announcements are customarily posted there, and only yesterday I spotted the name of a colleague; suffering from a heart attack, as I heard afterwards, he died before turning fifty. The notice is still there, a somber reminder of our common destiny, his face already fading from memory.
The regular beggar is also there in his wheelchair. I happen to have no coins in my pocket, so I studiously avoid his persistent stare. On a number of occasions I have dropped something in his cup, and now I wonder what he thinks of me when I ignore him. Will he excuse me for today’s neglect or mentally tick me off as a tight-fisted Scrooge? Should I care about his opinion of me? Strangely, I do. I know nothing about his actual circumstances; worse yet, I do not feel particularly inclined to get more involved.
My schedule only has a couple of appointments, so there is plenty of time for paperwork, web browsing (a couple of newspapers, some book reviews, an article in the New Yorker), even for a game of mahjong on the computer. All light-hearted and interesting, and I could spend the rest of the evening doing just that, but the bell rings. My first patient is here.
She is a lady I have seen regularly in the past. She has had scleroderma for a number of years and calls for a routine annual review. Physically she has been quite well. She has no evidence of fibrosis, her pulmonary hypertension is well-controlled, and she copes more than adequately with her tight, shiny, clawed fingers. However, her black dress is not dictated by fashion: a year ago she lost her husband to a hunting accident—a friend’s gun went off in the wrong direction. She gives me the story matter-of-factly, and I offer my words of sympathy as she shows me his picture on her cell phone. “I have to keep well, doctor, I have three sons to look after.” Her sons are in their twenties, but, in keeping with Greek tradition, they will live with her until they marry or move away, either prospect looming more difficult in these tight times.
My next patient also looks after a son; she has been doing that for the whole of his thirty-seven years. It is not exactly a healthy relationship. Reading the closely typed history she has brought with her reveals a lot about her mental health and that of her son. The boy had been a weakling in his tender age, with various visits to doctors and hospitals for real enough childhood illnesses, some of them serious. There is a mention of paternal violence, and an eventual divorce. One cannot tell when the mental illness became manifest in the mother, but it is obvious that the boy never had a chance to mature or even to veer out of the mother’s orbit. She does everything obsessively for him; she insists that she lives only for him, and I have no doubt about that. The boy, though intellectually bright, is mentally a mirror image of his mother. I do not know whether heredity has some role here, or if his behavior is simply the product of role modeling. I suspect he has no other regular contact with the rest of the world apart from his mother. What a life! A symbiosis of the most difficult kind. Fortunately his current respiratory problem is only trivial, and they both agree to my suggestion for psychiatric consultation and help. I think I know the right person to help them. I hope he will be able to do something.
The two appointments have dragged on, and it is almost time to close shop. This involves an established routine, and I go through the necessary motions: update patient records, balance the books, switch off lights, computer and air conditioning, lock the doors. As I go down the stairs I have that well-known and trusted feeling that I have left something behind: my bag feels lighter than usual, and, sure enough, when I retrace my steps, my old fashioned iPad-sized appointment diary still lies on my desk. I shove it in the bag, and lock the door again. End of the working day.
I decide to walk a couple of bus stops. It is already half past nine, and the heat is off for the day. The atmosphere is still sultry, so I take a leisurely stroll rather than a brisk march; still, it is a welcome change after three hours in the office armchair. There are no shoppers in the streets now, but sidewalk cafés are filled with young customers slowly enjoying a cup of coffee or a beer—exchanging pleasantries or brooding about their future or paying the modern equivalent of court to their loved ones over seemingly endless hours.
Walking provides an opportunity for reflection, and I mentally backtrack over the events of the evening. From a purely business viewpoint today’s balance sheet would appear as a failure: too much time for too little actual work (or gain). The two patient cases presented no real mental challenges regarding diagnosis or management: the clinical Sherlock Holmes would discard them as elementary, however much Dr. Watson might enjoy their human aspects. Should I feel disappointed? Seen from a different angle every single encounter of the day provides a cause for gratitude. I am alive and well. I have a job and a home to go to, while many people around me have neither. I do not have scleroderma or serious mental illness or any of the scores of diseases that might befall a person of my age. I have not lost a close relative, though some of my patients have departed under difficult and emotionally charged circumstances. I do not have to beg for my next meal. Unexpectedly I recall Pollyanna, a favorite read from my younger years: perhaps her “glad game” ought to be taught in schools, as a survival guide and a rule of life for all ages.
By the time I reach the bus stop a light breeze is on, making the air easier to breathe, almost pleasant. Thank God, here comes a number 2 bus—it will take me home a few minutes faster than the 31, which follows a more tortuous route. Another small blessing for the count.
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, United Kingdom. He is a postgraduate instructor in palliative medicine in the University of Thessaly, Larissa, Greece.