Lynchburg Family Medicine Residency, Virginia, United States (Fall 2011)
Photography by Stefania Slenzio
Five minutes early for his appointment, I met Dr. Ivan Minski at the weigh station. He was dressed in a sharp, blue suit and narrow tie. White hair graced his head, eyebrows, and even his ears, though his stooped shoulders prevented me from getting a good look at his face. Introducing myself, we shook hands—his voice trembled, and he took a few seconds too long to let go. Taking his cane, the nurse then helped him onto the scale. When he shuffled down the hall to the exam room, I wondered how long he had lived with Parkinson’s disease.
During the interview, I discovered Ivan had been a professor of medicine at Yale for 28 years and had written numerous articles and books on hepatic cancers. I could tell he was proud of his achievements, but I also sensed he harbored regrets about his life. He had recently moved to the area from New Haven to be closer to his son, John. The move was not what he had hoped for—his son had little time for him. John was busy practicing law and raising his own family. “And building his own name,” Ivan added ruefully.
Changing the subject, he then admitted that the purpose of this visit was to determine whether I would be a good “fit” for him. Asking around, he had heard my reputation was good.
“How are you feeling today?” I asked.
“I can’t complain. My back gets tired from hunching, but I live with it. Sometimes I have trouble sleeping.” Ivan continued to tell me more about his back, balance, and mobility problems. His review of systems was unremarkable.
After asking about his sleep habits and reviewing his past medical history (Parkinson’s disease, osteoporosis, and depression) and medications, I asked, “Dr. Minski, is there anything else you wish to discuss before I examine you?”
“Please, call me Ivan.”
Having established a more personal level of communication, I was tempted to tease him by asking if he thought I was a good fit for him, but I refrained. Then, pulling his chair closer to me, Ivan asked, “Doctor, have you ever felt something important was missing in your life?”
From my short stool, I looked up at his 72-year-old face. His impassive look reflected both Parkinson’s disease and depression. Without my reply, he continued, “Doctor, I am a man of science. I devoted my life to medicine and research. I cultivated colleagues, not friendships. Although I grew up Russian Orthodox, I did not let God or the Church distract me from my work. I’m ashamed to say it, but when my wife died nine years ago, I did not miss her. At that time, I had my career. Now, that’s gone, my health is failing, and I’m in a strange town where my son is too occupied to have lunch with me.”
Defeated, his chin dropped closer to his chest. I paused a few moments, then urged, “Please go on.”
He opened up, explaining the hardships his family experienced during Stalin’s rule in Russia and describing their escape to America where Ivan eventually was able to make a name for himself. I told him it was a privilege to hear his story and thanked him for sharing it.
After helping Ivan onto the table and performing a careful examination, I administered a depression questionnaire. His score: mild depression. To test his cognition, I asked Ivan to draw a clock displaying “ten after ten.” The clock’s numbers were correct, but he drew the arms at 11:55. At my urging, he explained, “I appreciate your thoroughness and interest, doctor, but I know you cannot fix me. It’s five minutes to midnight in my life.”
I smiled to myself, reflecting on his morbid humor. What could I offer this man? Did he have a chemical imbalance, a simple matter of boosting serotonin or norepinephrine at receptor sites in the brain? Did he need more dopamine to replace the depleted cells in his substantia nigra? Did he need grief therapy, now that he is finally mourning the loss of his wife? And what about the lost opportunities with his son—how could I help him with that?
Before I had a chance to review my thoughts with him, Ivan interrupted, “Whatever you recommend, we’re both old enough to know more medicines are not what I need.”
“And what is it you think you need, Ivan?”
“I don’t really know. All I know is perhaps it will take some time to work through things.”
I nodded in agreement. “How about coming back in a few weeks? We can talk more then.”
“Yes, I’d like that. May I call you Dean?”
“Yes, of course.”
“Well, until next time, Dean.”
At that, Ivan grabbed his cane with one hand and pushed himself off the chair with the other. Shuffling out the door, he turned to me and said, “One more thing, if I may.”
He slowly pulled his shirt sleeve up and looked down at his watch.
“I thought you ought to know—it’s now 15 minutes to midnight. Thank you.”
The above story is fictional. The names, events, and characters are imaginary, not real. Any resemblance to real persons or events is coincidental.
DEAN GIANAKOS, MD, FACP is an internist who serves as the associate director of Lynchburg Family Medicine Residency and Geriatrics Fellowship, Lynchburg, Virginia. He is an associate professor of Clinical Family Medicine at the University of Virginia. He is board certified in Internal Medicine and Hospice and Palliative Medicine. He frequently writes and lectures on end-of-life care and the medical humanities. He serves on the editorial board of the medical humanities journal, The Pharos.