One of my father’s musical manuscripts in Byzantine calligraphy

Anthony Papagiannis, MD, MRCP(UK), DipPallMed, FCCP

I had never talked with my father about his death. Even though he had had numerous and regular transactions with medicine since my penultimate year in medical school, he never touched this particular subject and I would not be the one to bring it up. Despite my training and professional involvement with dying people and my familiarity with the literature that suggests talking to patients about their death preferences, this topic was tacitly avoided between us. He had written his own traditional will (not the “living” kind) a while back, but as far as I know he had not discussed anything else with my mother or any other of my five brothers and sisters. He had not had any of the sorts of discussion we promote in modern medicine regarding personal wishes about resuscitation, aggressive therapy, place of death, funeral arrangements, or the like.

The reason, I believe, is that he never stopped feeling alive. Diseases and doctors had been his regular companions for thirty-five years, and he had been in intensive care on a number of occasions. However, he took all these in stride and kept living an organized and productive life as if this were going to last forever. He must have given thought to the prospect of dying as over the years he had had several close calls. At the age of eighty he had been mugged and robbed in the lift to his flat; given his long-standing heart problems he might have died on the spot. In fact he developed a slow-growing epidural hematoma which required evacuation a few months later.

His latest brush with death had started as a triviality. A minor operation under local anesthetic led to a major occult internal bleed because of coagulation problems. Overnight he dropped his hematocrit to nineteen percent, dangerously low for an 84-year old with advanced coronary heart disease. He required transfusions and repeat surgery, but he gradually picked up, and in a couple of weeks he returned to his usual routine: so many hours a day typing at his laptop, so many hours handwriting church music in his neat calligraphic Byzantine style (see picture), watching the news, occasionally improvising in the kitchen (always with good results).

I never saw him give up on life and work. He toiled daily not for profit but as a loving creator, motivated by a sense of duty to himself, to others, to God. In his retirement years he produced academic-level liturgical work that might have earned him a doctorate, had he cared for it. One day he told us, matter-of-factly, that he had finished typing his sermons of forty years in his computer: three volumes of these were published during his life, one more soon after his death. He wrote music with the ease we scribble a casual letter, and produced nineteen handwritten volumes (of 300-plus pages each) over his last fifteen years. He kept a record of the hours he spent at his pastime, and would note in the back of his books something like: “The handwriting of this book required 120 hours.” Another handicraft was book binding: a couple of weeks before the end he showed us six volumes of magazines which he had beautifully bound himself in his spare time.

Despite his disabilities (he was on regular dialysis for more than two years, and he walked with a frame due to advanced osteoarthritis in his knees) he never thought of neglecting his vocational duties. He had been a priest of the Greek Orthodox Church for fifty-five years, and though he had retired from regular parish duties long before, he would be driven to the church every Sunday and major feast day to attend Liturgy. If a feast coincided with a dialysis day, he would arrange to go for treatment at a later hour so that he would not have to leave before the end of mass.

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The events of that last Tuesday are etched in my memory. It is one of his dialysis days. This takes place at the hospital where I work, so I call at the renal unit for a routine talk. No particular problems, he is well, he mentions the occasional nighttime chest discomfort which goes away with a change of position in bed. We have looked into that before, nothing to worry about. He asks for a medical certificate for insurance purposes, and I promise to have it ready before he goes. See you in a couple of days. Back to work.

In the afternoon, just before I leave for the office, he rings me up. Apparently the certificate issued is not quite what he needs. I will amend it first thing tomorrow. Cheerio.

Having finished my evening clinic, I visit an elderly disabled lady. In the midst of my examination I get a call from my wife: “Dad has had a fall.” I promise to call back as soon as I finish, fearing a fractured hip. A few minutes later I return the call. “He collapsed at home, an ambulance is already there.” A cab takes me straight to my parents’ residence. Two ambulances, one a mobile cardiac unit, do not augur well. I ride the elevator to the home floor; my brother-in-law, a hospital physician, briefs me: “They have been doing CPR for twenty minutes now, we must decide.” There is only one answer: he is gone. As I learn, he had done the day’s work then sat down to dinner with mother, without any obvious difficulty. Walking the corridor afterwards he collapsed, and that was that. No pain, no agony, no suffering.

As soon as the end is officially declared I ring up his fellow parish priest who will have to dress the body: an Orthodox cleric is buried in his vestments, and these have to be put on by a priest, in ceremonial manner, as if the deceased is preparing to celebrate mass. “I will bring the set of robes he had designated for his funeral,” he says, and in that brief response I realize that he had talked about death with at least one person, the one that mattered. He would never leave such important issues to chance. I am now certain that he thought about death, prepared for it in the most appropriate way, anticipated it, but never allowed its specter to stop him from living to the end, whenever and however that might come.

In the daily litany of Orthodox prayers there is a regular request, recited in every morning and evening church service, for “a Christian end to our lives, painless, free of shame, and peaceful.” My father must have made this supplication literally thousands of times over the years. Given the circumstances of his health, his constantly creative life in the face of disease, and his final passage, I believe that his prayers were fulfilled.

Anthony Papagiannis is a practicing pulmonologist in Thessaloniki, Greece. He received his MD degree from the Aristotle University of Thessaloniki Medical School. 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. He also edits the journal of the Thessaloniki Medical Association, and blogs regularly.