Anthony Papagiannis, MD, MRCP(UK), DipPallMed, FCCP
It had been a placid day and I was anticipating a quiet evening at the office. My schedule only listed three patient appointments, an hour's work at the most. Even allowing for the occasional last-minute visitor, all should be fine, with plenty of time to spare. A chance to go home early on a Friday night.
My cell phone went off as I was walking from the bus stop to the office. I recognized the voice—it was the secretary of a translation office which every so often requests my help, usually with medical documents that needed to be translated. Could I take on something rather urgent, to be delivered by next morning? Yes, we know it is Saturday tomorrow, but we are doing this as a special favor.
From past experience I knew that a client's perception of urgency only rarely reflected the reality of the case. In my mind I pictured the commonest scenario. Some old patient had had a resection or biopsy, something nasty had been found, a relative or friend had suggested getting a second opinion from abroad, so his history and investigations had to be put into English med speak. I generally took a dim view of such requests. They conveyed an aura of mistrust towards the physician or surgeon who had done the initial job, and promoted the impression that somehow foreign doctors were better practiced and able to perform miracles. A leftover from the times when this might indeed have been the case, this mentality was difficult to eradicate. People thought they would be doing their folk a good turn by sending them to America or Germany or the UK or God knows where. At a considerable cost, I should add, which they would subsequently try to claim from the fast-emptying coffers of the public health insurance system. Oh well, who was I to argue? So I promised to do the job if they would e-mail me the documents forthwith.
My three appointments took no more time than anticipated, and nothing new appeared. So an hour later I switched on the music, selecting a favorite performance of Rimsky-Korsakoff's Shechrazade from the vast repository of YouTube. Then I opened the e-mailed file, and prepared for a routine application of my language skills.
The typed three-page report was better than the usual handwritten, difficult-to-decipher note. My first thought was to confirm my expert guess of the patient's age and problem. An eighty year old with prostate cancer? No, this was a girl. Age: thirteen. Diagnosis: acute leukemia. Duration of the disease: two months. I quickly went through the details. A brief nonspecific illness, a funny looking blood smear leading to a bone marrow biopsy, chemotherapy, unexpected complications and side-effects, and finally the amputation of a limb because of gangrene. A real thunderbolt out of a clear blue sky on a summer day. I felt the sharp jaws of guilt for my previous cynical and unkind thoughts bite deep into my soul.
Rimsky-Korsakoff's music, normally tranquil and soothing, could not wash away the depression caused by reading of that matter-of-fact narrative of the rapid transition from a happy and carefree life to the anteroom of death. What an ordeal for the young girl and her family! Could I imagine myself in their shoes? It is one thing to theorize from the safety of distance; it is quite another to face the reality of grim illness in those you love, especially in a child. I tried to envisage the family, grasping at whatever straws were available at home or away, alternately despairing and hoping, trying to see some light in the pitch black tunnel in which they had found themselves in.
I am sure many of those who read these lines have encountered similar dramas in their professional lives, and have probably gone through the same maze of feelings. It is in moments such as these that people, patients and professionals alike, turn their eyes from earth to heaven, and pray for a miracle for the girl with the name of a flower.
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 at the University of Thessaly, Larissa, Greece. He also edits the journal of the Thessaloniki Medical Association.