Hektoen International

A Journal of Medical Humanities

Aspects of distancing

Anthony Papagiannis
Thessaloniki, Greece


Corfu Island, Greece. Author Photo.

I will call him Bill. We had been unaware of each other’s existence until we first met as elected members of a professional committee in our local medical association. In this capacity we had been working together for several years, convening every two or three months depending on the current agenda. Different specialty, different workplace, a couple of years younger than me, and that was virtually all I knew about him. We had no other professional or social contact.

It was a dull day in March when I received a request from a translation office for which I do occasional specialist work. Could I put in English some medical reports, to be sent for consultation abroad? Of course I could. Sometimes such papers come anonymized, but on most occasions patient data are included. As I opened the attached text file the patient’s name hit me on the face like a backhander: it was Bill, with what appeared to be an advanced and quite aggressive cancer. He was already on treatment, and a second opinion was being sought in the hope that the grim outlook might somehow improve. I recalled that he had missed a couple of committee meetings, but there had been no comment from the chairman at the time—did he know? With mixed feelings of sadness, guilt, and gratitude for my own good health I completed the paperwork and mailed it back without letting the office know about my acquaintance with him.

Distancing is a well-known defense mechanism in our profession. When we feel threatened or stressed by a particular situation we tend to move away from it. We may avoid physical contact or personal communication or close emotional involvement. As long as I had no other interaction with Bill he was just another patient, not a seriously ill colleague whose eventual demise might cost me somewhat more. Once in a while I would think of him, wondering how I would feel if our roles were reversed, but in between I could keep him out of my mind.

This went on for some months. Every so often I would get a new scan report or biopsy or other test result for translation; the news was increasingly disappointing. There was no committee work at the time, and I did not seek further information. One day, unexpectedly, I discovered he was being treated in the oncology ward of my hospital. Feeling silently guilty I dropped in a few times during his chemotherapy sessions. We chatted socially and exchanged news about his course; I feigned ignorance, and offered well-worn and carefully chosen words of encouragement. I did not mention my behind-the-scenes involvement in his case: confidentiality is required in this business, and we are not supposed to communicate directly with the client. However, the question kept nagging me: should I tell him?

Hand in hand with this question there surfaced another dilemma. I would never charge Bill or another colleague for professional care. This is common courtesy in daily practice, and is not based on any expectation of patient referral or other reciprocation. I usually tell colleagues who insist on paying me for medical care that this is one of the few benefits available to our profession in this difficult financial climate. If they insist, I charge them a token one-off fee to deter them from searching for costly material gifts to express their gratitude. In this case I was acting as a translation consultant, even though my work might have a bearing on his medical management. I did not want to embarrass Bill and make him feel obliged to me in any way. Thus I opted to stick to the rules of the game and remain silent. Would that be labeled as betrayal, or disloyalty at the very least? The rational part of my brain kept calling it distancing, my emotional self rebelled against the cold, impersonal term.

For a while I had no further news from him. The epilogue was written one day in October, when I received a text message from the committee chairman: Bill’s funeral to be held next Thursday. End of the road. Unfortunately I was out of town on a teaching assignment—physical distancing this time. May he rest in peace.



ANTHONY PAPGIANNIS, MD, MRCP(UK), DipPallMed, FCCP, is a practicing pulmonologist in Thessaloniki, Greece. He graduated 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.


Spring 2018  |  Sections  |  Doctors, Patients, & Diseases

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