Alonissos Island, the Aegean, Greece
There is a fine but clearly visible tremor in the pale, smooth, well-groomed hands of my visitor. He makes an effort to keep his face still and composed, lips forcedly stiff, eyes unsmiling, the whole look somber. “I have had a new scan,” he says, placing the buff envelope on the desktop. I fumble with the digital disk and avoid looking at his hands, not wanting to embarrass him. He has read the report, I keep thinking. He is no average man-in-the-street who has picked up alarming and possibly irrelevant information from the web. He is a university professor in a field related to medicine: he knows, and this knowledge begets anxiety.
The scan appears on the screen while I peruse the report and listen to the patient telling me he has been getting increasingly breathless lately. Many months ago he had a blood clot in his lungs during chemotherapy and has been on blood thinners ever since. Could this be another bout of the same? A reasonable question, but also a way to eschew the other one that weighs heavier on his mind and soul: has the cancer come back?
Playing for time I proceed to examine him. There is dullness over the right base, his oxygen saturation is borderline, his spirometry down to fifty percent. The scan confirms the new presence of fluid, and also mentions an increase in the size of his lymph nodes compared to the one he had some months ago. His fears are well founded; there is no point in dodging the issue. “It is obvious that the fluid is the cause of your symptoms,” I offer. “We have to drain it for immediate relief, and also to check the cytology.” This is an indirect validation of his suspicion, and does nothing to allay his worries. His hands still shake.
We move next door, check the fluid with the ultrasound probe, and set up the tray for the pleural aspiration. As I work behind his back I have a chance to observe his hands unnoticed; they have not stopped trembling. “I have read your book,” he says unexpectedly while I stick the drainage needle in. Glad to take my mind, and his, away from the pressing matter, we spent the next few minutes talking about books, and when we finish I am holding a one-and-a-half liter bag full of the ominous liquid. His face is still solemn, but his breathing is already much easier. We get on with the paperwork and instructions and next appointment. I offer him my latest book as a gift and shake his hand formally, trying to transfuse support and impart some steadiness as we part. Until we get those results.
ANTHONY PAPAGIANNIS, 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.