Drama in brief
|Winter foliage. Photo by author.|
Four years earlier I had had the sad duty to announce her debut as a protagonist on the stage of cancer. Now I was witnessing the last act.
She came to the first visit with her elder sister, an old acquaintance from our student days and close friend of my sister’s. She was ten years my junior, just past fifty. There was no significant medical history, but over the last couple of months she had been increasingly breathless. The investigation so far showed anemia, moderate ascites, and a large pleural effusion. This last finding brought her to my attention. I tapped one and a half liters of fluid from her chest for immediate relief – an ominous sign. Cytology was positive for cancer, and she went under the care of the oncologists for an ovarian tumor. She responded quite well to chemotherapy, and underwent surgery after regression of the disease. One year later, she had a lymph node recurrence and more chemotherapy. I would see her socially whenever she came in for treatments; her morale seemed good, and seeing her smile, even if forced, gave me a dose of hope that she might win one more episode in this uneven struggle.
I had not seen her for some time. One evening my sister told me that the patient’s sister, our mutual friend, had that summer suddenly lost her husband. He was another former patient of mine, but I had not heard about it; it must have been during my vacation. “She tells me that her sister is not doing well, either,” she added. I made a mental note to discuss her with the oncologists. The next day, before I had a chance to inquire, they rang me: she had turned up at the hospital quite breathless. “What is the state of her tumor?” I asked. Rather grim. She had liver metastases and had practically exhausted all treatment options.
Now we were in the same room where everything had started. Her chest was full of fluid again, and under the brave face she wore, I could see she was scared. I made small talk, running over the events of the last year: family matters, her sister’s bereavement, the pandemic and how it had affected our everyday routines. Gradually, she seemed to relax. During the chest aspiration she sat still, uncomplaining, immersed in her thoughts. My occasional questions elicited prompt but brief answers: “I’m all right,” and “No, it doesn’t hurt at all.” I could see that her real concern lay below the surface.
When we finished, I put my hand on her shoulder in an attempt at reassurance. “Are you afraid?” I probed. “Very much,” she said in a muted tone, and I could feel rather than hear the catch in her throat. “It is only natural,” I said, hoping to sound encouraging. “We are human, we are not made of stone.” She said nothing. Obviously any further discussion would be painful. She paid her bill, rang her husband to come and pick her up. “See you next week,” I offered, hoping to have a chance to talk to her again about her fears. “Yes.” With that monosyllable she was gone. Two weeks later, I learned that she had died at home, her distress largely unrelieved.
Ever since I started in private practice, I have been keeping a record of my deceased patients, a medical necrology, as Dr. J.H. Schumann has termed it.1 No lengthy details, just a brief reminder. I open it and add another entry: VK, b. 1966, ovarian Ca, Aug 2017 – Nov 2021. So few words for so much human drama.
- Schumann J.H. “A Diary Of Deaths Reminds Doctor Of Life.” https://www.npr.org/sections/health-shots/2014/10/25/352761273/a-diary-of-deaths-reminds-doctor-of-life.
ANTHONY PAPAGIANNIS 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.
Winter 2022 | Sections | Doctors, Patients, & Diseases