One of the things we learn in medicine, not from books but from the daily encounters with patients over the years, and which never stops pleasantly surprising us, is man’s endurance in all kinds of adversity and hardship, including serious health problems. No diagnostic test, biological marker or imaging modality, however detailed and sophisticated, can foretell every patient’s precise course, regardless of the name of his disease or his general condition.
This reality springs to my mind this morning as I welcome my next patient. Almost eighty now, in serious respiratory failure, he comes to see me after a recent bout of bronchitis that worsened his usual shortness of breath. His oxygen saturation is borderline, and drops promptly after only a few steps. His psychology is deep down in the dumps, as he feels his strength seeping away. Spirometry shows that he is left with a quarter of his predicted lung capacity. In an attempt to boost his morale I briefly review his medical history. I have been seeing him for seven years now; his initial lung function was 30 percent of normal. He had just had open heart surgery and balloon angioplasty, followed by a large pleural effusion that required repeated chest aspirations. Eventually his tests showed tuberculous pleurisy, and he received full treatment, with good result. A few months after the end of this therapy a lung tumor was detected, and he underwent thoracoscopic resection. He tolerated the procedure quite well despite his low pulmonary function, and returned to almost normal activity, with occasional bronchitic exacerbations. One year ago he was admitted with Covid-19 infection and did well. Four months later a relapse of his cancer was diagnosed, and he had radiotherapy followed by immunotherapy. This is where we stand now.
I recount all this to my patient. Given his very low respiratory reserve, each of these ailments might well have been his last. It is not surprising that he is short of breath, with 25 percent of functional breathing. However, he has been marching like that for seven years now. The endurance of the human body is a mystery, one more miracle along the many we witness every day. What is required of man is the mental strength to accept and overcome difficulties. Despair and surrender, throwing in the towel in life’s struggle, is an ominous prognostic sign, and one of our most important duties as physicians is to try and dispel this, always in a realistic way, without offering false and unfounded hopes. A patient’s past history and course may help us in this task, and this is the case today. The old man shakes my hand and takes his leave, visibly improved in disposition.
As I walk out of the office I am greeted by an elderly lady in the outpatient waiting room. She has a similar history spanning several years, with numerous operations and complications and other problems in her medical trajectory. A few months back she had been admitted in a critical condition, with low expectations for recovery; secretly I confess that I did not expect to see her again. And now here she is, reasonably well and ambulatory, attending for a routine check by another colleague. One more example of human endurance. Thank God for that.
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 holds a postgraduate diploma in palliative medicine from the University of Cardiff, and is a postgraduate instructor in palliative medicine in the University of Thessaly. He also edits the journal of the Thessaloniki Medical Association, and blogs regularly.