Anthony Papagiannis
Thessaloniki, Greece

We are halfway through Advent and looking forward to Christmas. As I am finishing some late-night computer work and seriously thinking about sleep, the cell phone goes off. I recognize the voice of a man I saw recently. His problem is trouble with breathing, that vital function whose perceived difficulty flashes warning signals of impending doom. I remember him well: only ten days ago I tapped a liter of fluid from his chest. The tests did not show anything specific, but now he is breathless again. What can he do? The easy option would be to refer him to the state hospital. However, that would mean spending half the night in a waiting room, only to see a junior doctor with no previous knowledge of the patient and his history, and increasing anguish of the latter. Better handle this myself. I arrange to see him immediately in the private hospital where I consult.

It is unusual to get such calls these days. Financial constraints make people reluctant to “go private” with the same ease as in the past. One more reason to attend to this man personally. Within a few minutes, I am driving to the hospital. It is mid-December, past midnight, with the temperature down to near freezing, and a clear sky with no humidity. Static electricity weather: my woolen cardigan crackled sharply as I pulled it on, and my hand felt the familiar mild shock as I touched the car door. The streets are empty, with only an occasional stray cat foraging around the garbage bins. Christmas lights and decorations flicker from most balconies in the dark urban canyon between high-rise apartment buildings that will take me to the ring road. My default radio station has some light jazz on, quite agreeable at this hour and for my frame of mind. The all-night diner at the corner is empty. As I wait at the traffic lights, I slip my gloves on: better have warm hands for the clinical examination. The lights change; I am on the motorway. A quarter of an hour later, I walk into the examining room. My patient is already there, and we get down to business.

There is not much new to learn. After the initial relief from the chest tap, he soon started getting breathless again, to the point that he panicked on Sunday night and got on the phone. No fever or any other symptom. His oxygen saturation is borderline, his chest is dull on the right side, and a quick look with the ultrasound probe confirms the presence of a large pleural effusion. The EKG exonerates the heart (he has had previous coronary bypass surgery). However, he also has severe COPD, and it does not take much to upset his precarious respiratory balance. We have no diagnosis for the effusion, so another tap is in order both for relief and investigation. Within half an hour, he is four pounds lighter on the scales, and I am holding a bag with almost two liters of the guilty liquid. His breathing is much easier, but I decide to keep him in overnight, mostly for his peace of mind, and (I have to admit it) my own as well.

By now it is 2 a.m., and the short drive home is much more relaxed. Relief has been achieved, and that was the immediate objective. The doubts and suspicions about the underlying cause persist, but these cannot be resolved at this hour, so we will have to possess our souls in patience. Unexpectedly, I recall that the last time I was heading home from the hospital at such an hour was eighteen months ago, after a death. A young woman with underlying heart disease had been admitted acutely with H1N1 flu and severe bilateral pneumonia, and rapidly went into multi-organ failure. Three hours of vigorous attempts at resuscitation had finally left a large team of doctors, nurses, and technicians with the bitter taste of defeat and a feeling of dejection. Thank God, such tragedies are really very much the exception. At least now we have bought some time, and both patient and doctor can sleep more easily. Tomorrow, as Scarlett O’Hara would put it, will be another day.